Review ArticlePractice

Recommendations on screening for high blood pressure in Canadian adults

Patrice Lindsay, Sarah Connor Gorber, Michel Joffres, Richard Birtwhistle, Donald McKay and Lyne Cloutier
Canadian Family Physician September 2013; 59 (9) 927-933;

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    Hypertension analytical framework: This framework does not include management of diagnosed hypertension, as it is beyond the scope of the CTFPHC mandate.

    CHEP—Canadian Hypertension Education Program, CTFPHC—Canadian Task Force on Preventive Health Care, CQ—contextual question, CVD—cardiovascular disease, HTN—hypertension, KQ—key question.

    *Cardiovascular morbidity includes stroke, heart disease, renal disease, peripheral vascular disease, and retinal disease.

    †The recommendations will defer to CHEP for a description of the specific processes for taking office, home, and ambulatory blood pressure measurements.

Tables

  • Table 1

    Evidence summary of benefits associated with hypertension screening: The mean follow-up was 1 y. Each end point was assessed using mean cumulative hospital rates from 1 RCT.15 There was no serious risk of bias in this trial. There are no concerns about lack of blinding, as blinding is part of the intervention and therefore there is no risk of bias. There was no serious inconsistency, as only a single study was used (inconsistency is not applicable). There was serious indirectness, as the study focused on the population > 65 y of age (although younger patients were not denied participation); therefore, the study results are not generalizable to the general population. In addition to hypertension screening, the intervention included comprehensive cardiovascular risk assessment and education sessions. The efficacy of hypertension screening in isolation was not directly assessed. There was no serious imprecision seen in the trial. There was an insufficient number of studies to assess publication bias. The study was of moderate quality and critical importance.

    END POINTPATIENTS, N (%)EFFECT RELATIVE (95% CI)*ABSOLUTE NO. PER 1 000 000 (95% CI)
    KQ1 SCREENING (N = 69 942)CONTROL, NO SCREENING (N = 75 499)
    Composite1951 (2.8)†2275 (3.0)†RR 0.91 (0.86 to 0.97)2712 fewer (904 fewer to 4219 fewer)
    Acute myocardial infarction667 (1.0)†816 (1.1)†RR 0.87 (0.79 to 0.97)1405 fewer (324 fewer to 2270 fewer)
    Congestive heart failure735 (1.1)†923 (1.2)†RR 0.90 (0.81 to 0.99)1223 fewer (122 fewer to 2323 fewer)
    Stroke550 (0.8)†536 (0.7)†RR 0.99 (0.88 to 1.12)71 fewer (852 fewer to 852 more)
    All-cause mortality2377 (3.4)‡2608 (3.5)‡RR 0.98 (0.92 to 1.04)684 fewer (2618 fewer to 1368 more)

    • KQ1—key question 1, RCT—randomized controlled trial, RR—relative risk.

    • ↵* These outcomes represent the effect of the Cardiovascular Health Awareness Program. Outcome measures reported have been adjusted for hospital admission rates in the year before the intervention.

    • ↵† Calculations based on mean cumulative admissions.

    • ↵‡ Calculations based on the number of unique admissions.

    • Data from Kaczorowski et al.15

  • Table 2

    Suggested performance measures for the implementation of the recommendations on screening for high BP in adult Canadians

    PERFORMANCE INDICATORINCLUSIONTECHNICAL NOTES
    The proportion of patients aged 18 y and older in a primary care practice who have at least 1 documented BP measurement in the past 24 moInclude

    • age ≥ 18 y; and

    • patients with normal BP and those with history of elevated BP


    Exclude

    • patients with previously diagnosed hypertension

    • Links to recommendation 1

    • Evidence-based targets are not available

    • Creating targets should depend on the population being cared for, and targets might vary by age group and presence of comorbidities

    The proportion of patients aged 18 y and older with elevated BP on screening who have documentation of further assessment to determine whether the patient meets diagnostic criteria for hypertension as defined in the most current CHEP recommendations for assessment and diagnosis of hypertensionInclude

    • all patients with documented elevated BP who have not been formally diagnosed with hypertension


    Exclude

    • patients with normal BP; and

    • patients with previously diagnosed hypertension

    • Links to recommendations 2 and 3

    • Evidence-based targets are not available

    • The targets should be close to 100% for all patients, as this cohort includes only patients with elevated BP

    • The CHEP guidelines indicate that follow-up visits be scheduled for people with elevated BP to specifically measure BP; at the initial visit for the assessment of hypertension, if SBP is > 140 mm Hg or DBP is > 90 mm Hg, at least 2 more readings should be taken during the same visit using a validated device and according to the recommended procedure for accurate BP measurement

    The proportion of the population with a new diagnosis of hypertension in the past 24 moInclude

    • age ≥ 18 y; and

    • patients with normal BP and those with history of elevated BP

    Exclude

    • patients with diagnosis of hypertension made outside the designated 24-mo time frame

    • Intermediate-term outcome that links to recommendations 1 and 2

    • Current Public Health Agency of Canada surveillance data (released in 2010)31 indicated there were slightly more than 45 000 new cases of stroke in 2006–2007, and an age-standardized incidence rate of 25.8 per 1000 population for 12 mo

    • BP—blood pressure, CHEP—Canadian Hypertension Education Program, DBP—diastolic blood pressure, SBP—systolic blood pressure.

  • Table 3

    Comparison of national and international hypertension screening guidelines

    ORGANIZATIONAGERECOMMENDATION
    Current CTFPHC18 y and olderBP screening at all appropriate primary care visits
    CTFPHC 19948Adults and older adultsBP screening included in periodic health examination
    CTFPHC 1984725 y and overBP measurement during any physician visit
    CHEP 20115All adultsBP measurement at all appropriate physician visits
    USPSTF 20072118 y and olderScreen for BP every 1–2 y*
    Canadian Stroke Network 20109All adultsAll patients at risk of stroke should have their BP measured routinely, ideally at each health care encounter, but no less than once annually

    • BP—blood pressure, CHEP—Canadian Hypertension Education Program, CTFPHC—Canadian Task Force on Preventive Health Care, DBP—diastolic blood pressure, SBP—systolic blood pressure, USPSTF—US Preventive Services Task Force.

    • ↵* The interval comes from the 2000 sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,17 which recommends screening every 2 y with BP < 120/80 mm Hg and screening every year with SBP of 120–139 mm Hg or DBP of 80–90 mm Hg.

Additional Files

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools
Respond to this article
Recommendations on screening for high blood pressure in Canadian adults
Patrice Lindsay, Sarah Connor Gorber, Michel Joffres, Richard Birtwhistle, Donald McKay, Lyne Cloutier
Canadian Family Physician Sep 2013, 59 (9) 927-933;
Twitter logo Facebook logo Mendeley logo

Jump to section