The WHO HEARTS technical package for primary care management of hypertension consists of 6 components. Under the 'T' module (Treatment protocols), the WHO recommended first-line antihypertensive for most uncomplicated hypertension in low- and middle-income countries (LMICs) is:
- A Metoprolol 50–100 mg as first-line for all patients
- B Amlodipine 5–10 mg and/or low-dose thiazide diuretic as the backbone of single-pill combination therapy ✓
- C Ramipril 5–10 mg monotherapy regardless of comorbidity
- D Nifedipine immediate-release for all cases
Explanation
The WHO HEARTS (Healthy-lifestyle counselling; Evidence-based protocols; Access to medicines; Risk-based management; Team-care; Systems for monitoring) package recommends single-pill combination (SPC) therapy using amlodipine (a long-acting dihydropyridine CCB) with a thiazide diuretic (e.g., chlorthalidone or hydrochlorothiazide) as the preferred first-line approach in LMICs due to lower cost, better adherence with SPC, and wide applicability across patient subgroups. Beta-blockers (metoprolol) are not first-line for uncomplicated hypertension without specific indications (post-MI, HFrEF). Immediate-release nifedipine is specifically contraindicated for routine hypertension management.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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