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1993 Guidelines for the Management of Mild Hypertension: Memorandum From a World Health Organization/ International Society of Hypertension Meeting

Patients with hypertension, even those with mild elevation of blood pressure, are at increased risk of cardiovascular disease, whether or not symptoms are present. In most countries, as many as 15% to 25% of the adult population are found at screening to have raised blood pressure; about two thirds of them have mild elevation of blood pressure. However, blood pressure is not persistently raised in all, and not all need to be treated with antihypertensive drugs. The present guidelines for the management of hypertension concentrate on mild hypertension, as this condition often presents a diagnostic and therapeutic problem, and evidence for benefit in treating more severe hypertension is clear. Emphasis is also placed on systolic blood pressure as a criterion for decision making and on hypertension in the elderly, another condition in which careful judgment is necessary. Information is provided on useful methods for diagnostic evaluation and the assessment of cardiovascular risk. Additional information is provided on nondrug measures as well as drug treatment of hypertension and on the correction of other major risk factors for cardiovascular disease (see Table 1). In preparing these guidelines, the World Health Organization/International Society of Hypertension (WHO/ISH) Subcommittee has been keenly aware that marked differences exist among individual patients with similar levels of hypertension and that these differences have important implications for decisions about treatment. Hypertensive patients differ with respect to age, blood pressure elevation, organ damage, and concomitant risk factors and diseases, and they live in societies in which cardiovascular risk and economic resources also differ widely. Accordingly, guidelines should not be conceived as rigid constraints to the practicing doctor's