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

https://arctichealth.org/en/permalink/ahliterature189435
Source
Can J Cardiol. 2002 Jun;18(6):604-24
Publication Type
Article
Date
Jun-2002
Author
Kelly B Zarnke
Finlay A McAlister
Norman R C Campbell
Mitchell Levine
Ernesto L Schiffrin
Steven Grover
Donald W McKay
Martin G Myers
Thomas W Wilson
Simon W Rabkin
Ross D Feldman
Ellen Burgess
Peter Bolli
George Honos
Marcel Lebel
Karen Mann
Carl Abbott
Sheldon Tobe
Robert Petrella
Rhian M Touyz
Author Affiliation
London Health Sciences Centre, University Hospital Campus, London, Canada.
Source
Can J Cardiol. 2002 Jun;18(6):604-24
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Blood Pressure Monitoring, Ambulatory - standards
Canada
Cardiovascular Diseases - diagnosis - prevention & control - therapy
Diet
Exercise
Female
Humans
Hypertension - diagnosis - prevention & control - therapy
Life Style
Pregnancy
Pregnancy Complications, Cardiovascular - diagnosis - prevention & control
Risk assessment
Abstract
To provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk, identifiable causes and lifestyle modifications for adults with high blood pressure.
For persons in whom a high blood pressure value is recorded, hypertension is diagnosed based on the appropriate measurement of blood pressure, the level of the blood pressure elevation and the duration of follow-up. In addition, the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases must be assessed to determine the urgency, intensity and type of treatment. For persons receiving a diagnosis of hypertension, defining the overall risk of adverse cardiovascular outcomes requires an assessment of concomitant vascular risk factors, including laboratory testing, a search for target organ damage and an assessment for modifiable causes of hypertension. Home and ambulatory blood pressure assessment and echocardiography are options for selected patients.
The outcomes were: the identification of persons at increased risk of adverse cardiovascular outcomes; the quantification of overall cardiovascular risk; and the identification of persons with potentially modifiable causes of hypertension.
Medline searches were conducted from one year before the period of the last revision of the Canadian recommendations for the management of hypertension (May 1999 to May 2001). Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other studies. Identified articles were reviewed and appraised, using prespecified levels of evidence, by content experts and methodological experts. In addition to an update of the previous year's review, new sections on assessing overall cardiovascular risk and endocrine causes are provided.
A high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and of persons with identifiable causes of hypertension.
The identification of persons at higher risk of cardiovascular disease will permit counseling for lifestyle manoeuvres and introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. The identification of specific causes of hypertension may permit the use of cause-specific interventions. In certain subgroups of patients, and for specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity or mortality.
The present document contains recommendations for the assessment of the diagnosis, cardiovascular risk, identifiable causes and lifestyle modifications for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, the role of echocardiography and lifestyle modifications.
All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only those recommendations achieving high levels of consensus are reported. These guidelines will be updated annually.
These guidelines are endorsed by the Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, The Adult Disease Division and Bureau of Cardio-Respiratory Diseases and Diabetes at the Centre for Chronic Disease Prevention and Control, Health Canada.
PubMed ID
12107419 View in PubMed
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The 2001 Canadian recommendations for the management of hypertension: Part two--Therapy.

