2014 CHEP Hypertension Treatment Guidelines
The Canadian Hypertension Education Program (CHEP) is central to Hypertension Canada, the leading hypertension organization in the country. CHEP is known as the most credible source for evidence-based chronic disease management recommendations with annual updates, a well-validated review process and effective dissemination techniques across Canada
The 2014 evidence-based recommendations have been released, with 4 key messages (below.) Find more information and resources at: http://www.hypertension.ca/resources
- All Canadian adults should have their blood pressure assessed at all appropriate clinical visits. More than one
in five adult Canadians has hypertension and the lifetime risk of developing hypertension is approximately 90%. All adults require ongoing assessment of blood pressure throughout their lives. People with hypertension should be educated about home blood pressure monitoring and encouraged to monitor their blood pressure levels regularly.
Individuals with high normal blood pressure require annual reassessment because their two-year risk of developing hypertension is 40%.Optimum management of BP requires assessment of overall cardiovascular risk. Over 90% of Canadians with hypertension have additional cardiovascular risk factors, including an unhealthy diet, high dietary sodium intake, tobacco use, physical inactivity, abdominal obesity, dyslipidemia, and dysglycemia. Identifying and successfully managing these risk factors can reduce cardiovascular events by over 60% in hypertensive patients. Cardiovascular risk assessment should be communicated using an analogy like ‘vascular age’.
- Home BP monitoring is an important tool in self-monitoring and self-management. Home BP monitoring can be used to accurately identify individuals who are normotensive, have white coat hypertension and those that are truly hypertensive. Home BP monitoring also is useful for enhancing self-management skills and improving adherence.
Treat to target. Target blood pressure should be less than 140/90 mmHg in most patients, including those with chronic kidney disease. In patients with diabetes, blood pressure targets are less than 130/80. In the very elderly (age >80 years), the systolic target is 150 mm Hg. Caution should be exercised in elderly patients who are frail and in CAD patients with low DBP ( Lifestyle modifications are effective in preventing hypertension, treating hypertension and reducing cardiovascular risk. Blood pressure and other cardiovascular risk factors can be improved by following a healthy diet, engaging in regular physical activity, moderating alcohol consumption, reducing dietary sodium, avoiding tobacco exposure and managing high stress levels. Brief, individualized health care professional interventions increase the
probability of lifestyle change.
- Combinations of both lifestyle changes and drugs are generally necessary to achieve target blood pressures.
Most people with hypertension require lifestyle changes and pharmacotherapy to achieve recommended blood pressure targets. Diuretics are often required for ‘resistant’ hypertension. Many people with diabetes require three or more antihypertensive drugs including diuretics to achieve blood pressure targets. Regular follow-up and titration of therapy is required to achieve blood pressure targets.
- Focus on adherence. Non-adherence to healthy lifestyle behaviours and pharmacotherapy is an important cause of poor blood pressure control. Patient adherence to lifestyle modifications and pharmacotherapy should be assessed on each visit and interventions to improve adherence should be a part of clinical routine.
More info: http://www.hypertension.ca/resources