The 2000 Canadian recommendations for the management of hypertension: Partone - therapy

OBJECTIVE: To provide updated, evidence-based recommendations for the thera py of hypertension in adults. OPTIONS: For patients with hypertension, there are a number of lifestyle ma noeuvres and antihypertensive agents that may control blood pressure. Rando mized trials evaluating first-line therapy with thiazides, beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, calcium channel bloc kers, alpha-blockers, centrally acting agents or angiotensin II receptor an tagonists were reviewed. OUTCOMES: The health outcomes considered were changes in blood pressure, ca rdiovascular morbidity, and cardiovascular and/or all-cause mortality rates . Economic outcomes were not considered due to insufficient evidence. EVIDENCE: MEDLINE searches were conducted from the period of the last revis ion of the Canadian Recommendations for the Management of Hypertension (May 1998 to October 2000). Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to ide ntify other studies. All relevant articles were reviewed and appraised, usi ng prespecified levels of evidence, by content experts and methodological e xperts. VALUES: A high value was placed on the avoidance of cardiovascular morbidit y and mortality. BENEFITS, HARMS AND COSTS: Various lifestyle manoeuvres and antihypertensiv e agents reduce the blood pressure of patients with sustained hypertension. In certain settings, and fur specific classes of drugs, blood pressure low ering has been associated with reduced cardiovascular morbidity and/or mort ality. RECOMMENDATIONS: The present document contains detailed recommendations per taining to all aspects of the therapy of patients with hypertension, includ ing lifestyle modifications proven to, lower blood pressure, treatment thre sholds, target blood pressures, choice of agents in various settings and st rategies to, enhance adherence. Lower thresholds for blood pressure treatme nt are advocated for people with other cardiovascular risk factors or estab lished hypertensive target organ damage. implicit in the recommendations fo r therapy is the principle that treatment should be individualized for each patient and the choice of agent should be dictated by coexistent condition s. For the treatment of uncomplicated essential hypertension, thiazides, be ta-adrenergic antagonists, angiotension-converting enzyme inhibitors or cal cium channel blockers may be appropriate, depending on individual circumsta nces. VALIDATION: All recommendations were graded according to strength of the ev idence and voted on by the Canadian Hypertension Recommendations Working Gr oup. Only those recommendations achieving high levels of consensus are repo rted here. These guidelines will he updated annually.