https://arctichealth.org/en/permalink/ahliterature189434
Source
Can J Cardiol. 2002 Jun;18(6):625-41
Publication Type
Article
Date
Jun-2002
Author
Finlay A McAlister
Kelly B Zarnke
Norman R C Campbell
Ross D Feldman
Mitchell Levine
Jeff Mahon
Steven A Grover
Richard Lewanczuk
Frans Leenen
Sheldon Tobe
Marcel Lebel
James Stone
Ernesto L Schiffrin
Simon W Rabkin
Richard I Ogilvie
Pierre Larochelle
Charlotte Jones
George Honos
George Fodor
Ellen Burgess
Pavel Hamet
Robert Herman
Jane Irvine
Bruce Culleton
James M Wright
Author Affiliation
University of Alberta Hospital, Edmonton, Canada.
Source
Can J Cardiol. 2002 Jun;18(6):625-41
Date
Jun-2002
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - administration & dosage - therapeutic use
Canada
Cardiovascular Diseases - prevention & control
Humans
Hypertension - prevention & control
Randomized Controlled Trials as Topic
Abstract
To provide updated, evidence-based recommendations for the therapy of hypertension in adults.
For patients with hypertension, a number of antihypertensive agents may control blood pressure. Randomized trials evaluating first-line therapy with thiazides, beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, alpha-blockers, centrally acting agents or angiotensin II receptor antagonists were reviewed.
The health outcomes that were considered were changes in blood pressure, cardiovascular morbidity, and cardiovascular and/or all-cause mortality rates. Economic outcomes were not considered due to insufficient evidence.
MEDLINE was searched for the period March 1999 to October 2001 to identify studies not included in the 2000 revision of the Canadian Recommendations for the Management of Hypertension. Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other published studies. All relevant articles were reviewed and appraised, using prespecified levels of evidence, by content experts and methodological experts.
A high value was placed on the avoidance of cardiovascular morbidity and mortality.
Various antihypertensive agents reduce the blood pressure of patients with sustained hypertension. In certain settings, and for specific classes of drugs, blood-pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The present document contains detailed recommendations pertaining to treatment thresholds, target blood pressures, and choice of agents in various settings in patients with hypertension. The main changes from the 2000 Recommendations are the addition of a section on the treatment of hypertension in patients with diabetes mellitus, the amalgamation of the previous sections on treatment of hypertension in the young and old into one section, increased emphasis on the role of combination therapies over repeated trials of single agents and expansion of the section on the treatment of hypertension after stroke. Implicit in the recommendations for therapy is the principle that treatment for an individual patient should take into consideration global cardiovascular risk, the presence and/or absence of target organ damage, and comorbidities.
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Individuals with potential conflicts of interest relative to any specific recommendation were excluded from voting on that recommendation. Only those recommendations achieving high levels of consensus are reported here. These guidelines will continue to be updated annually.
PubMed ID
12107420 View in PubMed
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The 2005 Canadian Hypertension Education Program recommendations for the management of hypertension: part II - therapy.

https://arctichealth.org/en/permalink/ahliterature173954
Source
Can J Cardiol. 2005 Jun;21(8):657-72
Publication Type
Article
Date
Jun-2005
Author
Nadia A Khan
Finlay A McAlister
Richard Z Lewanczuk
Rhian M Touyz
Raj Padwal
Simon W Rabkin
Lawrence A Leiter
Marcel Lebel
Carol Herbert
Ernesto L Schiffrin
Robert J Herman
Pavel Hamet
George Fodor
George Carruthers
Bruce Culleton
Jacques DeChamplain
George Pylypchuk
Alexander G Logan
Norm Gledhill
Robert Petrella
Norman R C Campbell
Malcolm Arnold
Gordon Moe
Micharl D Hill
Charlotte Jones
Pierre Larochelle
Richard I Ogilvie
Sheldon Tobe
Robyn Houlden
Ellen Burgess
Ross D Feldman
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada.
Source
Can J Cardiol. 2005 Jun;21(8):657-72
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Canada
Diet
Evidence-Based Medicine
Exercise
Humans
Hypertension - therapy
Patient Education as Topic
Weight Loss
Abstract
To provide updated, evidence-based recommendations for the management of hypertension in adults.
For lifestyle and pharmacological interventions, evidence from randomized controlled trials and systematic reviews of trials was preferentially reviewed. While changes in cardiovascular morbidity and mortality were the primary outcomes of interest, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the lack of long-term morbidity/mortality data in this field, and for certain comorbid conditions, other relevant outcomes, such as development of proteinuria or worsening of kidney function, were considered.
MEDLINE searches were conducted from November 2003 to October 2004 to update the 2004 recommendations. Reference lists were scanned, experts were contacted, and the personal files of the subgroup members and authors were used to identify additional published studies. All relevant articles were reviewed and appraised independently, using prespecified levels of evidence, by content and methodology experts. As per previous years, only studies that had been published in the peer-reviewed literature were included; evidence from abstracts, conference presentations and unpublished personal communications was not included.
Lifestyle modifications to prevent and/or treat hypertension include the following: perform 30 min to 60 min of aerobic exercise on four to seven days of the week; maintain a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 units per week in men or nine units per week in women; follow a reduced fat, low cholesterol diet with an adequate intake of potassium, magnesium and calcium; restrict salt intake; and consider stress management (in selected individuals). Treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and any comorbid conditions. Blood pressure should be lowered to 140/90 mmHg or less in all patients, and to 130/80 mmHg or less in those with diabetes mellitus or chronic kidney disease. Most adults with hypertension require more than one agent to achieve target blood pressures. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (except in black patients), long-acting calcium channel blockers and angiotensin receptor antagonists. Other agents appropriate for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers and angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or thiazides in patients with diabetes mellitus without albuminuria) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy.
All recommendations were graded according to the strength of the evidence and voted on by the 43 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
PubMed ID
16003449 View in PubMed
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The 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
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PubMed ID
16755313 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
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PubMed ID
19417859 View in PubMed
Less detail

