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The 2004 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I--Blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature181499
Source
Can J Cardiol. 2004 Jan;20(1):31-40
Publication Type
Article
Date
Jan-2004
Author
Brenda R Hemmelgarn
Kelly B Zarnke
Norman R C Campbell
Ross D Feldman
Donald W McKay
Finlay A McAlister
Nadia Khan
Ernesto L Schiffrin
Martin G Myers
Peter Bolli
George Honos
Marcel Lebel
Mitchell Levine
Raj Padwal
Author Affiliation
Division of Nephrology, University of Calgary, Calgary, Canada.
Source
Can J Cardiol. 2004 Jan;20(1):31-40
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Blood Pressure Monitoring, Ambulatory - standards
Canada - epidemiology
Cardiovascular Diseases - prevention & control
Diet
Evidence-Based Medicine - standards
Female
Health Education - organization & administration
Humans
Hypertension - diagnosis - epidemiology - therapy
Incidence
Life Style
Male
Middle Aged
Prognosis
Risk assessment
Societies, Medical
Abstract
To provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk and identifiable causes for adults with high blood pressure.
For persons in whom a high blood pressure value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation and the duration of follow-up. In addition, the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, defining overall risk of adverse cardiovascular outcomes requires an assessment of concomitant vascular risk factors, including laboratory testing, a search for target organ damage and an assessment for modifiable causes of hypertension. Home and ambulatory blood pressure assessment and echocardiography are options for selected patients.
The identification of persons at increased risk of adverse cardiovascular outcomes; the quantification of overall cardiovascular risk; and the identification of persons with potentially modifiable causes of hypertension.
Medline searches were conducted from November 2001, one year before the period of the last revision of the Canadian recommendations for the management of hypertension, to October 2003. Reference lists were scanned, experts were polled, and the personal files of subgroup members and authors were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content experts and methodological experts.
A high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and persons with identifiable and potentially modifiable causes of hypertension.
The identification of persons at higher risk of cardiovascular disease will permit counselling for lifestyle maneuvers and introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. The identification of specific causes of hypertension may permit the use of cause-specific interventions. For certain subgroups of patients and specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The document contains recommendations for blood pressure measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, and the role of echocardiography for those with hypertension.
All recommendations were graded according to strength of evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Only the recommendations that achieved high levels of consensus are reported. These guidelines will be updated annually.
PubMed ID
14968141 View in PubMed
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The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1- blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature173955
Source
Can J Cardiol. 2005 Jun;21(8):645-56
Publication Type
Article
Date
Jun-2005
Author
Brenda R Hemmelgarn
Finlay A McAllister
Martin G Myers
Donald W McKay
Peter Bolli
Carl Abbott
Ernesto L Schiffrin
Steven Grover
George Honos
Marcel Lebel
Karen Mann
Thomas Wilson
Brian Penner
Guy Tremblay
Sheldon W Tobe
Ross D Feldman
Author Affiliation
Division of Nephrology, University of Calgary, Calgary, Canada.
Source
Can J Cardiol. 2005 Jun;21(8):645-56
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Blood Pressure Monitoring, Ambulatory
Canada
Decision Trees
Evidence-Based Medicine
Humans
Hypertension - diagnosis - prevention & control
Patient Education as Topic
Risk assessment
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with high blood pressure (BP).
For persons in whom a high BP value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of BP, the level of the BP elevation and the duration of follow-up. In addition, the presence of cardiovascular risk factors and target organ damage should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, estimating overall risk of adverse cardiovascular outcomes requires an assessment of other vascular risk factors and hypertensive target organ damage.
MEDLINE searches were conducted from November 2003 to October 2004 to update the 2004 recommendations. Reference lists were scanned, experts were polled, and the personal files of the authors and subgroup members were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content and methodological experts. As per previous years, only studies that had been published in the peer-reviewed literature were included; evidence from abstracts, conference presentations and unpublished personal communications was not included.
