Canadian Hypertension Guidelines 2010 - Diagnosis Assessment and Follow Up - RONAL
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Transcript of Canadian Hypertension Guidelines 2010 - Diagnosis Assessment and Follow Up - RONAL
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2010 Canadian Hypertension Education Program Recommendations1
Key CHEP messages for themanagement of hypertension
Know the current blood pressure of all your patients.
Encourage the use of approved devices and proper technique tomeasure blood pressure at home.
Assess and manage CV risk in hypertensives including: highdietary sodium intake smoking dyslipidemia dysglycemiaabdominal obesity unhealthy eating and physical inactivity.
!ustained lifestyle modification is the cornerstone for theprevention and control of hypertension and the management of
CV disease. Encourage reducing sodium intake according to"ealth Canada#s recommendations.
$reat blood pressure to %&'()*( mm"g. +n people with diabetesor chronic kidney disease target to %&,()-( mm"g and morethan one drug is usually required including diuretics to achieve/ targets.
Keep up to date with evidence and resources for hypertensionmanagement go to: www.htnupdate.ca. 0ownload the latesttools at: www.hypertension.ca)tools. "ave your patients sign upat www.my/site.ca to access the latest hypertension resourcesfor patients.
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2010 Canadian Hypertension Education Program Recommendations2
2010 Canadian HypertensionEducation Program (CHEP)
Whats Od !ut "ti #mportant$O%E &O$ HO'E 'E"$E'E*+ O& ,%OO- P$E""$E
Encourage hypertensi.e patients to use an appro.ed!ood pressure measuring de.ice and use propertechni/ue to assess !ood pressure at home
'easuring !ood pressure at home has a strongerassociation ith cardio.ascuar prognosis thanoffice !ased readings
Home measurement can confirm the diagnosis of
hypertension impro.e !ood pressure controreduce the need for medications in some detectthose ith hite coat and mas3ed hypertensionand impro.e medication adherence in non adherentpatients
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2010 Canadian Hypertension Education Program Recommendations3
2010 Canadian Hypertension EducationProgram (CHEP)
"1/E2$E3!+43 0+A534!+! A!!E!!6E3$ A30 748849;/
+. Accurate 6easurement of blood pressure
++. Criteria for the diagnosis of hypertension and followup
+++. Assessment of overall cardiovascular risk in hypertensive patients
+V. 2outine and optional laboratory tests for the investigation of patients withhypertension
V. Assessment of renovascular hypertension
V+. Endocrine hypertension
V++. "ome measurement of blood pressure
V+++. Ambulatory blood pressure measurement
+
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2010 Canadian Hypertension Education Program Recommendations4
# ccurate 'easure of ,ood Pressure1) ssess !ood pressure at a appropriate .isits
9hen should blood pressure be measured=
"ealth care professionals should know the bloodpressure of all of their patients and clients. loodpressure of all adults should be measured whenever itis appropriate using standardi>ed techniques.
$o screen for hypertension
$o assess cardiovascular risk$o monitor antihypertensive treatment
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2010 Canadian Hypertension Education Program Recommendations 5
2010 Canadian Hypertension EducationProgram (CHEP)
? Appro@imately *B of Canadians will develophypertension if they live an average lifespan
? 6ost overweight patients with high normalblood pressure &,(&,*)--* mm"gDdevelop hypertension within ' years andalmost &) within years. Annual followupof patients with high normal blood pressure is
recommended.
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2010 Canadian Hypertension Education Program Recommendations 6
What percent of Canadians ha.ehypertension4
CCHS CMAJ 1992
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2010 Canadian Hypertension Education Program Recommendations 7
%ife time ris3 of Hypertension in *ormotensi.e Women and'en aged 56 years
Risk of Hypertension %
0 2 4 6 8 10 12 14 16 18 20
Years to Follow-up
Women
Risk of Hypertension %
Years to Follow-up
0 2 4 6 8 10 12 14 16 18 20
Men
JAMA 2002: Framingham data.
