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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
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 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2--therapy.

https://arctichealth.org/en/permalink/ahliterature151164
Source
Can J Cardiol. 2009 May;25(5):287-98
Publication Type
Article
Date
May-2009
Author
Nadia A Khan
Brenda Hemmelgarn
Robert J Herman
Chaim M Bell
Jeff L Mahon
Lawrence A Leiter
Simon W Rabkin
Michael D Hill
Raj Padwal
Rhian M Touyz
Pierre Larochelle
Ross D Feldman
Ernesto L Schiffrin
Norman R C Campbell
Gordon Moe
Ramesh Prasad
Malcolm O Arnold
Tavis S Campbell
Alain Milot
James A Stone
Charlotte Jones
Richard I Ogilvie
Pavel Hamet
George Fodor
George Carruthers
Kevin D Burns
Marcel Ruzicka
Jacques DeChamplain
George Pylypchuk
Robert Petrella
Jean-Martin Boulanger
Luc Trudeau
Robert A Hegele
Vincent Woo
Phil McFarlane
Michel Vallée
Jonathan Howlett
Simon L Bacon
Patrice Lindsay
Richard E Gilbert
Richard Z Lewanczuk
Sheldon Tobe
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada. nakhan@shaw.ca
Source
Can J Cardiol. 2009 May;25(5):287-98
Date
May-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Canada
Case Management - standards
Combined Modality Therapy
Diet, Sodium-Restricted
Female
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Middle Aged
Patient Education as Topic
Prognosis
Program Evaluation
Randomized Controlled Trials as Topic
Treatment Outcome
Abstract
To update the evidence-based recommendations for the prevention and management of hypertension in adults for 2009.
For lifestyle and pharmacological interventions, evidence from randomized controlled trials and systematic reviews of trials was 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 lack of long-term morbidity and mortality data in this field. Progression of kidney dysfunction 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 2007 to August 2008 to update the 2008 recommendations. To identify additional published 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 less than 2300 mg (100 mmol)/day (and 1500 mg to 2300 mg [65 mmol to 100 mmol]/day in hypertensive patients); perform 30 min to 60 min of 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 (smaller than 102 cm for men and smaller 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 diet that is reduced in saturated fat and cholesterol, and that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on by the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to lower than 140/90 mmHg in all patients, and to lower than 130/80 mmHg in those 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, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic and/or systolic hypertension include angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor antagonists (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered as the initial treatment of hypertension if the systolic blood pressure is 20 mmHg above the target or if the diastolic blood pressure is 10 mmHg above the target. The combination of ACE inhibitors and ARBs should not be used. Other agents appropriate for first-line therapy for isolated systolic hypertension include long- acting dihydropyridine CCBs or ARBs. In patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors 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. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian Cardiovascular Society position statement (recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease). Selected high-risk patients with hypertension who do not achieve thresholds for statin therapy according to the position paper should nonetheless receive statin therapy. Once blood pressure is controlled, acetylsalicylic acid therapy should be considered.
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 achieved at least 95% consensus. These guidelines will continue to be updated annually.
Notes
Cites: Circulation. 2000 Jun 6;101(22):2612-710840013
Cites: Lancet. 1999 Nov 20;354(9192):1751-610577635
Cites: JAMA. 2001 Jan 24-31;285(4):437-4311242428
Cites: Can J Cardiol. 2001 May;17(5):543-5911381277
Cites: Lancet. 2001 Sep 29;358(9287):1033-4111589932
