Page 3 - hypertension_newsletter

REFLECTIONS
Hypertension
Hypertension Global Newsletter #10 2026

The guideline maintains the standard BP classification
framework: normal (<120/<80 mmHg), elevated (120-129/<80 Hypertension
mmHg), stage 1 hypertension (130-139 or 80-89 mmHg), and
stage 2 hypertension (≥140 or ≥90 mmHg). For management,
the guideline strongly recommend lifestyle interventions for
all adults, including the DASH (Dietary Approaches to Stop
Hypertension) diet, sodium reduction, moderate physical
activity, and the novel recommendation to use potassium-
based salt substitutes for home cooking. Pharmacological
treatment should be initiated for all adults with stage 2
hypertension, and for those with stage 1 hypertension who
have a PREVENT 10-year CVD risk of ≥7.5%, clinical CVD,
diabetes, or chronic kidney disease (CKD). A systolic BP
(SBP) goal of <130 mmHg, with encouragement to achieve
SBP <120 mmHg, is recommended to reduce the risk of CV
events and total mortality. To improve medication adherence
and clinical outcomes, the committee specifically recommends
that adults initiating treatment for stage 2 hypertension be
prescribed two first-line agents from different classes, ideally
combined into a single-pill combination (SPC).

Angiotensin-converting enzyme inhibitors (ACEis) and
angiotensin receptor blockers (ARBs) play a prominent role
in the updated pharmacological strategies. Both classes are
endorsed as first-line therapies for initiating BP treatment,
alongside thiazide-type diuretics and calcium channel blockers
(CCBs). ACEis and ARBs are strongly recommended for
adults who have hypertension alongside CKD or diabetes with
albuminuria. They are also highly recommended for secondary
stroke prevention and for patients managing HF. However, the
guideline emphasizes that an ACEi and an ARB should never
be prescribed simultaneously.

Although a continuous and graded association exists between Categories of BP in adults
higher BP and CVD risk, it is useful to categorize BP levels
for clinical and public health decision-making. Here, BP
was categorized into 4 levels based on observational data
demonstrating the association between SBP/diastolic BP (DBP)
and CVD risk. Heavy emphasis is also placed on the use of
out-of-office BP monitoring, such as home blood pressure
monitoring (HBPM) or ambulatory monitoring (ABPM), to confirm
diagnoses, rule out “white-coat” or “masked” hypertension,
and continuously adjust medication doses. Strict BP targets
(generally <130/80 mmHg) are recommended for high-risk BP indicates blood pressure (based on an average of ≥2 careful readings ob-
populations, including those with previous stroke, HF, and/or tained on ≥2 occasions, as detailed in Section 3 [“Evaluation and Diagnosis”]);
CKD, to minimize the progression of target organ damage and DBP, diastolic blood pressure; and SBP, systolic blood pressure.
*Adults with SBP and DBP in 2 categories should be designated to the higher
prevent mild cognitive impairment. BP category.

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