This document contains recommendations for BP measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high BP. These include the accurate measurement of BP, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory BP monitoring, and the role of echocardiography for those with hypertension. Key features of the 2005 recommendations include an expedited diagnostic algorithm for hypertension and an endorsement of the use of home/self and ambulatory BP assessment as validated techniques in establishing the diagnosis of hypertension.
All recommendations were graded according to the strength of the evidence and voted on by the 43 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported in the present paper received at least 95% consensus. These guidelines will continue to be updated annually.
PubMed ID
16003448 View in PubMed
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The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 1- blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature163301
Source
Can J Cardiol. 2007 May 15;23(7):529-38
Publication Type
Conference/Meeting Material
Article
Date
May-15-2007
Author
Raj S Padwal
Brenda R Hemmelgarn
Finlay A McAlister
Donald W McKay
Steven Grover
Thomas Wilson
Brian Penner
Ellen Burgess
Peter Bolli
Michael Hill
Jeff Mahon
Martin G Myers
Carl Abbott
Ernest L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Lyne Cloutier
Arun Chockalingam
Nadia A Khan
Simon W Rabkin
Martin Dawes
Rhian M Touyz
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Alberta. rpadwal@ualberta.ca
Source
Can J Cardiol. 2007 May 15;23(7):529-38
Date
May-15-2007
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Blood Pressure Determination
Blood Pressure Monitoring, Ambulatory
Canada
Health promotion
Humans
Hypertension - diagnosis - physiopathology - prevention & control
Patient Education as Topic
Risk factors
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and any associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk, and to determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2005 to October 2006 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2007 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of assessing the risk of cerebrovascular events as part of global risk assessment, the need for ongoing reassessment of patients with high normal blood pressure, and reviews of recent studies involving laboratory testing and home monitoring.
All recommendations were graded according to strength of the evidence and were voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.
Notes
Cites: Lancet. 2001 Nov 17;358(9294):1682-611728544
Cites: Clin Sci (Lond). 2001 Dec;101(6):671-911724655
Cites: J Hypertens. 2002 Apr;20(4):579-8111910284
Cites: Stroke. 2002 Jul;33(7):1776-8112105351
Cites: Can J Cardiol. 2002 Jun;18(6):604-2412107419
Cites: Can J Cardiol. 2002 Jun;18(6):625-4112107420
Cites: Blood Press Monit. 2002 Dec;7(6):293-30012488648
Cites: Lancet. 2002 Dec 14;360(9349):1903-1312493255
Cites: Eur Heart J. 2003 Jun;24(11):987-100312788299
Cites: Hypertension. 2004 Jan;43(1):10-714638619
Cites: Can J Cardiol. 2004 Jan;20(1):31-4014968141
Cites: Can J Cardiol. 2004 Jan;20(1):41-5414968142
Cites: JAMA. 2004 Mar 17;291(11):1342-915026401
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
Cites: Circulation. 1991 Jan;83(1):356-621984895
Cites: JAMA. 1996 May 22-29;275(20):1571-68622248
Cites: Arch Intern Med. 1996 Jul 8;156(13):1414-208678709
Cites: Arch Intern Med. 1998 Mar 23;158(6):655-629521231
Cites: Am J Epidemiol. 2004 Dec 1;160(11):1122-3115561992
Cites: Can J Cardiol. 2005 Jun;21(8):645-5616003448
Cites: Can J Cardiol. 2005 Jun;21(8):657-7216003449
Cites: Arch Intern Med. 2005 Jul 11;165(13):1541-616009871
Cites: Kidney Int. 2006 Jan;69(2):406-1116408134
Cites: J Hypertens. 2006 Apr;24(4):775-8116531808
