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Can J Cardiol. 2014 May;30(5):485-501. doi: 10.1016/j.cjca.2014.02.002. Epub 2014 Feb 22.

The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.

Author information

1
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: kaberi.dasgupta@mcgill.ca.
2
Division of Nephrology, Department of Medicine, and Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
3
Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
4
Departments of Medicine, Community Health, and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
5
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada.
6
Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
7
Division of Internal Medicine, McGill University, Montréal, Québec, Canada.
8
Western University, London, Ontario, Canada.
9
Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
10
McMaster University, Hamilton, Ontario, Canada.
11
University of Calgary, Calgary, Alberta, Canada.
12
Montreal Behavioural Medicine Centre, Concordia University and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
13
University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada.
14
Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
15
Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
16
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
17
Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Québec, Canada.
18
University of Montreal, Montreal, Québec, Canada.
19
Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Québec, Canada.
20
Ambulatory Internal Medicine Teaching Clinic, St Catharines, Ontario, Canada.
21
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
22
Best Practices and Performance, Heart and Stroke Foundation, Toronto, Ontario, Canada.
23
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
24
Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
25
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada.
26
Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada.
27
Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
28
University of Toronto, Toronto, Ontario, Canada.
29
Department of Medicine, l'Université Laval, Québec, Québec, Canada.
30
University of Alberta, Edmonton, Alberta, Canada.
31
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
32
Department of Medicine, University of Calgary, Calgary, Ontario, Canada.
33
Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Québec, Canada.
34
Institut de recherches cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada.
35
Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada.
36
Southern Medical Program, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada.
37
University Health Network, Departments of Medicine and Pharmacology, University of Toronto, Toronto, Ontario, Canada.
38
University of Manitoba, Winnipeg, Manitoba, Canada.
39
Université de Montréal and CHUM, Montréal, Québec, Canada.
40
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
41
Department of Family Medicine, Western University, London, Ontario, Canada.
42
Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada.
43
Department of Medicine, Université Laval, Québec, Québec, Canada.
44
Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
45
Faculty of Medicine, Université Laval, Québec, Québec, Canada.
46
Department of Psychology, University of Québec at Montreal (UQAM), Montréal, Québec, Canada.
47
Institut de Recherches Cliniques de Montréal, Université de Montréal, Québec, Canada.
48
CHU-Québec-Hopital St Sacrement, Québec, Québec, Canada.
49
Faculté de Médicine, Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
50
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
51
Lisburn, Northern Ireland, UK.
52
Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
53
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
54
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
55
Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada.
56
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
57
Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
58
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada.
59
University Health Network, University of Toronto, Toronto, Ontario, Canada.
60
Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
61
The Canadian Stroke Network, Ottawa, Ontario, Canada.
62
Canadian Forces Health Services, Department of National Defence and Dietitians of Canada, Ottawa, Ontario, Canada.
63
Northern Ontario School of Medicine, Greater Sudbury, Ontario, and University of Toronto, Toronto, Ontario, Canada.
64
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
65
Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Québec, Canada.

Abstract

Herein, updated evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in Canadian adults are detailed. For 2014, 3 existing recommendations were modified and 2 new recommendations were added. The following recommendations were modified: (1) the recommended sodium intake threshold was changed from ≤ 1500 mg (3.75 g of salt) to approximately 2000 mg (5 g of salt) per day; (2) a pharmacotherapy treatment initiation systolic blood pressure threshold of ≥ 160 mm Hg was added in very elderly (age ≥ 80 years) patients who do not have diabetes or target organ damage (systolic blood pressure target in this population remains at < 150 mm Hg); and (3) the target population recommended to receive low-dose acetylsalicylic acid therapy for primary prevention was narrowed from all patients with controlled hypertension to only those ≥ 50 years of age. The 2 new recommendations are: (1) advice to be cautious when lowering systolic blood pressure to target levels in patients with established coronary artery disease if diastolic blood pressure is ≤ 60 mm Hg because of concerns that myocardial ischemia might be exacerbated; and (2) the addition of glycated hemoglobin (A1c) in the diagnostic work-up of patients with newly diagnosed hypertension. The rationale for these recommendation changes is discussed. In addition, emerging data on blood pressure targets in stroke patients are discussed; these data did not lead to recommendation changes at this time. The Canadian Hypertension Education Program recommendations will continue to be updated annually.

PMID:
24786438
DOI:
10.1016/j.cjca.2014.02.002
[Indexed for MEDLINE]
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