The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.
Herein, updated evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in Canadian adults are detailed. For 2014, 3 existing recommendations were modified and 2 new recommendations were added. The following recommendations were modified: (1) the recommended sodium intake threshold was changed from ≤ 1500 mg (3.75 g of salt) to approximately 2000 mg (5 g of salt) per day; (2) a pharmacotherapy treatment initiation systolic blood pressure threshold of ≥ 160 mm Hg was added in very elderly (age ≥ 80 years) patients who do not have diabetes or target organ damage (systolic blood pressure target in this population remains at < 150 mm Hg); and (3) the target population recommended to receive low-dose acetylsalicylic acid therapy for primary prevention was narrowed from all patients with controlled hypertension to only those ≥ 50 years of age. The 2 new recommendations are: (1) advice to be cautious when lowering systolic blood pressure to target levels in patients with established coronary artery disease if diastolic blood pressure is ≤ 60 mm Hg because of concerns that myocardial ischemia might be exacerbated; and (2) the addition of glycated hemoglobin (A1c) in the diagnostic work-up of patients with newly diagnosed hypertension. The rationale for these recommendation changes is discussed. In addition, emerging data on blood pressure targets in stroke patients are discussed; these data did not lead to recommendation changes at this time. The Canadian Hypertension Education Program recommendations will continue to be updated annually.
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: kaberi.dasgupta@mcgill.ca.
Kaberi
K
Dasgupta
Division of Nephrology, Department of Medicine, and Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
Robert R
RR
Quinn
Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
Kelly B
KB
Zarnke
Departments of Medicine, Community Health, and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
Doreen M
DM
Rabi
Division of Nephrology, Department of Medicine, and Department of Community Health Sciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
Pietro
P
Ravani
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada.
Stella S
SS
Daskalopoulou
Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Simon W
SW
Rabkin
Division of Internal Medicine, McGill University, Montréal, Québec, Canada.
Luc
L
Trudeau
Western University, London, Ontario, Canada.
Ross D
RD
Feldman
Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
Lyne
L
Cloutier
McMaster University, Hamilton, Ontario, Canada.
Ally
A
Prebtani
University of Calgary, Calgary, Alberta, Canada.
Robert J
RJ
Herman
Montreal Behavioural Medicine Centre, Concordia University and Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
Simon L
SL
Bacon
University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada.
Richard E
RE
Gilbert
Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Marcel
M
Ruzicka
Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
Donald W
DW
McKay
Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Tavis S
TS
Campbell
Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Québec, Canada.
Steven
S
Grover
University of Montreal, Montreal, Québec, Canada.
George
G
Honos
Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Québec, Canada.
Ernesto L
EL
Schiffrin
Ambulatory Internal Medicine Teaching Clinic, St Catharines, Ontario, Canada.
Peter
P
Bolli
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Thomas W
TW
Wilson
Best Practices and Performance, Heart and Stroke Foundation, Toronto, Ontario, Canada.
Patrice
P
Lindsay
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Michael D
MD
Hill
Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Shelagh B
SB
Coutts
Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada.
Gord
G
Gubitz
Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada.
Mark
M
Gelfer
Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
Michel
M
Vallée
University of Toronto, Toronto, Ontario, Canada.
G V Ramesh
GV
Prasad
Department of Medicine, l'Université Laval, Québec, Québec, Canada.
Marcel
M
Lebel
University of Alberta, Edmonton, Alberta, Canada.
Donna
D
McLean
Western University, London, Ontario, Canada.
J Malcolm O
JM
Arnold
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Gordon W
GW
Moe
Department of Medicine, University of Calgary, Calgary, Ontario, Canada.
Jonathan G
JG
Howlett
Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Québec, Canada.
Jean-Martin
JM
Boulanger
Institut de recherches cliniques de Montréal, Université de Montréal, Montréal, Québec, Canada.
Pierre
P
Larochelle
Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada.
Lawrence A
LA
Leiter
Southern Medical Program, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada.
Charlotte
C
Jones
University Health Network, Departments of Medicine and Pharmacology, University of Toronto, Toronto, Ontario, Canada.
Richard I
RI
Ogilvie
University of Manitoba, Winnipeg, Manitoba, Canada.
Vincent
V
Woo
Université de Montréal and CHUM, Montréal, Québec, Canada.
Janusz
J
Kaczorowski
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Kevin D
KD
Burns
Department of Family Medicine, Western University, London, Ontario, Canada.
Robert J
RJ
Petrella
Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada.
Swapnil
S
Hiremath
Department of Medicine, Université Laval, Québec, Québec, Canada.
Alain
A
Milot
Division of Cardiology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
James A
JA
Stone
Faculty of Medicine, Université Laval, Québec, Québec, Canada.
Denis
D
Drouin
Department of Psychology, University of Québec at Montreal (UQAM), Montréal, Québec, Canada.
Kim L
KL
Lavoie
Institut de Recherches Cliniques de Montréal, Université de Montréal, Québec, Canada.
Maxime
M
Lamarre-Cliche
CHU-Québec-Hopital St Sacrement, Québec, Québec, Canada.
Guy
G
Tremblay
Faculté de Médicine, Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
Pavel
P
Hamet
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
George
G
Fodor
Lisburn, Northern Ireland, UK.
S George
SG
Carruthers
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
George B
GB
Pylypchuk
Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Ellen
E
Burgess
University of Alberta, Edmonton, Alberta, Canada.
Richard
R
Lewanczuk
Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
George K
GK
Dresser
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
S Brian
SB
Penner
Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada.
Robert A
RA
Hegele
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Philip A
PA
McFarlane
Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Milan
M
Khara
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute and University of Ottawa, Ottawa, Ontario, Canada.
Andrew
A
Pipe
University Health Network, University of Toronto, Toronto, Ontario, Canada.
Paul
P
Oh
Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
Peter
P
Selby
The Canadian Stroke Network, Ottawa, Ontario, Canada.
Mukul
M
Sharma
Canadian Forces Health Services, Department of National Defence and Dietitians of Canada, Ottawa, Ontario, Canada.
Debra J
DJ
Reid
Northern Ontario School of Medicine, Greater Sudbury, Ontario, and University of Toronto, Toronto, Ontario, Canada.
Sheldon W
SW
Tobe
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Raj S
RS
Padwal
Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Québec, Canada.
Luc
L
Poirier
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000592:standards*; D002170:Canada; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D008019:Life Style; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011379:Prognosis; D015397:Program Evaluation
D000959:Antihypertensive Agents