Cites: N Engl J Med. 2006 Apr 20;354(16):1685-9716537662
Cites: Hypertension. 2006 May;47(5):846-5316567588
Cites: Can J Cardiol. 2006 May 15;22(7):559-6416755310
Cites: Can J Cardiol. 2006 May 15;22(7):573-8116755312
Cites: Can J Cardiol. 2006 May 15;22(7):583-9316755313
Cites: Can J Cardiol. 2006 May 15;22(7):606-1316755316
Cites: Am J Epidemiol. 2006 Oct 15;164(8):725-716936069
Cites: Lancet. 2003 Nov 29;362(9398):1776-714654312
Cites: Can J Cardiol. 2001 Dec;17(12):1249-6311773936
Cites: Am Heart J. 2000 Feb;139(2 Pt 1):272-8110650300
Cites: Arch Intern Med. 2000 Mar 13;160(5):685-9310724055
Cites: Clin Radiol. 2000 May;55(5):346-5310816399
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
Cites: BMJ. 2001 Apr 21;322(7292):977-8011312234
Cites: Can J Cardiol. 2001 May;17(5):543-5911381277
Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: N Engl J Med. 2001 Nov 1;345(18):1291-711794147
Comment In: Can J Cardiol. 2007 May 15;23(7):603-417593584
PubMed ID
17534459 View in PubMed
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The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 - blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature156767
Source
Can J Cardiol. 2008 Jun;24(6):455-63
Publication Type
Article
Date
Jun-2008
Author
Raj S Padwal
Brenda R Hemmelgarn
Nadia A Khan
Steven Grover
Finlay A McAlister
Donald W McKay
Thomas Wilson
Brian Penner
Ellen Burgess
Peter Bolli
Michael D Hill
Jeff Mahon
Martin G Myers
Carl Abbott
Ernesto L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Lyne Cloutier
Arun Chockalingam
Simon W Rabkin
Martin Dawes Dawes
Rhian M Touyz
Chaim Bell
Kevin D Burns
Marcel Ruzicka
Norman R C Campbell
Marcel Lebel
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. rpadwal@ualberta.ca
Source
Can J Cardiol. 2008 Jun;24(6):455-63
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Blood Pressure - physiology
Blood Pressure Determination - standards
Canada
Clinical Competence
Diagnosis, Differential
Education, Medical, Continuing - standards
Humans
Hypertension - diagnosis - drug therapy - physiopathology
Practice Guidelines as Topic
Program Evaluation - trends
Risk Assessment - methods
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, degree of blood pressure elevation, method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2006 to October 2007 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2008 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.
Notes
Cites: Am Heart J. 2000 Feb;139(2 Pt 1):272-8110650300
Cites: Arch Intern Med. 2007 Nov 26;167(21):2296-30318039987
Cites: Clin Radiol. 2000 May;55(5):346-5310816399
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: Clin Sci (Lond). 2001 Dec;101(6):671-911724655
Cites: Stroke. 2002 Jul;33(7):1776-8112105351
Cites: Lancet. 2002 Dec 14;360(9349):1903-1312493255
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
Cites: Eur Heart J. 2003 Jun;24(11):987-100312788299
Cites: Lancet. 2003 Nov 29;362(9398):1776-714654312
Cites: Diabetes Care. 2004 Jan;27(1):247-5514693997
Cites: Hypertension. 2004 Jan;43(1):10-714638619
Cites: Hypertension. 2004 May;43(5):963-915037557
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
Cites: Circulation. 1991 Jan;83(1):356-621984895
Cites: JAMA. 1996 May 22-29;275(20):1571-68622248
Cites: Arch Intern Med. 1996 Jul 8;156(13):1414-208678709
Cites: Arch Intern Med. 1998 Mar 23;158(6):655-629521231
Cites: Am J Cardiol. 2005 Jan 1;95(1):29-3515619390
Cites: Can J Cardiol. 2005 Jun;21(8):645-5616003448
Cites: Can J Cardiol. 2006 May 15;22(7):559-6416755310
Cites: Can J Cardiol. 2006 May 15;22(7):573-8116755312
Cites: Can J Cardiol. 2006 May 15;22(7):606-1316755316
Cites: Hypertension. 2006 Aug;48(2):219-2416801488
Cites: N Engl J Med. 2006 Oct 12;355(15):1551-6216980380
