دانلود کتاب راهنمای درمان دارویی فشار خون در بزرگسالان

More people die each year from cardiovascular diseases than from any other cause. Over three quarters of heart disease and stroke-related deaths occur in low-income and middle-income countries (1). Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Blood pressure is written as two numbers. The first number (systolic) represents the pressure in blood vessels when the heart contracts or beats. The second number (diastolic) represents the pressure in the vessels when the heart rests between beats. Hypertension – or elevated blood pressure – is a serious medical condition that significantly increases the risk of diseases of the heart, brain, kidneys and other organs (2). Hypertension can be defined using specific systolic and diastolic blood pressure levels or reported use of antihypertensive medications. An estimated 1.4 billion people worldwide have high blood pressure, but just 14% have it under control (2). However, cost-effective treatment options do exist.  A World Health Organization (WHO) guideline dealing specifically with raised blood pressure was last published more than 20 years ago – in 1999 – and is now outdated. In 2007, a comprehensive guideline on cardiovascular risk included some recommendations on hypertension but this also needs revision and updating in the light of new evidence and practice (3). Guidance is particularly needed on some controversial issues, such as when to start treatment and whether laboratory testing and cardiovascular risk assessment are needed prior to starting treatment. In the past decade, WHO has included diagnosis and management of hypertension in a total cardiovascular risk approach as part of the WHO package of essential noncommunicable disease (NCD) Interventions (WHO PEN) 2007, 2010 and 2013. However, this approach has not included the most recent advances in pharmacological treatment.  The WHO Essential Medicines List (EML) identifies all classes of antihypertensive drugs – angiotensin-converting enzyme inhibitors (ACEi), calcium channel blockers (CCB), angiotensin receptor blockers (ARB) and thiazide diuretics – as essential. In June 2019, the EML included single-pill combination medications for hypertension. This further supports the evaluation of all classes of antihypertensive drugs as well as single-pill combinations in this current guideline.