Skip header and navigation

Refine By

10 records – page 1 of 1.

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
Less detail

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
Less detail

The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II - Therapy.

https://arctichealth.org/en/permalink/ahliterature168976
Source
Can J Cardiol. 2006 May 15;22(7):583-93
Publication Type
Article
Date
May-15-2006
Author
N A Khan
Finlay A McAlister
Simon W Rabkin
Raj Padwal
Ross D Feldman
Norman Rc Campbell
Lawrence A Leiter
Richard Z Lewanczuk
Ernesto L Schiffrin
Michael D Hill
Malcolm Arnold
Gordon Moe
Tavis S Campbell
Carol Herbert
Alain Milot
James A Stone
Ellen Burgess
B. Hemmelgarn
Charlotte Jones
Pierre Larochelle
Richard I Ogilvie
Robyn Houlden
Robert J Herman
Pavel Hamet
George Fodor
George Carruthers
Bruce Culleton
Jacques Dechamplain
George Pylypchuk
Alexander G Logan
Norm Gledhill
Robert Petrella
Sheldon Tobe
Rhian M Touyz
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada.
Source
Can J Cardiol. 2006 May 15;22(7):583-93
Date
May-15-2006
Language
English
Publication Type
Article
Keywords
Advisory Committees
Alcohol Drinking
Antihypertensive Agents - therapeutic use
Calcium, Dietary - administration & dosage
Canada
Cerebrovascular Disorders - therapy
Diabetes Mellitus - therapy
Diet
Exercise
Humans
Hypertension - therapy
Hypertrophy, Left Ventricular - therapy
Kidney Diseases - therapy
Life Style
Magnesium - administration & dosage
Myocardial Ischemia - therapy
Patient compliance
Potassium, Dietary - administration & dosage
Sodium, Dietary - administration & dosage
Stress, Psychological - prevention & control
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. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. For lifestyle interventions, blood pressure (BP) lowering was accepted as a primary outcome given the lack of long-term morbidity/mortality data in this field. For treatment of patients with kidney disease, the development of proteinuria or worsening of kidney function was also accepted as a clinically relevant primary outcome.
MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by content and methodological experts using prespecified levels of evidence.
Lifestyle modifications to prevent and/or treat hypertension include the following: perform 30 min to 60 min of aerobic exercise four to seven days per 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 standard drinks per week in men or nine standard drinks 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; 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 comorbid conditions. BP should be lowered to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease (regardless of the degree of proteinuria). Most adults with hypertension require more than one agent to achieve these target BPs. 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 (in nonblack patients), long-acting calcium channel blockers or angiotensin receptor antagonists. Other agents for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers or 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 in patients without albuminuria, thiazides or dihydropyridine calcium channel blockers) 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 strength of the evidence and voted on by the 45 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: N Engl J Med. 2000 Jan 20;342(3):145-5310639539
Cites: Lancet. 2006 Jan 21;367(9506):209; author reply 21016427487
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
Cites: Can J Cardiol. 2001 May;17(5):543-5911381277
Cites: Am J Med. 2001 Nov;111(7):553-811705432
Cites: N Engl J Med. 2002 Feb 7;346(6):393-40311832527
Cites: Can J Cardiol. 2002 Jun;18(6):625-4112107420
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
Cites: JAMA. 2003 Apr 23-30;289(16):2083-9312709466
Cites: Arch Intern Med. 2003 May 12;163(9):1069-7512742805
Cites: JAMA. 2003 May 21;289(19):2534-4412759325
Cites: Am J Cardiol. 2003 Jun 1;91(11):1316-2212767423
Cites: J Hypertens. 2003 Jun;21(6):1055-7612777939
Cites: J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S99-S10212819311
Cites: Lancet. 2003 Sep 6;362(9386):767-7113678869
Cites: Lancet. 2003 Sep 6;362(9386):782-813678872
Cites: N Engl J Med. 2003 Nov 13;349(20):1893-90614610160
Cites: Congest Heart Fail. 2003 Nov-Dec;9(6):324-3214688505
Cites: Can J Cardiol. 2004 Jan;20(1):41-5414968142
Cites: Can J Cardiol. 2004 Jan;20(1):55-914968143
Cites: Int J Cardiol. 2004 Feb;93(2-3):105-1114975535
Cites: Arch Intern Med. 2004 May 24;164(10):1084-9115159265
Cites: Lancet. 2004 Jun 19;363(9426):2022-3115207952
Cites: Am J Hypertens. 1997 Oct;10(10 Pt 1):1097-1029370379
Cites: Lancet. 1998 Oct 24;352(9137):1347-519802273
Cites: N Engl J Med. 2004 Nov 11;351(20):2058-6815531767
Cites: Bull World Health Organ. 2004 Dec;82(12):935-915654408
Cites: Lancet. 2005 Mar 12-18;365(9463):939-4615766995
Cites: Stroke. 2005 Jun;36(6):1218-2615879332
Cites: Arch Intern Med. 2005 Jun 27;165(12):1401-915983290
Cites: Can J Cardiol. 2005 Jun;21(8):657-7216003449
Cites: Lancet. 2005 Sep 10-16;366(9489):895-90616154016
Cites: Lancet. 2005 Oct 29-Nov 4;366(9496):1545-5316257341
Cites: Pharmacotherapy. 2000 Apr;20(4):410-610772372
PubMed ID
16755313 View in PubMed
Less detail

