New ISH Hypertension Guidelines were published in December 2013 together with the American Society of Hypertension (ASH).
The guidelines have been written to provide a straightforward approach to managing hypertension in the community, for practitioners in low and middle-income countries as well as developed countries.
In August 2007, the World Health Organization (WHO) and the International Society of Hypertension (ISH) released cardiovascular risk predication charts for all WHO regions, as part of the WHO recommendations for primary prevention of cardiovascular disease.
The aim of these charts is to help low and middle income countries to manage the burden of cardiovascular disease effectively by targeting limited healthcare resources at people who are at high risk of cardiovascular disease. Please see below to view further information including a set of questions and answers regarding the charts.
World Health Organization: Guidelines for assessment and management of cardiovascular risk
This publication provides guidance on reducing disability and premature deaths from coronary heart disease, cerebrovascular disease and peripheral vascular disease in people at high risk, who have not yet experienced a cardiovascular event. People with established cardiovascular disease are at very high risk of recurrent events and are not the subject of these guidelines. They have been addressed in previous WHO guidelines. The WHO/ISH risk prediction charts that accompany these guidelines allow treatment to be targeted according to simple predictions of absolute cardiovascular risk.
Recommendations are made for management of major cardiovascular risk factors through changes in lifestyle and prophylactic drug therapies. The guidelines provide a framework for the development of national guidance on prevention of cardiovascular disease that takes into account the particular political, economic, social and medical circumstances.
Pocket guidelines for assessment and management of cardiovascular risk
These pocket guidelines provide evidence-based guidance on how to reduce the incidence of first and recurrent clinical events due to coronary heart disease (CHD), cerebrovascular disease (CeVD) and peripheral vascular disease in two categories of people. They include; 1. People with risk factors who have not yet developed clinically manifest cardiovascular disease (primary prevention). 2. People with established CHD, CeVD or peripheral vascular disease (secondary prevention).
The accompanying World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts enable the estimation of total cardiovascular risk of people in the first category. The evidence-based recommendations given in Part 1 of these guidelines, provide guidance on which specific preventive actions to initiate, and with what degree of intensity. People in the second category have high cardiovascular risk and need intensive lifestyle interventions and appropriate drug therapy as elaborated in Part II of these guidelines. Risk stratification using risk charts is not required for making treatment decisions in them.
WHO/ISH Cardiovascular Risk Prediction Charts
WHO/ISH risk prediction charts The WHO/ISH risk prediction charts indicate 10-year risk of a fatal or nonfatal major cardiovascular event (myocardial infarction or stroke), according to age, sex, blood pressure, smoking status, total blood cholesterol and presence or absence of diabetes mellitus for 14 WHO epidemiological sub-regions.
There are two sets of charts. One set (14 charts) can be used in settings where blood cholesterol can be measured. The other set (14 charts) is for settings in which blood cholesterol cannot be measured. Both sets are available in colour and shades of black on a compact disc. Each chart can only be used in countries of the specific WHO epidemiological sub-region.
The charts provide approximate estimates of CVD risk in people who do not have established coronary heart disease, stroke or other atherosclerotic disease. They are useful as tools to help identify those at high cardiovascular risk, and to motivate patients, particularly to change behaviour and, when appropriate, to take antihypertensive, lipid-lowering drugs and aspirin.
Strengths and Limitations of the charts
Please click here to view a set of questions and answers regarding the charts. Questions included in this document are as follows:
- Who is the target audience for these charts?
- What is the added value of these charts?
- Why not make the charts more accurate by using more variables?
- What is their added value?
- How have they been developed?
- What are their limitations?
- If the charts are not perfect, is it safe to use them?
- When can treatment decisions be made without the charts?
- When are the charts useful for stratifying risk?
For further information please view the World Health Organisation website