title: A New Algorithm for the Diagnosis of Hypertension in Canada.
abstract: Accurate blood pressure measurement is critical to properly identify and treat individuals with hypertension. In 2005, the Canadian Hypertension Education Program produced a revised algorithm to be used for the diagnosis of hypertension. Subsequent annual reviews of the literature have identified 2 major deficiencies in the current diagnostic process. First, auscultatory measurements performed in routine clinical settings have serious accuracy limitations that have not been overcome despite great efforts to educate health care professionals over several years. Thus, alternatives to auscultatory measurements should be used. Second, recent data indicate that patients with white coat hypertension must be identified earlier in the process and in a systematic manner rather than on an ad hoc or voluntary basis so they are not unnecessarily treated with antihypertensive medications. The economic and health consequences of white coat hypertension are reviewed. In this article evidence for a revised algorithm to diagnose hypertension is presented. Protocols for home blood pressure measurement and ambulatory blood pressure monitoring are reviewed. The role of automated office blood pressure measurement is updated. The revised algorithm strongly encourages the use of validated electronic digital oscillometric devices and recommends that out-of-office blood pressure measurements, ambulatory blood pressure monitoring (preferred), or home blood pressure measurement, should be performed to confirm the diagnosis of hypertension.
authors.affiliation: Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada. Electronic address: lyne.cloutier@uqtr.ca.
authors.forename: Lyne
authors.initials: L
authors.lastname: Cloutier
authors.affiliation: Divisions of General Internal Medicine and Experimental Medicine, Department of Medicine, McGill University, Montréal, Québec, Canada.
authors.forename: Stella S
authors.initials: SS
authors.lastname: Daskalopoulou
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Padwal
authors.affiliation: Institut de Recherches Cliniques de Montréal, Université de Montréal, Monréal, Québec, Canada.
authors.forename: Maxime
authors.initials: M
authors.lastname: Lamarre-Cliche
authors.affiliation: Ambulatory Internal Medicine Teaching Clinic, St Catharines, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Bolli
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Donna
authors.initials: D
authors.lastname: McLean
authors.affiliation: Department of Medicine, Université Laval, Québec, Québec, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Milot
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sheldon W
authors.initials: SW
authors.lastname: Tobe
authors.affiliation: CHU-Québec-Hopital St Sacrement, Québec, Québec, Canada.
authors.forename: Guy
authors.initials: G
authors.lastname: Tremblay
authors.affiliation: Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
authors.forename: Donald W
authors.initials: DW
authors.lastname: McKay
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Townsend
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Norm
authors.initials: N
authors.lastname: Campbell
authors.affiliation: Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Gelfer
mesh_terms: D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods / Q000592:standards; D002170:Canada; D005260:Female; D017408:Guidelines as Topic; D006266:Health Education / Q000592:standards; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D018570:Risk Assessment; D012648:Self Care / Q000379:methods / Q000592:standards
chemical_list: D000959:Antihypertensive Agents