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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
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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
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Cites: Lancet. 2000 Dec 9;356(9246):1955-6411130523
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
Cites: N Engl J Med. 2000 Jan 20;342(3):145-5310639539
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Cites: Hypertension. 2009 Feb;53(2):128-3419114646
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PubMed ID
19417857 View in PubMed
Less detail

2010 Canadian Hypertension Education Program (CHEP) recommendations: the scientific summary - an update of the 2010 theme and the science behind new CHEP recommendations.

https://arctichealth.org/en/permalink/ahliterature143446
Source
Can J Cardiol. 2010 May;26(5):236-40
Publication Type
Article
Date
May-2010
Author
Norman R C Campbell
Janusz Kaczorowski
Richard Z Lewanczuk
Ross Feldman
Luc Poirier
Margaret Moy Kwong
Marcel Lebel
Finlay A McAlister
Sheldon W Tobe
Author Affiliation
Department of Medicine, University of Calgary, Alberta. ncampbel@ucalgary.ca
Source
Can J Cardiol. 2010 May;26(5):236-40
Date
May-2010
Language
English
Publication Type
Article
Keywords
Antihypertensive Agents - administration & dosage
Canada
Diet, Sodium-Restricted
Female
Health promotion
Humans
Hypertension - prevention & control - therapy
Life Style
Male
Patient Education as Topic
Practice Guidelines as Topic
Randomized Controlled Trials as Topic
Risk Reduction Behavior
Abstract
The present article is a summary of the theme, the key recommendations for management of hypertension and the supporting clinical evidence of the 2010 Canadian Hypertension Education Program (CHEP). In 2010, CHEP emphasizes the need for health care professionals to stay informed about hypertension through automated updates at www.htnupdate.ca. A new interactive Internet-based lecture series will be available in 2010 and a program to train community hypertension leaders will be expanded. Patients can also sign up to receive regular updates in a pilot program at www.myBPsite.ca. In 2010, the new recommendations include consideration for using automated office blood pressure monitors, new targets for dietary sodium for the prevention and treatment of hypertension that are aligned with the national adequate intake values, and recommendations for considering treatment of selected hypertensive patients at high risk with calcium channel blocker/angiotensin-converting enzyme inhibitor combinations and the use of angiotensin receptor blockers.
Notes
Cites: CMAJ. 1999 Jan 12;160(1):31-79934341
Cites: Lancet. 2007 Dec 15;370(9604):2044-5318063027
Cites: BMC Cardiovasc Disord. 2005;5(1):1815985180
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Cites: Can J Cardiol. 2008 Apr;24(4):269-7318401466
Cites: N Engl J Med. 2008 Apr 10;358(15):1547-5918378520
Cites: CMAJ. 2008 May 20;178(11):1441-918490640
Cites: Can J Cardiol. 2008 Jun;24(6):507-1218548150
Cites: Lancet. 2008 Aug 16;372(9638):547-5318707986
Cites: N Engl J Med. 2008 Sep 18;359(12):1225-3718753639
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Cites: Lancet. 2008 Sep 27;372(9644):1174-8318757085
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Cites: Hypertension. 2009 Feb;53(2):128-3419114646
Cites: PLoS Med. 2009 Apr 28;6(4):e100005819399161
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Cites: J Hypertens. 2009 Jun;27(6):1136-5119451836
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Cites: J Clin Hypertens (Greenwich). 2007 Apr;9(4):267-7017396069
Cites: J Hum Hypertens. 2007 Jul;21(7):588-9017377600
Cites: Can J Cardiol. 2005 May 15;21(7):589-9315940357
PubMed ID
20485687 View in PubMed
Less detail

The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy.