Cites: N Engl J Med. 2001 Dec 6;345(23):1667-7511759645
Cites: Can J Cardiol. 2002 Jun;18(6):625-4112107420
Cites: Am J Med. 2002 Oct 1;113(5):359-6412401529
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
Cites: JAMA. 2003 May 21;289(19):2534-4412759325
Cites: J Am Coll Cardiol. 2003 Jun 18;41(12):2197-20412821247
Cites: Lancet. 2003 Sep 6;362(9386):767-7113678869
Cites: BMJ. 2004 Feb 7;328(7435):32614744823
Cites: Can J Cardiol. 2004 Jan;20(1):41-5414968142
Cites: Can J Cardiol. 2004 Jan;20(1):55-914968143
Cites: CMAJ. 1992 Jun 1;146(11):1997-20051596849
Cites: Am J Cardiol. 1998 Oct 16;82(8A):2N-9N9809895
Cites: Am J Kidney Dis. 1998 Nov;32(5 Suppl 3):S112-99820470
Cites: Lancet. 1999 Feb 20;353(9153):611-610030325
Cites: Lancet. 1999 Mar 6;353(9155):793-610459960
Cites: Ann Intern Med. 2004 Nov 16;141(10):781-815545678
Cites: BMC Cardiovasc Disord. 2005;5(1):415691376
Cites: J Am Coll Cardiol. 2005 Mar 1;45(5):712-915734615
Cites: Stroke. 2005 Jun;36(6):1218-2615879332
Cites: Can J Cardiol. 2005 Jun;21(8):657-7216003449
Cites: J Hypertens. 2005 Dec;23(12):2157-7216269957
Cites: Can J Cardiol. 2005 Dec;21(14):1265-7116341294
Cites: J Am Soc Nephrol. 2006 Mar;17(3 Suppl 1):S1-2716497879
Cites: J Cardiovasc Med (Hagerstown). 2006 Jan;7(1):29-3816645357
Cites: Can J Cardiol. 2006 May 15;22(7):559-6416755310
Cites: Can J Cardiol. 2006 May 15;22(7):583-9316755313
Cites: J Am Geriatr Soc. 2007 Mar;55(3):383-817341240
Cites: Lancet. 2007 Sep 8;370(9590):829-4017765963
Cites: Ann Intern Med. 2008 Jan 1;148(1):30-4817984482
Cites: Am J Ther. 2008 Jan-Feb;15(1):36-4318223352
Cites: Am J Hypertens. 2008 Feb;21(2):148-5218174885
Cites: J Hypertens. 2008 Mar;26(3):403-1118300848
Cites: J Hypertens. 2008 Apr;26(4):672-718327075
Cites: N Engl J Med. 2008 Apr 10;358(15):1547-5918378520
Cites: N Engl J Med. 2008 May 1;358(18):1887-9818378519
Cites: Lancet. 2008 May 10;371(9624):1575-618468534
Cites: Hypertension. 2008 Jun;51(6):1552-618391094
Cites: J Intern Med. 2008 Aug;264(2):187-9418393959
Cites: Lancet. 2008 Aug 16;372(9638):547-5318707986
Cites: N Engl J Med. 2008 Sep 18;359(12):1225-3718753639
Cites: Lancet. 2008 Sep 27;372(9644):1174-8318757085
Cites: Lancet. 2000 Dec 9;356(9246):1955-6411130523
PubMed ID
19417859 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
Cites: Pediatrics. 2004 Aug;114(2 Suppl 4th Report):555-7615286277
Cites: Can J Cardiol. 2007 May 15;23(7):529-3817534459
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: BMC Cardiovasc Disord. 2005;5(1):1815985180
Cites: Can J Cardiol. 2005 Jun;21(8):645-5616003448
Cites: Blood Press Monit. 2005 Oct;10(5):257-6216205444
Cites: Can J Cardiol. 2007 May 15;23(7):539-5017534460
Cites: J Hum Hypertens. 2007 Jul;21(7):588-9017377600
Cites: Arch Intern Med. 2007 Nov 26;167(21):2296-30318039987
Cites: Am J Hypertens. 2008 Mar;21(3):280-318219304
Cites: Can J Cardiol. 2008 Jun;24(6):455-6318548142
Cites: Can J Cardiol. 2008 Jun;24(6):465-7518548143
Cites: JAMA. 2008 Jul 9;300(2):197-20818612117
Cites: Blood Press Monit. 2008 Oct;13(5):299-30318799957
Cites: Int J Clin Pract. 2008 Oct;62(10):1484-9818691228
Cites: J Hypertens. 2009 Feb;27(2):280-619155785
Cites: Can J Cardiol. 2009 May;25(5):279-8619417858
Cites: Can J Cardiol. 2009 May;25(5):287-9819417859
Cites: Blood Press Monit. 2009 Jun;14(3):108-1119417634
Cites: J Am Coll Cardiol. 2009 Sep 29;54(14):1209-2719778661
Cites: Am Heart J. 2000 Feb;139(2 Pt 1):272-8110650300
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
Cites: Blood Press Monit. 2001 Apr;6(2):107-1011433132
Cites: JAMA. 2001 Jul 11;286(2):180-711448281
Cites: Blood Press Monit. 2001 Jun;6(3):161-511518840
Cites: Lancet. 2002 Dec 14;360(9349):1903-1312493255
Cites: Eur Heart J. 2003 Jun;24(11):987-100312788299
Cites: Lancet. 2003 Nov 29;362(9398):1776-714654312
Cites: Hypertension. 2004 Jan;43(1):10-714638619
Cites: Blood Press Monit. 2006 Apr;11(2):59-6216534406
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: J Clin Hypertens (Greenwich). 2007 Apr;9(4):267-7017396069
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
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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The 2013 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.