The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy.

https://arctichealth.org/en/permalink/ahliterature163300
Source
Can J Cardiol. 2007 May 15;23(7):539-50
Publication Type
Conference/Meeting Material
Article
Date
May-15-2007
Author
Nadia A Khan
Brenda Hemmelgarn
Raj Padwal
Pierre Larochelle
Jeff L Mahon
Richard Z Lewanczuk
Finlay A McAlister
Simon W Rabkin
Michael D Hill
Ross D Feldman
Ernesto L Schiffrin
Norman R C Campbell
Alexander G Logan
Malcolm Arnold
Gordon Moe
Tavis S Campbell
Alain Milot
James A Stone
Charlotte Jones
Lawrence A Leiter
Richard I Ogilvie
Robert J Herman
Pavel Hamet
George Fodor
George Carruthers
Bruce Culleton
Kevin D Burns
Marcel Ruzicka
Jacques deChamplain
George Pylypchuk
Norm Gledhill
Robert Petrella
Jean-Martin Boulanger
Luc Trudeau
Robert A Hegele
Vincent Woo
Phil McFarlane
Rhian M Touyz
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia. nakhan@shaw.ca
Source
Can J Cardiol. 2007 May 15;23(7):539-50
Date
May-15-2007
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Antihypertensive Agents - therapeutic use
Canada
Diet, Sodium-Restricted
Health promotion
Humans
Hypertension - drug therapy - prevention & control - therapy
Patient Education as Topic
Randomized Controlled Trials as Topic
Risk Reduction Behavior
Abstract
To provide updated, evidence-based recommendations for the prevention and management of hypertension in adults.
For lifestyle and pharmacological interventions, evidence was reviewed from randomized controlled trials and systematic reviews of trials. 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. For treatment of patients with kidney disease, the progression of kidney dysfunction was also accepted as a clinically relevant primary outcome.
A Cochrane collaboration librarian conducted an independent MEDLINE search from 2005 to August 2006 to update the 2006 Canadian Hypertension Education Program recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence.
Dietary lifestyle modifications for prevention of hypertension, in addition to a well-balanced diet, include a dietary sodium intake of less than 100 mmol/day. In hypertensive patients, the dietary sodium intake should be limited to 65 mmol/day to 100 mmol/day. Other lifestyle modifications for both normotensive and hypertensive patients include: performing 30 min to 60 min of aerobic exercise four to seven days per week; maintaining a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm in men and less than 88 cm in women); limiting alcohol consumption to no more than 14 units per week in men or nine units per week in women; following a diet reduced in saturated fat and cholesterol, and one that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources; and considering stress management in selected individuals with hypertension. For the pharmacological management of hypertension, 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 lower than 140/90 mmHg in all patients and lower than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease. Most patients require more than one agent to achieve these blood pressure targets. In 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 (except in black patients), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age). First-line therapy for isolated systolic hypertension includes long-acting dihydropyridine CCBs or ARBs. 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 cerebrovascular disease, an ACE inhibitor plus diuretic combination is preferred; in patients with nondiabetic chronic kidney disease, 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: Arch Intern Med. 2000 Mar 13;160(5):685-9310724055
Cites: JAMA. 2003 Apr 23-30;289(16):2083-9312709466
Cites: N Engl J Med. 2001 Jan 4;344(1):3-1011136953
Cites: Can J Cardiol. 2001 May;17(5):543-5911381277
Cites: Ann Intern Med. 2001 Jul 17;135(2):73-8711453706
Cites: Lancet. 2004 Sep 11-17;364(9438):937-5215364185
Cites: Kidney Int Suppl. 2004 Nov;(92):S90-615485427
Cites: Hypertension. 2004 Nov;44(5):637-4215381674
Cites: Lancet. 1990 Mar 31;335(8692):765-741969518
Cites: Hypertension. 1991 Jan;17(1 Suppl):I16-201986996
Cites: JAMA. 2003 May 21;289(19):2534-4412759325
Cites: Am J Cardiol. 2003 Jun 1;91(11):1316-2212767423
Cites: J Hypertens. 2003 Jun;21(6):1055-7612777939
Cites: J Am Soc Nephrol. 2003 Jul;14(7 Suppl 2):S99-S10212819311
Cites: Can J Cardiol. 2004 Jan;20(1):41-5414968142
Cites: Can J Cardiol. 2004 Jan;20(1):55-914968143
Cites: Arch Intern Med. 2004 May 24;164(10):1084-9115159265
Cites: Lancet. 2004 Jun 19;363(9426):2022-3115207952
Cites: Cochrane Database Syst Rev. 2004;(3):CD00493715266549
Cites: Diabetes Care. 1993 Jul;16(7):996-10038359108
Cites: Diabetes Care. 1996 Jan;19(1):79-898720542
Cites: Diabetes Care. 1999 Feb;22(2):307-1310333950
Cites: Ann Intern Med. 2005 Jul 5;143(1):1-915998749
Cites: Can J Cardiol. 2005 Jun;21(8):657-7216003449
Cites: J Hypertens. 2005 Dec;23(12):2157-7216269957
Cites: JAMA. 2005 Nov 16;294(19):2455-6416287956
Cites: J Hum Hypertens. 2005 Dec;19 Suppl 3:S10-916302005
Cites: J Am Coll Cardiol. 2006 Jan 3;47(1):65-7116386666
Cites: Hypertension. 2006 Feb;47(2):296-30816434724
Cites: Am J Clin Nutr. 2006 Feb;83(2):221-616469978
Cites: Can J Cardiol. 2006 May 15;22(7):583-9316755313
Cites: Am J Clin Nutr. 2006 Jun;83(6):1289-9616762939
Cites: Ann Intern Med. 2006 Jun 20;144(12):884-9316785477
Cites: Am J Med. 2001 Nov;111(7):553-811705432
Cites: N Engl J Med. 2002 Feb 7;346(6):393-40311832527
Cites: Lancet. 2002 Mar 23;359(9311):1004-1011937179
Cites: Can J Cardiol. 2002 Jun;18(6):625-4112107420
Cites: Lancet. 2003 Jan 11;361(9352):117-2412531578
Cites: Lancet. 2003 Mar 1;361(9359):717-2512620735
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
Comment In: Can J Cardiol. 2007 May 15;23(7):603-417593584
PubMed ID
17534460 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

