GuidelinesThe 2013 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension
Section snippets
Executive Summary
Objective: To provide annually updated evidence-based recommendations for the prevention, diagnosis, assessment, and treatment of hypertension in adults for 2013.
Methods: A Cochrane Collaboration librarian conducted an independent MedLine search up to August 2012. To identify additional studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by content and methodology experts using standardized grading algorithms. For
Diagnosis and assessment
Recommendations for BP measurement, criteria for hypertension diagnosis and follow-up, diagnosis of white coat hypertension, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, ambulatory monitoring, and the use of echocardiography in hypertensive individuals are unchanged.
Prevention and treatment
New recommendations include: (1) for nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise (such as
Methods
The CHEP Recommendations Task Force is a multidisciplinary panel comprised of 2 co-chairs and 23 subgroups. Subgroup members, considered content experts in their fields, were responsible for reviewing annual search results and, if indicated, drafting new recommendations or proposing changes to old recommendations (see Supplemental Appendix S1 for the current CHEP membership list). An independent central review committee of methodology experts who had no industry affiliations separately
I. Accurate measurement of BP
Recommendations Health care professionals who have been specifically trained to measure BP accurately should assess BP in all adult patients at all appropriate visits to determine cardiovascular risk and monitor antihypertensive treatment (Grade D). Use of standardized measurement techniques (Supplemental Table S2) is recommended when assessing BP (Grade D). Automated office BP measurement (OBPM) can be used in the assessment of office BP (Grade D). When used in proper conditions, automated office SBP of ≥ 135 mm
I. Health behaviour management
Recommendations Physical exercise For nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise (such as free weight lifting, fixed-weight lifting, or handgrip exercise) does not adversely influence BP (Grade D) (new recommendation). For nonhypertensive individuals (to reduce the possibility of becoming hypertensive) or for hypertensive patients (to reduce their BP), prescribe the accumulation of 30-60 minutes of moderate intensity dynamic exercise (eg, walking,
Implementation
The implementation task force conducts an extensive knowledge translation effort to enhance uptake and applicability of these recommendations. These efforts include knowledge exchange forums, targeted educational materials for primary care providers and patients, and freely available slide kits and summary documents of all recommendations on the Canadian Hypertension Society Web site (www.hypertension.ca). Documents are available in French and English, and some documents are translated into
Future Directions
Table 1 contains a summary of pharmacological management recommendations for hypertension. The present report represents the 14th iteration of the annually updated CHEP recommendations for the management of hypertension. The Recommendations Task Force will continue to conduct systematic reviews of the clinical trial evidence and update these recommendations annually.
Acknowledgements
The authors thank Drs Lee Green, Sonia Singh, and Karen Tu for external appraisal of the manuscript, and Ms Susan Carter for expert technical assistance with the manuscript.
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See page 541 for disclosure information.
A version of the hypertension recommendations designed for patient and public education has been developed to assist health care practitioners managing hypertension. The summary is available electronically (go to http://www.hypertension.ca or http://www.heartandstroke.ca).