100
80
60
40
20
0
100
80
60
40
20
0
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2010 Canadian Hypertension Education Program Recommendations 8
$e.ersi!e ris3s for de.eoping hypertension
4besity
/oor dietary habits
"igh sodium intake
!edentary lifestyle
"igh alcohol consumption
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2010 Canadian Hypertension Education Program Recommendations 9
#ncidence of hypertension in those identified ith highnorma !ood pressure
FF subGects mean age '-.
3ot receiving treatment for "ypertension
Average of , blood pressures at baseline:
!/ &,(&,* and 0/ % -* 42!/ % &,* and 0/ --*
/rimary endpoint H new onset "ypertension
Iulius !. 3EI6 ((J,':&J-*F
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2010 Canadian Hypertension Education Program Recommendations 10
*e onset hypertension in peope ith high norma!ood pressure
Iulius !. 3EI6 ((J,':&J-*F
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2010 Canadian Hypertension Education Program Recommendations 11
-e.eopment of hypertension in those ith highnorma !ood pressure
&ramingham cohort Vasan. 8ancet ((&
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2010 Canadian Hypertension Education Program Recommendations 12
High ris3 of de.eoping hypertension in those ith highnorma !ood pressure
Annual followup of patients with high normalblood pressure is recommended.
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2010 Canadian Hypertension Education Program Recommendations 13
ccurate 'easurement of ,ood Pressure
Automated office blood pressure measurementscan be used in the assessment of office bloodpressureL.
9hen used under proper conditions automatedoffice !/ of &, mm"g or higher or 0/ values of- mm"g or higher should be consideredanalogous to mean awake ambulatory !/ of &,mm"g or higher or 0/ of - mm"g or higherL.
Lsee notes
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2010 Canadian Hypertension Education Program Recommendations 14
se of standardi7ed measurement techni/ues isrecommended hen assessing !ood pressure
9hen using automated office oscillometricdevices such as the p$2; the patient shouldbe seated in a quiet room alone. 9ith the
device set to take measures at & or minuteintervals the first measurement is taken by ahealth professional to verify cuff position andvalidity of the measurement. $he patient isleft alone after the first measurement while
the device automatically takes subsequentreadings.
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2010 Canadian Hypertension Education Program Recommendations 15
## Criteria for the diagnosis of hypertension andrecommendations for foo8up
,P9 1:081;< =
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2010 Canadian Hypertension Education Program Recommendations 16
## Criteria for the diagnosis of hypertension andrecommendations for foo8up
Hypertension ?isit 1,P 'easurement
History and Physicae@amination
Hypertension ?isit 1,P 'easurement
History and Physicae@amination
Hypertension ?isit 2ithin 1 month
>es
,P A1:0=
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2010 Canadian Hypertension Education Program Recommendations 17
## Criteria for the diagnosis of hypertension andrecommendations for foo8up
,P9 1:081;< =
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2010 Canadian Hypertension Education Program Recommendations 18
## Criteria for the diagnosis of hypertension andrecommendations for foo8up
L Consider "ome blood pressuremeasurement in hypertensionmanagement to assess for thepresence of masked hypertension orwhite coat effect and to enhanceadherence.
