RESUMO
Hypertension Canada's 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.
Assuntos
Hipertensão/diagnóstico , Hipertensão/terapia , Adulto , Algoritmos , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Canadá , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/prevenção & controle , Criança , Complicações do Diabetes , Resistência a Medicamentos , Feminino , Promoção da Saúde , Insuficiência Cardíaca/complicações , Humanos , Hipertensão/complicações , Hipertensão/etiologia , Hipertrofia Ventricular Esquerda/complicações , Adesão à Medicação , Cuidado Pré-Concepcional , Gravidez , Complicações Cardiovasculares na Gravidez/terapia , Insuficiência Renal Crônica/complicações , Medição de Risco , Acidente Vascular Cerebral/complicações , TelemedicinaRESUMO
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
Assuntos
Determinação da Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/prevenção & controle , Hipertensão , Serviços Preventivos de Saúde/métodos , Adulto , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/classificação , Determinação da Pressão Arterial/instrumentação , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitorização Ambulatorial da Pressão Arterial/métodos , Canadá , Doenças Cardiovasculares/etiologia , Criança , Prática Clínica Baseada em Evidências , Feminino , Promoção da Saúde/métodos , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/terapia , Masculino , Medição de Risco/métodosRESUMO
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
Assuntos
Anti-Hipertensivos , Determinação da Pressão Arterial/métodos , Diuréticos , Hipertensão , Adulto , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Canadá/epidemiologia , Comorbidade , Diuréticos/classificação , Diuréticos/uso terapêutico , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Masculino , Conduta do Tratamento Medicamentoso/normas , Pessoa de Meia-Idade , Medição de Risco/métodosRESUMO
Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force provides annually updated, evidence-based recommendations to guide the diagnosis, assessment, prevention, and treatment of hypertension. This year, we present 4 new recommendations, as well as revisions to 2 previous recommendations. In the diagnosis and assessment of hypertension, automated office blood pressure, taken without patient-health provider interaction, is now recommended as the preferred method of measuring in-office blood pressure. Also, although a serum lipid panel remains part of the routine laboratory testing for patients with hypertension, fasting and nonfasting collections are now considered acceptable. For individuals with secondary hypertension arising from primary hyperaldosteronism, adrenal vein sampling is recommended for those who are candidates for potential adrenalectomy. With respect to the treatment of hypertension, a new recommendation that has been added is for increasing dietary potassium to reduce blood pressure in those who are not at high risk for hyperkalemia. Furthermore, in selected high-risk patients, intensive blood pressure reduction to a target systolic blood pressure ≤ 120 mm Hg should be considered to decrease the risk of cardiovascular events. Finally, in hypertensive individuals with uncomplicated, stable angina pectoris, either a ß-blocker or calcium channel blocker may be considered for initial therapy. The specific evidence and rationale underlying each of these recommendations are discussed. Hypertension Canada's Canadian Hypertension Education Program Guidelines Task Force will continue to provide annual updates.
Assuntos
Anti-Hipertensivos , Determinação da Pressão Arterial , Hipertensão , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/métodos , Canadá , Medicina Baseada em Evidências , Educação em Saúde , Humanos , Hiperaldosteronismo/tratamento farmacológico , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/prevenção & controle , Medição de Risco , Fatores de RiscoRESUMO
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.
Assuntos
Determinação da Pressão Arterial/normas , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Anti-Hipertensivos/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial/normas , Canadá , Educação Médica Continuada/normas , Feminino , Humanos , Hipertensão/prevenção & controle , Masculino , Medição de RiscoRESUMO
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.
Assuntos
Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/normas , Promoção da Saúde/organização & administração , Hipertensão , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Pressão Sanguínea , Canadá , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/prevenção & controle , Estilo de Vida , PrognósticoRESUMO
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2013. This year's update includes 2 new recommendations. First, among nonhypertensive or stage 1 hypertensive individuals, the use of resistance or weight training exercise does not adversely influence blood pressure (BP) (Grade D). Thus, such patients need not avoid this type of exercise for fear of increasing BP. Second, and separately, for very elderly patients with isolated systolic hypertension (age 80 years or older), the target for systolic BP should be < 150 mm Hg (Grade C) rather than < 140 mm Hg as recommended for younger patients. We also discuss 2 additional topics at length (the pharmacological treatment of mild hypertension and the possibility of a diastolic J curve in hypertensive patients with coronary artery disease). In light of several methodological limitations, a recent systematic review of 4 trials in patients with stage 1 uncomplicated hypertension did not lead to changes in management recommendations. In addition, because of a lack of prospective randomized data assessing diastolic BP thresholds in patients with coronary artery disease and hypertension, no recommendation to set a selective diastolic cut point for such patients could be affirmed. However, both of these issues will be examined on an ongoing basis, in particular as new evidence emerges.
Assuntos
Envelhecimento/fisiologia , Determinação da Pressão Arterial , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/prevenção & controle , Exercício Físico/fisiologia , Hipertensão/diagnóstico , Adulto , Anti-Hipertensivos/uso terapêutico , Canadá , Educação em Saúde , Humanos , Hipertensão/tratamento farmacológico , Medição de RiscoRESUMO
BACKGROUND AND PURPOSE: Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion. METHODS: Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008-2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided. RESULTS: Comprehensive and optimal stroke care in Canada would decrease the number of annual hospital episodes by 1062 (3.3%), the number of acute care days by 166 000 (25.9%), and the number of residential care days by 573 000 (12.8%). The number of deaths in the hospital would be reduced by 1061 (14.9%). Total avoidance of costs was estimated at $682 million annually ($307.4 million in direct costs, $374.3 million in indirect costs). CONCLUSIONS: The costs of stroke care in Canada can be substantially reduced, at the same time as improving patient outcomes, with the greater use of known effective treatment modalities.
Assuntos
Controle de Custos/métodos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/terapia , Idoso , Isquemia Encefálica/complicações , Isquemia Encefálica/economia , Isquemia Encefálica/epidemiologia , Canadá , Hemorragia Cerebral/complicações , Hemorragia Cerebral/economia , Hemorragia Cerebral/epidemiologia , Custos e Análise de Custo , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Modelos Estatísticos , Anos de Vida Ajustados por Qualidade de Vida , Sistema de Registros , Acidente Vascular Cerebral/etiologia , Resultado do TratamentoRESUMO
This article provides the scientific rationale and background information for the Canadian Hypertension Education Program's 2012 recommendations for the management of hypertension. It also summarizes the key new recommendations and the theme for 2012, which is the prevention of hypertension. The full recommendations are available at www.hypertension.ca.