Transcript Document

Part 1: Recommendations for
Hypertension Diagnosis
Assessment and Follow up
2011 Canadian Hypertension
Education Program
Recommendations
CHEP 2011 Recommendations
What’s new?
• Increased emphasis on the use of single pill
combinations (and more guidance on which
combinations to use).
• In stroke patients avoid excessive blood pressure
reductions, except in the setting of the most severe
elevations
• The most important step in prescription of
antihypertensive therapy is achieving patient “buy-in”:
new tips for improving adherence
• For your patients – ask them
to sign up at
www.myBPsite.ca for free
access to the latest
information & resources on
high blood pressure
• For health care professionals
– sign up at
www.htnupdate.ca for
automatic updates and on
current hypertension
educational resources
2011 Canadian Hypertension Education
Program (CHEP)
• A red flag has been posted where
recommendations were updated for 2011.
• Slide kits for medical education and health care
professionals, patient and public information can be
downloaded (English and French versions) at:
www.hypertension.ca/tools
Key CHEP Messages for the Management of
Hypertension
1. Assess blood pressure at all appropriate visits.
2. Promote a healthy lifestyle to lower blood pressure and reduce
the risk of cardiovascular disease at each visit with interventions
to reduce high dietary sodium, for smoking cessation, to reduce
abdominal obesity, to promote a healthy weight, to increase
physical activity and to manage dyslipidemia and dysglycemia.
3. Treat blood pressure to less than 140/90 mmHg in most people
and to less than 130/80 mmHg in people with diabetes or
chronic kidney disease using a combination of drugs and
lifestyle modifications.
4. Advocate for healthy public policies to prevent hypertension and
advance the health of patients and populations.
5. Keep up to date with resources for the prevention and control of
hypertension by registering at www.htnupdate.ca and
downloading and ordering tools at www.hypertension.ca/tools.
2011 Canadian Hypertension Education
Program (CHEP)
Table of contents
HYPERTENSION DIAGNOSIS, ASSESSMENT AND FOLLOW-UP
I. Accurate measurement of blood pressure
II. Criteria for the diagnosis of hypertension and follow-up
III. Assessment of overall cardiovascular risk in hypertensive
patients
IV. Routine and optional laboratory tests for the investigation of
patients with hypertension
V. Assessment of renovascular hypertension
VI. Endocrine hypertension
VII. Home measurement of blood pressure
VIII. Ambulatory blood pressure measurement
IX. Role of echocardiography
Accurate Measure of Blood Pressure
1) Assess blood pressure at all appropriate visits
When should blood pressure be measured?
• Health care professionals should know the blood
pressure of all of their patients and clients. Blood
pressure of all adults should be measured whenever
it is appropriate using standardized techniques.
– To screen for hypertension
– To assess cardiovascular risk
– To monitor antihypertensive treatment
Prevalence of Hypertension in Canada
Mean systolic
and diastolic
BP by sex and
age group,
household
population
aged 20-79
years, March
2007 to
February 2009
Wilkins et al. Health Reports Feb 2010
Prevalence of Hypertension in Canada
Wilkins et al. Health Reports Feb 2010
Life time risk of Hypertension in Normotensive
Women and Men aged 65 years
Risk of Hypertension %
Risk of Hypertension %
100
100
Women
80
80
60
60
40
40
20
20
0
0
2
4
6
8
10
12
14
Years to Follow-up
16
18
20
0
Men
0
2
4
6
8
10
12
14
16
18
20
Years to Follow-up
JAMA 2002: Framingham data.
Reversible risks for developing hypertension
•
•
•
•
•
Obesity
Poor dietary habits
High sodium intake
Sedentary lifestyle
High alcohol consumption
Incidence of hypertension in those identified
with high normal blood pressure
• 772 subjects, mean age 48.5
• Not receiving treatment for Hypertension
• Average of 3 blood pressures at baseline:
–
–
SBP 130-139 and DBP < 89 OR
SBP < 139 and DBP 85-89
• Primary endpoint – new onset Hypertension
Julius S. NEJM 2006;354:1685-97
New onset hypertension in people with high
normal blood pressure
80
60
New
hypertension
(%)
40
20
0
1
2
3
4
Year of Follow-up
Julius S. NEJM 2006;354:1685-97
Development of hypertension in those with high
normal blood pressure
Age 35-64
Age 65-94
45
40
Percent
35
30
25
20
15
10
5
0
Year 1
Year 2
Year 3
Framingham cohort Vasan. Lancet 2001
High risk of developing hypertension in those
with high normal blood pressure
Annual follow-up of patients with high normal blood
pressure is recommended.