!ymptoms !everehypertension +ntolerance
to antihypertensivetreatment or $arget 4rgan
0amage
Are / readings below target during consecutive visits=
3on /harmacological treatment
9ith or without /harmacological treatment
-iagnosis of hypertension
7ollowup at ,Jmonth intervals L
*o>es
>es
'ore fre/uent.isits
?isits e.ery 1to 2 months
*o
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2010 Canadian Hypertension Education Program Recommendations 19
+he concept of mas3ed hypertension
Office SBP mmHg
HomeorDaytim
eABPM
SBPmmH
g
True
hypertensive
True
Normotensive White Coat HTN
Maske HTN
!"#
!$%
!"#
!$%
Derived from Pickering et al. Hypertension 2002: 40: 795-7
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2010 Canadian Hypertension Education Program Recommendations 20
+he prognosisof mas3ed hypertension
I "ypertension ((F:&*,*-
/revalence of masked hypertension is appro@imately &(B in the general population but ishigher in patients with diabetes
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2010 Canadian Hypertension Education Program Recommendations 21
"earch for target organ damage
Cere!ro.ascuar disease transient ischemic attacks
ischemic or hemorrhagic stroke
vascular dementia
Hypertensi.e retinopathy
%eft .entricuar dysfunction
%eft .entricuar hypertrophy
Coronary artery disease
myocardial infarction
angina pectoris
congestive heart failure
Chronic 3idney disease
hypertensive nephropathy 572 % J(
ml)min)&.F, mD albuminuria
Periphera artery disease
intermittent claudication
ankle brachial inde@ % (.*
### ssessment of the o.era cardio.ascuar ris3
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2010 Canadian Hypertension Education Program Recommendations 22
"earch for e@ogenous potentiay modifia!e factors thatcan induce=aggra.ate hypertension
Prescription -rugs9 3!A+0s including co@ibs Corticosteroids and anabolic steroids 4ral contraceptive and se@ hormones Vasoconstricting)sympathomimetic decongestants Calcineurin inhibitors cyclosporin tacrolimusD Erythropoietin and analogues Antidepressants: 6onoamine o@idase inhibitors 6A4+sD
!32+s !!2+s 6idodrine
Other9 8icorice root !timulants including cocaine !alt E@cessive alcohol use
### ssessment of the o.era cardio.ascuar ris3
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4ver *(B of hypertensive Canadians have othercardiovascular risks
Assess and manage hypertensive patients fordyslipidemia dysglycemia e.g. impaired fastingglucose diabetesD abdominal obesity unhealthy
eating and physical inactivity
### ssessment of the o.era cardio.ascuar ris3
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2010 Canadian Hypertension Education Program Recommendations 24
+reat Hypertension in the Conte@t of O.eraCardio.ascuar $is3
&. 4verall cardiovascular risk should be assessed. +nhypertensive patients consider using calculations thatinclude cerebrovascular events
. +n the absence of Canadian data to determine the accuracyof risk calculations avoid using absolute levels of risk tosupport treatment decisions at specific risk thresholds.
Simply counting risk factors may underestimate risk
### ssessment of the o.era cardio.ascuar ris3
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Cardio.ascuar $is3 &actors
Presence of $is3 &actors +ncreasing age
6ale gender !moking 7amily history of premature cardiovascular disease age% in men and
% J in womenD 0yslipidemia !edentary lifestyle
;nhealthy eating Abdominal obesity 0ysglycemia diabetes impaired glucose tolerance impaired fasting
glucoseDPresence of +arget Organ -amage 6icroalbuminuria or proteinuria 8eft ventricular hypertrophy
Chronic kidney disease glomerular filtration rate % J( ml)min)&.F, mDPresence of atheroscerotic .ascuar disease /revious stroke or $+A Coronary "eart 0isease /eripheral arterial disease
CV Risk Factors tat may a!ter treso!"s an" tar#ets in te treatment of H$
### ssessment of the o.era cardio.ascuar ris3
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2010 Canadian Hypertension Education Program Recommendations 26
'ethods of $is3 ssessment
Clinical impression
2isk factor counting
2isk calculation or equation tools
7ramingham hard coronary heart disease C"0D
http:))hp(&(.nhlbihin.net)atpiii)calculator.asp=usertypeNprof
!C42E Canada H !ystematic Cerebrovascular and Coronary2isk Evaluation
www.scorecanada.ca
Cardiovascular Age$6
www.myhealthcheckup.com
4thers: see notes
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2010 Canadian Hypertension Education Program Recommendations 27
"CO$E 10 year &ata Cardio.ascuar$is3 E.auation in Canada
* Systematic Coronary Risk Evaluation
Find the cell nearest to the persons
risk factors values :
Age
Se
S!oking Status
S"stolic #lood $ressure%otal&Chol' ( H)*&C' +atio
SC,+- Canada : S"ste!aticCere.rovascular and c,ronar"
+isk -valuation
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SystolicBP
Total Cholesterol (mmol/L)
SmokerNon smoker
"CO$E Canada9 $eati.e $is3 E.auationfor use in those ess than :0 years od
/ nti!es risk
at sa!e age
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2010 Canadian Hypertension Education Program Recommendations 29
&actors to ta3e into account using "CO$ECanada to estimate ris3 of &ata C?-
/erson approaching ne@t age category
/reclinical evidence of atherosclerosis imaging testD
!trong family history of premature CV0: 6ultiply risk by &.'
