1 Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: aacleung@ucalgary.ca.
2 Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada.
3 Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
4 Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.
5 Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
6 Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
7 Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
8 Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
9 Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
10 Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada.
11 Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada.
12 Department of Medicine, Université Laval, Québec, Quebec, Canada.
13 McMaster University, Hamilton, Ontario, Canada.
14 CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada.
15 University of Alberta, Edmonton, Alberta, Canada.
16 University of Toronto, Toronto, Ontario, Canada.
17 Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
18 Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada.
19 Department of Medicine, Division of Clinical Pharmacology, Western University, London, Ontario, Canada.
20 Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador.
21 Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
22 University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
23 Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
24 Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
25 University Health Network, University of Toronto, Toronto, Ontario, Canada.
26 Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada.
27 Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
28 Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
29 Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
30 Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
31 Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Mont

Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults.

Can J Cardiol. 2017 05;33(5):557-576

Authors: Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tran KC, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Gryn SE, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Sivapalan P, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Kline G, Leiter LA, Jones C, Côté AM, Woo V, Kaczorowski J, Trudeau L, Tsuyuki RT, Hiremath S, Drouin D, Lavoie KL, Hamet P, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM, Hypertension Canada

Abstract

Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings = 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to = 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.

PMID: 28449828 [PubMed - indexed for MEDLINE]