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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 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 2004 Canadian recommendations for the management of hypertension: Part II--Therapy.

https://arctichealth.org/en/permalink/ahliterature181498
Source
Can J Cardiol. 2004 Jan;20(1):41-54
Publication Type
Article
Date
Jan-2004
Author
Nadia A Khan
Finlay A McAlister
Norman R C Campbell
Ross D Feldman
Simon Rabkin
Jeff Mahon
Richard Lewanczuk
Kelly B Zarnke
Brenda Hemmelgarn
Marcel Lebel
Mitchell Levine
Carol Herbert
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada.
Source
Can J Cardiol. 2004 Jan;20(1):41-54
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - administration & dosage
Blood Pressure Determination - standards
Canada - epidemiology
Cardiovascular Diseases - prevention & control
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Evidence-Based Medicine - standards
Female
Humans
Hypertension - diagnosis - drug therapy - epidemiology
Male
Middle Aged
Prognosis
Risk assessment
Severity of Illness Index
Societies, Medical
Treatment Outcome
Abstract
To provide updated, evidence-based recommendations for the management of hypertension in adults.
For patients who require pharmacological therapy for hypertension, a number of antihypertensive agents may be used. Randomized trials evaluating first-line therapy with diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), alpha-blockers, centrally acting agents or angiotensin receptor antagonists were reviewed. Also, randomized trials evaluating other agents, such as statins or acetylsalicylic acid, in patients with hypertension were reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. In addition, other relevant outcomes such as development of end-stage renal disease or changes in blood pressure were examined where appropriate.
MEDLINE searches were conducted from November 2001 to October 2003 to update the 2001 Recommendations for the management of hypertension. 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.
This document contains detailed recommendations and supporting evidence on treatment thresholds, target blood pressures and choice of agents for hypertensive patients with or without comorbidities. Lifestyle modifications are a key component of any antiatherosclerotic management strategy and detailed recommendations are contained in a separate document. Key recommendations for pharmacotherapy include the following: treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and comorbidities, with particular attention to systolic blood pressure; blood pressure should be lowered to 140/90 mmHg or less in all patients, and 130/80 mmHg or less in those with diabetes mellitus or renal disease (125/75 mmHg or less in those with nondiabetic renal disease and more than 1 g of proteinuria per day); 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), ACE inhibitors (in non-Blacks), long-acting dihydropyridine CCBs or angiotensin receptor antagonists; other agents appropriate for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine CCBs or angiotensin receptor antagonists; certain comorbidities 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 mild to moderate nondiabetic renal 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 as per the Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease; and selected patients with hypertension should also receive statin and/or acetylsalicylic acid therapy.
All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Individuals with irreconcilable competing interests (declared by all members, compiled and circulated before the meeting) relative to any specific recommendation were excluded from voting on that recommendation. Only recommendations achieving at least 70% consensus are reported here. These guidelines will continue to be updated annually.
PubMed ID
14968142 View in PubMed
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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
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PubMed ID
19417858 View in PubMed
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2009 Canadian Hypertension Education Program recommendations: the scientific summary--an annual update.

https://arctichealth.org/en/permalink/ahliterature151166
Source
Can J Cardiol. 2009 May;25(5):271-7
Publication Type
Article
Date
May-2009
Author
Norman R C Campbell
Nadia A Khan
Michael D Hill
Guy Tremblay
Marcel Lebel
Janusz Kaczorowski
Finlay A McAlister
Richard Z Lewanczuk
Sheldon Tobe
Author Affiliation
Department of Medicine, University of Calgary, Calgary, Canada. ncampbel@ucalgary.ca
Source
Can J Cardiol. 2009 May;25(5):271-7
Date
May-2009
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Attitude to Health
Blood Pressure Determination
Canada
Combined Modality Therapy
Diet, Sodium-Restricted
Female
Health Knowledge, Attitudes, Practice
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Patient Education as Topic
Program Evaluation
Randomized Controlled Trials as Topic
Severity of Illness Index
Abstract
The present report highlights the key messages of the 2009 Canadian Hypertension Education Program (CHEP) recommendations for the management of hypertension and the supporting clinical evidence. In 2009, the CHEP emphasizes the need to improve the control of hypertension in people with diabetes. Intensive reduction in blood pressure (to less than 130/80 mmHg) in people with diabetes leads to significant reductions in mortality rates, disability rates and overall health care system costs, and may lead to improved quality of life. The CHEP recommendations continue to emphasize the important role of patient self-efficacy by promoting lifestyle changes to prevent and control hypertension, and encouraging home measurement of blood pressure. Unfortunately, most Canadians make only minor changes in lifestyle after a diagnosis of hypertension. Routine blood pressure measurement at all appropriate visits, and screening for and management of all cardiovascular risks are key to blood pressure management. Many young hypertensive Canadians with multiple cardiovascular risks are not treated with antihypertensive drugs. This is despite the evidence that individuals with multiple cardiovascular risks and hypertension should be strongly considered for antihypertensive drug therapy regardless of age. In 2009, the CHEP specifically recommends not to combine an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker in people with uncomplicated hypertension, diabetes (without micro- or macroalbuminuria), chronic kidney disease (without nephropathy [micro- or overt proteinuria]) or ischemic heart disease (without heart failure).
Notes
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PubMed ID
19417857 View in PubMed
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2010 Canadian Hypertension Education Program (CHEP) recommendations: the scientific summary - an update of the 2010 theme and the science behind new CHEP recommendations.