Accurate Measurement of Blood Pressure
• Automated office blood pressure measurements can
be used in the assessment of office blood pressure*.
• When used under proper conditions, automated
office SBP of 135 mmHg or higher or DBP values of
85 mmHg or higher should be considered analogous
to mean awake ambulatory SBP of 135 mmHg or
higher or DBP of 85 mmHg or higher*.
*see notes
Use of standardized measurement techniques is
recommended when assessing blood pressure
• When using automated office oscillometric devices
such as the BpTRU, the patient should be seated in a
quiet room alone. With the device set to take
measures at 1 or 2 minute intervals, the first
measurement is taken by a health professional to
verify cuff position and validity of the measurement.
The patient is left alone after the first measurement
while the device automatically takes subsequent
readings.
II. Criteria for the diagnosis of hypertension and
recommendations for follow-up
Elevated Out of the
Office BP
measurement
Elevated Random
Office BP
Measurement
Hypertension Visit 1
BP Measurement,
History and Physical
examination
Hypertension Visit 2
Target Organ Damage
or Diabetes
or Chronic Kidney Disease
or BP >180/110?
Hypertensive
Urgency /
Emergency
Yes
Diagnosis
of HTN
No
BP: 140-179 / 90-109
Clinic BPM
ABPM (If available)
Home BPM (If available)
2011 Canadian Hypertension Education Program Recommendations
II. Criteria for the diagnosis of hypertension and
recommendations for follow-up
Elevated Out of the
Office BP
measurement
Elevated Random
Office BP
Measurement
Hypertensive
Urgency /
Emergency
Hypertension Visit 1
BP Measurement,
History and Physical examination
Diagnostic tests ordering
at visit 1 or 2
Hypertension Visit 2
within 1 month
BP >140/90 mmHg and Target
organ damage or Diabetes or
Chronic Kidney Disease or BP
>180/110?
Yes
Diagnosis
of HTN
No
BP: 140-179 / 90-109mmHg
2011 Canadian Hypertension Education Program Recommendations
II. Criteria for the diagnosis of hypertension and
recommendations for follow-up
BP: 140-179 / 90-109
Clinic BP
ABPM (If available)
Home BPM
Hypertension visit 3
>160 SBP or
>100 DBP
<160 / 100
Diagnosis
of HTN
or
ABPM or HBPM
Awake BP
<135/85
and
24-hour
<130/80
Awake BP
>135 SBP or
>85 DBP or
24-hour
>130 SBP or
>80 DBP
Continue to
follow-up
Diagnosis
of HTN
Hypertension visit 4-5
>140 SBP or
>90 DBP
< 140 / 90
Diagnosis
of HTN
< 135/85
>135/85
or
Continue to
follow-up
Diagnosis
of HTN
Continue to
follow-up
Patients with high normal blood pressure (clinic SBP 130-139 and/or DBP 85-89) should be followed annually.
II. Criteria for the diagnosis of hypertension and
recommendations for follow-up
Diagnosis of hypertension
Non Pharmacological treatment
With or without Pharmacological treatment
*Consider home
blood pressure
measurement in
hypertension
management, to
assess for the
presence of
masked
hypertension or
white coat effect
and to enhance
adherence.
Are BP readings below target during 2 consecutive visits?
Yes
Follow-up at 3-6
month intervals *
No
Symptoms, Severe hypertension,
Intolerance to anti-hypertensive treatment
or Target Organ Damage
Yes
More frequent
visits *
No
Visits every 1 to 2
months*
The concept of masked hypertension
Home or Daytime ABPM
SBP mmHg
140
True hypertensive
Masked HTN
135
135
True
Normotensive
White Coat HTN
140
Office SBP mmHg
Derived from Pickering et al. Hypertension 2002: 40: 795-796.
