HTN Guidelines

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The Canadian Hypertension Society updates their recommendations annually based on the evolving evidence. Whereas the recommendations are kept current, it can be difficult to keep up clinically with rapidly evolving guidelines. The CHEP (Canadian Hypertension Education Program) has a coordinated dissemination strategy for their latest recommendations that is second to none, but implementation, therapy and compliance are still sub-optimal. The 2006 Canadian Hypertension Society Recommendations were released on the CHS Website January 25, 2006.  For 2005 the CHS focuse5 on the evidence supporting expedited assessment of both the hypertension-related risk of atherosclerotic disease, as well as a more global atherosclerotic risk assessment. As well the 2005 CHS recommendations support the concept that blood pressure control supercedes putative pleiotropic effects of individual medications or classes of medications. In 2006 the focus is on expedited diagnosis of hypertension and measures to improve patient compliance and adherence. Targets are simplified with the elimination of the < 125/75 target for patients with non-diabetic chronic kidney disease.

Key CHEP messages for the management of hypertension

  • Assess blood pressure at every visit
  • Assess global cardiovascular risk in all hypertensive patients
  • Lifestyle modifications are the cornerstone of  both antihypertensive and antiatherosclerotic therapy
  • Treat to target (<140/90 mmHg; <130/80 mmHg in patients with diabetes or chronic kidney disease)
  • Combinations of drugs are usually required to achieve blood pressure targets
  • Focus on patient adherence to lifestyle modifications and antihypertensive therapy

Additional sources of hypertension guidelines include the JNC from the NHLBI . JNC 6 (2000) has been supplanted by JNC 7. The JNC 7 Express summary has been published as of May 21, 2003 in JAMA The accompanying JAMA Editorial details the worldwide CARE GAP in hypertension control. The full JNC 7 report is available on the NHLBI website.

The joint European Society of Hypertension/ European Society of Cardiology ESH/ESC Hypertension Guidelines 2003 is available for download from the ESH website.

The WHO/ISH Guidelines were reviewed in 2000 and a statement on this review has been published in the Journal of Hypertension (ref: J Hypertens. 2003 Nov;21(11):1983-1992). This review places special emphasis on public health implications and evidence-base of recommendations. The WHO has also published a document on the Integrated Management of Cardiovascular Risk that details worldwide strategies of CVD Risk Management stratified according to available technology. Visit the WHO Cardiovascular Disease website for further details.

The slideshow on this page reviews the evidence for guideline evolution and summarizes the evolution of CHS recommendations. For 2005the CHS recommendations incorporate key clinical trials evidence including:

As well as 2003 update from the BP Lowering Treatment Trialists Collaboration11

For 2006, the recommendations incorporated ASCOT-BLA12, ALLHAT diabetes subgroup13, MOSES14, VALIANT10 and SHEAF1 publications as well as a number of smaller studies, systemic reviews and the Cochrane Database.

For further information on the landmark trials visit the KEY Clinical Trials links on the Sponsors page and the accompanying HTN Clinical Trials page summarizes the major hypertension trials chronologicall

14. J Schrader et al. for the MOSES Study Group. Morbidity and Mortality after Stroke - Eprosartan Compared to Nitrendipine for Secondary Prevention. Principal Results of a Prospective Randomised Controlled Study. Stroke 2005; 36: 1218-1224. See MOSES Study homepage http://www.moses-study.com/


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