Achieving quality indicator benchmarks and potential impact on coronary heart disease mortality.

https://arctichealth.org/en/permalink/ahliterature131252
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Publication Type
Article
Author
Harindra C Wijeysundera
Nicholas Mitsakakis
William Witteman
Mike Paulden
Gabrielle van der Velde
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Simon Capewell
Murray Krahn
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. wijeysundera@gmail.com
Source
Can J Cardiol. 2011 Nov-Dec;27(6):756-62
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Benchmarking - methods
Coronary Disease - mortality - therapy
Female
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Revascularization - methods - standards
Ontario - epidemiology
Prognosis
Quality Indicators, Health Care - utilization
Retrospective Studies
Risk Assessment - methods
Risk factors
Abstract
Quality indicators in coronary heart disease (CHD) measure the practice gap between optimal care and current clinical practice. However, the potential impact of achieving quality indicator benchmarks remains unknown.
Using a validated, epidemiologic model of CHD in Ontario, Canada, we estimated the potential impact on mortality of improved utilization on CHD quality indicators from 2005 levels to recommend benchmark utilization of 90%. Eight CHD disease subgroups were evaluated, including inpatients with acute myocardial infarction (AMI), acute coronary syndromes, and heart failure, in addition to ambulatory patients who were post-acute myocardial infarction survivors, or had heart failure, chronic stable angina, hypertension, or hyperlipidemia. The primary outcome was the predicted mortality reduction associated with meeting quality indicator targets for each CHD subgroup-treatment combination.
In 2005, there were 10,060 CHD deaths in Ontario, representing an age-adjusted CHD mortality of 191 per 100,000 people. By meeting quality indicator utilization benchmarks, mortality could be potentially reduced by approximately 20% (95% confidence interval 17.8-21.1), representing approximately 1960 avoidable deaths. The bulk of this potential benefit was in ambulatory patients with chronic stable angina (36% of reduction) and heart failure (31% of reduction). The biggest drivers were optimizing angiotensin-converting enzyme inhibitor use in chronic stable angina patients (approximately 440 avoidable deaths) and ß-blocker use in heart failure (approximately 400 avoidable deaths).
These findings reinforce the importance of quality indicators and could aid policy makers in prioritizing strategies to meet the goals outlined in the Canadian Heart Health Strategy and Action Plan for reducing cardiovascular mortality.
PubMed ID
21920697 View in PubMed
Less detail

