1999 World Health Organization: International Society of Hypertension guidelines for the management of hypertension

The present Guidelines come at a critically important time globally for the management of hypertension and the prevention of associated cardiovascular disorders. The second half of the twentieth century has seen a progressive decrease in cardiovascular mortality in North America, Western Europe, Japan and Australasia [1]. At the same time, the control of hypertension in these regions has improved considerably. For example, the Health Examination Surveys in the United States have demonstrated that whereas 10% of hypertensive subjects had their blood pressure lowered to below 140/90 mmHg in 1976-1980, by 1988-1991 the proportion had risen to 27% [2]. It is important to note that this leaves over 70% of hypertensive subjects with imperfect control (or no treatment at all), as has been reported in many other countries [3], and that there are worrying signs that the rate of improvement has plateaued or even reversed in some cases. In the United Kingdom, a recent survey indicated that only 6% of hypertensive patients had their blood pressure lowered to below 140/90 mmHg [4]. Additionally, in the United States, there is recent evidence that age-adjusted stroke mortality rates have risen slightly and that the rate of decline of coronary heart disease (CHD) mortality has decreased. Moreover, given the ageing population structure of most developed countries, total numbers of strokes and CHD events are typically increasing or remaining static, even in those countries that continue to experience falling age-adjusted event rates.