https://arctichealth.org/en/permalink/ahliterature143444
Source
Can J Cardiol. 2010 May;26(5):249-58
Publication Type
Article
Date
May-2010
Author
Daniel G Hackam
Nadia A Khan
Brenda R Hemmelgarn
Simon W Rabkin
Rhian M Touyz
Norman R C Campbell
Raj Padwal
Tavis S Campbell
M Patrice Lindsay
Michael D Hill
Robert R Quinn
Jeff L Mahon
Robert J Herman
Ernesto L Schiffrin
Marcel Ruzicka
Pierre Larochelle
Ross D Feldman
Marcel Lebel
Luc Poirier
J Malcolm O Arnold
Gordon W Moe
Jonathan G Howlett
Luc Trudeau
Simon L Bacon
Robert J Petrella
Alain Milot
James A Stone
Denis Drouin
Jean-Martin Boulanger
Mukul Sharma
Pavel Hamet
George Fodor
George K Dresser
S George Carruthers
George Pylypchuk
Ellen D Burgess
Kevin D Burns
Michel Vallée
G V Ramesh Prasad
Richard E Gilbert
Lawrence A Leiter
Charlotte Jones
Richard I Ogilvie
Vincent Woo
Philip A McFarlane
Robert A Hegele
Sheldon W Tobe
Author Affiliation
Department of Medicine and Epidemiology, Division of Clinical Pharmacology and Clinical Neurological Sciences, University of Western Ontario, London, Ontario. dhackam@uwo.ca
Source
Can J Cardiol. 2010 May;26(5):249-58
Date
May-2010
Language
English
Publication Type
Article
Keywords
Adult
Antihypertensive Agents - therapeutic use
Canada
Cardiovascular Diseases - prevention & control
Combined Modality Therapy
Diet, Sodium-Restricted
Evidence-Based Medicine
Female
Humans
Hypertension - diagnosis - prevention & control - therapy
Life Style
Male
Middle Aged
Patient Education as Topic
Practice Guidelines as Topic
Primary Prevention - standards
Prognosis
Risk assessment
Abstract
To update the evidence-based recommendations for the prevention and treatment of hypertension in adults for 2010.
For lifestyle and pharmacological interventions, randomized trials and systematic reviews of trials were preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the general lack of long-term morbidity and mortality data in this field. Progressive renal impairment was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease.
A Cochrane Collaboration librarian conducted an independent MEDLINE search from 2008 to August 2009 to update the 2009 recommendations. To identify additional studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence.
For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium to 1500 mg (65 mmol) per day in adults 50 years of age or younger, to 1300 mg (57 mmol) per day in adults 51 to 70 years of age, and to 1200 mg (52 mmol) per day in adults older than 70 years of age; perform 30 min to 60 min of moderate aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m(2) to 24.9 kg/m(2)) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 standard drinks per week for men or nine standard drinks per week for women; follow a diet that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources, and that is low in saturated fat and cholesterol; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. Antihypertensive therapy should be considered in all adult patients regardless of age (caution should be exercised in elderly patients who are frail). For adults without compelling indications for other agents, considerations for initial therapy should include thiazide diuretics, angiotensin- converting enzyme (ACE) inhibitors (in patients who are not black), long-acting calcium channel blockers (CCBs), angiotensin receptor blockers (ARBs) or beta-blockers (in those younger than 60 years of age). A combination of two first-line agents may also be considered as initial treatment of hypertension if systolic blood pressure is 20 mmHg above target or if diastolic blood pressure is 10 mmHg above target. The combination of ACE inhibitors and ARBs should not be used, unless compelling indications are present to suggest consideration of dual therapy. Agents appropriate for first-line therapy for isolated systolic hypertension include thiazide diuretics, long-acting dihydropyridine CCBs or ARBs. In patients with coronary artery disease, ACE inhibitors, ARBs or betablockers are recommended as first-line therapy; in patients with cerebrovascular disease, an ACE inhibitor/diuretic combination is preferred; in patients with proteinuric nondiabetic chronic kidney disease, ACE inhibitors or ARBs (if intolerant to ACE inhibitors) are recommended; and in patients with diabetes mellitus, ACE inhibitors or ARBs (or, in patients without albuminuria, thiazides or dihydropyridine CCBs) are appropriate first-line therapies. In selected high-risk patients in whom combination therapy is being considered, an ACE inhibitor plus a long-acting dihydropyridine CCB is preferable to an ACE inhibitor plus a thiazide diuretic. All hypertensive patients with dyslipidemia should be treated using the thresholds, targets and agents outlined in the Canadian lipid treatment guidelines. Selected patients with hypertension who do not achieve thresholds for statin therapy, but who are otherwise at high risk for cardiovascular events, should nonetheless receive statin therapy. Once blood pressure is controlled, low-dose acetylsalicylic acid therapy should be considered.
All recommendations were graded according to the strength of the evidence and voted on by the 63 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 80% consensus. These guidelines will continue to be updated annually.
The Canadian Hypertension Education Program process is sponsored by the Canadian Hypertension Society, Blood Pressure Canada, the Public Health Agency of Canada, the College of Family Physicians of Canada, the Canadian Pharmacists Association, the Canadian Council of Cardiovascular Nurses, and the Heart and Stroke Foundation of Canada.
Notes
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Cites: Nephrol Dial Transplant. 2009 May;24(5):1663-7119145003
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Cites: Can J Cardiol. 2009 May;25(5):287-9819417859
Cites: Can J Cardiol. 2009 Oct;25(10):567-7919812802
Cites: J Hypertens. 2009 Dec;27(12):2321-3119727007
Cites: Lancet. 2003 Apr 5;361(9364):1149-5812686036
PubMed ID
20485689 View in PubMed
Less detail