Cites: Arch Intern Med. 2006 Nov 13;166(20):2191-20117101936
Cites: Lancet. 2007 Jan 20;369(9557):201-717240286
Cites: AJR Am J Roentgenol. 2007 Mar;188(3):798-81117312071
Cites: Can J Cardiol. 2007 May 15;23(7):529-3817534459
Cites: Can J Cardiol. 2007 May 15;23(7):539-5017534460
Cites: J Hypertens. 2007 Jun;25(6):1311-717563546
Cites: Kidney Int. 2007 Aug;72(3):260-417507905
Cites: Hypertension. 2007 Sep;50(3):467-7317679652
Cites: N Engl J Med. 2000 Mar 30;342(13):905-1210738048
PubMed ID
18548142 View in PubMed
Less detail

The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1--blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature151165
Source
Can J Cardiol. 2009 May;25(5):279-86
Publication Type
Article
Date
May-2009
Author
Raj S Padwal
Brenda R Hemmelgarn
Nadia A Khan
Steven Grover
Donald W McKay
Thomas Wilson
Brian Penner
Ellen Burgess
Finlay A McAlister
Peter Bolli
Machael D Hill
Jeff Mahon
Martin G Myers
Carl Abbott
Ernesto L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Lyne Cloutier
Arun Chockalingam
Simon W Rabkin
Martin Dawes
Rhian M Touyz
Chaim Bell
Kevin D Burns
Marcel Ruzicka
Norman R C Campbell
Michel Vallée
Ramesh Prasad
Marcel Lebel
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. rpadwal@ualberta.ca
Source
Can J Cardiol. 2009 May;25(5):279-86
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Canada
Clinical Competence
Combined Modality Therapy
Education, Medical, Continuing - standards
Female
Guideline Adherence
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Middle Aged
Prognosis
Randomized Controlled Trials as Topic
Risk Management
Treatment Outcome
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2007 to October 2008 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.
Notes
Cites: Diabetes Care. 2004 Jan;27(1):247-5514693997
Cites: JAMA. 2008 Jul 9;300(2):197-20818612117
Cites: Hypertension. 2004 May;43(5):963-915037557
Cites: Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-7615286277
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
Cites: Circulation. 1991 Jan;83(1):356-621984895
Cites: JAMA. 1996 May 22-29;275(20):1571-68622248
Cites: Arch Intern Med. 1996 Jul 8;156(13):1414-208678709
Cites: Arch Intern Med. 1998 Mar 23;158(6):655-629521231
Cites: Am J Cardiol. 2005 Jan 1;95(1):29-3515619390
Cites: Can J Cardiol. 2005 Jun;21(8):645-5616003448
Cites: Can J Cardiol. 2006 May 15;22(7):559-6416755310
Cites: Can J Cardiol. 2006 May 15;22(7):573-8116755312
Cites: Can J Cardiol. 2006 May 15;22(7):606-1316755316
Cites: N Engl J Med. 2006 Oct 12;355(15):1551-6216980380
Cites: Arch Intern Med. 2006 Nov 13;166(20):2191-20117101936
Cites: Lancet. 2007 Jan 20;369(9557):201-717240286
Cites: AJR Am J Roentgenol. 2007 Mar;188(3):798-81117312071
Cites: Can J Cardiol. 2007 May 15;23(7):529-3817534459
Cites: Can J Cardiol. 2007 May 15;23(7):539-5017534460
Cites: J Hypertens. 2007 Jun;25(6):1311-717563546
Cites: Kidney Int. 2007 Aug;72(3):260-417507905
Cites: Hypertension. 2007 Sep;50(3):467-7317679652
Cites: Am Heart J. 2000 Feb;139(2 Pt 1):272-8110650300
Cites: N Engl J Med. 2000 Mar 30;342(13):905-1210738048
Cites: Clin Radiol. 2000 May;55(5):346-5310816399
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: Clin Sci (Lond). 2001 Dec;101(6):671-911724655
Cites: Stroke. 2002 Jul;33(7):1776-8112105351
Cites: Lancet. 2002 Dec 14;360(9349):1903-1312493255
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
Cites: Eur Heart J. 2003 Jun;24(11):987-100312788299
Cites: Lancet. 2003 Nov 29;362(9398):1776-714654312
Cites: Arch Intern Med. 2007 Nov 26;167(21):2296-30318039987
Cites: Can J Cardiol. 2008 Jun;24(6):455-6318548142
Cites: Can J Cardiol. 2008 Jun;24(6):465-7518548143
Cites: Hypertension. 2004 Jan;43(1):10-714638619
PubMed ID
19417858 View in PubMed
Less detail

The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy.

