The 2010 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2 – therapy

Objective To update the evidence-based recommendations for the prevention and treatment of hypertension in adults for 2010. Options and outcomes For lifestyle and pharmacological interventions, randomized trials and systematic reviews of trials were preferentially reviewed. Changes in cardiovascular...

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Veröffentlicht in:	Canadian journal of cardiology 2010-05, Vol.26 (5), p.249-258
Hauptverfasser:	Hackam, Daniel G., MD PhD, Khan, Nadia A., MD MSc, Hemmelgarn, Brenda R., MD PhD, Rabkin, Simon W., MD, Touyz, Rhian M., MD PhD, Campbell, Norman R.C., MD, Padwal, Raj, MD MSc, Campbell, Tavis S., PhD, Patrice Lindsay, M., BScN PhD, Hill, Michael D., MD MSc, Quinn, Robert R., MD PhD, Mahon, Jeff L., MD MSc, Herman, Robert J., MD, Schiffrin, Ernesto L., MD PhD, Ruzicka, Marcel, MD PhD, Larochelle, Pierre, MD PhD, Feldman, Ross D., MD, Lebel, Marcel, MD, Poirier, Luc, BPharm MSc, Arnold, J. Malcolm O., MD, Moe, Gordon W., MD MSc, Howlett, Jonathan G., MD, Trudeau, Luc, MD, Bacon, Simon L., PhD, Petrella, Robert J., MD PhD, Milot, Alain, MD MSc, Stone, James A., MD PhD, Drouin, Denis, MD, Boulanger, Jean-Martin, MD, Sharma, Mukul, MD MSc, Hamet, Pavel, MD PhD, Fodor, George, MD PhD, Dresser, George K., MD PhD, George Carruthers, S., MD, Pylypchuk, George, MD, Burgess, Ellen D., MD, Burns, Kevin D., MD, Vallée, Michel, MD PhD, Ramesh Prasad, G.V., MBBS MSc, Gilbert, Richard E., MD PhD, Leiter, Lawrence A., MD, Jones, Charlotte, PhD MD, Ogilvie, Richard I., MD, Woo, Vincent, MD, McFarlane, Philip A., MD PhD, Hegele, Robert A., MD, Tobe, Sheldon W., MD
Format:	Artikel
Sprache:	eng
Schlagworte:	Adult Antihypertensive Agents - therapeutic use Antihypertensive drugs Blood pressure Canada Cardiovascular Cardiovascular Diseases - prevention & control Combined Modality Therapy Diet, Sodium-Restricted Evidence-Based Medicine Female Guidelines High blood pressure Humans Hypertension Hypertension - diagnosis Hypertension - prevention & control Hypertension - therapy Life Style Lifestyle interventions Male Middle Aged Patient Education as Topic Practice Guidelines as Topic Primary Prevention - standards Prognosis Risk Assessment
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Zusammenfassung:	Objective To update the evidence-based recommendations for the prevention and treatment of hypertension in adults for 2010. Options and outcomes For lifestyle and pharmacological interventions, randomized trials and systematic reviews of trials were preferentially reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. However, for lifestyle interventions, blood pressure lowering was accepted as a primary outcome given the general lack of long-term morbidity and mortality data in this field. Progressive renal impairment was also accepted as a clinically relevant primary outcome among patients with chronic kidney disease. Evidence A Cochrane Collaboration librarian conducted an independent MEDLINE search from 2008 to August 2009 to update the 2009 recommendations. To identify additional studies, reference lists were reviewed and experts were contacted. All relevant articles were reviewed and appraised independently by both content and methodological experts using prespecified levels of evidence. Recommendations For lifestyle modifications to prevent and treat hypertension, restrict dietary sodium to 1500 mg (65 mmol) per day in adults 50 years of age or younger, to 1300 mg (57 mmol) per day in adults 51 to 70 years of age, and to 1200 mg (52 mmol) per day in adults older than 70 years of age; perform 30 min to 60 min of moderate aerobic exercise four to seven days per week; maintain a healthy body weight (body mass index 18.5 kg/m2 to 24.9 kg/m2 ) and waist circumference (less than 102 cm for men and less than 88 cm for women); limit alcohol consumption to no more than 14 standard drinks per week for men or nine standard drinks per week for women; follow a diet that emphasizes fruits, vegetables and low-fat dairy products, dietary and soluble fibre, whole grains and protein from plant sources, and that is low in saturated fat and cholesterol; and consider stress management in selected individuals with hypertension. For the pharmacological management of hypertension, treatment thresholds and targets should be predicated on the patient's global atherosclerotic risk, target organ damage and comorbid conditions. Blood pressure should be decreased to less than 140/90 mmHg in all patients, and to less than 130/80 mmHg in patients with diabetes mellitus or chronic kidney disease. Most patients will require more than one agent to achieve these target blood pressures. Antihypertensive therapy should be considered in all adu
ISSN:	0828-282X 1916-7075
DOI:	10.1016/S0828-282X(10)70379-2