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.
The use of short message services and mobile phone technology for ambulatory care management is the most accessible and most inexpensive way to transition from traditional ambulatory care management to active ambulatory care management in patients with arterial hypertension (AH). The aim of this study was to compare the clinical efficacy of active ambulatory care management supported by short message services and mobile phone technology with traditional ambulatory care management in AH patients. The study included 97 hypertensive patients under active ambulatory care management and 102 patients under traditional ambulatory care management. Blood pressure levels, body mass, and smoking history of patients were analyzed in the study. The duration of study was 1 year. In the active ambulatory care management group, 36% of patients were withdrawn from the study within a year. At the end of the year, 77% of patients from the active care management group had achieved the goal blood pressure level. That was more than 5 times higher than that in the traditional ambulatory care management group (P
The aim of the present study has been to study the reproducibility, validity and normal values of ambulatory blood pressure measurement in a healthy Finnish cohort. The reproducibility of ambulatory blood pressure monitoring was examined in healthy volunteers and normal values were determined in a Finnish cohort of males and women of different ages. In the reproducibility study the recording was repeated at 2-week intervals. In the validity study simultaneous measurements were done manually with a mercury sphygmomanometer and compared with the measurement by the ambulatory blood pressure recording unit, both connected with the cuff by a T-tube; this study included 100 consecutive measurements in a patient group. A relatively small cohort was taken from the normal value study group. In addition to ambulatory blood pressure their left ventricle mass was also determined by echocardiography. The correlation between manual blood pressure measurement and simultaneous measurement by the ambulatory blood pressure unit was 0.98. In the reproducibility study the correlations between the two 24-h measurements 2 weeks apart were also good. Depending on the parameter (daytime, nighttime or 24-h blood pressure mean, systolic or diastolic values) the correlation coefficient varied between 0.81 and 0.91. Thus both systolic and diastolic blood pressures, whether expressed as 24-h averages and daytime or nighttime averages, correlated well between these two recording sessions. The data obtained in the present Finnish cohort were well within the published reference value limits, showing only fairly modest age-dependence appearing at quite an old age. There was no significant correlation between the left ventricle mass and ambulatory blood pressure values in a population having normal blood pressure. The results suggest good intra-individual correlation and reproducibility in ambulatory blood pressure monitoring, suggesting this method to be useful in the monitoring of individual blood pressure levels. The validity of the method is good and the published reference values can be applied with reasonable reliability in different populations. In an adult population with normal blood pressure, no correlation between left ventricle mass and blood pressure values can be found, suggesting this correlation may first appear in cohorts including persons with elevated blood pressure values.
Monitoring of intracranial pressure (ICP) is important in the optimal treatment of various neurological and neurosurgical diseases. Telemetric ICP monitoring allows long-term measurements in the patient's everyday life and the possibility to perform additional measurements without the procedure related risks of repeated transducer insertions.
We identified all patients in our clinic with an implanted Raumedic(®) telemetric ICP probe (NEUROVENT(®)-P-tel). For each patient we identified diagnosis, indication for implantation, surgical complications, duration of ICP reading, number of ICP recording sessions (in relation to symptoms of increased ICP) and their clinical consequence.
We included 21 patients in the evaluation (11 female and 10 male). Median age was 28 (2-83) years and median duration of disease was 11 (0-30) years. Eleven patients had various kinds of hydrocephalus, seven patients had idiopathic intracranial hypertension (IIH) and three patients had normal pressure hydrocephalus (NPH). Fifteen patients had a shunt prior to implantation. Median duration of implantation was 248 (49-666) days and median duration from implantation to last recording session was 154 (8-433) days. In total, 86 recording sessions were performed; 29 resulted in surgical shunt revision, 30 in change of acetazolamide dose or programmable valve setting, 20 required no action and 5 resulted in a new recording session. No surgical complications occurred, except for late wound infection at the surgical site in two patients.
Telemetric ICP monitoring is useful in patients with complicated CSF dynamic disturbances who would otherwise require repeated invasive pressure monitoring. It seems to be a feasible method to guide adjustment of programmable valve settings and to identify patients with chronic or repeated shunt problems.
In the Russian program FORTISSIMO administration of fixed combination of perindopril arginine/indapamide (10 mg/2.5 mg) in 2120 patients with poorly controlled arterial hypertension instead of angiotensin converting enzyme inhibitors (ACEI) or -receptor antagonists (ARB) with hydrochlorothiazide given separately or in fixed combinations resulted in significant lowering of arterial pressure (AP) and achievement of its target level in 84% of patients. Mean AP was lowered from 177/99 to 130/80 mm Hg in 3 months while substantial reduction down to 149/89 mm Hg occurred just after 2 weeks of treatment. Improvement of compliance to therapy was also noted. Fixed perindopril/indapamide combination was well tolerated and turned out to be effective for AP control irrespective of previously conducted therapy (ACEI or ARB with diuretic).