The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.
The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada. Electronic address: stella.daskalopoulou@mcgill.ca.
Stella S
SS
Daskalopoulou
Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada.
Doreen M
DM
Rabi
Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada.
Kelly B
KB
Zarnke
Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Québec, Canada.
Kaberi
K
Dasgupta
Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
Kara
K
Nerenberg
Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
Lyne
L
Cloutier
Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada.
Mark
M
Gelfer
Institut de Recherches Cliniques de Montréal, Université de Montréal, Québec, Canada.
Maxime
M
Lamarre-Cliche
Department of Medicine, Université Laval, Québec, Québec, Canada.
Alain
A
Milot
Ambulatory Internal Medicine Teaching Clinic, St Catharines, Ontario, Canada.
Peter
P
Bolli
Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
Donald W
DW
McKay
CHU-Québec-Hopital St. Sacrement, Québec, Québec, Canada.
Guy
G
Tremblay
University of Alberta, Edmonton, Alberta, Canada.
Donna
D
McLean
University of Toronto, Toronto, Ontario, Canada.
Sheldon W
SW
Tobe
Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Marcel
M
Ruzicka
Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Kevin D
KD
Burns
Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada.
Michel
M
Vallée
University of Toronto, Toronto, Ontario, Canada.
G V
GV
Ramesh Prasad
Department of Medicine, l'Université Laval, Québec, Québec, Canada.
Marcel
M
Lebel
Western University, London, Ontario, Canada.
Ross D
RD
Feldman
Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
Peter
P
Selby
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Andrew
A
Pipe
Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Québec, Canada.
Ernesto L
EL
Schiffrin
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Philip A
PA
McFarlane
University Health Network, University of Toronto, Toronto, Ontario, Canada.
Paul
P
Oh
Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada.
Robert A
RA
Hegele
Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Milan
M
Khara
Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Thomas W
TW
Wilson
Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
S
S
Brian Penner
Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Ellen
E
Burgess
University of Calgary, Calgary, Alberta, Canada.
Robert J
RJ
Herman
Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
Simon L
SL
Bacon
Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Simon W
SW
Rabkin
University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada.
Richard E
RE
Gilbert
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
Best Practices & Performance, Heart & 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
Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
Norman R C
NR
Campbell
St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Gordon W
GW
Moe
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Jonathan G
JG
Howlett
Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Québec, Canada.
Jean-Martin
JM
Boulanger
McMaster University, Hamilton, Ontario, Canada.
Ally
A
Prebtani
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
University of British Columbia, Vancouver, British Columbia, Canada.
Charlotte
C
Jones
University Health Network, Departments of Medicine & 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
Division of Internal Medicine, McGill University, Montréal, Québec, Canada.
Luc
L
Trudeau
Department of Family Medicine, Western University, London, Ontario, Canada.
Robert J
RJ
Petrella
Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Swapnil
S
Hiremath
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
Faculté de Médicine, Université de Montréal, Montréal, Québec, Canada.
Pavel
P
Hamet
Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Québec, Canada.
George
G
Fodor
Université de Montréal, Institut de cardiologie de Montréal, Montréal, Québec, Canada.
Jean C
JC
Grégoire
Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
Anne
A
Fournier
University of Alberta, Edmonton, Alberta, Canada.
Richard
R
Lewanczuk
Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
George K
GK
Dresser
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
D
Reid
Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
Geneviève
G
Benoit
Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
Janusz
J
Feber
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Kevin C
KC
Harris
Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Québec, Canada.
Luc
L
Poirier
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Raj S
RS
Padwal
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination / Q000592:standards*; D018660:Blood Pressure Monitoring, Ambulatory / Q000592:standards; D002170:Canada; D004502:Education, Medical, Continuing / Q000592:standards; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy* / Q000517:prevention & control; D008297:Male; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000592:standards*; D018570:Risk Assessment
D000959:Antihypertensive Agents