The prognosis of masked hypertension
2.5
2
Relative risk of
CVD
1.5
1
0.5
0
Normotension
White Coat
Hypertension
Masked
Hypertension
Hypertension
Prevalence of masked hypertension is approximately 10% in the general population but is
higher in patients with diabetes
J Hypertension 2007;25:2193-98
III. Assessment of the overall cardiovascular risk
Search for target organ damage
•
Cerebrovascular disease
–
–
–
•
•
•
•
Hypertensive retinopathy
Left ventricular dysfunction
Left ventricular hypertrophy
Coronary artery disease
–
–
–
•
myocardial infarction
angina pectoris
congestive heart failure
Chronic kidney disease
–
–
•
transient ischemic attacks
ischemic or hemorrhagic stroke
vascular dementia
hypertensive nephropathy
(GFR < 60 ml/min/1.73 m2)
albuminuria
Peripheral artery disease
–
–
intermittent claudication
ankle brachial index < 0.9
III. Assessment of the overall cardiovascular
risk
• Search for exogenous potentially modifiable factors that can
induce/aggravate hypertension
– Prescription Drugs:
•
•
•
•
•
•
•
•
NSAIDs, including coxibs
Corticosteroids and anabolic steroids
Oral contraceptive and sex hormones
Vasoconstricting/sympathomimetic decongestants
Calcineurin inhibitors (cyclosporin, tacrolimus)
Erythropoietin and analogues
Antidepressants: Monoamine oxidase inhibitors (MAOIs), SNRIs, SSRIs
Midodrine
– Other:
•
•
•
•
Licorice root
Stimulants including cocaine
Salt
Excessive alcohol use
III. Assessment of the overall cardiovascular
risk
• Over 90% of hypertensive Canadians have other
cardiovascular risks
• Assess and manage hypertensive patients for
dyslipidemia, dysglycemia (e.g. impaired fasting
glucose, diabetes) abdominal obesity, unhealthy
eating and physical inactivity
III. Assessment of the overall cardiovascular
risk
Treat Hypertension in the Context of Overall Cardiovascular
Risk
1. Overall cardiovascular risk should be assessed. In
hypertensive patients consider using calculations that include
cerebrovascular events.
2. In the absence of Canadian data to determine the accuracy of
risk calculations, avoid using absolute levels of risk to support
treatment decisions at specific risk thresholds.
3. Discuss global risk using analogies that describe comparative
risk such as “Cardiovascular Age”, “Vascular Age” or “Heart
Age” to inform patients of their risk status and to improve the
effectiveness of risk factor modification.
Simply counting risk factors may underestimate risk
III. Assessment of the overall cardiovascular
risk
Cardiovascular Risk Factors
• Presence of Risk Factors
–
–
–
–
–
–
–
–
–
•
Presence of Target Organ Damage
–
–
–
•
Increasing age
Male gender
Smoking
Family history of premature cardiovascular disease (age< 55 in men and < 65 in women)
Dyslipidemia
Sedentary lifestyle
Unhealthy eating
Abdominal obesity
Dysglycemia (diabetes, impaired glucose tolerance, impaired fasting glucose)
Microalbuminuria or proteinuria
Left ventricular hypertrophy
Chronic kidney disease (glomerular filtration rate < 60 ml/min/1.73 m2)
Presence of atherosclerotic vascular disease
–
–
–
Previous stroke or TIA
Coronary Heart Disease
Peripheral arterial disease
CV Risk Factors that may alter thresholds and targets in the treatment of HTN
Methods of Risk Assessment
• Clinical impression
• Risk factor counting
• Risk calculation or equation tools
•
•
•
•
Framingham hard coronary heart disease (CHD)
http://hp2011.nhlbihin.net/atpiii/calculator.asp?usertype=prof
SCORE Canada – Systematic Cerebrovascular and Coronary Risk
Evaluation www.scorecanada.ca
Cardiovascular Age™ www.myhealthcheckup.com
Others: see notes
SCORE 10 year Fatal Cardiovascular
Risk Evaluation in Canada
SCORE
Canada : Systematic
Cerebrovascular and cOronary
Risk Evaluation
Find the cell nearest to the
person’s risk factors values :
Age
Sex
Smoking Status
Systolic Blood Pressure
Total-Chol. / HDL-C. Ratio
* Systematic Coronary Risk Evaluation
SCORE Canada: Relative Risk Evaluation
for use in those less than 40 years old
Smoker
Systolic BP
Non smoker
= n times risk
at same age
Total Cholesterol (mmol/L)
Factors to take into account using SCORE
Canada to estimate risk of Fatal CVD
• Person approaching next age category
• Pre-clinical evidence of atherosclerosis (imaging test)
• Strong family history of premature CVD: Multiply risk
by 1.4
• Obesity ; BMI > 30 kg/m2, ; Waist circumference >
102 cm (men) and > 88 cm (woman)
• Sedentary lifestyle
• Diabetes: multiply risk by 2 for men and by 4 for
women
• Raised serum triglycerides level
• Raised level of C-reactive prot., Fibrinogen,
Homocysteine, Apolipoprotein B or Lp(a)
IV. Routine Laboratory Tests
Preliminary Investigations of patients with hypertension
1.
