The 2000 Canadian recommendations for the management of hypertension: part two--diagnosis and assessment of people with high blood pressure.
OBJECTIVE
To provide updated, evidence-based recommendations for the diagnosis and assessment of high blood pressure in adults.


METHODS
For people with high blood pressure, the assignment of a diagnosis of hypertension depends on the appropriate measurement of blood pressure, the level of the blood pressure elevation, the duration of follow-up and the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases. For people diagnosed with hypertension, defining the overall risk of adverse cardiovascular outcomes requires laboratory testing, a search for target organ damage and an assessment of the modifiable causes of hypertension. Out-of-clinic blood pressure assessment and echocardiography are options for selected patients.


RESULTS
People at increased risk of adverse cardiovascular outcomes and were identified and quantified.


METHODS
Medline searches were conducted from the period of the last revision 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 identify other studies. All relevant articles were reviewed and appraised, using prespecified levels of evidence, by content experts and methodological experts.


METHODS
A high value was placed on the identification of people at increased risk of cardiovascular morbidity and mortality.


RESULTS
The identification of people at higher risk of cardiovascular disease will permit counselling for lifestyle manoeuvres and the introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. In certain settings, and for specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.


CONCLUSIONS
The present document contains detailed recommendations pertaining to aspects of the diagnosis and assessment of patients with hypertension, including the accurate measurement of blood pressure, criteria for the diagnosis of hypertension and recommendations for follow-up, routine and optional laboratory testing, assessment for renovascular hypertension, home and ambulatory blood pressure monitoring, and the role of echocardiography in hypertension.


RESULTS
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Only the recommendations achieving high levels of consensus are reported here. These guidelines will be updated annually.


BACKGROUND
These recommendations are endorsed by the Canadian Hypertension Society, The Canadian Coalition for High Blood Pressure Prevention and Control, The College of Family Physicians of Canada, The Heart and Stroke Foundation of Canada, The Adult Disease Division and Bureau of Cardio-Respiratory Diseases and Diabetes at the Centre for Chronic Disease Prevention and Control of Health Canada.
Zarnke
K B
KB
Department of Medicine, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada. Kelly.Zarnke@lhsc.on.ca
Levine
M
M
McAlister
F A
FA
Campbell
N R
NR
Myers
M G
MG
McKay
D W
DW
Bolli
P
P
Honos
G
G
Lebel
M
M
Mann
K
K
Wilson
T W
TW
Abbott
C
C
Tobe
S
S
Burgess
E
E
Rabkin
S
S
D000310:Adrenal Gland Neoplasms / Q000150:complications; D000328:Adult; D001795:Blood Pressure Determination / Q000379:methods / Q000523:psychology / Q000592:standards*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000592:standards; D002170:Canada; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control*; D019411:Clinical Laboratory Techniques / Q000592:standards; D048909:Diabetes Complications; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis; D004452:Echocardiography / Q000592:standards; D004562:Electrocardiography; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D006978:Hypertension, Renovascular / Q000175:diagnosis; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D009819:Office Visits; D010349:Patient Compliance; D010673:Pheochromocytoma / Q000150:complications / Q000175:diagnosis; D012307:Risk Factors; D012648:Self Care / Q000379:methods / Q000592:standards