https://arctichealth.org/en/permalink/ahliterature115112
Source
Can J Cardiol. 2013 May;29(5):528-42
Publication Type
Article
Date
May-2013
Author
Daniel G Hackam
Robert R Quinn
Pietro Ravani
Doreen M Rabi
Kaberi Dasgupta
Stella S Daskalopoulou
Nadia A Khan
Robert J Herman
Simon L Bacon
Lyne Cloutier
Martin Dawes
Simon W Rabkin
Richard E Gilbert
Marcel Ruzicka
Donald W McKay
Tavis S Campbell
Steven Grover
George Honos
Ernesto L Schiffrin
Peter Bolli
Thomas W Wilson
Ross D Feldman
Patrice Lindsay
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
Robert J Petrella
Alain Milot
James A Stone
Denis Drouin
Kim L Lavoie
Maxime Lamarre-Cliche
Marshall Godwin
Guy Tremblay
Pavel Hamet
George Fodor
S George Carruthers
George B Pylypchuk
Ellen Burgess
Richard Lewanczuk
George K Dresser
S Brian Penner
Robert A Hegele
Philip A McFarlane
Mukul Sharma
Debra J Reid
Sheldon W Tobe
Luc Poirier
Raj S Padwal
Author Affiliation
Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada. dhackam@uwo.ca
Source
Can J Cardiol. 2013 May;29(5):528-42
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adult
Aging - physiology
Antihypertensive Agents - therapeutic use
Blood Pressure - physiology
Blood Pressure Determination
Canada
Cardiovascular Diseases - prevention & control
Exercise - physiology
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 2013. This year's update includes 2 new recommendations. First, among nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise does not adversely influence blood pressure (BP) (Grade D). Thus, such patients need not avoid this type of exercise for fear of increasing BP. Second, and separately, for very elderly patients with isolated systolic hypertension (age 80 years or older), the target for systolic BP should be
PubMed ID
23541660 View in PubMed
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The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.

https://arctichealth.org/en/permalink/ahliterature104360
Source
Can J Cardiol. 2014 May;30(5):485-501
Publication Type
Article
Date
May-2014
Author
Kaberi Dasgupta
Robert R Quinn
Kelly B Zarnke
Doreen M Rabi
Pietro Ravani
Stella S Daskalopoulou
Simon W Rabkin
Luc Trudeau
Ross D Feldman
Lyne Cloutier
Ally Prebtani
Robert J Herman
Simon L Bacon
Richard E Gilbert
Marcel Ruzicka
Donald W McKay
Tavis S Campbell
Steven Grover
George Honos
Ernesto L Schiffrin
Peter Bolli
Thomas W Wilson
Patrice Lindsay
Michael D Hill
Shelagh B Coutts
Gord Gubitz
Mark Gelfer
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
Kevin D Burns
Robert J Petrella
Swapnil Hiremath
Alain Milot
James A Stone
Denis Drouin
Kim L Lavoie
Maxime Lamarre-Cliche
Guy Tremblay
Pavel Hamet
George Fodor
S George Carruthers
George B Pylypchuk
Ellen Burgess
Richard Lewanczuk
George K Dresser
S Brian Penner
Robert A Hegele
Philip A McFarlane
Milan Khara
Andrew Pipe
Paul Oh
Peter Selby
Mukul Sharma
Debra J Reid
Sheldon W Tobe
Raj S Padwal
Luc Poirier
Author Affiliation
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: kaberi.dasgupta@mcgill.ca.
Source
Can J Cardiol. 2014 May;30(5):485-501
Date
May-2014
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Blood pressure
Blood Pressure Determination - standards
Canada
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - drug therapy - prevention & control
Life Style
Patient Education as Topic
Practice Guidelines as Topic
Prognosis
Program Evaluation
Abstract
Herein, updated evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in Canadian adults are detailed. For 2014, 3 existing recommendations were modified and 2 new recommendations were added. The following recommendations were modified: (1) the recommended sodium intake threshold was changed from = 1500 mg (3.75 g of salt) to approximately 2000 mg (5 g of salt) per day; (2) a pharmacotherapy treatment initiation systolic blood pressure threshold of = 160 mm Hg was added in very elderly (age = 80 years) patients who do not have diabetes or target organ damage (systolic blood pressure target in this population remains at
PubMed ID
24786438 View in PubMed
Less detail

Comparison of oral and intravenous alfacalcidol in chronic hemodialysis patients.

https://arctichealth.org/en/permalink/ahliterature105079
Source
BMC Nephrol. 2014;15:27
Publication Type
Article
Date
2014
Author
Myriam Lessard
Denis Ouimet
Martine Leblanc
Annie-Claire Nadeau-Fredette
Robert Bell
Jean-Philippe Lafrance
Vincent Pichette
Michel Vallée
Author Affiliation
Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal H1T 2 M4, Québec, Canada. mvallee.hmr@ssss.gouv.qc.ca.
