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The 2001 Canadian recommendations for the management of hypertension: Part one--Assessment for diagnosis, cardiovascular risk, causes and lifestyle modification.

https://arctichealth.org/en/permalink/ahliterature189435
Source
Can J Cardiol. 2002 Jun;18(6):604-24
Publication Type
Article
Date
Jun-2002
Author
Kelly B Zarnke
Finlay A McAlister
Norman R C Campbell
Mitchell Levine
Ernesto L Schiffrin
Steven Grover
Donald W McKay
Martin G Myers
Thomas W Wilson
Simon W Rabkin
Ross D Feldman
Ellen Burgess
Peter Bolli
George Honos
Marcel Lebel
Karen Mann
Carl Abbott
Sheldon Tobe
Robert Petrella
Rhian M Touyz
Author Affiliation
London Health Sciences Centre, University Hospital Campus, London, Canada.
Source
Can J Cardiol. 2002 Jun;18(6):604-24
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Blood Pressure Monitoring, Ambulatory - standards
Canada
Cardiovascular Diseases - diagnosis - prevention & control - therapy
Diet
Exercise
Female
Humans
Hypertension - diagnosis - prevention & control - therapy
Life Style
Pregnancy
Pregnancy Complications, Cardiovascular - diagnosis - prevention & control
Risk assessment
Abstract
To provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk, identifiable causes and lifestyle modifications for adults with high blood pressure.
For persons in whom a high blood pressure value is recorded, hypertension is diagnosed based 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 must be assessed to determine the urgency, intensity and type of treatment. For persons receiving a diagnosis of hypertension, defining the 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 outcomes were: 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 one year before the period of the last revision of the Canadian recommendations for the management of hypertension (May 1999 to May 2001). Reference lists were scanned, experts were polled, and the personal files of the 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. In addition to an update of the previous year's review, new sections on assessing overall cardiovascular risk and endocrine causes are provided.
A high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and of persons with identifiable causes of hypertension.
The identification of persons at higher risk of cardiovascular disease will permit counseling for lifestyle manoeuvres 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. In certain subgroups of patients, and for specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity or mortality.
The present document contains recommendations for the assessment of the diagnosis, cardiovascular risk, identifiable causes and lifestyle modifications for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for the 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, the role of echocardiography and lifestyle modifications.
All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only those recommendations achieving high levels of consensus are reported. These guidelines will be updated annually.
These guidelines 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, Health Canada.
PubMed ID
12107419 View in PubMed
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The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part II - therapy.

https://arctichealth.org/en/permalink/ahliterature173954
Source
Can J Cardiol. 2005 Jun;21(8):657-72
Publication Type
Article
Date
Jun-2005
Author
Nadia A Khan
Finlay A McAlister
Richard Z Lewanczuk
Rhian M Touyz
Raj Padwal
Simon W Rabkin
Lawrence A Leiter
Marcel Lebel
Carol Herbert
Ernesto L Schiffrin
Robert J Herman
Pavel Hamet
George Fodor
George Carruthers
Bruce Culleton
Jacques DeChamplain
George Pylypchuk
Alexander G Logan
Norm Gledhill
Robert Petrella
Norman R C Campbell
Malcolm Arnold
Gordon Moe
Micharl D Hill
Charlotte Jones
Pierre Larochelle
Richard I Ogilvie
Sheldon Tobe
Robyn Houlden
Ellen Burgess
Ross D Feldman
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada.
Source
Can J Cardiol. 2005 Jun;21(8):657-72
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Canada
Diet
Evidence-Based Medicine
Exercise
Humans
Hypertension - therapy
Patient Education as Topic
Weight Loss
Abstract
To provide updated, evidence-based recommendations for the management of hypertension in adults.
For lifestyle and pharmacological interventions, evidence from randomized controlled trials and systematic reviews of trials was preferentially reviewed. While changes in cardiovascular morbidity and mortality were the primary outcomes of interest, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity/mortality data in this field, and for certain comorbid conditions, other relevant outcomes, such as development of proteinuria or worsening of kidney function, were considered.
MEDLINE searches were conducted from November 2003 to October 2004 to update the 2004 recommendations. Reference lists were scanned, experts were contacted, and the personal files of the subgroup members and authors were used to identify additional published studies. All relevant articles were reviewed and appraised independently, using prespecified levels of evidence, by content and methodology 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.
Lifestyle modifications to prevent and/or treat hypertension include the following: perform 30 min to 60 min of aerobic exercise on four to seven days of the week; maintain a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 units per week in men or nine units per week in women; follow a reduced fat, low cholesterol diet with an adequate intake of potassium, magnesium and calcium; restrict salt intake; and consider stress management (in selected individuals). Treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and any comorbid conditions. Blood pressure should be lowered to 140/90 mmHg or less in all patients, and to 130/80 mmHg or less in those with diabetes mellitus or chronic kidney disease. Most adults with hypertension require more than one agent to achieve target blood pressures. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (except in black patients), long-acting calcium channel blockers and angiotensin receptor antagonists. Other agents appropriate for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers and angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or thiazides in patients with diabetes mellitus without albuminuria) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy.
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 here achieved at least 95% consensus. These guidelines will continue to be updated annually.
PubMed ID
16003449 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
Cites: Can J Cardiol. 2002 Jun;18(6):625-4112107420
Cites: BMJ. 2009;339:b456719934192
Cites: CMAJ. 1992 Jun 1;146(11):1997-20051596849
Cites: BMC Cardiovasc Disord. 2005;5(1):415691376
Cites: Can J Cardiol. 2006 May 15;22(7):559-6416755310
Cites: Lancet. 2006 Oct 21;368(9545):1449-5617055947
Cites: Blood Press. 2007;16(1):13-917453747
Cites: BMJ. 2007 Apr 28;334(7599):885-817449506
Cites: Can J Cardiol. 2007 May 1;23(6):437-4317487286
Cites: N Engl J Med. 2008 Apr 10;358(15):1547-5918378520
Cites: Lancet. 2008 May 3;371(9623):1513-818456100
Cites: N Engl J Med. 2008 Sep 18;359(12):1225-3718753639
Cites: Lancet. 2008 Sep 27;372(9644):1174-8318757085
Cites: N Engl J Med. 2008 Dec 4;359(23):2417-2819052124
Cites: Circulation. 2009 Feb 3;119(4):530-719153265
Cites: Am J Med. 2009 Mar;122(3):290-30019272490
Cites: Hypertension. 2009 Apr;53(4):646-5319237683
Cites: Nephrol Dial Transplant. 2009 May;24(5):1663-7119145003
Cites: Can J Cardiol. 2009 May;25(5):271-719417857
Cites: Can J Cardiol. 2009 May;25(5):287-9819417859
Cites: Can J Cardiol. 2009 Oct;25(10):567-7919812802
Cites: J Hypertens. 2009 Dec;27(12):2321-3119727007
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
PubMed ID
20485689 View in PubMed
Less detail

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
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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
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