BACKGROUND: Canada has historically been among the world leaders in hypertension care, but hypertension treatment and control rates have regressed in recent years. This guideline is intended to provide pragmatic primary care-focused recommendations to improve hypertension management in adults at the population level.
METHODS: We employed Grading of Recommendations Assessment, Development and Evaluation and ADAPTE frameworks in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE II) quality and reporting standards to develop recommendations on managing hypertension for adults aged 18 years and older. We used the HEARTS framework - a model of care developed by the World Health Organization to improve hypertension control and reduce cardiovascular burden - to integrate these recommendations into streamlined, pragmatic, and evidence-based algorithms. The guideline committee predominantly comprised primary care providers and also included patient, methodology, and hypertension specialist representatives. Our process for managing competing interests adhered to Guidelines International Network principles.
RECOMMENDATIONS: The 9 recommendations for managing hypertension in adults are grouped under the categories of diagnosis and treatment. Diagnostic recommendations include a standardized approach to measuring blood pressure (BP) and confirming hypertension, as well as providing a uniform definition for hypertension of BP = 130/80 mm Hg. Treatment recommendations include targeting a systolic BP < 130 mm Hg, implementing healthy lifestyle changes, and providing stepwise guidance on optimal medication choices for patients requiring pharmacotherapy.
INTERPRETATION: Our aim is to enhance the standard of hypertension care in the Canadian primary care setting. Accurate diagnosis and optimal treatment of hypertension can reduce adverse cardiovascular events and risk of death.
| Discipline Area | Score |
|---|---|
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Cardiology | |
Strengths: 1. Recommending home/ambulatory BP monitoring is evidence-based and practical; 2. Lifestyle advice on sodium, diet, weight, and alcohol is appropriate; 3. Offering non-drug options for low-risk patients reflects good care principles. Suggestions for Enhancement: Root cause exploration. Encouraging further investigation into: 1. Insulin resistance, inflammation; 2. Nutrient deficiencies (magnesium, potassium, CoQ10); 3. Stress and autonomic imbalance would support more personalised care. Lifestyle Specificity: Advice could include clearer dietary models (e.g. DASH), time-restricted eating, and stress techniques. Tools like SMART goals or brief coaching methods could support change. 3. Practitioner Tools: Simple aids to identify key drivers would help with practical application. With added specificity and root-cause framing, it could offer even more value to clinicians.
I'm not sure what in here is going to be news to the average primary care physician. There may be some quibbling about the 130/80 threshold, but I think all the rest of is standard of care.
