title: The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II - Therapy.
abstract: OBJECTIVE
  To provide updated, evidence-based recommendations for the management of hypertension in adults.
  
  
  METHODS
  For lifestyle and pharmacological interventions, evidence from randomized, controlled trials and systematic reviews of trials was preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. For lifestyle interventions, blood pressure (BP) lowering was accepted as a primary outcome given the lack of long-term morbidity/mortality data in this field. For treatment of patients with kidney disease, the development of proteinuria or worsening of kidney function was also accepted as a clinically relevant primary outcome.
  
  
  METHODS
  MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by content and methodological experts using prespecified levels of evidence.
  
  
  CONCLUSIONS
  Lifestyle modifications to prevent and/or treat hypertension include the following: perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 standard drinks per week in men or nine standard drinks per week in women; follow a diet that is reduced in saturated fat and cholesterol and that emphasizes fruits, vegetables and low-fat dairy products; restrict salt intake; and consider stress management in selected individuals. Treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and comorbid conditions. BP should be lowered to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease (regardless of the degree of proteinuria). Most adults with hypertension require more than one agent to achieve these target BPs. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (in nonblack patients), long-acting calcium channel blockers or angiotensin receptor antagonists. Other agents for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers or angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or in patients without albuminuria, thiazides or dihydropyridine calcium channel blockers) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy.
  
  
  RESULTS
  All recommendations were graded according to strength of the evidence and voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually.
authors.affiliation: Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: N A
authors.initials: NA
authors.lastname: Khan
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Simon W
authors.initials: SW
authors.lastname: Rabkin
authors.forename: Raj
authors.initials: R
authors.lastname: Padwal
authors.forename: Ross D
authors.initials: RD
authors.lastname: Feldman
authors.forename: Norman Rc
authors.initials: NR
authors.lastname: Campbell
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.forename: Richard Z
authors.initials: RZ
authors.lastname: Lewanczuk
authors.forename: Ernesto L
authors.initials: EL
authors.lastname: Schiffrin
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Malcolm
authors.initials: M
authors.lastname: Arnold
authors.forename: Gordon
authors.initials: G
authors.lastname: Moe
authors.forename: Tavis S
authors.initials: TS
authors.lastname: Campbell
authors.forename: Carol
authors.initials: C
authors.lastname: Herbert
authors.forename: Alain
authors.initials: A
authors.lastname: Milot
authors.forename: James A
authors.initials: JA
authors.lastname: Stone
authors.forename: Ellen
authors.initials: E
authors.lastname: Burgess
authors.forename: B
authors.initials: B
authors.lastname: Hemmelgarn
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jones
authors.forename: Pierre
authors.initials: P
authors.lastname: Larochelle
authors.forename: Richard I
authors.initials: RI
authors.lastname: Ogilvie
authors.forename: Robyn
authors.initials: R
authors.lastname: Houlden
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herman
authors.forename: Pavel
authors.initials: P
authors.lastname: Hamet
authors.forename: George
authors.initials: G
authors.lastname: Fodor
authors.forename: George
authors.initials: G
authors.lastname: Carruthers
authors.forename: Bruce
authors.initials: B
authors.lastname: Culleton
authors.forename: Jacques
authors.initials: J
authors.lastname: Dechamplain
authors.forename: George
authors.initials: G
authors.lastname: Pylypchuk
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Logan
authors.forename: Norm
authors.initials: N
authors.lastname: Gledhill
authors.forename: Robert
authors.initials: R
authors.lastname: Petrella
authors.forename: Sheldon
authors.initials: S
authors.lastname: Tobe
authors.forename: Rhian M
authors.initials: RM
authors.lastname: Touyz
mesh_terms: D026683:Advisory Committees; D000428:Alcohol Drinking; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002136:Calcium, Dietary / Q000008:administration & dosage; D002170:Canada; D002561:Cerebrovascular Disorders / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D004032:Diet; D015444:Exercise; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D017379:Hypertrophy, Left Ventricular / Q000628:therapy; D007674:Kidney Diseases / Q000628:therapy; D008019:Life Style; D008274:Magnesium / Q000008:administration & dosage; D017202:Myocardial Ischemia / Q000628:therapy; D010349:Patient Compliance; D017419:Potassium, Dietary / Q000008:administration & dosage; D012982:Sodium, Dietary / Q000008:administration & dosage; D013315:Stress, Psychological / Q000517:prevention & control; D015431:Weight Loss
chemical_list: D000959:Antihypertensive Agents; D002136:Calcium, Dietary; D017419:Potassium, Dietary; D012982:Sodium, Dietary; D008274:Magnesium