4besity 6+ M ,( kg)m 9aist circumference M &( cm menD
and M -- cm womanD
!edentary lifestyle
0iabetes: multiply risk by for men and by ' for women
2aised serum triglycerides level
2aised level of Creactive prot. 7ibrinogen "omocysteine
Apolipoprotein or 8paD
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#? $outine %a!oratory +ests
Preiminary #n.estigations of patients ith hypertension
&. ;rinalysis
. lood chemistry potassium sodium and creatinineD
,. 7asting glucose'. 7asting total cholesterol and high density lipoproteincholesterol "08D low density lipoprotein cholesterol 808Dtriglycerides
. !tandard &leads EC5
Currently there is insufficient evidence to recommendroutine testing of microalbuminuria in people withhypertension who do not have diabetes
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#? $outine %a!oratory +ests
&oo8up in.estigations of patients ith hypertension
0uring the maintenance phase of hypertension managementtests including electrolytes creatinine glucose and fasting
lipidsD should be repeated with a frequency reflecting the clinicalsituation.
0iabetes develops in &,B)year of those with drug treated
hypertension. $he risk is higher in those treated with a diureticor beta blocker in the obese sedentary with higher fastingglucose and who have unhealthy eating patterns. Assess fordiabetes more frequently in these patients.
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#? Optiona %a!oratory +ests
#n.estigation in specific patient su!groups
? 7or those with diabetes or chronic kidney disease: assessurinary albumin e@cretion since therapeutic
recommendations differ if proteinuria is present.? 7or those suspected of having an endocrine cause for the
high blood pressure or renovascular hypertension seefollowing slides.
? 4ther secondary forms of hypertension require specifictesting.
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!norma rinary !umin e.es
!etting ;rinary albumin: creatinine
level mg)mmolD
6en 9omen
Chronickidney
0isease
M,(
0iabetes M M.-
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? "creening for $eno.ascuar Hypertension
/atients presenting with two or more of the following
clinical clues listed below suggesting renovascularhypertension should be investigated.
iD sudden onset or worsening of hypertension and Mage or % age ,(
iiD the presence of an abdominal bruit
iiiD hypertension resistant to , or more drugsivDa rise in creatinine of ,(B or more associated with
use of an angiotensin converting en>yme inhibitor orangiotensin ++ receptor blocker
vD other atherosclerotic vascular disease particularly in
patients who smoke or have dyslipidemiaviDrecurrent pulmonary edema associated with
hypertensive surges
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? "creening for $eno.ascuar Hypertension
$he following tests are recommended when
available to screen for renal vascular disease:
captoprilenhanced radioisotope renal scanL
doppler sonography
magnetic resonance angiography
C$angiography for those with normal renalfunction
L captoprilenhanced radioisotope renal scan is notrecommended for those with glomerular filtration
rates %J( m8)minD
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?# "creening for Hyperadosteronism
!pontaneous hypokalemia %,. mmol)8D.
/rofound diureticinduced hypokalemia %,.(mmol)8D.
"ypertension refractory to treatment with , or moredrugs.
+ncidental adrenal adenomas.
