Update of the clinical guideline for hypertension diagnosis and treatment in Iran
Authors: Bagherikholenjani Fahimeh , Shahidi Shahla , Khosravi Alireza , Mansouri Asieh , Ashoorion Vahid , Sarrafzadegan Nizal ,   Guideline Updating Group (GUG), Siavash Mansour , Shahidi Shahrzad , Khorvash Fariborz , Sadeghi Masoumeh , Farshidi Hossein , Assareh Ahmadreza , Shafiei Davood , Jorjani Masoumeh , Badri Shirinsadat , Hajhashemi Valiollah , Hoseinkhani Ramesh , Mortazavi Mojgan , Ghabaei Mojdeh , Khanjani Somayeh , Hashemi Elham , Dehghan Bahar , Davari Majid , Fatemi Behzad , Mohammadifard Noushin , Mobarhan Majid Ghayour , babadi Maryam Eghbali , Ahmadi Alireza , Hassannejad Razieh , Noohi Fereidoun ,   Steering Committee, Kheiri Maryam , Tabatabaeilotfi Mosa , Bakhshandeh Sanaz , Haghighi Azadeh ,   Systematics Review Group (SRG), Mansourian Marjan , Farajzadegan Ziba , Ashraf Hale , Omidi Negar , Tavakolifard Negah , Alizade Mahasti , Vaseghi Golnaz ,   External Review Group (ERG), Nematipour Ebrahim , Ghaffari Samad , Sanjari Mojgan , Shabestari Mahmoud Mohammadzade , Heidarpour Maryam 
Published: June 2024

Background

This article introduces the updated version of the Iranian guideline for the diagnosis and treatment of hypertension in adults. The initial version of the national guideline was developed in 2011 and updated in 2014. Among the reasons necessitating the update of this guideline were the passage of time, the incompleteness of the scopes, the limitation of the target group, and more important is the request of the ministry of health in Iran.

Method

The members of the guideline updating group, after reviewing the original version and the new evidence, prepared 10 clinical questions regarding hypertension, and based on the evidence found from the latest scientific documents, provided recommendations or suggestions to answer these questions.

Result

According to the updated guideline, the threshold for office prehypertension diagnosis should be considered the systolic blood pressure (SBP) of 130-139 mmHg and/or the diastolic blood pressure (DBP) of 80-89 mmHg, and in adults under 75 years of age without comorbidities, the threshold for office hypertension diagnosis should be SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg.

The goal of treatment in adults who lack comorbidities and risk factors is SBP < 140 mmHg and DBP < 90 mmHg. The first-line treatment recommended in people with prehypertension is lifestyle modification, while for those with hypertension, pharmacotherapy along with lifestyle modification. The threshold to start drug therapy is determined at SBP ≥ 140 mmHg and or DBP ≥ 90 mmHg, and the first-line treatment is considered a drug or a combined pill of antihypertensive drugs, including ACEIs, ARBs, thiazide and thiazide-like agents, or CCBs.

At the beginning of the pharmacotherapy, the Guideline Updating Group members suggested studying serum electrolytes, creatinine, lipid profile, fasting sugar, urinalysis, and an electrocardiogram. Regarding the visit intervals, monthly visits are suggested at the beginning of the treatment or in case of any change in the type or dosage of the drug until achieving the treatment goal, followed by every 3-to-6-month visits. Moreover, to reduce further complications, it was suggested that healthcare unit employees use telehealth strategies.

Conclusions

In this guideline, specific recommendations and suggestions have been presented for adults and subgroups like older people or those with cardiovascular disease, diabetes mellitus, chronic kidney disease, and COVID-19.