1999 Canadian recommendations for the management of hypertension

Feldman, Ross D.; Campbell, Norman; Larochelle, Pierre; Bolli, Peter; Burgess, Ellen D.; Carruthers, S. George; Floras, John S.; Haynes, R. Brian; Honos, George; Leenen, Frans H. H.; Leiter, Larry A.; Logan, Alexander G.; Myers, Martin G.; Spence, J. David; Zarnke, Kelly B.
December 1999
CMAJ: Canadian Medical Association Journal;12/14/99 Supplement, Vol. 161, pS1
Academic Journal
Objective: To provide updated, evidence-based recommendations for health care professionals on the management of hypertension in adults. Options: For patients with hypertension, there are both lifestyle options and pharmacological therapy options that may control blood pressure. For those patients who are using pharmacological therapy, a range of antihypertensive drugs is available. The choice of a specific antihypertensive drug is dependent upon the severity of the hypertension and the presence of other cardiovascular risk factors and concurrent diseases. Outcomes: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no economic outcomes were considered. Evidence: MEDLINE searches were conducted from the period of the last revision of the Canadian Recommendations for the Management of Hypertension (January 1993 to May 1998). Reference lists were scanned, experts were polled and the personal files of the authors were used to identify other studies. All relevant articles were reviewed, classified according to study design and graded according to levels of evidence. Values: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. Benefits, harms and costs: The diagnosis and treatment of hypertension with pharmacological therapy will reduce the blood pressure of patients with sustained hypertension. In certain settings, and for specific drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and mortality. Recommendations: This document contains detailed recommendations pertaining to all aspects of the diagnosis and pharmacological therapy of hypertensive patients. With respect to diagnosis, the recommendations endorse the greater use of non-office-based measures of blood pressure control (i.e., using home blood pressure and automatic ambulatory blood pressure monitoring equipment) and greater emphasis on the identification of other cardiovascular risk factors, both in the assessment of prognosis in hypertension and in the choice of therapy. On the treatment side, lower targets for blood pressure control are advocated for some subgroups of hypertensive patients, in particular, those with diabetes and renal disease. Implicit in the recommendations for therapy is the principle that for the vast majority of hypertensive patients treated pharmacologically, practitioners should not follow a stepped-care approach. Instead, therapy should be individualized, based on consideration of concurrent diseases, both cardiovascular and noncardiovascular. Validation: All recommendations were graded according to the strength of the evidence and the consensus of all relevant stakeholders. Sponsors: The Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control.


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