The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1 - blood pressure measurement, diagnosis and assessment of risk.
OBJECTIVE
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.


METHODS
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, degree of blood pressure elevation, method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.


METHODS
MEDLINE searches were conducted from November 2006 to October 2007 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only.


CONCLUSIONS
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2008 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.


RESULTS
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.
Padwal
Raj S
RS
Division of General Internal Medicine, University of Alberta, Edmonton, Canada. rpadwal@ualberta.ca
Hemmelgarn
Brenda R
BR
Khan
Nadia A
NA
Grover
Steven
S
McAlister
Finlay A
FA
McKay
Donald W
DW
Wilson
Thomas
T
Penner
Brian
B
Burgess
Ellen
E
Bolli
Peter
P
Hill
Michael D
MD
Mahon
Jeff
J
Myers
Martin G
MG
Abbott
Carl
C
Schiffrin
Ernesto L
EL
Honos
George
G
Mann
Karen
K
Tremblay
Guy
G
Milot
Alain
A
Cloutier
Lyne
L
Chockalingam
Arun
A
Rabkin
Simon W
SW
Dawes
Martin Dawes
MD
Touyz
Rhian M
RM
Bell
Chaim
C
Burns
Kevin D
KD
Ruzicka
Marcel
M
Campbell
Norman R C
NR
Lebel
Marcel
M
Tobe
Sheldon W
SW
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000592:standards*; D002170:Canada; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000639:trends*; D018570:Risk Assessment / Q000379:methods*
D000959:Antihypertensive Agents