1999 Canadian recommendations for the management of hypertension

Objective: To provide updated, evidence-based recommendations for health ca re professionals on the management of hypertension in adults. Options: For patients with hypertension, there are both lifestyle options a nd pharmacological therapy options that may control blood pressure. For tho se patients who are using pharmacological therapy, a range of antihypertens ive drugs is available. The choice of a specific antihypertensive drug is d ependent upon the severity of the hypertension and the presence of other ca rdiovascular risk factors and concurrent diseases. Outcomes: The health outcomes considered were changes in blood pressure and in morbidity and mortality rates. Because of insufficient evidence, no eco nomic outcomes were considered. Evidence: MEDLINE searches were conducted from the period of the last revis ion of the Canadian Recommendations for the Management of Hypertension (Jan uary 1993 to May 1998). Reference lists were scanned, experts were polled a nd the personal files of the authors were used to identify other studies. A ll relevant articles were reviewed, classified according to study design an d graded according to levels of evidence. Values: A high value was placed on the avoidance of cardiovascular morbidit y and premature death caused by untreated hypertension. Benefits, harms and costs: The diagnosis and treatment of hypertension with pharmacological therapy will reduce the blood pressure of patients with su stained hypertension. In certain settings, and for specific drugs, blood pr essure lowering has been associated with reduced cardiovascular morbidity a nd mortality. Recommendations: This document contains detailed recommendations pertaining to all aspects of the diagnosis and pharmacological therapy of hypertensiv e patients. With respect to diagnosis, the recommendations endorse the grea ter use of non-office-based measures of blood pressure control (i.e., using home blood pressure and automatic ambulatory blood pressure monitoring equ ipment) and greater emphasis on the identification of other cardiovascular risk factors, both in the assessment of prognosis in hypertension and in th e choice of therapy. On the treatment side, lower targets for blood pressur e control are advocated for some subgroups of hypertensive patients, in par ticular, those with diabetes and renal disease. Implicit in the recommendat ions for therapy is the principle that for the vast majority of hypertensiv e patients treated pharmacologically, practitioners should not follow a ste pped-care approach. Instead, therapy should be individualized, based on con sideration of concurrent diseases, both cardiovascular and noncardiovascula r. Validation: All recommendations were graded according to the strength of th e evidence and the consensus of all relevant stakeholders. Sponsors: The Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control.