The WHO HEARTS technical package for hypertension management at primary care level includes six modules. The 'R' (Risk-based CVD management) module recommends treatment initiation based on:

• A Blood pressure ≥140/90 mmHg alone, regardless of other risk factors
• B Cholesterol >200 mg/dL combined with any hypertension
• C Framingham risk score >20% for antihypertensive initiation
• D 10-year cardiovascular risk ≥10% assessed by WHO/ISH risk charts, or BP ≥140/90 with existing CVD ✓

Explanation

The WHO HEARTS package promotes risk-based rather than blood pressure threshold-based decision making: treatment is initiated if 10-year CVD risk ≥10% using WHO/ISH risk charts, or if BP ≥140/90 mmHg in persons with established CVD (diabetes, prior MI/stroke, chronic kidney disease). This approach prioritises resources towards high-risk individuals and is adapted for low/middle-income country primary care settings with limited lab infrastructure. The Framingham score was an older model; WHO/ISH charts are calibrated for LMIC populations.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.