https://arctichealth.org/en/permalink/ahliterature143444
Source
Can J Cardiol. 2010 May;26(5):249-58
Publication Type
Article
Date
May-2010
Author
Daniel G Hackam
Nadia A Khan
Brenda R Hemmelgarn
Simon W Rabkin
Rhian M Touyz
Norman R C Campbell
Raj Padwal
Tavis S Campbell
M Patrice Lindsay
Michael D Hill
Robert R Quinn
Jeff L Mahon
Robert J Herman
Ernesto L Schiffrin
Marcel Ruzicka
Pierre Larochelle
Ross D Feldman
Marcel Lebel
Luc Poirier
J Malcolm O Arnold
Gordon W Moe
Jonathan G Howlett
Luc Trudeau
Simon L Bacon
Robert J Petrella
Alain Milot
James A Stone
Denis Drouin
Jean-Martin Boulanger
Mukul Sharma
Pavel Hamet
George Fodor
George K Dresser
S George Carruthers
George Pylypchuk
Ellen D Burgess
Kevin D Burns
Michel Vallée
G V Ramesh Prasad
Richard E Gilbert
Lawrence A Leiter
Charlotte Jones
Richard I Ogilvie
Vincent Woo
Philip A McFarlane
Robert A Hegele
Sheldon W Tobe
Author Affiliation
Department of Medicine and Epidemiology, Division of Clinical Pharmacology and Clinical Neurological Sciences, University of Western Ontario, London, Ontario. dhackam@uwo.ca
Source
Can J Cardiol. 2010 May;26(5):249-58
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adult
Antihypertensive Agents - therapeutic use
Canada
Cardiovascular Diseases - prevention & control
Combined Modality Therapy
Diet, Sodium-Restricted
Evidence-Based Medicine
Female
Humans
Hypertension - diagnosis - prevention & control - therapy
Life Style
Male
Middle Aged
Patient Education as Topic
Practice Guidelines as Topic
Primary Prevention - standards
Prognosis
Risk assessment
Abstract
To update the evidence-based recommendations for the prevention and treatment of hypertension in adults for 2010.
For lifestyle and pharmacological interventions, randomized trials and systematic reviews of trials were preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the general lack of long-term morbidity and mortality data in this field. Progressive renal impairment was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease.
A Cochrane Collaboration librarian conducted an independent MEDLINE search from 2008 to August 2009 to update the 2009 recommendations. To identify additional studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence.