Association of temporal trends in risk factors and treatment uptake with coronary heart disease mortality, 1994-2005.

https://arctichealth.org/en/permalink/ahliterature143630
Source
JAMA. 2010 May 12;303(18):1841-7
Publication Type
Article
Date
May-12-2010
Author
Harindra C Wijeysundera
Márcio Machado
Farah Farahati
Xuesong Wang
William Witteman
Gabrielle van der Velde
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Murray Krahn
Simon Capewell
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. wijeysundera@gmail.com
Source
JAMA. 2010 May 12;303(18):1841-7
Date
May-12-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Blood pressure
Cholesterol - blood
Coronary Disease - mortality - therapy
Evidence-Based Medicine
Female
Humans
Male
Middle Aged
Models, Theoretical
Mortality - trends
Ontario - epidemiology
Prospective Studies
Risk factors
Abstract
Coronary heart disease (CHD) mortality has declined substantially in Canada since 1994.
To determine what proportion of this decline was associated with temporal trends in CHD risk factors and advancements in medical treatments.
Prospective analytic study of the Ontario, Canada, population aged 25 to 84 years between 1994 and 2005, using an updated version of the validated IMPACT model, which integrates data on population size, CHD mortality, risk factors, and treatment uptake changes. Relative risks and regression coefficients from the published literature quantified the relationship between CHD mortality and (1) evidence-based therapies in 8 distinct CHD subpopulations (acute myocardial infarction [AMI], acute coronary syndromes, secondary prevention post-AMI, chronic coronary artery disease, heart failure in the hospital vs in the community, and primary prevention for hyperlipidemia or hypertension) and (2) population trends in 6 risk factors (smoking, diabetes mellitus, systolic blood pressure, plasma cholesterol level, exercise, and obesity).
The number of deaths prevented or delayed in 2005; secondary outcome measures were improvements in medical treatments and trends in risk factors.
Between 1994 and 2005, the age-adjusted CHD mortality rate in Ontario decreased by 35% from 191 to 125 deaths per 100,000 inhabitants, translating to an estimated 7585 fewer CHD deaths in 2005. Improvements in medical and surgical treatments were associated with 43% (range, 11% to 124%) of the total mortality decrease, most notably in AMI (8%; range, -5% to 40%), chronic stable coronary artery disease (17%; range, 7% to 35%), and heart failure occurring while in the community (10%; range, 6% to 31%). Trends in risk factors accounted for 3660 fewer CHD deaths prevented or delayed (48% of total; range, 28% to 64%), specifically, reductions in total cholesterol (23%; range, 10% to 33%) and systolic blood pressure (20%; range, 13% to 26%). Increasing diabetes prevalence and body mass index had an inverse relationship associated with higher CHD mortality of 6% (range, 4% to 8%) and 2% (range, 1% to 4%), respectively.
Between 1994 and 2005, there was a decrease in CHD mortality rates in Ontario that was associated primarily with trends in risk factors and improvements in medical treatments, each explaining about half of the decrease.
PubMed ID
20460623 View in PubMed
Less detail