2009 Canadian Hypertension Education Program recommendations: the scientific summary--an annual update.

https://arctichealth.org/en/permalink/ahliterature151166
Source
Can J Cardiol. 2009 May;25(5):271-7
Publication Type
Article
Date
May-2009
Author
Norman R C Campbell
Nadia A Khan
Michael D Hill
Guy Tremblay
Marcel Lebel
Janusz Kaczorowski
Finlay A McAlister
Richard Z Lewanczuk
Sheldon Tobe
Author Affiliation
Department of Medicine, University of Calgary, Calgary, Canada. ncampbel@ucalgary.ca
Source
Can J Cardiol. 2009 May;25(5):271-7
Date
May-2009
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Attitude to Health
Blood Pressure Determination
Canada
Combined Modality Therapy
Diet, Sodium-Restricted
Female
Health Knowledge, Attitudes, Practice
Health Promotion - organization & administration
Humans
Hypertension - diagnosis - therapy
Life Style
Male
Patient Education as Topic
Program Evaluation
Randomized Controlled Trials as Topic
Severity of Illness Index
Abstract
The present report highlights the key messages of the 2009 Canadian Hypertension Education Program (CHEP) recommendations for the management of hypertension and the supporting clinical evidence. In 2009, the CHEP emphasizes the need to improve the control of hypertension in people with diabetes. Intensive reduction in blood pressure (to less than 130/80 mmHg) in people with diabetes leads to significant reductions in mortality rates, disability rates and overall health care system costs, and may lead to improved quality of life. The CHEP recommendations continue to emphasize the important role of patient self-efficacy by promoting lifestyle changes to prevent and control hypertension, and encouraging home measurement of blood pressure. Unfortunately, most Canadians make only minor changes in lifestyle after a diagnosis of hypertension. Routine blood pressure measurement at all appropriate visits, and screening for and management of all cardiovascular risks are key to blood pressure management. Many young hypertensive Canadians with multiple cardiovascular risks are not treated with antihypertensive drugs. This is despite the evidence that individuals with multiple cardiovascular risks and hypertension should be strongly considered for antihypertensive drug therapy regardless of age. In 2009, the CHEP specifically recommends not to combine an angiotensin-converting enzyme inhibitor with an angiotensin receptor blocker in people with uncomplicated hypertension, diabetes (without micro- or macroalbuminuria), chronic kidney disease (without nephropathy [micro- or overt proteinuria]) or ischemic heart disease (without heart failure).
Notes
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PubMed ID
19417857 View in PubMed
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Applying the 2005 Canadian Hypertension Education Program recommendations: 5. Therapy for patients with hypertension and diabetes mellitus.

https://arctichealth.org/en/permalink/ahliterature172087
Source
CMAJ. 2005 Nov 8;173(10):1154-7
Publication Type
Article
Date
Nov-8-2005
Author
Sheldon Tobe
Finlay A McAlister
Lawrence Leiter
Author Affiliation
Division of Nephrology, University of Toronto, Toronto, Ont.
Source
CMAJ. 2005 Nov 8;173(10):1154-7
Date
Nov-8-2005
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Canada
Diabetes Complications - prevention & control
Humans
Hypertension - complications - drug therapy
Male
Middle Aged
Patient Education as Topic
Practice Guidelines as Topic
Risk factors
Notes
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PubMed ID
16275963 View in PubMed
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Blood pressure 2 years after a chronic disease management intervention study.