2.
3.
4.
Urinalysis
Blood chemistry (potassium, sodium and creatinine)
Fasting glucose
Fasting total cholesterol and high density lipoprotein
cholesterol (HDL), low density lipoprotein cholesterol (LDL),
triglycerides
5. Standard 12-leads ECG
Currently there is insufficient evidence to recommend routine
testing of microalbuminuria in people with hypertension who
do not have diabetes
IV. Routine Laboratory Tests
Follow-up investigations of patients with hypertension
• During the maintenance phase of hypertension
management, tests (including electrolytes, creatinine,
glucose, and fasting lipids) should be repeated with a
frequency reflecting the clinical situation.
• Diabetes develops in 1-3%/year of those with drug
treated hypertension. The risk is higher in those treated
with a diuretic or beta blocker, in the obese, sedentary,
with higher fasting glucose and who have unhealthy
eating patterns. Assess for diabetes more frequently in
these patients.
IV. Optional Laboratory Tests
Investigation in specific patient subgroups
• For those with diabetes or chronic kidney disease:
assess urinary albumin excretion, since therapeutic
recommendations differ if proteinuria is present.
• For those suspected of having an endocrine cause
for the high blood pressure, or renovascular
hypertension, see following slides.
• Other secondary forms of hypertension require
specific testing.
Abnormal Urinary Albumin levels
Setting
Urinary albumin: creatinine level (mg/mmol)
Men
Women
Chronic kidney
Disease
Diabetes
>30
>2
>2.8
V. Screening for Renovascular Hypertension
Patients presenting with two or more of the following clinical clues
listed below suggesting renovascular hypertension should be
investigated.
I.
II.
III.
IV.
Sudden onset or worsening of hypertension and > age 55 or < age 30
The presence of an abdominal bruit
Hypertension resistant to 3 or more drugs
A rise in creatinine of 30% or more associated with use of an
angiotensin converting enzyme inhibitor or angiotensin II receptor
blocker
V. Other atherosclerotic vascular disease, particularly in patients who
smoke or have dyslipidemia
VI. Recurrent pulmonary edema associated with hypertensive surges
V. Screening for Renovascular Hypertension
The following tests are recommended, when available,
to screen for renal vascular disease:
• captopril-enhanced radioisotope renal scan*
• doppler sonography
• magnetic resonance angiography
• CT-angiography (for those with normal renal function
* captopril-enhanced radioisotope renal scan is not recommended for
those with glomerular filtration rates <60 mL/min)
VI. Screening for Hyperaldosteronism
Should be considered for patients with the following
characteristics:
–
–
–
–
Spontaneous hypokalemia (<3.5 mmol/L).
Profound diuretic-induced hypokalemia (<3.0 mmol/L).
Hypertension refractory to treatment with 3 or more drugs.
Incidental adrenal adenomas.
VI. Screening for hyperaldosteronism
Screening for hyperaldosteronism should include
plasma aldosterone and renin activity (or renin
concentration)
– measured in morning samples.
– taken from patients in a sitting position after resting at least
15 minutes.
• Aldosterone antagonists, ARBs, beta-blockers and clonidine
should be discontinued prior to testing.
• A positive screening test should lead to referral or further
testing.
VI. Renin, Aldosterone and Ratio
Conversion factors
A. To estimate:
B. From:
Multiply (B) by:
Renin Concentration
(ng/mL)
Plasma Renin
Activity
(ng/mL/hr)
0.206
Plasma Renin
Activity
(g/L/sec)
Plasma Renin
Activity
(ng/mL/hr)
0.278
Aldosterone
concentration
(pmol/L)
Aldosterone
concentration
(ng/dL)
28
VI. Screening for Pheochromocytoma
• Should be considered for patients with the following
characteristics:
– Paroxysmal and/or severe sustained hypertension refractory to
usual antihypertensive therapy;
– Hypertension and symptoms suggestive of catecholamine
excess (two or more of headaches, palpitations, sweating, etc);
– Hypertension triggered by beta-blockers, monoamine oxidase
inhibitors, micturition, or changes in abdominal pressure;
– Incidentally discovered adrenal mass;
– Multiple endocrine neoplasia (MEN) 2A or 2B; von
Recklinghausen’s neurofibromatosis, or von Hippel-Lindau
disease.
