Hypertension Canada’s 2020 Evidence Review and Guidelines for the Management of Resistant Hypertension

We present Hypertension Canada’s inaugural evidence-based recommendations for the diagnosis and management of resistant hypertension. Hypertension is present in 21% of the Canadian population, and among those with hypertension, resistant hypertension has an estimated prevalence from 10% to 30%. This subgroup of hypertensive individuals is important, because resistant hypertension portends a high cardiovascular risk. Because of its importance, Hypertension Canada formed a Guidelines Committee to conduct a review of the evidence and develop recommendations for the diagnosis and management of resistant hypertension. The Hypertension Canada Guidelines Committee recommends that patients with blood pressure above target, despite use of 3 or more blood pressure-lowering drugs at optimal doses, preferably including a diuretic, be identified as those with apparent resistant hypertension. Patients identified with apparent resistant hypertension should be assessed for white coat effect, nonadherence, and therapeutic inertia, investigated for secondary hypertension, and referred to a provider with expertise in hypertension. There is no randomized controlled trial evidence for better cardiovascular outcomes with any class of antihypertensive agent at this time, so recommendations for a preferred drug class cannot be made. Furthermore, we provide a summary of the current evidence concerning the role of device therapy in the management of resistant hypertension. We will continue updating the guidelines as additional high-quality evidence with relevance to daily practice becomes available. Nous présentons ici les premières recommandations d'Hypertension Canada, basées sur des données probantes, pour le diagnostic et la prise en charge de l'hypertension résistante. L'hypertension est présente dans 21 % de la population canadienne, et parmi les personnes souffrant d'hypertension, l'hypertension résistante a une prévalence estimée entre 10 % et 30 %. Ce sous-groupe d’individus hypertendus est important, car l'hypertension résistante laisse présager un risque cardiovasculaire élevé. Compte tenu de son importance, Hypertension Canada a formé un comité des lignes directrices pour effectuer un examen des données probantes disponibles et élaborer des recommandations pour le diagnostic et la prise en charge de l'hypertension résistante. Le comité des lignes directrices d'Hypertension Canada recommande que les patients dont la pression artérielle est supérieure à la valeur cible, m