Addressing poor nutrition to promote heart health: moving upstream.

https://arctichealth.org/en/permalink/ahliterature140561
Source
Can J Cardiol. 2010 Aug-Sep;26 Suppl C:21C-4C
Publication Type
Article
Author
Kim D Raine
Author Affiliation
Center for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. kim.raine@ualberta.ca
Source
Can J Cardiol. 2010 Aug-Sep;26 Suppl C:21C-4C
Language
English
Publication Type
Article
Keywords
Animals
Body mass index
Canada
Cardiovascular Diseases - diet therapy - prevention & control
Cereals
Diet, Sodium-Restricted
Dietary Fiber
Energy intake
Evidence-Based Medicine
Fatty acids
Fishes
Food Habits
Fruit
Health promotion
Humans
Life Style
Nutrition Policy
Nuts
Obesity - diet therapy - prevention & control
Patient Education as Topic
Practice Guidelines as Topic
Public Health
Randomized Controlled Trials as Topic
Vegetables
Abstract
Current dietary recommendations for cardiovascular disease prevention suggest dietary patterns that promote achieving healthy weight, emphasize vegetables, legumes, fruit, whole grains, fish and nuts, substituting mono-unsaturated fats for saturated fats and restricting dietary sodium to less than 2300 mg/day. However, trends in nutrient intake and food consumption patterns suggest that the need for improvement in the dietary patterns of Canadians is clear. Influencing eating behaviour requires more than addressing nutrition knowledge and perceptions of healthy eating - it requires tackling the context within which individuals make choices. A comprehensive approach to improving nutrition includes traditional downstream strategies such as counselling to improve knowledge and skills; midstream strategies such as using the media to change social norms; and upstream strategies such as creating supportive environments through public policy including regulatory measures. While the evidence base for more upstream strategies continues to grow, key examples of comprehensive approaches to population change provide a call to action.
Notes
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Cites: MMWR Recomm Rep. 2001 Sep 28;50(RR-16):1-1511594724
Cites: Am J Public Health. 2005 Mar;95(3):432-515727972
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Cites: Can J Public Health. 2005 Jul-Aug;96 Suppl 3:S8-14, S8-1516042158
Cites: Health Rep. 2006 Aug;17(3):9-2516981483
Cites: Health Educ Res. 2007 Jun;22(3):414-2416982650
Cites: Health Rep. 2007 May;18(2):47-5217578015
Cites: Can J Cardiol. 2008 Jun;24(6):497-118548148
Cites: Circulation. 2008 Jul 22;118(4):428-6418591433
Cites: Can J Public Health. 2009 Jan-Feb;100(1):Suppl I20-619263979
Cites: Arch Intern Med. 2009 Apr 13;169(7):659-6919364995
Cites: Can J Cardiol. 2009 May;25(5):287-9819417859
Cites: MMWR Recomm Rep. 2009 Jul 24;58(RR-7):1-2619629029
Cites: Can J Cardiol. 2009 Oct;25(10):567-7919812802
Cites: Health Psychol. 2000 Jan;19(1 Suppl):76-8310709951
Cites: Obes Rev. 2005 Feb;6(1):23-3315655036
PubMed ID
20847988 View in PubMed
Less detail

[An analysis of a selected Danish meta-analysis].