VI. Screening for Pheochromocytoma
• Screening for pheochromocytoma should include a
24 hour urine for metanephrines and creatinine.
• Assessment of urinary VMA is inadequate.
• A normal plasma metanephrine level can be used to
exclude pheochromocytoma in low risk patients but
the test is performed by few laboratories.
VII. Home measurement of blood pressure
Home BP measurement should be encouraged to
increase patient involvement in care
• Which patients?
–
–
–
–
Uncomplicated hypertension
Suspected non adherence
Office-induced blood pressure elevation (white coat effect)
Masked hypertension
Average BP > 135/85 mm Hg should be considered elevated
Potential advantages of home blood pressure
measurement
• More rapid confirmation of the diagnosis of
hypertension
• Improved ability to predict cardiovascular prognosis
• Improved blood pressure control
• Can be used to assess patients for white coat
hypertension (WCH) and masked hypertension
• Reduced medication use in some (WCH)
• Improved adherence to drug therapy
Not all patients are suited to home
measurement
• Undue anxiety in response to high blood pressure
readings
• Physical or mental disability prevents accurate
technique or recording
• Arm not suited to blood pressure cuff (e.g. conical
shaped arm)
• Irregular pulse or arrhythmias prevent accurate
readings
• Lack of interest
Most patients can be trained to measure blood pressure
Periodic reassessment of technique and retraining is desirable
VII. Suggested Protocol for Home Measurement of
Blood Pressure for the diagnosis of hypertension
• Home blood pressure values should be based on:
– Duplicate measures,
– Morning and evening,
– For an initial 7-day period.
• First day home BP values should not be considered.
• The following six days blood pressure readings
should be averaged
• Average BP equal to or over 135/85 mmHg should be
considered elevated (for those patients whose clinic
BP target is less than 140/90 mmHg).
Recommended electronic blood pressure monitors
for home blood pressure measurement
• Monitors that have been validated as accurate and available in
Canada are listed at www.hypertension.ca in the ‘device
endorsements’ section
• The boxes containing the device are also be marked with
VII. Home Measurement of BP: Patient
Education
• Assist patients select a model with the correct size of cuff
• Measure and record the patients mid arm circumference so they
can match it to cuff size.
• Recommend devices listed at www.hypertension.ca or marked
with this symbol
• Ask patients to carefully follow the instructions with device and
to record only those blood pressures where they have followed
recommended procedure
• Advise patients that average readings equal to or over 135/85
mmHg are high
• In patients with diabetes or chronic kidney disease, lower
therapeutic targets and diagnostic criteria are likely required
Web based home monitoring
• Website resources are available
www.heartandstroke.ca/bp
• Individualized automated counseling and tracking to
assist patients home monitor and to enhance self
management of lifestyle.
More resources for home monitoring
• www.hypertension.ca
• Information to assist you in training patients to measure blood
pressure at home
– Brief action tool for Health Care professionals under resources in
the Education tools for health care professionals section
• Information for patients on how to purchase a device for home
measurement and how to measure blood pressure at home
– Learn how to measure your blood pressure at home and home
measurement of blood pressure under resources in the education
tools for health care professionals section).
• A training DVD on home measurement of blood pressure is
available for download at www.hypertension.ca
2011 Canadian Hypertension Education Program Recommendations
Advice for patients on when to contact a health care professional
based on high average home blood pressure readings
Systolic BP
(mmHg)
Diastolic BP
reading
Less than 130
Less than 85
Usual follow-up
130-179*
85-109*
Check reading again using the correct technique. If the
readings remain high, discuss with your healthcare provider
at your next regularly scheduled appointment
180 – 199*
110-119
Check reading again using the correct technique. If the
readings remain high, schedule an appointment with your
doctor to discuss your treatment plan.
More than 200*
More than 120
Check reading again using the correct technique. If the
readings remain high, schedule an urgent appointment with
your doctor to discuss your treatment plan.
*Patients with diabetes, chronic kidney disease or who are at high risk of cardiovascular
events require individualized advice.
