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1999 Canadian recommendations for the management of hypertension. Task Force for the Development of the 1999 Canadian Recommendations for the Management of Hypertension.

https://arctichealth.org/en/permalink/ahliterature199846
Source
CMAJ. 1999;161 Suppl 12:S1-17
Publication Type
Article
Date
1999
Author
R D Feldman
N. Campbell
P. Larochelle
P. Bolli
E D Burgess
S G Carruthers
J S Floras
R B Haynes
G. Honos
F H Leenen
L A Leiter
A G Logan
M G Myers
J D Spence
K B Zarnke
Author Affiliation
Robarts Research Institute, University of Western Ontario, London. feldmanr@lhsc.on.ca
Source
CMAJ. 1999;161 Suppl 12:S1-17
Date
1999
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Canada
Humans
Hypertension - diagnosis - drug therapy
Middle Aged
Abstract
To provide updated, evidence-based recommendations for health care professionals on the management of hypertension in adults.
For patients with hypertension, there are both lifestyle options and pharmacological therapy options that may control blood pressure. For those patients who are using pharmacological therapy, a range of antihypertensive drugs is available. The choice of a specific antihypertensive drug is dependent upon the severity of the hypertension and the presence of other cardiovascular risk factors and concurrent diseases.
The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered.
MEDLINE searches were conducted from the period of the last revision of the Canadian Recommendations for the Management of Hypertension (January 1993 to May 1998). Reference lists were scanned, experts were polled and the personal files of the authors were used to identify other studies. All relevant articles were reviewed, classified according to study design and graded according to levels of evidence.
A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension.
Harms and costs: The diagnosis and treatment of hypertension with pharmacological therapy will reduce the blood pressure of patients with sustained hypertension. In certain settings, and for specific drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and mortality.
This document contains detailed recommendations pertaining to all aspects of the diagnosis and pharmacological therapy of hypertensive patients. With respect to diagnosis, the recommendations endorse the greater use of non-office-based measures of blood pressure control (i.e., using home blood pressure and automatic ambulatory blood pressure monitoring equipment) and greater emphasis on the identification of other cardiovascular risk factors, both in the assessment of prognosis in hypertension and in the choice of therapy. On the treatment side, lower targets for blood pressure control are advocated for some subgroups of hypertensive patients, in particular, those with diabetes and renal disease. Implicit in the recommendations for therapy is the principle that for the vast majority of hypertensive patients treated pharmacologically, practitioners should not follow a stepped-care approach. Instead, therapy should be individualized, based on consideration of concurrent diseases, both cardiovascular and noncardiovascular.
All recommendations were graded according to the strength of the evidence and the consensus of all relevant stakeholders.
The Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control.
Notes
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Comment In: CMAJ. 2000 May 30;162(11):1555-610862227
Comment In: CMAJ. 2000 May 30;162(11):1554-5; author reply 155610862226
PubMed ID
10624417 View in PubMed
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The 2000 Canadian recommendations for the management of hypertension: part two--diagnosis and assessment of people with high blood pressure.

https://arctichealth.org/en/permalink/ahliterature192030
Source
Can J Cardiol. 2001 Dec;17(12):1249-63
Publication Type
Conference/Meeting Material
Article
Date
Dec-2001
Author
K B Zarnke
M. Levine
F A McAlister
N R Campbell
M G Myers
D W McKay
P. Bolli
G. Honos
M. Lebel
K. Mann
T W Wilson
C. Abbott
S. Tobe
E. Burgess
S. Rabkin
Author Affiliation
Department of Medicine, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada. Kelly.Zarnke@lhsc.on.ca
Source
Can J Cardiol. 2001 Dec;17(12):1249-63
Date
Dec-2001
Language
English
French
Publication Type
Conference/Meeting Material
Article
Keywords
Adrenal Gland Neoplasms - complications
Adult
Blood Pressure Determination - methods - psychology - standards
Blood Pressure Monitoring, Ambulatory - methods - standards
Canada
Cardiovascular Diseases - etiology - prevention & control
Clinical Laboratory Techniques - standards
Diabetes Complications
Diabetic Nephropathies - complications - diagnosis
Echocardiography - standards
Electrocardiography
Evidence-Based Medicine - methods
Humans
Hypertension - complications - diagnosis - etiology - psychology
Hypertension, Renovascular - diagnosis
Hypertrophy, Left Ventricular - complications - ultrasonography
Office Visits
Patient compliance
Pheochromocytoma - complications - diagnosis
Risk factors
Self Care - methods - standards
Abstract
To provide updated, evidence-based recommendations for the diagnosis and assessment of high blood pressure in adults.
For people with high blood pressure, the assignment of a diagnosis of hypertension depends on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the duration of follow-up and the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases. For people diagnosed with hypertension, defining the overall risk of adverse cardiovascular outcomes requires laboratory testing, a search for target organ damage and an assessment of the modifiable causes of hypertension. Out-of-clinic blood pressure assessment and echocardiography are options for selected patients.
People at increased risk of adverse cardiovascular outcomes and were identified and quantified.
Medline searches were conducted from the period of the last revision of the Canadian recommendations for the management of hypertension (May 1998 to October 2000). Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other studies. All relevant 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 people at increased risk of cardiovascular morbidity and mortality.
The identification of people at higher risk of cardiovascular disease will permit counselling for lifestyle manoeuvres and the introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. In certain settings, and for specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The present document contains detailed recommendations pertaining to aspects of the diagnosis and assessment of patients with hypertension, including the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, routine and optional laboratory testing, assessment for renovascular hypertension, home and ambulatory blood pressure monitoring, and the role of echocardiography in hypertension.
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only the recommendations achieving high levels of consensus are reported here. These guidelines will be updated annually.
These recommendations are endorsed by the Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, The Adult Disease Division and Bureau of Cardio-Respiratory Diseases and Diabetes at the Centre for Chronic Disease Prevention and Control of Health Canada.
PubMed ID
11773936 View in PubMed
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