2005 Recommendations of the Canadian Hypertension Education Program: The 60-Second Version

Abstract

INTRODUCTION

This year, 2005, marks the sixth consecutive year that the Canadian Hypertension Education Program has updated recommendations for the management of hypertension. The goal of this effort has been twofold: to offer those in clinical practice a consensus view of how to manage the more than 5 million Canadians with hypertension (based on a critical analysis of the most recent clinical trials data in the field) and to use these updates as an opportunity to reiterate the key components of an optimal management program in hypertension. In some ways, the most notable aspect of the 2005 process is the appreciation that despite the advances that have been made in the management of hypertension, there remains a substantial gap at the “front-end” of disease management, that is, in the detection and diagnosis of hypertension. Thus, for 2005 we have focused on the evidence supporting expedited assessment of hypertension-related risk of atherosclerotic disease as well as a more “global” atherosclerotic risk assessment. In addition, the 2005 recommendations support the increasingly widely held belief that in the choice of antihypertensive drugs, consideration of the effectiveness of blood pressure control supersedes consideration of “pleiotropic” effects for the 5 major antihypertensive classes.

The new key messages identified in the 2005 recommendations are as follows:

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

• Practitioners can use any of the 3 validated technologies (office, ambulatory, and self or home measurements) 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. These new messages need to be incorporated into what remain as the “older but still really important” considerations for the management of the patient with hypertension:

• 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.

• Focus on adherence.