https://arctichealth.org/en/permalink/ahliterature225660
Source
Ugeskr Laeger. 1991 Sep 30;153(40):2840-2
Publication Type
Article
Date
Sep-30-1991
Author
N C Henningsen
Source
Ugeskr Laeger. 1991 Sep 30;153(40):2840-2
Date
Sep-30-1991
Language
Danish
Publication Type
Article
Keywords
Blood Pressure - physiology
Denmark
Diet, Sodium-Restricted
Humans
Meta-Analysis as Topic
PubMed ID
1926627 View in PubMed
Less detail

Assessment of consumers’ level of engagement in following recommendations for lowering sodium intake.

https://arctichealth.org/en/permalink/ahliterature105022
Source
Appetite. 2014 Feb;73:51-7
Publication Type
Article
Date
Feb-2014
Author
Julio Ernesto Mendoza
Grietje Anna Schram
JoAnne Arcand
Spencer Henson
Mary L'Abbe
Source
Appetite. 2014 Feb;73:51-7
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Consumer Participation
Data Collection
Diet
Diet, Sodium-Restricted
Female
Food Handling
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Nutrition Policy
Ontario
Restaurants
Socioeconomic Factors
Sodium - administration & dosage
Sodium Chloride, Dietary - administration & dosage
Young Adult
Abstract
Population-wide sodium reduction strategies encourage consumer participation in lowering dietary sodium. This study aims to measure and rank consumers’ level of engagement in following 23 recommendations to reduce dietary sodium and to compare variation in level of consumers’ engagement by sociodemographic sub-groups. The study included 869 randomly selected participants of an online food panel survey from Ontario during November and December 2010. Rasch modelling was used for the analysis. Consumers were less likely to be engaged in 9 out of the 23 recommendations, in particular those related to avoiding foods higher in sodium and implementing sodium reduction strategies while eating in restaurants. Higher level of consumers’ engagement was observed in relation to food preparation practices, including use of low sodium ingredients. In comparison to the relevant reference group, men, older individuals, with lower educational level, single, and those who do not prepare food from scratch showed an overall lower level of engagement in following recommendations to lowering dietary sodium, particularly related to avoiding processed foods. These data provide novel insights and can inform public education campaigns, and highlight the need for interventions and programs targeted at the food supply that can assist consumers in lowering their sodium intake.
PubMed ID
24511619 View in PubMed
Less detail

Association between body composition and conformity to the recommendations of Canada's Food Guide and the Dietary Approaches to Stop Hypertension (DASH) diet in peri-adolescence.

https://arctichealth.org/en/permalink/ahliterature123235
Source
Public Health Nutr. 2012 Oct;15(10):1890-6
Publication Type
Article
Date
Oct-2012
Author
Samantha Hajna
Jian Liu
Paul J LeBlanc
Brent E Faught
Anwar T Merchant
John Cairney
John Hay
Author Affiliation
Department of Community Health Sciences, Brock University, 500 Glenridge Avenue, St Catharines, Ontario, Canada.
Source
Public Health Nutr. 2012 Oct;15(10):1890-6
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Body Composition - physiology
Body mass index
Child
Diet, Sodium-Restricted
Female
Guideline Adherence
Humans
Hypertension - prevention & control
Male
Nutrition Policy
Ontario - epidemiology
Overweight - epidemiology - prevention & control
Sex Factors
Sodium Chloride, Dietary - administration & dosage
Waist Circumference
Waist-Hip Ratio
Abstract
The role of following the recommendations of Canada's Food Guide (CFG) and the Dietary Approaches to Stop Hypertension (DASH) diet on body composition in children is unknown. The present study assessed how conformity to the recommendations of these diets was associated with BMI, waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist girth (WG), hip girth (HG) and risk of overweight in peri-adolescents.
CFG and DASH indices were derived from responses to a food questionnaire, with a higher index representing greater conformity to CFG and DASH diet recommendations. Body composition was assessed by trained research assistants.
Schools within the Niagara region (Ontario, Canada).
Children (n 1570) aged 12.4 (sd 0.3) years.
After adjustment for age to peak height velocity and total physical activity, a higher CFG index was associated with lower WHtR (b = -0.001, 95 % CI -0.002, -0.0004), WHR (b = -0.001, 95 % CI -0.002, -0.001) and WG (b = -0.18, 95 % CI -0.30, -0.07) in girls. No associations were observed in boys. In contrast, a higher DASH index was associated with decreased body composition measures in both genders. Specifically, the DASH index was negatively associated with BMI (girls: b = -0.07, 95 % CI -0.10, -0.04; boys: b = -0.05, 95 % CI -0.08, -0.02), WHtR (girls: b = -0.001, 95 % CI -0.002, -0.001; boys: b = -0.001, 95 % CI -0.002, -0.0004), WHR (girls: b = -0.001, 95 % CI -0.002, -0.001; boys: b = -0.001, 95 % CI -0.001, -0.00004), WG (girls: b = -0.24, 95 % CI -0.31, -0.16; boys: b = -0.15, 95 % CI -0.24, -0.07) and HG (girls: b = -0.15, 95 % CI -0.23, -0.07; boys: b = -0.12, 95 % CI -0.19, -0.04). A higher DASH index was also associated with lower odds of overweight in girls (OR = 0.70, 95 % CI 0.56, 0.87) and boys (OR = 0.76, 95 % CI 0.62, 0.93).
The DASH diet may prevent overweight in peri-adolescents.
PubMed ID
22717343 View in PubMed
Less detail

