To provide updated, evidence-based recommendations for the diagnosis and assessment of high blood pressure in adults.
For people with high blood pressure, the assignment of a diagnosis of hypertension depends on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the duration of follow-up and the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases. For people diagnosed with hypertension, defining the overall risk of adverse cardiovascular outcomes requires laboratory testing, a search for target organ damage and an assessment of the modifiable causes of hypertension. Out-of-clinic blood pressure assessment and echocardiography are options for selected patients.
People at increased risk of adverse cardiovascular outcomes and were identified and quantified.
Medline searches were conducted from the period of the last revision of the Canadian recommendations for the management of hypertension (May 1998 to October 2000). Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other 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 identification of people at increased risk of cardiovascular morbidity and mortality.
The identification of people at higher risk of cardiovascular disease will permit counselling for lifestyle manoeuvres and the introduction of antihypertensive drugs to reduce blood pressure for 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 aspects of the diagnosis and assessment of patients with hypertension, including the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, routine and optional laboratory testing, assessment for renovascular hypertension, home and ambulatory blood pressure monitoring, and the role of echocardiography in hypertension.
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only the recommendations achieving high levels of consensus are reported here. These guidelines will be updated annually.
These recommendations 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 of Health Canada.
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
The analysis of age features of prevalence of an arterial hypertensia in the basic professional groups of the coal-mining enterprises was carried out. In total 1575 workers of collieries and cuts of Kuzbas united in 9 professional groups participated in the research. The results of research demonstrated the distinctions of age structure in the professional groups, testifying about expressed professional senescence among workers of mines, which reveals itself in the decrease in relative density of persons of 50+ years. In these groups with the expressed professional senescence the decrease in relative density of persons with an arterial hypertensia--so-called effect of the "healthy worker", in turn, is observed.
To study the association between the ankle-brachial pressure index (ABPI), premature death and the need for surgical treatment for lower limb ischaemia.
Population based cohort study.
Three hundred and fifty-three men and women, 50-89 years old, underwent a leg pain questionnaire and measurement of ABPI and was then followed for 10 years.
All cause mortality, vascular procedures and major amputations.
A low ABPI was independently associated with premature all cause mortality in the multiple regression analysis, carrying a relative risk of 3.4 (95% confidence interval 2.0-5.9) and 2.1 (1.3-3.3) for ABPIs or=1.0. Individuals with an ABPI in the interval 0.81-0.99 suffered only a slight, not statistically significant risk increase compared to normals. A low ABPI at baseline implied a continuous constant increased risk of death throughout the study period. The same risk was observed among elderly (70-89, median 77 years), and in the middle aged (50-69, median 63 years) individuals. The vast majority of those subjected to vascular intervention or major amputation during follow-up had an ABPI
Some of the greatest barriers to achieving blood pressure control are perceived to be failure to prescribe antihypertensive medication and lack of adherence to medication prescriptions.
Self-reported data from 6017 Canadians with diagnosed hypertension who responded to the 2008 Canadian Community Health Survey and the 2009 Survey on Living with Chronic Diseases in Canada were examined.
The majority (82%) of individuals with diagnosed hypertension reported using antihypertensive medications. The main reasons for not taking medications were either that they were not prescribed (42%) or that blood pressure had been controlled without medications (45%). Of those not taking antihypertensive medications in 2008 (n = 963), 18% had started antihypertensive medications by 2009, and of those initially taking medications (n = 5058), 5% had stopped. Of those taking medications in 2009, 89% indicated they took the medication as prescribed, and 10% indicated they occasionally missed a dose. Participants who were recently diagnosed, not measuring blood pressure at home, not having a plan to control blood pressure, or not receiving instructions on how to take medications were less likely to be taking antihypertensive medications; similar factors tended to be associated with stopping antihypertensive medication use.
Compatible with high rates of hypertension control, most Canadians diagnosed with hypertension take antihypertensive medications and report adherence. Widespread implementation of self-management strategies for blood pressure control and standardized instructions on antihypertensive medication may further optimize drug treatment.
Arterial hypertension (AH) refers to the most common cardiovascular diseases. The expert community regularly creates recommendations on the definition, diagnostics and treatment of hypertension. The most significant documents are recommendations American Medical Societies and the European Society for Hygiene in association with the European cardiological society. The latter document, as a rule, is fundamental for the creation of Russian recommendations on AH. Similarities are discussed in the article and differences in perceptions of the classification of hypertension, target levels of blood pressure, approaches to non-drug and drug therapy of the disease.
