Figure 1 - uploaded by Anne Fournier
Content may be subject to copyright.
Hypertension diagnostic algorithm. ABPM, ambulatory blood pressure measurement; AOBP, automated office blood pressure; BP, blood pressure. *If AOBP is used, use the mean calculated and displayed by the device. If non-AOBP (see y ) is used, take at least 3 readings, discard the first, and calculate the mean of the remaining measurements. A history and physical exam should be performed and diagnostic tests ordered. y 

Hypertension diagnostic algorithm. ABPM, ambulatory blood pressure measurement; AOBP, automated office blood pressure; BP, blood pressure. *If AOBP is used, use the mean calculated and displayed by the device. If non-AOBP (see y ) is used, take at least 3 readings, discard the first, and calculate the mean of the remaining measurements. A history and physical exam should be performed and diagnostic tests ordered. y 

Source publication
Article
Full-text available
Hypertension Canada provides annually-updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initi...

Citations

... e inclusion criteria were as follows: meet the CHEP (Canadian Hypertension Education Program) hypertension guidelines [10] for the diagnosis of hypertension: systolic blood pressure (SBP) ≥ 140 mm·Hg and/or diastolic blood pressure (DBP) ≥ 90 mm·Hg (1 mm·Hg � 0.133 kPa); meet the ACC (American College of Cardiology/AHA (American Heart Association) guidelines for secondary prevention of patients with coronary artery disease and other atherosclerotic vascular disease [11] for the diagnosis of carotid atherosclerosis: intimal medial thickness (IMT) of carotid arteries ≥1.3 mm suggesting plaque formation; age of onset 40-75 years; carotid color Doppler ultrasound showed atheromatous plaque at any of the carotid bifurcation, the distal bilateral common carotid arteries, or the beginning of the internal carotid artery; primary hypertension; and those who had signed written informed consent. ...
Article
Full-text available
Purpose. To observe and analyze the efficacy of Ginkgo ketone ester drop pill intervention in patients with hypertension combined with carotid atherosclerotic plaque. Methods. The subjects were 300 patients with hypertension complicated with carotid atherosclerotic plaque treated in our hospital from January 2019 to September 2021. The grouping was done by the random number table method and 300 patients were divided equally into 2 groups. One group was treated with Western medicine alone (clopidogrel sulfate tablets, phenyl amlodipine tablets, irbesartan tablets, and resorvastatin) as the Western medicine group (WM group, n = 150), and one group was added to this intervention with Ginkgo ketone ester drop pill as the Chinese medicine group (CM group, n = 150). The observation indexes were the improvement of blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), blood lipids (low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and total cholesterol (TC)), vascular endothelial function (nitric oxide (NO) and endothelin-1 (ET-1)), inflammatory factors (C-reactive protein (CRP) and interleukin-6 (IL-6)), plaque (intimal medial thickness (IMT) of carotid artery and plaque area), and efficacy after intervention and adverse effects during intervention in both groups. Results. After intervention, SBP, DBP, LDL-C, TG, and TC levels were lower and HDL-C levels were higher in both groups than before intervention in the same group, and both CM groups improved significantly compared with the WM group ( P < 0.05 ). After intervention, NO levels were higher and ET-1 levels were lower in both groups than before the intervention in the same group, and both CM groups improved significantly compared with the WM group ( P < 0.05 ). After intervention, CRP and IL-6 levels were lower in both groups than before intervention in the same group, and both CM groups improved significantly compared with the WM group ( P < 0.05 ). After intervention, IMT and plaque area were lower in both groups than before intervention in the same group and both CM groups improved significantly compared with the WM group ( P < 0.05 ). The total effective number of the CM group was better than the WM group ( P < 0.05 ), and there was no significant difference in the adverse reactions number in both groups ( P > 0.05 ). Conclusions. The treatment of hypertension combined with carotid atherosclerotic plaque with Ginkgo ketone ester drop pill helps to improve the blood pressure, blood lipid, and vascular endothelial function of patients and helps to inhibit the inflammation level and atherosclerotic plaque of patients, with significant efficacy and no significant adverse effects in patients, which is worthy of clinical promotion.
... In the 2018 European Society of Cardiology/ European Society of HTN [8] and 2018 Korean Society of HTN guidelines [9], 140 mmHg was recommended. In Canadian guidelines, an SBP target in AOBP < 120 mm Hg was proposed for all individuals aged over 75 years [28] (Table 1). ...
Article
Full-text available
As the elderly population is growing rapidly, management of hypertension in South Korea faces major challenges because the proportion of elderly hypertension patients is also increasing. The characteristics of this population are also much more complex than younger patients. Elderly hypertension is characterized by wide variations in (1) fitness or biological age, (2) white-coat effect, (3) poor functional status or frailty, (4) dependency in activities of daily living or institutionalization, (5) orthostatic hypotension, and (6) multiple comorbidities. All of these should be considered when choosing optimal target blood pressure in individual patients. Recent randomized clinical trials have shown that the benefits of intensive blood pressure control for elderly patients is greater than previously thought. For generalization of these results and implementation of the guidelines based on these studies, defining the clinician’s role for individualization is critically important. For individualized decisions for target blood pressure (BP) in the elderly with hypertension, four components should first be checked. These consist of (1) the minimum requirement of functional status and capability of activities of daily living, (2) lack of harmful evidence by the target BP, (3) absence of white-coat hypertension, and (4) standing systolic BP ≥ 110 mmHg without orthostatic symptoms. Risk of decreased organ perfusion by arterial stenosis should be screened before starting intensive BP control. When the target BP differs among comorbidities, the lowest target BP should be given preference. After starting intensive BP lowering therapy, tolerability should be monitored, and the titration should be based on the mean level of blood pressure by office supplemented by out-of-office BPs. Applications of the clinical algorithms will be useful to achieve more standardized and simplified applications of target BP in the elderly.
