Hypertension and the American Academy of Pediatrics for children (>5 years).5,15 ABPM is well correlated with target organ damage167–169 and is reliable in pediatric CKD.144 It can detect nocturnal and masked hypertension, which are both more common in CKD.158,159 An “ABPM-first” approach for pediatric hypertension referrals (i.e., performing ABPM in all new referrals to confirm hypertension before consultation and to avoid unnecessary expensive secondary hypertension workups) is a potential cost-saving strategy.176 However, there are limitations to widespread pediatric ABPM utilization. There are few validated pediatric devices, costs are prohibitive, and global access is limited. Existing ABPM normative data are also problematic. Current normative data were derived from a relatively small Caucasian German population.177,178 There are minimal data for children 130/80 mm Hg, sleep BP > 110/65, or 24-hour BP > 125/75), that predict cardiovascular events.182,183 In the pediatric American Heart Association guidelines, ambulatory hypertension is categorized by mean BP and BP load.169 However, up to 20% to 40% of children are unclassified using these criteria and hypertension thresholds may be higher than adult thresholds for children $12 years old.184–186 There is emerging evidence that isolated elevated BP load is not significantly associated with target organ damage.185,187,188 Removing BP load criteria and using adult thresholds for adolescents would simplify ABPM interpretation.186,188 Because oscillometric ABPM devices measure MAP, it may also be preferable to classify ABPM using MAP, instead of calculated systolic/diastolic BP. Pediatric Hypertension Management Optimal pediatric BP thresholds are unknown (Table 1), but the goal is to reduce BP to a level that minimizes cardiovascular and kidney disease risks. In adults with hypertension, the Systolic Blood Pressure Intervention Trial demonstrated that intensive BP control (systolic BP target The Guideline for the pharmacological treatment of hypertension in adults was prepared by the World Health Organization (WHO) Department of Noncommunicable Diseases. The departments of HIV, Hepatitis and Sexually Transmitted Infections (HHS), Mental and Substance use Disorders (MSD), Medicines and health products (MHP), the regional offices for Africa (AFRO), South East Asia (SEARO), Europe (EURO) and Eastern Mediterranean (EMRO), and the Pan American Health Organization/Regional Office of the Americas (PAHO/AMRO) also contributed. These departments were represented on the WHO Steering Group for this guideline. Responsible technical officer: Taskeen Khan WHO Steering Group members: Bernadette Cappello (MHP), Neerja Chowdhury (MSD), Gampo Dorji (SEARO), Jill Farrington (EURO), Taskeen Khan (NCD), Pedro Ordunez (PAHO/AMRO), Steven Shongwe (AFRO), Slim Slama (EMRO), Cherian Varghese (NCD), Marco Vitoria (HHS), Temo Waqanivalu (NCD). Guideline Development Group: WHO would like to thank the members of the Guideline Development Group (GDG) for their commitment, enthusiasm and expertise. GDG members were: Shrish Acharya (WPRO), Akram Al-Makki (AMRO), Hind Mamoun Beheiry (EMRO), Beatriz Champagne (AMRO), Ugyen Choden (SEARO), Kenneth Connell (AMRO), Marie Therese Cooney (EURO), Donald DiPette (AMRO), Nnenna Ezeigwe (AFRO), Tom Gaziano (AMRO), Agaba Gidio (AFRO), Vilma Irazola (AMRO), Patricio Lopez Jaramillo (AMRO), Unab Khan (EMRO), Vindya Kumarapeli (SEARO), Andrew Moran (AMRO), Margaret Mswema Silwimba (AFRO), Brian Rayner (AFRO), K. Srinath Reddy (SEARO), Nizal Sarrafzadegan (EMRO), Apichard Sukonthasan (SEARO), Paul Whelton (AMRO), Jing Yu (WPRO). Methodologist: M Hassan Murad (Professor of Medicine at the Mayo Clinic, Rochester, USA) Systematic Review Team: Reem Mustapha, Abdallah Al Alayli, Romina Brignardello, Sara Jdiaa, Veena Manja (University of Kansas Medical Center, Kansas, USA) External Review Group: WHO is grateful for the contributions of the following individuals who peerreviewed the draft guideline: Mabel Aoun, Antoinette Péchère Bertschi, Jennifer Cohn, Prabhdeep Kaur, Daniel T Lackland, Venus Mushininga, Marcelo Orias, and Xin Hua Zhang. Rebekah Thomas from the WHO Guidelines Review Committee Secretariat, and Nathan Ford, Chair of the Guidelines Review Committee are gratefully acknowledged for their technical support throughout the process. Thanks are also due to Alma Alic from the Department of Compliance, Risk Management and Ethics for her support in the assessment of declarations of interests. Sheila Nakpil from the Department of NCDs provided logistical support. WHO would like to recognize the voices of persons with lived experiences with hypertension whom we heard from through consultation during development of this guideline. ACKNOWLEDGEMENTS v GUIDELINE FOR THE PHARMACOLOGICAL TREATMENT OF HYPERTENSION IN ADULTS Acronyms and abbreviations ACE1 angiotensin-converting enzyme 1 ACE2 angiotensin-converting enzyme 2 ACEi angiotensin-converting enzyme inhibitor ARB angiotensin-II-receptor blocker BB beta-blocker BP blood pressure CAD coronary artery disease CCB calcium channel blocker CKD chronic kidney disease CRE WHO Office