!hould be considered for patients with thefollowing characteristics:
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?# "creening for hyperadosteronism
"creening for hyperadosteronism shoud incudepasma adosterone and renin acti.ity (or reninconcentration)
measured in morning samples.
taken from patients in a sitting position after
resting at least & minutes.
Aldosterone antagonists A2s betablockers andclonidine should be discontinued prior to testing.
A positive screening test should lead to referral or
further testing.
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?# $enin dosterone and $atioCon.ersion factors
+o
estimate9, &rom9
'utipy (,)
!y9
Renin
Concentration(ng/mL)
Plasma Renin
Actiit!(ng/mL/"r) 0#206
Plasma ReninActiit!(g/L/sec)
Plasma ReninActiit!(ng/mL/"r)
0#278
Al$osteroneconcentration(%mol/L)
Al$osteroneconcentration(ng/$L)
28
?# "creening for Pheochromocytoma
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?# "creening for Pheochromocytoma
/aro@ysmal and)or severe sustained hypertension refractoryto usual antihypertensive therapy
"ypertension and symptoms suggestive of catecholamine
e@cess two or more of headaches palpitations sweatingetcD
"ypertension triggered by betablockers monoamineo@idase inhibitors micturition or changes in abdominalpressure
+ncidentally discovered adrenal mass 6ultiple endocrine neoplasia 6E3D A or von
2ecklinghausenOs neurofibromatosis or von "ippel8indaudisease.
"houd !e considered for patients ith thefooing characteristics9
?# "creening for Pheochromocytoma
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?# "creening for Pheochromocytoma
!creening for pheochromocytoma should include a 'hour urine for metanephrines and creatinine.
Assessment of urinary V6A is inade/uate.
A normal plasma metanephrine level can be used to
e@clude pheochromocytoma in low risk patients butthe test is performed by few laboratories.
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?## Home measurement of !ood pressure
ncompicated hypertension "uspected non adherence Office8induced !ood pressure ee.ation (hite coat
effect)
'as3ed hypertension
Whichpatients4
Average / M &,)- mm "g should be considered elevated
Home ,P measurement shoud !e encouraged to
increase patient in.o.ement in care
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Potentia ad.antages of home !oodpressure measurement
6ore rapid confirmation of the diagnosis ofhypertension
+mproved ability to predict cardiovascular prognosis +mproved blood pressure control
Can be used to assess patients for white coathypertension 9C"D and masked hypertension
2educed medication use in some 9C"D +mproved adherence to drug therapy
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*ot a patients are suited to homemeasurement
;ndue an@iety in response to high blood pressurereadings
/hysical or mental disability prevents accuratetechnique or recording
Arm not suited to blood pressure cuff e.g. conical
shaped armD +rregular pulse or arrhythmias prevent accurate
readings
8ack of interest
'ost patients can !e trained to measure !ood pressure
Periodic reassessment of techni/ue and retraining is desira!e
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?## "uggested Protoco for Home 'easurement of,ood Pressure for the diagnosis of hypertension
"ome blood pressure values should be based on: duplicate measures morning and evening for an initial Fday period.
7irst day home / values should not be considered.
$he following si@ days blood pressure readings should beaveraged
Average / equal to or over &,)-mm"g should be considered elevated.