Cost-effectiveness of specialized multidisciplinary heart failure clinics in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature139161
Source
Value Health. 2010 Dec;13(8):915-21
Publication Type
Article
Date
Dec-2010
Author
Harindra C Wijeysundera
Márcio Machado
Xuesong Wang
Gabrielle Van Der Velde
Nancy Sikich
William Witteman
Jack V Tu
Douglas S Lee
Shaun G Goodman
Robert Petrella
Martin O'Flaherty
Simon Capewell
Murray Krahn
Author Affiliation
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. wijeysundera@gmail.com
Source
Value Health. 2010 Dec;13(8):915-21
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Aged
Cost-Benefit Analysis
Female
Health Care Costs
Heart Failure - economics - therapy
Humans
Life expectancy
Male
Middle Aged
Ontario
Outpatient Clinics, Hospital - economics
Patient Care Team - economics
Abstract
Specialized multidisciplinary clinics have been shown to reduce mortality in heart failure (HF). Our objective was to evaluate the cost-effectiveness of this model of care delivery.
We performed a cost-effectiveness analysis, with a 12-year time horizon, from the perspective of the Ontario Ministry of Health and Long-term Care, comparing a standard care cohort, consisting of all patients admitted to hospital with HF in 2005, to a hypothetical cohort treated in HF clinics. Survival curves describing the natural history of HF were constructed using mortality estimates from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Survival benefits and resource uptake associated with HF clinics were estimated from a meta-analysis of published trials. HF clinics costs were obtained by costing a representative clinic in Ontario. Health-related costs were determined through linkage to administrative databases. Outcome measures included life expectancy (years), costs (in 2008 Canadian dollars) and the incremental cost-effectiveness ratio (ICER).
HF clinics were associated with a 29% reduction in all-cause mortality (risk ratio [RR] 0.71; 95% confidence interval [CI] 0.56-0.91) but a 12% increase in hospitalizations (RR 1.12; 95% CI 0.92-1.135). The cost of care in HF clinics was $52 per 30 patient-days. Projected life-expectancy of HF clinic patients was 3.91 years, compared to 3.21 years for standard care. The 12-year cumulative cost per patient in the HF clinic group was $66,532 versus $53,638 in the standard care group. The ICER was $18,259/life-year gained.
HF clinics appear to be a cost effective way of delivering ambulatory care to HF patients.
PubMed ID
21091970 View in PubMed
Less detail

Public education on hypertension: a new initiative to improve the prevention, treatment and control of hypertension in Canada.

https://arctichealth.org/en/permalink/ahliterature168975
Source
Can J Cardiol. 2006 May 15;22(7):599-603
Publication Type
Article
Date
May-15-2006
Author
N R Campbell
Robert Petrella
Janusz Kaczorowski
Author Affiliation
Departments of Medicine, Pharmacology and Therapeutics, Libin Cardiovascular Institute, University of Alberta, 3330 Hospital Drive Northwest, Calgary, Alberta, Canada. ncampbel@ucalgary.ca
Source
Can J Cardiol. 2006 May 15;22(7):599-603
Date
May-15-2006
Language
English
Publication Type
Article
Keywords
Canada
Health Education - methods
Health promotion
Humans
Hypertension - therapy
Practice Guidelines as Topic
Abstract
High blood pressure is one of the leading risk factors for death. Nevertheless, there is a lack of awareness of hypertension as a risk factor, as well as significant misconceptions about hypertension in the Canadian population. Furthermore, according to the Canadian Heart Health Surveys (1985 to 1992), 42% of hypertensive adult Canadians are unaware of their hypertensive status. A collaboration between Blood Pressure Canada, the Heart and Stroke Foundation of Canada, the Canadian Hypertension Society and the Canadian Hypertension Education Program has been formed to improve public and patient awareness and knowledge of hypertension. The effort will involve the translation of Canadian Hypertension Education Program recommendations for the prevention and management of hypertension to a public level with a broad and evolving dissemination strategy; the training of health professionals to speak to the public and patients on hypertension, coupled with opportunities to speak in forums organized in their local communities; and, media releases and information on hypertension in association with World Hypertension Day and the release of the annually updated public recommendations. Based on higher rates of awareness of hypertension in countries with sustained public education programs on hypertension, it is anticipated that this evolving program will result in improvement in the rates of awareness, treatment and control of hypertension and, ultimately, in lower cardiovascular disease rates in Canada. Public health programs that could reduce the prevalence of hypertension will be integrated into key public recommendations. The program outcomes will be monitored using Statistics Canada national surveys and by specific surveys examining hypertension knowledge in the Canadian population.
Notes
Cites: Science. 1999 Oct 15;286(5439):487-9110521338
Cites: Am J Hypertens. 2005 Feb;18(2 Pt 1):270-515752956
Cites: Can J Cardiol. 2005 May 15;21(7):589-9315940357
Cites: Can J Cardiol. 2005 Jun;21(8):657-7216003449
Cites: J Hum Hypertens. 2004 Aug;18(8):553-615002003
Cites: Can J Cardiol. 2000 Sep;16(9):1087-9311021952
Cites: Am J Hypertens. 2001 Nov;14(11 Pt 1):1099-10511724207
Cites: Arch Intern Med. 2002 Jan 28;162(2):131-211802745
Cites: JAMA. 2002 Feb 27;287(8):1003-1011866648
Cites: Lancet. 2002 Nov 2;360(9343):1347-6012423980
Cites: JAMA. 2003 May 14;289(18):2363-912746359
Cites: J Hypertens. 2003 Aug;21(8):1591-712872055
Cites: Can J Cardiol. 2003 Aug;19(9):997-100412915926
Cites: J Hum Hypertens. 2003 Sep;17(9):655-77513679955
SummaryForPatientsIn: Can J Cardiol. 2006 May 15;22(7):601-60216789347
PubMed ID
16755315 View in PubMed
Less detail

