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Can J Cardiol. 2015 May;31(5):549-68. doi: 10.1016/j.cjca.2015.02.016.

The 2015 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: stella.daskalopoulou@mcgill.ca.
2
Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
3
Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
4
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada.
5
Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
6
Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
7
Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada.
8
Institut de Recherches Cliniques de Montréal, Université de Montréal, Québec, Canada.
9
Department of Medicine, Université Laval, Québec, Québec, Canada.
10
Ambulatory Internal Medicine Teaching Clinic, St Catharines, Ontario, Canada.
11
Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
12
CHU-Québec-Hopital St. Sacrement, Québec, Québec, Canada.
13
University of Alberta, Edmonton, Alberta, Canada.
14
University of Toronto, Toronto, Ontario, Canada.
15
Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
16
Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
17
Department of Medicine, l'Université Laval, Québec, Québec, Canada.
18
Western University, London, Ontario, Canada.
19
Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
20
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
21
Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Québec, Canada.
22
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
23
University Health Network, University of Toronto, Toronto, Ontario, Canada.
24
Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada.
25
Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
26
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
27
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
28
Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
29
University of Calgary, Calgary, Alberta, Canada.
30
Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
31
Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
32
University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada.
33
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
34
Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Québec, Canada.
35
University of Montreal, Montreal, Québec, Canada.
36
Best Practices & Performance, Heart & Stroke Foundation, Toronto, Ontario, Canada.
37
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
38
Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
39
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada.
40
Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
41
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
42
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
43
Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Québec, Canada.
44
McMaster University, Hamilton, Ontario, Canada.
45
Institut de recherches cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada.
46
Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada.
47
University of British Columbia, Vancouver, British Columbia, Canada.
48
University Health Network, Departments of Medicine & Pharmacology, University of Toronto, Toronto, Ontario, Canada.
49
University of Manitoba, Winnipeg, Manitoba, Canada.
50
Université de Montréal and CHUM, Montréal, Québec, Canada.
51
Division of Internal Medicine, McGill University, Montréal, Québec, Canada.
52
Department of Family Medicine, Western University, London, Ontario, Canada.
53
Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
54
Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
55
Faculty of Medicine, Université Laval, Québec, Québec, Canada.
56
Department of Psychology, University of Québec at Montreal (UQAM), Montréal, Québec, Canada.
57
Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada.
58
Université de Montréal, Institut de cardiologie de Montréal, Montréal, Québec, Canada.
59
Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
60
Schulich School of Medicine & Dentistry, Western University, London, 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
Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
64
Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
65
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
66
Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Québec, Canada.
67
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

Abstract

The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.

PMID:
25936483
DOI:
10.1016/j.cjca.2015.02.016
[Indexed for MEDLINE]
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