The 2001 Canadian recommendations for the management of hypertension: Part two--Therapy.
OBJECTIVE
To provide updated, evidence-based recommendations for the therapy of hypertension in adults.


METHODS
For patients with hypertension, a number of antihypertensive agents may control blood pressure. Randomized trials evaluating first-line therapy with thiazides, beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, alpha-blockers, centrally acting agents or angiotensin II receptor antagonists were reviewed.


RESULTS
The health outcomes that were considered were changes in blood pressure, cardiovascular morbidity, and cardiovascular and/or all-cause mortality rates. Economic outcomes were not considered due to insufficient evidence.


METHODS
MEDLINE was searched for the period March 1999 to October 2001 to identify studies not included in the 2000 revision of the Canadian Recommendations for the Management of Hypertension. Reference lists were scanned, experts were polled, and the personal files of the subgroup members and authors were used to identify other published 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 avoidance of cardiovascular morbidity and mortality.


RESULTS
Various antihypertensive agents reduce the blood pressure of 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 treatment thresholds, target blood pressures, and choice of agents in various settings in patients with hypertension. The main changes from the 2000 Recommendations are the addition of a section on the treatment of hypertension in patients with diabetes mellitus, the amalgamation of the previous sections on treatment of hypertension in the young and old into one section, increased emphasis on the role of combination therapies over repeated trials of single agents and expansion of the section on the treatment of hypertension after stroke. Implicit in the recommendations for therapy is the principle that treatment for an individual patient should take into consideration global cardiovascular risk, the presence and/or absence of target organ damage, and comorbidities.


RESULTS
All recommendations were graded according to strength of the evidence and voted on by the Canadian Hypertension Recommendations Working Group. Individuals with potential conflicts of interest relative to any specific recommendation were excluded from voting on that recommendation. Only those recommendations achieving high levels of consensus are reported here. These guidelines will continue to be updated annually.
McAlister
Finlay A
FA
University of Alberta Hospital, Edmonton, Canada.
Zarnke
Kelly B
KB
Campbell
Norman R C
NR
Feldman
Ross D
RD
Levine
Mitchell
M
Mahon
Jeff
J
Grover
Steven A
SA
Lewanczuk
Richard
R
Leenen
Frans
F
Tobe
Sheldon
S
Lebel
Marcel
M
Stone
James
J
Schiffrin
Ernesto L
EL
Rabkin
Simon W
SW
Ogilvie
Richard I
RI
Larochelle
Pierre
P
Jones
Charlotte
C
Honos
George
G
Fodor
George
G
Burgess
Ellen
E
Hamet
Pavel
P
Herman
Robert
R
Irvine
Jane
J
Culleton
Bruce
B
Wright
James M
JM
D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002170:Canada; D002318:Cardiovascular Diseases / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic
D000959:Antihypertensive Agents