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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The 2006 Canadian Hypertension Education Program recommendations for the management of hypertension: Part II - Therapy
Canadian Journal of Cardiology, Volume 22, No. 7, Year 2006
Notification
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Description
Objective: To provide updated, evidence-based recommendations for the management of hypertension in adults. Options and outcomes: For lifestyle and pharmacological interventions, evidence from randomized, controlled trials and systematic reviews of trials was preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. For lifestyle interventions, blood pressure (BP) lowering was accepted as a primary outcome given the lack of long-term morbidity/mortality data in this field. For treatment of patients with kidney disease, the development of proteinuria or worsening of kidney function was also accepted as a clinically relevant primary outcome. Evidence: MEDLINE searches were conducted from November 2004 to October 2005 to update the 2005 recommendations. In addition, reference lists were scanned and experts were contacted to identify additional published studies. All relevant articles were reviewed and appraised independently by content and methodological experts using prespecified levels of evidence. Recommendations: Lifestyle modifications to prevent and/or tr eat hypertension include the following: perform 30 min to 60 min of aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index of 18.5 kg/m2 to 24.9 kg/m2) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 standard drinks per week in men or nine standard drinks per week in women; follow a diet that is reduced in saturated fat and cholesterol and that emphasizes fruits, vegetables and low-fat dairy products; restrict salt intake; and consider stress management in selected individuals. Treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and comorbid conditions. BP should be lowered to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in those with diabetes mellitus or chronic kidney disease (regardless of the degree of proteinuria). Most adults with hypertension require more than one agent to achieve these target BPs. For adults without compelling indications for other agents, initial therapy should include thiazide diuretics. Other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), angiotensin-converting enzyme (ACE) inhibitors (in nonblack patients), long-acting calcium channel blockers or angiotensin receptor antagonists. Other agents for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine calcium channel blockers or angiotensin receptor antagonists. Certain comorbid conditions provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or in patients without albuminuria, thiazides or dihydropyridine calcium channel blockers) are appropriate first-line therapies; and in patients with nondiabetic chronic kidney disease, ACE inhibitors are recommended. All hypertensive patients should have their fasting lipids screened, and those with dyslipidemia should be treated using the thresholds, targets and agents recommended by the Canadian Hypertension Education Program Working Group on the management of dyslipidemia and the prevention of cardiovascular disease. Selected patients with hypertension, but without dyslipidemia, should also receive statin therapy and/or acetylsalicylic acid therapy. Validation: All recommenda tions were graded according to strength of the evidence and voted on by the 45 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here achieved at least 95% consensus. These guidelines will continue to be updated annually. © 2006 Pulsus Group Inc. All rights reserved.
Authors & Co-Authors
Khan, Nadia A.
Canada, Vancouver
The University of British Columbia
Canada, Vancouver
St. Paul's Hospital, Vancouver
McAlister, Finlay A.
Canada, Edmonton
University of Alberta
Rabkin, Simon W.
Canada, Vancouver
The University of British Columbia
Padwal, Raj S.
Canada, Edmonton
University of Alberta
Feldman, Ross D.
Canada, London
Robarts Research Institute
Campbell, Norm R.C.
Canada, Calgary
University of Calgary
Leiter, Lawrence Alan
Canada, Toronto
Saint Michael's Hospital University of Toronto
Lewanczuk, Richard Z.
Canada, Edmonton
University of Alberta
Schiffrin, Ernesto L.
Canada, Montreal
Institut de Recherches Cliniques de Montréal
Hill, Michael D.
Canada, Calgary
University of Calgary
Arnold, John Malcolm O.
Canada, London
Western University
Moe, Gordon W.
Canada, Toronto
Saint Michael's Hospital University of Toronto
Campbell, Tavis S.
Canada, Calgary
Cumming School of Medicine
Herbert, Carol
Canada, London
Western University
Milot, Alain
Canada, Quebec
Université Laval
Stone, James A.
Canada, Calgary
University of Calgary
Burgess, Ellen
Canada, Calgary
University of Calgary
Hemmelgarn, Brenda R.
Canada, Calgary
University of Calgary
Jones, Charlotte Ann
Canada, Calgary
University of Calgary
Larochelle, Pierre
Canada, Montreal
University of Montreal
Ogilvie, Richard Ian
Canada, Toronto
University Health Network University of Toronto
Houlden, Robyn L.
Canada, Kingston
Queen’s University
Herman, Robert J.
Canada, Calgary
University of Calgary
Hamet, Pavel
Canada, Montreal
University of Montreal
Fodor, Jiri George
Canada, Ottawa
University of Ottawa
Carruthers, George
United Arab Emirates, Al Ain
United Arab Emirates University
Culleton, Bruce F.
Canada, Calgary
University of Calgary
deChamplain, Jacques
Canada, Montreal
Institut de Recherches Cliniques de Montréal
Pylypchuk, George B.
Canada, Saskatoon
University of Saskatchewan, College of Medicine
Logan, Alexander Gordon
Canada, Toronto
University of Toronto
Gledhill, Norman O.
Canada, Toronto
York University
Petrella, Robert John
Canada, London
Western University
Tobe, Sheldon W.
Canada, Toronto
University of Toronto
Touys, Rhian M.
Canada, Montreal
Institut de Recherches Cliniques de Montréal
Statistics
Citations: 125
Authors: 34
Affiliations: 18
Identifiers
Doi:
10.1016/S0828-282X(06)70280-X
ISSN:
0828282X
Research Areas
Noncommunicable Diseases
Substance Abuse
Participants Gender
Male
Female