The Bad News About Prevalence, the Good News About Treatments -- But Pay Attention to the Details

Linda Brookes, MSc


February 14, 2005

In This Article

More Guidelines -- Canadians Call for Quicker Diagnosis, Faster Treatment for High Blood Pressure

The latest Canadian hypertension guidelines, released January 14,[16] call for physicians to diagnose hypertension within days or weeks rather than over months, so that patients with hypertension get their blood pressure under control quicker, to the benefit of their future heart health. The new guidelines have been devised by the Canadian Hypertension Education Program (CHEP), an expert panel that annually reviews new scientific literature on hypertension and revises recommendations to physicians as needed. Between 4 and 5 million Canadians are believed to have hypertension. Studies suggest as many as 40% are unaware of their condition, and only 16% of those who are aware that they have hypertension have their blood pressure well controlled (to levels < 140/90 mm Hg in the general population or to levels < 130/80 mm Hg in patients with diabetes or renal disease).

Currently, physicians in Canada may take up to 5 months to diagnose hypertension and start treatment, the experts say. Blood pressure is checked over 5 separate visits to a physician, to rule out white-coat effects, but persuading patients to return for so many visits is often difficult. The expert panel recommends that doctors encourage patients believed to have hypertension to monitor their blood pressure at home over a series of days and return with the readings. If the readings consistently show a problem, treatment should begin immediately.

The year 2005 marks the sixth consecutive year that the CHEP has updated recommendations for the management of hypertension. This year's guidelines focus on expedited assessment of both the hypertension-related risk of atherosclerotic disease as well as a more "global" atherosclerotic risk assessment. In addition, the guidelines state that choice of antihypertensive drugs should be based on consideration of the effectiveness of blood pressure control rather than consideration of "pleiotropic" effects for the 5 major antihypertensive classes. The new key messages identified in the 2005 recommendations are:

  • The diagnosis of hypertension should be expedited (especially in the setting of increased risk).

  • Practitioners can utilize any of the 3 validated technologies to diagnose hypertension. Office, ambulatory, and self/home measurements should all be considered as first-line technologies with which to diagnose hypertension.

  • Reducing hypertension-related complications in the general population of patients with hypertension depends more on the extent of blood pressure lowering achieved than on the choice of any specific "first-line" drug class. Nondihydropyridine calcium channel blockers (verapamil and diltiazem) have been added to the list of first-line agents.

The guidelines say that these new messages need to be incorporated with the "older but still really important" considerations for the management of the patient with hypertension, namely:

  • The management plan for patients with hypertension must be based on their global cardiovascular risk.

  • Lifestyle modifications are the cornerstone of both antihypertensive and antiatherosclerotic therapy.

  • Combinations of therapies (both drug and lifestyle) are generally necessary to achieve target blood pressures. Most patients require more than 1 antihypertensive drug to achieve recommended blood pressure targets.

  • Focus on adherence. Failure to achieve this is probably the most important factor leading to the ongoing challenge to improve blood pressure control and reduce the epidemic of hypertension-related morbidity and mortality.


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