https://arctichealth.org/en/permalink/ahliterature143446
Source
Can J Cardiol. 2010 May;26(5):236-40
Publication Type
Article
Date
May-2010
Author
Norman R C Campbell
Janusz Kaczorowski
Richard Z Lewanczuk
Ross Feldman
Luc Poirier
Margaret Moy Kwong
Marcel Lebel
Finlay A McAlister
Sheldon W Tobe
Author Affiliation
Department of Medicine, University of Calgary, Alberta. ncampbel@ucalgary.ca
Source
Can J Cardiol. 2010 May;26(5):236-40
Date
May-2010
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - administration & dosage
Canada
Diet, Sodium-Restricted
Female
Health promotion
Humans
Hypertension - prevention & control - therapy
Life Style
Male
Patient Education as Topic
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Risk Reduction Behavior
Abstract
The present article is a summary of the theme, the key recommendations for management of hypertension and the supporting clinical evidence of the 2010 Canadian Hypertension Education Program (CHEP). In 2010, CHEP emphasizes the need for health care professionals to stay informed about hypertension through automated updates at www.htnupdate.ca. A new interactive Internet-based lecture series will be available in 2010 and a program to train community hypertension leaders will be expanded. Patients can also sign up to receive regular updates in a pilot program at www.myBPsite.ca. In 2010, the new recommendations include consideration for using automated office blood pressure monitors, new targets for dietary sodium for the prevention and treatment of hypertension that are aligned with the national adequate intake values, and recommendations for considering treatment of selected hypertensive patients at high risk with calcium channel blocker/angiotensin-converting enzyme inhibitor combinations and the use of angiotensin receptor blockers.
Notes
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PubMed ID
20485687 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 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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Determinants of progression of aortic stiffness in hemodialysis patients: a prospective longitudinal study.

https://arctichealth.org/en/permalink/ahliterature114114
Source
Hypertension. 2013 Jul;62(1):154-60
Publication Type
Article
Date
Jul-2013
Author
Mihai S Utescu
Véronique Couture
Fabrice Mac-Way
Sacha A De Serres
Karine Marquis
Richard Larivière
Simon Desmeules
Marcel Lebel
Pierre Boutouyrie
Mohsen Agharazii
Author Affiliation
CHU de Québec Research Center, L’Hôtel Dieu de Québec Hospital Quebec, Quebec, Canada.
Source
Hypertension. 2013 Jul;62(1):154-60
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - epidemiology - etiology - physiopathology
Disease Progression
Female
Follow-Up Studies
Humans
Incidence
Kidney Failure, Chronic - therapy
Male
Middle Aged
Prospective Studies
Quebec - epidemiology
Renal Dialysis - adverse effects
Risk factors
Survival Rate - trends
Vascular Stiffness
Abstract
Aortic stiffness is associated with increased cardiovascular mortality in patients with chronic kidney disease. However, the rate of progression of arterial stiffness and the role of cardiovascular risk factors in the progression of arterial stiffness has never been established in a longitudinal study. In a prospective, longitudinal, observational study, carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were assessed in 109 hemodialysis patients at baseline and after a mean follow-up of 1.2 years. We examined the impact of age, atherosclerotic cardiovascular disease, diabetes mellitus, dialysis vintage, and pentosidine (a well-characterized, advanced glycation end products) on the rate of progression of aortic stiffness. The annual rate of changes in carotid-femoral pulse wave velocity and carotid-radial pulse wave velocity were 0.84 m/s per year (95% confidence interval, 0.50-1.12 m/s per year) and -0.66 m/s per year (95% confidence interval, -0.85 to -0.47 m/s per year), respectively. Older subjects, and patients with diabetes mellitus or atherosclerotic cardiovascular disease had higher aortic stiffness at baseline, however, the rate of progression of aortic stiffness was only determined by plasma pentosidine levels (P=0.001). The degree of baseline aortic stiffness was a significant determinant of the regression of brachial stiffness (P
PubMed ID
23648699 View in PubMed
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11 records – page 1 of 2.