Abstract
Background: Systemic arterial hypertension is a serious health condition with a worldwide prevalence of 1.3 billion between 30 and 79 years of age. In Brazil, despite the existence of official documents from the Ministry of Health (MoH), there is no clinical practice guideline (CPG) with recommendations on what should be offered by the Unified Health System (SUS). Objectives: Describe the main recommendations for the care of children and adults with suspected or diagnosed hypertension, as well as the guideline development process. Methods: The guideline development process followed the GRADE recommendations. Researchers, specialists (i.e., cardiologist, nephrologist, family doctor, pediatrician, nutritionist, physical education professional and nurse), representatives of the MoH, health professionals' societies and patients' representatives participated in this process. After four planning meetings, the scope of the document was outlined, and five new technologies (chlorthalidone, benazepril, benazepril+amlodipine, losartan+hydrochlorothiazide, home blood pressure monitoring (HBPM)) were prioritized regarding the potential for coverage in SUS. Results: Hypertension screening, diagnosis, treatment (goals, pharmacological and non pharmacological treatment – related to food and nutrition, alcohol intake, smoking, physical activity and exercise, stress management and self-care; and treatment in specific populations) and monitoring, including health promotion and prevention guidelines, were recommended in this CPG. Highlights included the use of HBPM to diagnose hypertension in adults and the adoption of the HEARTS tool (from Pan American Health Organization) for cardiovascular risk stratification in adults. Although four medicines were prioritized for evaluation, the National Committee for Health Technology Incorporation (Conitec) recommended against them due to the high budgetary impact and reduced incremental benefit compared to current options in SUS. Therefore, the final document includes 17 medicines, that were already being used in SUS, mainly beta-blockers, angiotensin II receptor blockers, calcium channel blockers, diuretics, and angiotensin-converting enzyme inhibitors. The document is under review by the Brazilian MoH. The next steps comprehend Conitec evaluation and decision, public consultation, and CPG publication. Conclusions: The guideline will consolidate recommendations for the care of people with suspected and diagnosed hypertension, contributing to the quality of primary health care, and respecting the health system's principles of universality, comprehensiveness, and equity.