(Resource available at www.hypertension.ca in the 3 Minute Hypertension Action
Tool or www.heartandstroke.ca/BP)
Home measurement: Doing it right
EQUIPMENT
• Validated device
• Look for the
logo or go to
www.hypertenion.ca for a list
of validated devices
available in Canada
• Ensure the cuff size is
appropriate
• Ensure the device is
accurate in the patient at
purchase and annually
Home measurement: Doing it right
Preparation
DO
• Read and carefully follow the
instructions provided with the
device
• Relax in a comfortable chair
with back support for 5
minutes
• Sit quietly without talking or
distractions (e.g. TV)
DON’T
• Measure if stressed, cold, in pain
or if your bowel or bladder are
uncomfortable
• Measure within 1 hour of heavy
physical activity
• Measure within 30 minutes of
smoking or drinking coffee
Home measurement: Doing it right
Preparation
DO
• Put the cuff on a bare arm or one with a light sleeve
• Support the arm on a table so it is at heart level
• Record two readings in the morning and evening daily for 7 days
(discarding the first days readings) to help diagnose hypertension
• Measure and record your blood pressure (as above) for several
days before an appointment with a health care professional
Home measurement: Doing it right
• Posters and handouts providing recommendations to
patients on how to measure blood pressure can be
found at www.hypertension.ca
• Learn how to measure your blood pressure at home
and Home measurement of blood pressure in the
Education tools for health care professionals section
VII. Home Measurement of BP: Confirm
contradictory home measurement readings
If office BP
measurement is
elevated and home BP
is normal or vice versa
Consider further
assess using 24-h
ambulatory
blood pressure
monitoring
VIII. Ambulatory BP Monitoring
Beyond the diagnosis of hypertension, ABPM measurement may also
be considered for selected patients for the management of HTN
Which patients?
– Untreated
• Mild (Grade 1) to moderate (Grade 2) clinic BP elevation and
without target organ damage.
– Treated patients
• Blood pressure that is not below target values despite receiving
appropriate antihypertensive therapy.
• Symptoms suggestive of hypotension.
• Fluctuating office blood pressure readings.
VIII. Ambulatory BP Monitoring
How to?
• Use validated devices
• How to interpret?
– Mean daytime ambulatory blood pressure >135/85 mmHg
is considered elevated.
– Mean 24 h ambulatory blood pressure >130/80 mmHg is
considered elevated.
A drop in nocturnal BP of <10% is associated with increased risk of CV events
Clinic, Home, Ambulatory (ABP) Blood Pressure
Measurement Equivalence Numbers
A clinic blood pressure of 140/90 mmHg has a
similar risk of a:
Description
Blood Pressure mmHg
Home pressure average
135 / 85
Daytime average ABP
135 / 85
24-hour average ABP
130 / 80
Follow Up Algorithm For High Blood Pressure
Using Ambulatory Blood Pressure Measurement
24-h ABPM
Awake BP
>135 SBP or
>85 DBP
or
24-hour
>130 SBP or
>80 DBP
Awake BP
< 135/85
and
24-hour
< 130/80
Consistent with HTN
Continue
to follow-up
Patients with high normal blood pressure should be followed annually.
Follow Up Algorithm For High Blood Pressure
Using Ambulatory Blood Pressure Measurement
• 30-40% of patients with white coat hypertension
diagnosed based on a single ABPM session will have
true hypertension on retesting.
• Some patients with white coat hypertension develop
sustained hypertension.
• Patients with white coat hypertension may be
followed with home BP measurement or repeat
ABPM could be considered every 1-2 years
IX. The Role of Echocardiography
• Echocardiography is useful for:
– Assessment of left ventricular dysfunction and the presence
of left ventricular hypertrophy
• Echocardiography is not useful for routine evaluation
of hypertensive patients
Key CHEP Messages for the
Management of Hypertension
1. Assess blood pressure at all appropriate visits.
2. Promote a healthy lifestyle to lower blood pressure and reduce the
risk of cardiovascular disease at each visit with interventions to
reduce high dietary sodium, for smoking cessation, to reduce
abdominal obesity, to promote a healthy weight, to increase physical
activity and to manage dyslipidemia and dysglycemia.
3. Treat blood pressure to less than 140/90 mmHg in most people and
to less than 130/80 mmHg in people with diabetes or chronic kidney
disease using a combination of drugs and lifestyle modifications.
4. Advocate for healthy public policies to prevent hypertension and
advance the health of patients and populations.
5. Keep up to date with resources for the prevention and control of
hypertension by registering at www.htnupdate.ca and downloading
and ordering tools at www.hypertension.ca/tools.
• For your patients – ask them
to sign up at
www.myBPsite.ca for free
access to the latest
information & resources on
HBP
• For health care professionals
– sign up at
www.htnupdate.ca for
automatic updates and on
current hypertension
educational resources.