https://arctichealth.org/en/permalink/ahliterature145323
Source
Int J Circumpolar Health. 2010 Feb;69(1):50-60
Publication Type
Article
Date
Feb-2010
Author
Sheldon Tobe
Lloyd Vincent
Joan Wentworth
Denise Hildebrandt
Alexander Kiss
Nancy Perkins
Susan Hartman
Laurie Ironstand
Jacquie Hoppe
Katie Hunter
George Pylypchuk
Author Affiliation
Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada. sheldon.tobe@sunnybrook.ca
Source
Int J Circumpolar Health. 2010 Feb;69(1):50-60
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - therapeutic use
Blood pressure
Canada
Chronic Disease
Diabetes Mellitus, Type 2 - complications - ethnology
Female
Humans
Hypertension - complications - drug therapy - ethnology - physiopathology
Indians, North American
Male
Middle Aged
Randomized Controlled Trials as Topic
Abstract
To follow blood pressure change over time in participants who had participated in a 1- year chronic disease management program focused on blood pressure reduction. The expectation was that blood pressure would return back to the baseline once the study was completed.
Prospective, single-arm observational study.
Study participants were Status Indians living on-reserve with type 2 diabetes and persistent hypertension who had participated in the DREAM3 study. Blood pressure was measured with the BpTRU automated device every 6 months for 2 years. The primary endpoint was the change in systolic blood pressure over the follow-up period.
Sixty of the original 96 participants agreed to participate in the follow-up. Mean blood pressure at the beginning of the follow-up was 130/76 (SD 18/12) mmHg. Mean blood pressure at the end of the follow-up period was 132/76 (17/9 SD) mmHg. Target blood pressure (
PubMed ID
20167156 View in PubMed
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Canadian randomized trial of hemoglobin maintenance to prevent or delay left ventricular mass growth in patients with CKD.

https://arctichealth.org/en/permalink/ahliterature172255
Source
Am J Kidney Dis. 2005 Nov;46(5):799-811
Publication Type
Article
Date
Nov-2005
Author
Adeera Levin
Ognjenka Djurdjev
Christopher Thompson
Brendan Barrett
Jean Ethier
Euan Carlisle
Paul Barre
Peter Magner
Norman Muirhead
Sheldon Tobe
Paul Tam
Jose Arturo Wadgymar
Joanne Kappel
David Holland
Vincent Pichette
Ahmed Shoker
George Soltys
Mauro Verrelli
Joel Singer
Author Affiliation
University of British Columbia, St Paul's Hospital, Vancouver, British Columbia, Canada. alevin@providencehealth.bc.ca
Source
Am J Kidney Dis. 2005 Nov;46(5):799-811
Date
Nov-2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anemia - drug therapy - prevention & control
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Antihypertensive Agents - therapeutic use
Calcium - blood
Canada
Chronic Disease
Erythropoietin - therapeutic use
Female
Heart Failure - etiology - prevention & control
Heart Ventricles - drug effects - pathology - ultrasonography
Hemoglobins - analysis
Humans
Hypertension - complications - drug therapy
Hypertrophy, Left Ventricular - etiology - prevention & control - ultrasonography
Kidney Diseases - complications - therapy
Lipids - blood
Male
Middle Aged
Organ Size - drug effects
Parathyroid Hormone - blood
Phosphates - blood
Recombinant Proteins
Renal Dialysis
Single-Blind Method
Treatment Failure
Abstract
This randomized clinical trial is designed to assess whether the prevention and/or correction of anemia, by immediate versus delayed treatment with erythropoietin alfa in patients with chronic kidney disease, would delay left ventricular (LV) growth. Study design and sample size calculations were based on previously published Canadian data.
One hundred seventy-two patients were randomly assigned. The treatment group received therapy with erythropoietin alfa subcutaneously to maintain or achieve hemoglobin (Hgb) level targets of 12.0 to 14.0 g/dL (120 to 140 g/L). The control/delayed treatment group had Hgb levels of 9.0 +/- 0.5 g/dL (90 +/- 5 g/L) before therapy was started: target level was 9.0 to 10.5 g/dL (90 to 105 g/L). Optimal blood pressure and parathyroid hormone, calcium, and phosphate level targets were prescribed; all patients were iron replete. The primary end point is LV growth at 24 months.
One hundred fifty-two patients were eligible for the intention-to-treat analysis: mean age was 57 years, 30% were women, 38% had diabetes, and median glomerular filtration rate was 29 mL/min (0.48 mL/s; range, 12 to 55 mL/min [0.20 to 0.92 mL/s]). Blood pressure and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use were similar in the control/delayed treatment and treatment groups at baseline. Erythropoietin therapy was administered to 77 of 78 patients in the treatment group, with a median final dose of 2,000 IU/wk. Sixteen patients in the control/delayed treatment group were administered erythropoietin at a median final dose of 3,000 IU/wk. There was no statistically significant difference between groups for the primary outcome of mean change in LV mass index (LVMI) from baseline to 24 months, which was 5.21 +/- 30.3 g/m2 in the control/delayed treatment group versus 0.37 +/- 25.0 g/m2 in the treatment group. Absolute mean difference between groups was 4.85 g/m2 (95% confidence interval, -4.0 to 13.7; P = 0.28). Mean Hgb level was greater in the treatment group throughout the study and at study end was 12.75 g/dL (127.5 g/L in treatment group versus 11.46 g/dL [114.6 g/L] in control/delayed treatment group; P = 0.0001). LV growth occurred in 20.1% in the treatment group versus 31% in the control/delayed treatment group (P = 0.136). In patients with a stable Hgb level, mean LVMI did not change (-0.25 +/- 26.7 g/m2), but it increased in those with decreasing Hgb levels (19.3 +/- 28.2 g/m2; P = 0.002).
This trial describes disparity between observational and randomized controlled trial data: observed and randomly assigned Hgb level and LVMI are not linked; thus, there is strong evidence that the association between Hgb level and LVMI likely is not causal. Large randomized controlled trials with unselected patients, using morbidity and mortality as outcomes, are needed.
Notes
Comment In: Am J Kidney Dis. 2005 Nov;46(5):970-316253741
PubMed ID
16253719 View in PubMed
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Canadian Society of Nephrology commentary on the 2012 KDIGO clinical practice guideline for the management of blood pressure in CKD.