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$ecommended eectronic !ood pressure monitors for home!ood pressure measurement
8'onitors that ha.e !een .aidated as accurate and
a.aia!e in Canada are isted at hypertensionca=chs
in the Fde.ice endorsements section
8+he !o@es containing the de.ice are aso !e mar3ed ith
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?## Home 'easurement of ,P9 Patient Education
ssist patients seect a mode ith thecorrect si7e of cuff
'easure and record the patients mid armcircumference so they can match it to cuffsi7e
$ecommend de.ices isted athypertensionca or mar3ed ith thissym!o
s3 patients to carefuy foo theinstructions ith de.ice and to recordony those !ood pressures here theyha.e fooed recommended procedure
d.ise patients that a.erage readings e/uato or o.er 16=B6 mmHg are high
#n patients ith dia!etes or chronic 3idneydisease oer therapeutic targets anddiagnostic criteria are i3ey re/uired
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We! !ased home monitoring
We!site resources are a.aia!eheartandstro3eca=!p
#ndi.iduai7ed automatedcounseing and trac3ing to assistpatients home monitor and to
enhance sef management ofifestye
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2010 Canadian Hypertension Education Program Recommendations 482010 Canadian Hypertension Education Program Recommendations
'ore resources for home monitoring
hypertensionca=!pc
#nformation to assist you in training patients tomeasure !ood pressure at home ,rief action too for Heath Care professionas
under resources in the Education toos for heathcare professionas section
#nformation for patients on ho to purchase a de.icefor home measurement and ho to measure !oodpressure at home %earn ho to measure your !ood pressure at
homeand Home measurement of !ood pressureunder resources in the Education toos for heathcare professionas section)
training -?- on home measurement of !oodpressure is a.aia!e for donoad athypertensionca
d i f i h h h
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2010 Canadian Hypertension Education Program Recommendations 49
d.ice for patients on hen to contact a heath careprofessiona !ased on high a.erage home !ood pressure
readings
Systolic BP (mmHg) Diastolic BP reading
Less than 13 Less than !" #s$al %ollo&'$
13'1*+ !"'1*+ Check reading again $sing the correct techni,$e- .%the readings remain high disc$ss &ith yo$rhealthcare ro0ider at yo$r net reg$larlysched$led aointment
1! 2 1**+ 11'11* Check reading again $sing the correct techni,$e- .%the readings remain high sched$le anaointment &ith yo$r doctor to disc$ss yo$rtreatment lan-
ore than 4+ ore than 14 Check reading again $sing the correct techni,$e- .%the readings remain high sched$le an $rgentaointment &ith yo$r doctor to disc$ss yo$rtreatment lan-
( resource a.aia!e at hypertensionca in the 'inuteHypertension ction +oo or heartandstro3eca=,P)
L/atients with diabetes chronic kidney disease or who are at high
risk of cardiovascular events require individuali>ed advice.
H t - i it i ht
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Home measurement9 -oing it right
EP;+/6E3$
Validated device
8ook for the logo or go towww.hypertenion.ca for a list
of validated devices available inCanada
Ensure the cuff si>e is appropriate
Ensure the device is accurate inthe patient at purchase and
annually
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Home measurement9 -oing it right
/2E/A2A$+43
042ead and carefully follow the
instructions provided with thedevice
2ela@ in a comfortable chair with backsupport for minutes
!it quietly without talking ordistractions e.g. $VD
043O$6easure if stressed cold in pain or if
your bowel or bladder are
uncomfortable6easure within & hour of heavyphysical activity
6easure within ,( minutes of smokingor drinking coffee
Home measurement9 -oing it right
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Home measurement9 -oing it right
/2E/A2A$+4304/ut the cuff on a bare arm or
one with a light sleeve!upport the arm on a table so
it is at heart level
2ecord two readings in themorning and evening dailyfor seven days discardingthe first days readingsD tohelp diagnose hypertension
6easure and record your blood
pressure as aboveD forseveral days before anappointment with a healthcare professional
H t - i it i ht
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Home measurement9 -oing it right
/osters and handouts
providing recommendationsto patients on how tomeasure blood pressure canbe found atwww.hypertension.ca
8earn how to measure yourblood pressure at home and"ome measurement of bloodpressure in the Educationtools for health careprofessionals sectionD
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2010 Canadian Hypertension Education Program Recommendations 54
?## Home 'easurement of ,P9 Confirm contradictoryhome measurement readings
+f office / measurementis elevated and home /is normal or vice versa
Consider further assessusing 'h ambulatoryblood pressure monitoring
?### m!uatory ,P 'onitoring9
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2010 Canadian Hypertension Education Program Recommendations 55
?### m!uatory ,P 'onitoring9
ntreated 6ild 5rade &D to moderate 5rade D clinic / elevation and
without target organ damage.