For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium to 1500 mg (65 mmol) per day in adults 50 years of age or younger, to 1300 mg (57 mmol) per day in adults 51 to 70 years of age, and to 1200 mg (52 mmol) per day in adults older than 70 years of age; perform 30 min to 60 min of moderate aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m(2) to 24.9 kg/m(2)) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 standard drinks per week for men or nine standard drinks per week for women; follow a diet that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources, and that is low in saturated fat and cholesterol; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. Antihypertensive therapy should be considered in all adult patients regardless of age (caution should be exercised in elderly patients who are frail). For adults without compelling indications for other agents, considerations for initial therapy should include thiazide diuretics, angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered as initial treatment of hypertension if systolic blood pressure is 20 mmHg above target or if diastolic blood pressure is 10 mmHg above target. The combination of ACE inhibitors and ARBs should not be used, unless compelling indications are present to suggest consideration of dual therapy. Agents appropriate for first-line therapy for isolated systolic hypertension include thiazide diuretics, long-acting dihydropyridine CCBs or ARBs. In patients with coronary artery disease, ACE inhibitors, ARBs or betablockers are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred; in patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors or ARBs (if intolerant to ACE inhibitors) are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. In selected high-risk patients in whom combination therapy is being considered, an ACE inhibitor plus a long-acting dihydropyridine CCB is preferable to an ACE inhibitor plus a thiazide diuretic. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian lipid treatment guidelines. Selected patients with hypertension who do not achieve thresholds for statin therapy, but who are otherwise at high risk for cardiovascular events, should nonetheless receive statin therapy. Once blood pressure is controlled, low-dose acetylsalicylic acid therapy should be considered.
All recommendations were graded according to the strength of the evidence and voted on by the 63 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 80% consensus. These guidelines will continue to be updated annually.
The Canadian Hypertension Education Program process is sponsored by the Canadian Hypertension Society, Blood Pressure Canada, the Public Health Agency of Canada, the College of Family Physicians of Canada, the Canadian Pharmacists Association, the Canadian Council of Cardiovascular Nurses, and the Heart and Stroke Foundation of Canada.
Notes
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PubMed ID
20485689 View in PubMed
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The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part I - blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature143445
Source
Can J Cardiol. 2010 May;26(5):241-8
Publication Type
Article
Date
May-2010
Author
Robert R Quinn
Brenda R Hemmelgarn
Raj S Padwal
Martin G Myers
Lyne Cloutier
Peter Bolli
Donald W McKay
Nadia A Khan
Michael D Hill
Jeff Mahon
Daniel G Hackam
Steven Grover
Thomas Wilson
Brian Penner
Ellen Burgess
Finlay A McAlister
Maxime Lamarre-Cliche
Donna McLean
Ernesto L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Arun Chockalingam
Simon W Rabkin
Martin Dawes
Rhian M Touyz
Kevin D Burns
Marcel Ruzicka
Norman R C Campbell
Michel Vallée
G V Ramesh Prasad
Marcel Lebel
Sheldon W Tobe
Author Affiliation
Division of Nephrology, University of Calgary, Alberta. rob.quinn@albertahealthservices.ca
Source
Can J Cardiol. 2010 May;26(5):241-8
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Pressure Determination - standards
Blood Pressure Monitoring, Ambulatory - standards
Canada
Cardiovascular Diseases - epidemiology - prevention & control
Female
Humans
Hypertension - diagnosis - epidemiology
Male
Middle Aged
Physician's Practice Patterns
Practice Guidelines as Topic
Quality of Health Care
Risk assessment
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
MEDLINE searches were conducted from November 2008 to October 2009 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Changes to the recommendations for 2010 relate to automated office blood pressure measurements. Automated office blood pressure measurements can be used in the assessment of office blood pressure. When used under proper conditions, an automated office systolic blood pressure of 135 mmHg or higher or diastolic blood pressure of 85 mmHg or higher should be considered analogous to a mean awake ambulatory systolic blood pressure of 135 mmHg or higher and diastolic blood pressure of 85 mmHg or higher, respectively.
All recommendations were graded according to strength of the evidence and voted on by the 63 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. To be approved, all recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.
Notes
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PubMed ID
20485688 View in PubMed
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The 2011 Canadian Hypertension Education Program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy.