https://arctichealth.org/en/permalink/ahliterature104526
Source
Am J Kidney Dis. 2014 Jun;63(6):869-87
Publication Type
Article
Date
Jun-2014
Author
Marcel Ruzicka
Robert R Quinn
Phil McFarlane
Brenda Hemmelgarn
G V Ramesh Prasad
Janusz Feber
Gihad Nesrallah
Martin MacKinnon
Navdeep Tangri
Brendan McCormick
Sheldon Tobe
Tom D Blydt-Hansen
Swapnil Hiremath
Author Affiliation
Division of Nephrology, University of Ottawa, Ottawa, Ontario. Electronic address: mruzicka@ottawahospital.on.ca.
Source
Am J Kidney Dis. 2014 Jun;63(6):869-87
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Canada
Diabetic Nephropathies - physiopathology
Humans
Hypertension - complications - therapy
Life Style
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic - complications - physiopathology
Societies, Medical
Sodium, Dietary - administration & dosage
Abstract
The KDIGO (Kidney Disease: Improving Global Outcomes) 2012 clinical practice guideline for the management of blood pressure (BP) in chronic kidney disease (CKD) provides the structural and evidence base for the Canadian Society of Nephrology (CSN) commentary on this guideline's relevancy and application to the Canadian health care system. While in general agreement, we provide commentary on 13 of the 21 KDIGO guideline statements. Specifically, we agreed that nonpharmacological interventions should play a significant role in the management of hypertension in patients with CKD. We also agreed that the approach to the management of hypertension in elderly patients with CKD should be individualized and take into account comorbid conditions to avoid adverse outcomes from excessive BP lowering. In contrast to KDIGO, the CSN Work Group believes there is insufficient evidence to target a lower BP for nondiabetic CKD patients based on the presence and severity of albuminuria. The CSN Work Group concurs with the Canadian Hypertension Education Program (CHEP) recommendation of a target BP for all non-dialysis-dependent CKD patients without diabetes of =140 mm Hg systolic and =90 mm Hg diastolic. Similarly, it is our position that in diabetic patients with CKD and normal urinary albumin excretion, raising the threshold for treatment from
PubMed ID
24725980 View in PubMed
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