+reated patients
lood pressure that is not below target values despite
receiving appropriate antihypertensive therapy. !ymptoms suggestive of hypotension.
7luctuating office blood pressure readings.
Which patients4
eyond the diagnosis of hypertension A/6 measurementmay also be considered for selected patients for the
management of "$3
?### ! t ,P ' i i
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2010 Canadian Hypertension Education Program Recommendations 56
?### m!uatory,P 'onitoring
A drop in nocturnal / of %&(B is associated with increased risk of CVevents
se .aidated de.ices
Ho to interpret46ean daytime ambulatory !ood pressure A16=B6 mmHgis considered elevated.6ean ' h ambulatory !ood pressure A10=B0 mmHgis considered elevated.
Ho to 4
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2010 Canadian Hypertension Education Program Recommendations 57
-escription ,ood Pressure mmHg
"ome pressure average &, ) -
0aytime average A/ &, ) -
'hour average A/ &,( ) -(
A clinic blood pressure of &'()*( mm"g
has a similar risk of a:
Cinic Home m!uatory (,P) ,ood Pressure'easurement E/ui.aence *um!ers
&oo p gorithm &or High ,ood Pressure
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2010 Canadian Hypertension Education Program Recommendations 58
&oo p gorithm &or High ,ood Pressuresing m!uatory ,ood Pressure 'easurement
2:8h ,P'2:8h ,P'
Consistent ith H+*
a3e ,PA&, !/ or
A- 0/
or2:8hour
A&,( !/ orA-( 0/
a3e ,PA&, !/ or
A- 0/
or2:8hour
A&,( !/ orA-( 0/
a3e ,P% &,)-
and
2:8hour% &,()-(
a3e ,P% &,)-
and
2:8hour% &,()-(
Continueto foo8up
/atients with high normal blood pressure should be followed annually.
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2010 Canadian Hypertension Education Program Recommendations 59
&oo p gorithm &or High ,ood Pressure singm!uatory ,ood Pressure 'easurement
,('(B of patients with white coat hypertensiondiagnosed based on a single A/6 session will havetrue hypertension on retesting.
!ome patients with white coat hypertension developsustained hypertension.
/atients with white coat hypertension may befollowed with home / measurement or repeat A/6could be considered every & years
#G +he $oe of Echocardiography
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#G +he $oe of Echocardiography
Echocardiography is not usefu for routinee.auation of hypertensi.e patients
Echocardiography is usefu for9ssessment of eft .entricuar dysfunction and thepresence of eft .entricuar hypertrophy
Key CHEP messages for the
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y gmanagement of hypertension
Know the current blood pressure of all your patients. Encourage people with hypertension to use approved devices and
proper technique to measure blood pressure at home. Assess and manage cardiovascular risk in all people with
hypertension: high dietary sodium smoking dyslipidemiadysglycemia abdominal obesity unhealthy eating and physicalinactivity.
!ustained lifestyle modification is the cornerstone for the preventionand control of hypertension and the management of cardiovascular
disease. Encourage patients to reduce their intake according to"ealth Canada recommendations.
$reat blood pressure to %&'()*( mm"g in most people and to%&,()-( mm"g in people with diabetes or chronic kidney disease.6ore than one drug is usually required. 6an people with diabetesor chronic kidney disease require three or more antihypertensivedrugs including diuretics to achieve blood pressure targets.
$o keep up to date with the latest evidence and resources for theprevention and control of hypertension go to: www."t3update.ca.0ownload current resources at: www.hypertension.ca)tools. +n(&( look for an interactive casebased internet lecture seriesfeaturing top Canadian hypertension e@perts. "ave your patientssign up at www.my/site.ca to access the latest hypertensionresources