https://arctichealth.org/en/permalink/ahliterature132607
Source
Can J Cardiol. 2011 Jul-Aug;27(4):415-433.e1-2
Publication Type
Article
Author
Doreen M Rabi
Stella S Daskalopoulou
Raj S Padwal
Nadia A Khan
Steven A Grover
Daniel G Hackam
Martin G Myers
Donald W McKay
Robert R Quinn
Brenda R Hemmelgarn
Lyne Cloutier
Peter Bolli
Michael D Hill
Thomas Wilson
Brian Penner
Ellen Burgess
Maxime Lamarre-Cliché
Donna McLean
Ernesto L Schiffrin
George Honos
Karen Mann
Guy Tremblay
Alain Milot
Arun Chockalingam
Simon W Rabkin
Martin Dawes
Rhian M Touyz
Kevin D Burns
Marcel Ruzicka
Norman R C Campbell
Michel Vallée
G V Ramesh Prasad
Marcel Lebel
Tavis S Campbell
M Patrice Lindsay
Robert J Herman
Pierre Larochelle
Ross D Feldman
J Malcolm O Arnold
Gordon W Moe
Jonathan G Howlett
Luc Trudeau
Simon L Bacon
Robert J Petrella
Richard Lewanczuk
James A Stone
Denis Drouin
Jean-Martin Boulanger
Mukul Sharma
Pavel Hamet
George Fodor
George K Dresser
S George Carruthers
George Pylypchuk
Richard E Gilbert
Lawrence A Leiter
Charlotte Jones
Richard I Ogilvie
Vincent Woo
Philip A McFarlane
Robert A Hegele
Luc Poirier
Sheldon W Tobe
Author Affiliation
Department of Medicine, University of Calgary, Calgary, Alberta, Canada. doreen.rabi@albertahealthservices.ca
Source
Can J Cardiol. 2011 Jul-Aug;27(4):415-433.e1-2
Language
English
French
Publication Type
Article
Keywords
Adult
Antihypertensive Agents - therapeutic use
Blood Pressure Determination
Canada
Health education
Humans
Hypertension - diagnosis - drug therapy
Risk assessment
Abstract
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2011. The major guideline changes this year are: (1) a recommendation was made for using comparative risk analogies when communicating a patient's cardiovascular risk; (2) diagnostic testing issues for renal artery stenosis were discussed; (3) recommendations were added for the management of hypertension during the acute phase of stroke; (4) people with hypertension and diabetes are now considered high risk for cardiovascular events if they have elevated urinary albumin excretion, overt kidney disease, cardiovascular disease, or the presence of other cardiovascular risk factors; (5) the combination of an angiotensin-converting enzyme (ACE) inhibitor and a dihydropyridine calcium channel blocker (CCB) is preferred over the combination of an ACE inhibitor and a thiazide diuretic in persons with diabetes and hypertension; and (6) a recommendation was made to coordinate with pharmacists to improve antihypertensive medication adherence. We also discussed the recent analyses that examined the association between angiotensin II receptor blockers (ARBs) and cancer.
PubMed ID
21801975 View in PubMed
Less detail

The 2012 Canadian hypertension education program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy.

