The Selection and Use of Essential Medicines - WHO Technical Report Series, No. 920: 7. Recommendations: 7.4 Review of the antihypertensive medicines

The Selection and Use of Essential Medicines - WHO Technical Report Series, No. 920
(2003; 137 pages)

Table of Contents

1. Introduction
2. Open session
3. Update on current activities
	3.1 Dissemination of the previous report of the Expert Committee (including the 12th Model List)
	3.2 The twenty-fifth anniversary of the WHO Model List of Essential Medicines
	3.3 The WHO model formulary
	3.4 Review of the New Emergency Health Kit
	3.5 Review of essential medicines for reproductive health
	3.6 Report of an ad hoc Advisory Committee on priority vaccines
	3.7 The WHO Essential Medicines Library
	3.8 Promoting rational use of essential medicines
		3.8.1 Update on activities to contain antimicrobial resistance
		3.8.2 Guidelines for drugs and therapeutic committees
		3.8.3 WHO database on rational drug use studies
4. Changes made in revising the Model List
	4.1 Applications for additions
		4.1.1 Amodiaquine
		4.1.2 Azithromycin
		4.1.3 Ibuprofen (paediatric formulation)
		4.1.4 Insulin semilente
		4.1.5 Miconazole nitrate buccal tablets
		4.1.6 Misoprostol
		4.1.7 Valaciclovir
	4.2 Applications for deletions
		4.2.1 Ethinylestradiol + levonorgestrel tablets (50µg + 250µg, pack of four)
		4.2.2 Nonoxynol
	4.3 Applications for addition of information
		4.3.1 Anti-leprosy medicines
	4.4 Other changes
		4.4.1 Oral rehydration salts
		4.4.2 Streptokinase
5. Reviews of sections of the Model List
	5.1 "Fast-track" procedure for deleting items from the Model List
	5.2 Review of core versus complementary listing of medicines
	5.3 Review of the use of the square box symbol (including a review of the corticosteroids)
	5.4 Review of the antihypertensive medicines
6. Priorities for future reviews
7. Recommendations
	7.1 Additions, deletions and other changes to the Model List
	7.2 Core versus complementary listing of medicines
	7.3 Use of the square box symbol (including review of the corticosteroids
	7.4 Review of the antihypertensive medicines
	7.5 Future priorities
References
Annex 1 The 13th WHO Model List of Essential Medicines
Annex 2 The Anatomical Therapeutic Chemical (ATC) classification system¹
Alphabetical list of essential medicines (with ATC classification code numbers)
Selected WHO Publications of Related Interest

7.4 Review of the antihypertensive medicines

1. The Committee recommended that the following modifications be made to the medicines listed in section 12.3 of the Model List (Antihypertensive medicines):

• Reserpine and prazosin should be deleted.

• Captopril should be replaced by enalapril as the listed example of the therapeutic group.

• Methyldopa should be retained as a core list medicine but with the addition of the following footnote:

Methyldopa is listed for use in the management of pregnancy-induced hypertension only. Its use in the treatment of essential hypertension is not recommended in view of the availability of more evidence of efficacy and safety of other medicines.

• The square box symbol should be removed from sodium nitroprusside.

2. In sum, the Committee recommended that section 12.3 (Antihypertensive medicines) comprise: atenolol (tablet, 50mg, 100mg) with a square box; enalapril (tablet, 25mg); hydrochlorothiazide (scored tablet, 25mg) with a square box; methyldopa (tablet, 250mg) and nifedipine (tablet, 10mg and as slow-release formulations) with a square box as core list medicines and sodium nitroprusside (powder for infusion, 50mg in ampoule) as a complementary list medicine.

3. The Committee recommended that more research be done on the treatment of hypertension in pregnancy, in particular on long-term outcomes and effects on child development, and that a thorough and critical review be carried out of the justification of the use of dihydropyridine calcium-channel blockers as first-line treatment drug for hypertension.