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Review
. 2008 Jun;24(6):455-63.
doi: 10.1016/s0828-282x(08)70619-6.

The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 - blood pressure measurement, diagnosis and assessment of risk

Raj S Padwal  1 , Brenda R Hemmelgarn, Nadia A Khan, Steven Grover, Finlay A McAlister, Donald W McKay, Thomas Wilson, Brian Penner, Ellen Burgess, Peter Bolli, Michael D Hill, Jeff Mahon, Martin G Myers, Carl Abbott, Ernesto L Schiffrin, George Honos, Karen Mann, Guy Tremblay, Alain Milot, Lyne Cloutier, Arun Chockalingam, Simon W Rabkin, Martin Dawes Dawes, Rhian M Touyz, Chaim Bell, Kevin D Burns, Marcel Ruzicka, Norman R C Campbell, Marcel Lebel, Sheldon W Tobe; Canadian Hypertension Education Program
Affiliations
Review

The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 - blood pressure measurement, diagnosis and assessment of risk

Raj S Padwal et al. Can J Cardiol. 2008 Jun.

Abstract
in English, French

Objective: To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.

Options and outcomes: The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, degree of blood pressure elevation, method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.

Evidence: MEDLINE searches were conducted from November 2006 to October 2007 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only.

Recommendations: Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2008 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.

Validation: All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.

VALIDATION:: All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.

OBJECTIF :: Fournir des recommandations probantes et à jour pour le diagnostic et l’évaluation des adultes atteints d’hypertension.

POSSIBILITÉS ET ISSUES :: Le diagnostic d’hypertension dépend d’une mesure pertinente de la tension artérielle, de l’évaluation opportune de lectures sérielles élevées, du taux d’élévation de la tension artérielle, du mode de mesure (en cabinet, en milieu ambulatoire, à domicile) et des comorbidités connexes. Il faut évaluer la présence de facteurs de risque cardiovasculaires et l’atteinte des organes cibles afin de déterminer le risque cardiovasculaire global ainsi que l’urgence, l’intensité et le type de traitement.

DONNÉES PROBANTES :: Des recherches dans MEDLINE ont été exécutées entre novembre 2006 et octobre 2007 avec l’aide d’un bibliothécaire médical. On a dépouillé les listes de référence, communiqué avec des experts et utilisé les dossiers personnels des auteurs et des membres des sous-groupes pour repérer d’autres études publiées. Des spécialistes du contenu et de la méthodologie ont évalué les études de manière indépendante au moyen d’algorithmes normalisés, probants et préétablis. Les recommandations sont fondées sur des données probantes tirées d’articles intégraux révisés par des pairs.

RECOMMANDATIONS :: Le présent document contient des recommandations sur la mesure de la tension artérielle, les critères de diagnostic et de suivi de l’hypertension, l’évaluation du risque cardiovasculaire global, les tests diagnostiques, le diagnostic des causes rénovasculaires et endocriniennes de l’hypertension, la surveillance ambulatoire et à domicile et le recours à l’échocardiographie chez les hypertendus. Les principaux messages pour 2008 exposent l’importance d’un diagnostic rapide et exact de l’hypertension, de l’évaluation du risque global et du besoin d’assurer une surveillance continue des patients hypertendus pour repérer les cas incidents de diabète de type 2.

VALIDATION :: Toutes les recommandations ont été classées selon la solidité des données probantes, et les 57 membres du groupe de travail des recommandations du Programme éducatif canadien sur l’hypertension ont exercé leur vote à leur égard. Toutes les recommandations publiées ont obtenu un consensus d’au moins 70 %. Ces lignes directrices continueront d’être mises à jour chaque année.

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Figures

Figure 1)
Figure 1)
The expedited assessment and diagnosis of patients with hypertension (HTN): focus on validated technologies for blood pressure (BP) assessment. *Thresholds refer to BP values averaged across the corresponding number of visits, and not just the most recent office visit. ABPM Ambulatory BP monitoring; DBP Diastolic BP; SBP Systolic BP. Reprinted with permission from the Canadian Hypertension Education Program
See this image and copyright information in PMC

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    1. Padwal RS, Hemmelgarn BR, McAlister FA, et al. for the Canadian Hypertension Education Program The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 – blood pressure measurement, diagnosis and assessment of risk. Can J Cardiol. 2007;23:529–38. - PMC - PubMed
    1. Khan NA, Hemmelgarn B, Padwal R, et al. for the Canadian Hypertension Education Program The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy. Can J Cardiol. 2007;23:539–50. - PMC - PubMed

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