https://arctichealth.org/en/permalink/ahliterature124290
Source
Can J Cardiol. 2012 May;28(3):270-87
Publication Type
Article
Date
May-2012
Author
Stella S Daskalopoulou
Nadia A Khan
Robert R Quinn
Marcel Ruzicka
Donald W McKay
Daniel G Hackam
Simon W Rabkin
Doreen M Rabi
Richard E Gilbert
Raj S Padwal
Martin Dawes
Rhian M Touyz
Tavis S Campbell
Lyne Cloutier
Steven Grover
George Honos
Robert J Herman
Ernesto L Schiffrin
Peter Bolli
Thomas Wilson
Ross D Feldman
M Patrice Lindsay
Brenda R Hemmelgarn
Michael D Hill
Mark Gelfer
Kevin D Burns
Michel Vallée
G V Ramesh Prasad
Marcel Lebel
Donna McLean
J Malcolm O Arnold
Gordon W Moe
Jonathan G Howlett
Jean-Martin Boulanger
Pierre Larochelle
Lawrence A Leiter
Charlotte Jones
Richard I Ogilvie
Vincent Woo
Janusz Kaczorowski
Luc Trudeau
Simon L Bacon
Robert J Petrella
Alain Milot
James A Stone
Denis Drouin
Maxime Lamarre-Cliché
Marshall Godwin
Guy Tremblay
Pavel Hamet
George Fodor
S George Carruthers
George Pylypchuk
Ellen Burgess
Richard Lewanczuk
George K Dresser
Brian Penner
Robert A Hegele
Philip A McFarlane
Mukul Sharma
Norman R C Campbell
Debra Reid
Luc Poirier
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, McGill University, Montreal, Québec, Canada. stella.daskalopoulou@mcgill.ca
Source
Can J Cardiol. 2012 May;28(3):270-87
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - methods
Canada
Cardiovascular Diseases - etiology - prevention & control
Education, Medical, Continuing - standards
Evidence-Based Medicine - standards
Female
Health Education - standards
Humans
Hypertension - complications - diagnosis - therapy
Male
Middle Aged
Monitoring, Physiologic - methods
Practice Guidelines as Topic - standards
Prognosis
Risk assessment
Treatment Outcome
Abstract
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2012. The new recommendations are: (1) use of home blood pressure monitoring to confirm a diagnosis of white coat syndrome; (2) mineralocorticoid receptor antagonists may be used in selected patients with hypertension and systolic heart failure; (3) a history of atrial fibrillation in patients with hypertension should not be a factor in deciding to prescribe an angiotensin-receptor blocker for the treatment of hypertension; and (4) the blood pressure target for patients with nondiabetic chronic kidney disease has now been changed to
PubMed ID
22595447 View in PubMed
Less detail

Access to health care among status Aboriginal people with chronic kidney disease.

https://arctichealth.org/en/permalink/ahliterature154422
Source
CMAJ. 2008 Nov 4;179(10):1007-12
Publication Type
Article
Date
Nov-4-2008
Author
Song Gao
Braden J Manns
Bruce F Culleton
Marcello Tonelli
Hude Quan
Lynden Crowshoe
William A Ghali
Lawrence W Svenson
Sofia Ahmed
Brenda R Hemmelgarn
Author Affiliation
Department of Medicine, Division of Nephrology, University of Calgary, Calgary, AB.
Source
CMAJ. 2008 Nov 4;179(10):1007-12
Date
Nov-4-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta - epidemiology
Chronic Disease
Creatinine - blood
Delphi Technique
Female
Glomerular Filtration Rate
Health Services Accessibility
Healthcare Disparities
Humans
Indians, North American - statistics & numerical data
Kidney Diseases - epidemiology
Male
Middle Aged
Nephrology
Office visits - statistics & numerical data
Patient Admission - statistics & numerical data
Registries
Severity of Illness Index
Abstract
Ethnic disparities in access to health care and health outcomes are well documented. It is unclear whether similar differences exist between Aboriginal and non-Aboriginal people with chronic kidney disease in Canada. We determined whether access to care differed between status Aboriginal people (Aboriginal people registered under the federal Indian Act) and non-Aboriginal people with chronic kidney disease.
We identified 106 511 non-Aboriginal and 1182 Aboriginal patients with chronic kidney disease (estimated glomerular filtration rate less than 60 mL/min/1.73 m(2)). We compared outcomes, including hospital admissions, that may have been preventable with appropriate outpatient care (ambulatory-care-sensitive conditions) as well as use of specialist services, including visits to nephrologists and general internists.
Aboriginal people were almost twice as likely as non-Aboriginal people to be admitted to hospital for an ambulatory-care-sensitive condition (rate ratio 1.77, 95% confidence interval [CI] 1.46-2.13). Aboriginal people with severe chronic kidney disease (estimated glomerular filtration rate
Notes
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PubMed ID
18981441 View in PubMed
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