Source
BMC Nephrol. 2014;15:27
Date
2014
Language
English
Publication Type
Article
Keywords
Administration, Oral
Bone Density Conservation Agents - administration & dosage - economics
Cohort Studies
Cost-Benefit Analysis
Female
Health Care Costs - statistics & numerical data
Humans
Hydroxycholecalciferols - administration & dosage - economics
Hyperparathyroidism, Secondary - drug therapy - economics - etiology
Injections, Intravenous - economics
Male
Middle Aged
Quebec
Renal Dialysis - adverse effects - economics
Renal Insufficiency, Chronic - complications - drug therapy - economics
Retrospective Studies
Treatment Outcome
Abstract
Activated vitamin D is the mainstay of treatment for secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients. However, the optimal route of administration is still debated. The aim of our study was to compare efficacy of oral vs intravenous (IV) administration of alfacalcidol in hemodialysis. A secondary objective was to determine the cost-effectiveness advantage of oral administration.
Eighty-eight chronic hemodialysis patients receiving IV alfacalcidol three times a week were included in the study. All were switched to the same dose of alfacalcidol given orally three times a week during the hemodialysis session. A budget impact analysis was performed.
Mean patient age was 64 years old and 43% were males. The mean alfacalcidol dose administered was 2.1 µg three times a week. After three months, serum parathormone (PTH) levels decreased from 80 to 59 pmol/L (p =?0.001) and total serum calcium levels increased from 2.34 to 2.40 mmol/L (p =?0.002). After six months, total serum calcium levels were still significantly higher. Alfacalcidol dosage was significantly decreased during study period; the mean reduction was 0.44 µg per dose. Finally, oral administration was associated with an annual cost reduction of 197 678$CAN and an annual nursing time reduction of 25 days.
Our findings support that switching IV to oral administration of alfacalcidol during hemodialysis sessions may lead to a similar control of SHPT with lower doses of activated vitamin D. This is a good strategy for optimizing compliance and may allow a dose reduction because of a greater efficacy to suppress PTH. Oral administration also has significant cost-effectiveness advantages.
Notes
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PubMed ID
24495277 View in PubMed
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Magnitude of discordance between registry data and death certificate when evaluating leading causes of death in dialysis patients.

https://arctichealth.org/en/permalink/ahliterature115213
Source
BMC Med Res Methodol. 2013;13:51
Publication Type
Article
Date
2013
Author
Jean-Philippe Lafrance
Elham Rahme
Sameena Iqbal
Martine Leblanc
Vincent Pichette
Naoual Elftouh
Michel Vallée
Author Affiliation
Centre de recherche Hôpital Maisonneuve-Rosemont, Montréal, Canada. jean-philippe.lafrance@umontreal.ca
Source
BMC Med Res Methodol. 2013;13:51
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Cardiovascular Diseases - complications - epidemiology - mortality
Cause of Death
Cohort Studies
Death Certificates
Female
Humans
Male
Middle Aged
Neoplasms - complications - epidemiology - mortality
Population Surveillance
Quebec - epidemiology
Registries
Renal Dialysis - statistics & numerical data
Retrospective Studies
Sex Distribution
Survival Analysis
Abstract
Discordance between dialysis registry and death certificate reported death has been demonstrated. Since cause of death is measured using registry data in dialysis patients and death certificate data in the general population, comparisons of cause of death proportions between dialysis patients and the general population may be biased. Our aim was to compare the proportion of deaths attributed to cardiovascular disease (CVD), malignancy, and infections between patients receiving dialysis and the general population using death certificates for both, and to quantify the magnitude of discrepancy between registry and death certificate estimates in dialysis patients.
A retrospective cohort study of 5858 patients initiating maintenance dialysis between 2001 and 2007 was conducted. Cause of death was obtained from both registry and death certificate data for dialysis patients, and from death certificate data for the general population.
Compared to the general population, use of death certificate data in dialysis patients resulted in smaller differences in the proportion of deaths attributed to CVD or infection than that from the registry. In the general population, the proportion of deaths due to CVD is 29.3% for men and 28.2% for women, and the proportion of deaths due to infection is 3.3% for men and 3.6% for women. For men, the proportion of deaths in dialysis patients due to CVD using registry data is 41.5%, compared with a proportion of 32.1% using death certificate data. Similarly for women, the proportion of deaths due to CVD using registry data is 35.2% and that using death certificate data 24.3%. The proportion of deaths due to infection in dialysis patients follows the same pattern: for men, the proportion of deaths due to infection using registry data is 9.9% and that from death certificate data at 5.0%; while for women the proportions are 11.6% and 4.8%, respectively.
While absolute cause-specific mortality rates did differ, evaluation of causes of death using death certificate in dialysis patients in Quebec revealed that they do not have substantially different proportion of death due to CVD or infections than the general population. Infections appeared to be a frequent complication leading to death, suggesting that infections are an important target to consider for reducing mortality in dialysis populations.
Notes
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PubMed ID
23530603 View in PubMed
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