GuidelinesHypertension Canada’s 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children
Section snippets
Methods
Hypertension Canada’s guidelines are developed annually through a highly structured and systematic process designed to minimize bias. Hypertension Canada’s guideline process has been externally reviewed and is in concordance with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument for guideline development (guidelines.hypertension.ca/about/overview-process).38 The Hypertension Canada Guidelines Committee (HCGC) is comprised of a multidisciplinary panel of content as
I. Accurate measurement of blood pressure
Background. Blood pressure (BP) is traditionally measured using an upper arm cuff, however, recent studies suggest that accurate measurement of BP can be challenging in patients with increased upper arm size, particularly in obese patients with a body mass index > 35.2, 39, 40 In these patients, there is a concern of hidden undercuffing (ie, the cuff bladder is too small or narrow for the arm size) leading to falsely elevated BP values.39 A 2016 systematic review and meta-analysis examined the
Hypertension Canada’s 2018 Guidelines: Prevention and Treatment of Hypertension in Adults
Hereafter, all BP treatment thresholds and targets refer to non-AOBP measurements performed in office (see Supplemental Table S2, section on Recommended Technique for Automated Office Blood Pressure [AOBP]), because most of the supporting evidence is derived from studies using this BP measurement method. A summary of the potential factors that should be considered when selecting specific drug therapy for individualized treatment is presented in Table 1. BP thresholds for initiation of treatment
Hypertension Canada’s 2018 Guidelines: Diagnosis and Assessment of Hypertension in Children
Background. There are no changes to these guidelines35 for 2018.
Hypertension Canada’s 2018 Guidelines: Prevention and Treatment of Hypertension in Children
There are no changes to these guidelines36 for 2018.
Summary/Future Directions
These guidelines are a summary of the best available evidence to guide clinicians in the measurement, diagnosis, and treatment of hypertension in adults and children (key similarities and differences are summarized in Table 10). The next update for Hypertension Canada’s guideline is planned for 2020 to allow for optimal dissemination of the 2018 guidelines although literature searches will be continued on an annual basis. New evidence identified as being “practice-changing” for clinicians (ie,
Implementation
Implementation and dissemination of the guidelines is a priority for Hypertension Canada. Many strategies are used to reach a variety of providers who care for patients with hypertension. Efforts include knowledge exchange forums, targeted educational materials for primary care providers and patients, “Train the Trainer” teaching sessions, as well as slide kits and summary documents, which are freely available online in French and English (www.hypertension.ca). Hypertension Canada receives
Acknowledgements
Hypertension Canada thanks Ms Angela Eady for assistance with the literature searches. We sincerely thank Ms Susan Carter for providing technical assistance with the manuscript and administrative support of the process and committee.
Funding Sources
Activities of the HCGC are supported by Hypertension Canada. The members of the HCGC are unpaid volunteers who contribute their time and expertise to the annual development and dissemination of the Hypertension Canada guidelines. To maintain professional credibility of the content, the process for the development of the guidelines is fully independent and free from external influence. External partners assist with the dissemination of the approved guidelines.
Disclosures
Please see Supplemental Appendix S2 for a complete list of disclosures.
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