To reveal possible associations between metabolic syndrome (MS) and reduced lung function.
In 2013-016, a cross-sectional survey was conducted in 908 Novosibirsk dwellers, which included spirometry to evaluate external respiratory function (ERF). For the detection of MS, the investigators used the 2009 All-Russian Research Society of Cardiologists criteria: waist circumference (WC) > 80 cm for women and >94 cm for men in combination with two of the following criteria: blood pressure (BP) =130/85 mm Hg, triglycerides (TG) =1.7 mmol/l, high-density lipoproteins (HDL) cholesterol 3.0 mmol/l, and glucose =6.1 mmol/l.
The mean values of WC were significantly greater with a forced expiratory volume in one second (FEV1) 80 ?? ? ?????? ? >94 ?? ? ?????? ? ????????? ? ????? ?? ????????? ?????????: ???????????? ???????? (??) =130/85 ?? ??.??., ??????? ????????????? (??) =1,7 ?????/?, ??????????? (??) ????????????? ??????? ????????? (????) 3,0 ?????/?, ??????? =6,1 ?????/?. ??????????. ??????? ???????? ?? ????????? ?????????? ?????? ??? ?????? ?????????????? ?????? ?? 1-? ??????? (???1)
A total of 3,790 school pupils aged 14 and 15 years attending the ninth form during the school session 1986/87 were submitted to blood pressure measurements employing a digital sphygmomanometer. Where boys were concerned an average blood pressure of 123.9/65.9 mmHg was found while, in girls, the average blood pressure was 117.6/70.9 mmHg. In cases with blood pressure readings over the 90% fractile, repeated measurements are recommended. The 90% fractile for boys was 139/80 mmHg and for and for girls 133/84 mmHg. In cases where repeated measurements show blood pressure readings over the 95% fractile, further investigation and advice about risk factors are recommended. The 95% fractile for boys was 144/84 mmHg and 138/88 mmHg for girls. The influence of pubertal development and body-weight on the blood pressure are reviewed. Screening in connection with health examination in the ninth form is recommended in order to identify adolescents at risk for development of hypertension.
Because blood pressure (BP) tracks from childhood to adulthood, assessing levels in youth is relevant. There are no recent BP data for Canadian children and adolescents, and past studies have used a variety of design and measurement devices.
With a clinically validated oscillometric device, resting BP was measured in 2,079 respondents aged 6 to 19 years from the Canadian Health Measures Survey. The average of the last five of six BP measures taken one minute apart at a single visit was used in this report. Borderline or elevated BP was defined as greater than or equal to the 90th percentile of US reference values for participants aged 6 to 17 years. Borderline or elevated BP for 18- to 19-year-olds was defined as equal to or greater than 120 systolic BP or equal to or greater than 80 diastolic BP. Participants of any age who reported taking antihypertensive medication in the past month were also defined as having elevated BP.
At ages 6 to 11 years, mean (standard error) systolic/diastolic blood pressure was 93(0)/61(1) in boys and 93(0)/60(0) mmHg in girls, and at ages 12 to 19 years, 101(1)/63(1) and 98(1)/63(1) mmHg, respectively. An estimated 2.1% (95% confidence interval 1.3% to 3.0%) of Canadian children and youth had borderline levels; 0.8% (0.4% to 1.4%) had elevated BP.
Despite the prevalence of obesity among young people, BP levels were lower than reported in provincial samples, which may, in part, reflect differences in methodologies and measurement instruments.
The question of whether blood pressure is one of the main risk factors for cardiovascular diseases in childhood has been evaluated in a Study of Cardiovascular Risk in Young Finns. In the second follow-up study, carried out in 1986, blood pressure was successfully measured in 2500 individuals aged nine to 24 years using a random zero sphygmomanometer. The mean systolic blood pressure in girls rose from 102 mmHg (95th percentile 119 mmHg) at age nine to 116 mmHg (138 mmHg) at age 24 and that in boys from 102 mmHg (95th percentile 121 mmHg) to 128 mmHg (148 mmHg). Diastolic blood pressure was more often measurable using Korotkoff's 5th than the 4th phase. The values observed were similar to those reported by the Second Task Force on Blood Pressure Control in Children, but owing to differences in the methods used to measure blood pressure it cannot be reliably concluded that the blood pressures were similar in the two series. Even in childhood blood pressure measurement is important, and since it changes with the physical size of the child, observations should be compared with normal values such as those reported here. No data are yet available to suggest that children with blood pressure values in the high normal range would benefit from interventions. Thus normal blood pressure value curves should be applied with caution when assessing children.