New Canadian streamlined guidelines on hypertension lower blood pressure thresholds

New Canadian hypertension guidelines are lowering blood pressure thresholds for both defining hypertension and treatment. This means more Canadians will be categorized as having hypertension. The authors wrote that the current evidence strongly supports the lower thresholds to promote early detection of hypertension. It is hoped this will mitigate long-term cardiovascular complications at the population level.The new guideline to diagnose and treat hypertension was aimed at helping primary care clinicians, nurses, nurse practitioners and pharmacists improve care. The new guideline is the first of two coming from Hypertension Canada and was published in the Canadian Medical Association Journal (CMAJ). It provides pragmatic, evidence-based recommendations and algorithms to improve the standard for care for hypertension management in the Canadian primary care setting. The authors wrote that Canada has historically been a world leader in hypertension care but treatment and control rates have regressed in recent years. There are a number of factors that may have been contributing to this trend, including discrepancies in optimal blood pressure targets, complex guideline recommendations and less engagement with front-line healthcare providers. The recommendations within this guideline were developed based on evidence syntheses and adaptation of recommendations from several sources, including the American Heart Association (AHA) and World Health Organization (WHO) hypertension guidelines. The committee that developed the new guidance used Grading Recommendations Assessment, Development and Evaluation and ADAPTS frameworks. It also utilized HEARTS, which is a care model developed by the WHO to improve hypertension control. The guideline committee was predominantly made up of primary care providers but also included patients and hypertension specialists.The guideline includes nine recommendations, grouped under the categories of diagnosis and treatment. Diagnostic recommendations include blood pressure (BP) measuring and provide a uniform definition of hypertension of BP of 130 mmHG or higher. The new treatment recommendations include targeting for a systolic BP < 130 mm Hg by adopting healthy lifestyle changes and stepwise guidance on optimal medication choices.For adults requiring pharmacotherapy, low-dose combination therapy (preferably in a single pill) is recommended as initial treatment. It includes drugs from two of three classes of medications (ACEIs or ARBs, thiazide or thiazide-like diuretics, and long-acting dihydropyridine CCBs). If the two-drug combination therapy fails, then a three-drug combination therapy consisting of an ACEI or ARB, a thiazide or thiazide-like diuretic, and a long-acting dihydropyridine CCB is recommended.Further considerations on pharmacotherapy included hard-to-treat hypertension. The guideline committee considered efficacy, tolerability, cost, coverage, availability, protection from future drug shortages, and ability to split pills when selecting medications for treatment. Ongoing research will continue to improve care and more updates are expected, the authors noted. A number of new drug classes have been developed and once data are accumulated they may point toward improved management strategies. The authors noted that looking at how best to integrate care with complementary treatments (statins, sodium–glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor antagonists) to lower cardiovascular risk among patients with hypertension was beyond the scope of the guideline. However, these treatments will be addressed with the forthcoming Hypertension Canada comprehensive guideline. The guideline is not intended to be applied in all clinical scenarios, such as managing pediatric hypertension or in women who are pregnant or trying to become pregnant. Separate guidelines are available for those patient populations. Hypertension is reportedly the most common modifiable risk factor for heart disease and death. It is estimated to affect about one in four adults in Canada. The preliminary guideline was posted on the Hypertension Canada website from September 27, 2024, through October 25, 2024, as part of a formal review. Family physicians, pharmacists, nurses, hypertension specialists, patients and caregivers from across Canada were invited to review the guideline and provide feedback.

New Canadian streamlined guidelines on hypertension lower blood pressure thresholds

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