Retrospective analysis of real-world efficacy of angiotensin receptor blockers versus other classes of antihypertensive agents in blood pressure management.

https://arctichealth.org/en/permalink/ahliterature131704
Source
Clin Ther. 2011 Sep;33(9):1190-203
Publication Type
Article
Date
Sep-2011
Author
Robert Petrella
Paul Michailidis
Author Affiliation
Faculty of Medicine, Dentistry University of Western Ontario, London, Canada. petrella@uwo.ca
Source
Clin Ther. 2011 Sep;33(9):1190-203
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Aged
Angiotensin Receptor Antagonists - administration & dosage - therapeutic use
Antihypertensive Agents - administration & dosage - therapeutic use
Blood Pressure - drug effects
Databases, Factual
Drug Therapy, Combination
Female
Humans
Hypertension - drug therapy
Male
Middle Aged
Ontario
Retrospective Studies
Treatment Outcome
Abstract
Efficacy of blood pressure (BP) lowering may differ between clinical trials and what is observed in clinical practice. These differences may contribute to poor BP control rates among those at risk.
We conducted an observational study to determine the BP-lowering efficacy of angiotensin receptor blocker (ARB) versus non-ARB-based antihypertensive treatments in a large Canadian primary care database.
We analyzed the South Western Ontario database of 170,000 adults (aged >18 years) with hypertension persisting with antihypertensive medication for =9 months. Routine standard of care office BP was measured using approved manual aneroid or automated devices. BP 0.05), 26% (265 of 1020) on calcium channel blockers (CCBs) (P > 0.05), 21% (221 of 1050) on ß-blockers (P = 0.002), and 19% (276 of 1450) on diuretics (P = 0.001). Attainment rates were significantly higher with irbesartan (38%; 332 of 873) versus losartan (32%; 335 of 1047; P = 0.01), valsartan (19%; 186 of 977; P = 0.001), and candesartan (25%; 148 of 593; P = 0.001). BP goal attainment rates were significantly higher when ARB was compared with non-ARB-based dual therapy (39%; 1007 of 2584 vs 31%; 1109 of 3576; P = 0.004); irbesartan + hydrochlorothiazide (HCTZ) was significantly higher than losartan + HCTZ (36%; 500 of 1390 vs 20%; 252 of 1261; P = 0.001). For patients receiving dual or tri-therapy, 48% (667 of 1390) of patients receiving irbesartan reached target BP versus 41% to 42% for losartan (517 of 1261), valsartan (194 of 462), and candesartan (168 of 401) (P = 0.001 for each). After 4 years, persistence rates were not statistically different among ARB, CCB, and diuretic monotherapies, but appeared somewhat higher with ACEIs and ß-blockers (78%, 78%, 79%, 91%, and 84%, respectively). Persistence was not significantly different between irbesartan and losartan monotherapy (76% for both; P > 0.05), but was significantly higher with irbesartan + HCTZ versus losartan + HCTZ (96% vs 73%, respectively; P = 0.001). Patients treated with ARBs reported fewer CV events than those receiving ACEIs or CCBs (4.3% vs 7.0% and 11.0%, respectively; P
PubMed ID
21885126 View in PubMed
Less detail

10 records – page 1 of 1.