Association of dietary sodium intake with atherogenesis in experimental diabetes and with cardiovascular disease in patients with Type 1 diabetes.

https://arctichealth.org/en/permalink/ahliterature118381
Source
Clin Sci (Lond). 2013 May;124(10):617-26
Publication Type
Article
Date
May-2013
Author
Chris Tikellis
Raelene J Pickering
Despina Tsorotes
Valma Harjutsalo
Lena Thorn
Aila Ahola
Johan Wadén
Nina Tolonen
Markku Saraheimo
Daniel Gordin
Carol Forsblom
Per-Henrik Groop
Mark E Cooper
John Moran
Merlin C Thomas
Author Affiliation
Baker IDI Heart and Diabetes Institute, PO Box 6492, Melbourne, Australia.
Source
Clin Sci (Lond). 2013 May;124(10):617-26
Date
May-2013
Language
English
Publication Type
Article
Keywords
Adult
Angiotensin-Converting Enzyme Inhibitors - pharmacology
Animals
Apolipoproteins E - deficiency
Atherosclerosis - chemically induced
Cardiovascular Diseases - etiology - mortality
Cohort Studies
Diabetes Mellitus, Experimental - complications
Diabetes Mellitus, Type 1 - mortality - urine
Diet, Sodium-Restricted
Female
Finland - epidemiology
Humans
Male
Mice
Mice, Knockout
Middle Aged
Perindopril
Plaque, Atherosclerotic - pathology - prevention & control
Renin-Angiotensin System - drug effects - physiology
Sodium - urine
Sodium, Dietary - administration & dosage
Abstract
It is recommended that individuals with diabetes restrict their dietary sodium intake. However, although salt intake is correlated with BP (blood pressure), it also partly determines the activation state of the RAAS (renin-angiotensin-aldosterone system), a key mediator of diabetes-associated atherosclerosis. apoE KO (apolipoprotein E knockout) mice were allocated for the induction of diabetes with streptozotocin or citrate buffer (controls) and further randomized to isocaloric diets containing 0.05%, 0.3% or 3.1% sodium with or without the ACEi [ACE (angiotensin-converting enzyme) inhibitor] perindopril. After 6 weeks of study, plaque accumulation was quantified and markers of atherogenesis were assessed using RT-PCR (reverse transcription-PCR) and ELISA. The association of sodium intake and adverse cardiovascular and mortality outcomes were explored in 2648 adults with Type 1 diabetes without prior CVD (cardiovascular disease) from the FinnDiane study. A 0.05% sodium diet was associated with increased plaque accumulation in diabetic apoE KO mice, associated with activation of the RAAS. By contrast, a diet containing 3.1% sodium suppressed atherogenesis associated with suppression of the RAAS, with an efficacy comparable with ACE inhibition. In adults with Type 1 diabetes, low sodium intake was also associated with an increased risk of all-cause mortality and new-onset cardiovascular events. However, high sodium intake was also associated with adverse outcomes, leading to a J-shaped relationship overall. Although BP lowering is an important goal for the management of diabetes, off-target actions to activate the RAAS may contribute to an observed lack of protection from cardiovascular complications in patients with Type 1 diabetes with low sodium intake.
PubMed ID
23216128 View in PubMed
Less detail

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