... 33 Unattended AOBP with its effect on eliminating white-coat effects was promoted by the Canadian hypertension guideline. 59,60 There are 4 essential components for AOBP: electronic and automated device, multiple readings, averaged mean, unattended and undisturbed spaces (EMAU). 50 Some studies have suggested that BP measured with staff present results in higher readings than those obtained with staff absent during measurements. ...
Article
Full-text available
Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Despite the positive correlations between blood pressure (BP) levels and later CV events since BP levels as low as 100/60 mmHg have been reported in numerous epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years. The publication of both the SPRINT and STEP trials (comprising > 8,500 Caucasian/African and Chinese participants, respectively) provided evidence to shake this 140/90 mmHg dogma. Another dogma regarding hypertension management is the dependence on office (or clinic) BP measurements. Although standardized office BP measurements have been widely recommended and adopted in large-scale CV outcome trials, the practice of office BP measurements has never been ideal in real-world practice. Home BP monitoring (HBPM) is easy to perform, more likely to be free of environmental and/or emotional stress, feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events, compared to routine office BP measurements. In the 2022 Taiwan Hypertension Guidelines of the Taiwan Society of Cardiology (TSOC) and the Taiwan Hypertension Society (THS), we break these two dogmas by recommending the definition of hypertension as ≥ 130/80 mmHg and a universal BP target of < 130/80 mmHg, based on standardized HBPM obtained according to the 722 protocol. The 722 protocol refers to duplicate BP readings taken per occasion ("2"), twice daily ("2"), over seven consecutive days ("7"). To facilitate implementation of the guidelines, a series of flowcharts encompassing assessment, adjustment, and HBPM-guided hypertension management are provided. Other key messages include that: 1) lifestyle modification, summarized as the mnemonic S-ABCDE, should be applied to people with elevated BP and hypertensive patients to reduce life-time BP burden; 2) all 5 major antihypertensive drugs (angiotensin-converting enzyme inhibitors [A], angiotensin receptor blockers [A], β-blockers [B], calcium-channel blockers [C], and thiazide diuretics [D]) are recommended as first-line antihypertensive drugs; 3) initial combination therapy, preferably in a single-pill combination, is recommended for patients with BP ≥ 20/10 mmHg above targets; 4) a target hierarchy (HBPM-HMOD- ambulatory BP monitoring [ABPM]) should be considered to optimize hypertension management, which indicates reaching the HBPM target first and then keeping HMOD stable or regressed, otherwise ABPM can be arranged to guide treatment adjustment; and 5) renal denervation can be considered as an alternative BP-lowering strategy after careful clinical and imaging evaluation.
... Numerous automatic office-based BP records significantly correspond to the average BP records during the daytime [65], although it is not always consistent [66]. Although 2017 ACC/AHA recommendations did not specifically advocate that automatic office BP recordings are superior to ABPM, they noted that "there is growing evidence supporting the use of automated office BP" [67]. ISH 2020 guideline recommendation has not stated that ABPM is superior to the office automatic BP measurement method [27]. ...
Article
Full-text available
Hypertension (HTN) is common in chronic kidney disease (CKD), and it may aggravate CKD progression. The optimal blood pressure (BP) value in CKD patients is not established yet, although systolic BP ≤130 mmHg is acceptable as a target. Continuous BP monitoring is essential to detect the different variants of high BP and monitor the treatment response. Various methods of BP measurement in the clinic office and at home are currently used. One of these methods is ambulatory BP monitoring (ABPM), by which BP can be closely assessed for even diurnal changes. We conducted a non-systematic literature review to explore and update the association between high BP and the course of CKD and to review various BP monitoring methods to determine the optimal method for BP recording in CKD patients. PubMed, EMBASE, Google, Google Scholar, and Web Science were searched for published reviews and original articles on BP and CKD by using various phrases and keywords such as "hypertension and CKD", "CKD progression and hypertension", "CKD stage and hypertension", "BP control in CKD", "BP measurement methods", "diurnal BP variation effect on CKD progression", and "types of hypertension." We evaluated and discussed published articles relevant to the review objective. Before preparing the final draft of this article, each author was assigned a section of the topic to read, research deeply, and write a summary about the assigned section. Then a summary of each author's contribution was collected and discussed in several group sessions. Early detection of high BP is essential to prevent CKD development and progression. Although the latest Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest that a systolic BP ≤120 mmHg is the target toprevent CKD progression, systolic BP ≤130 mmHg is universally recommended.ABPM is a promising method to diagnose and follow up on BP control; however, the high cost of the new devices and patient unfamiliarity with them have proven to be major disadvantages with regard to this method.
... PE in pregnancy is associated with future atherosclerotic disease and metabolic syndrome (Murphy et al., 2014(Murphy et al., , 2015Sabour et al., 2007). This group had a higher BMI and blood pressure, as well as total cholesterol, compared to normotensive women, and was more likely to be defined as hypertensive according to International Diabetes Foundation criteria (Leung et al., 2017). While 8 women in the study totally met IDF criteria for elevated blood pressure, only 1 had blood pressure that would require medication. ...
Article
Full-text available
Preeclampsia (PE) is a hypertensive obstetrical complication associated with increased cardiovascular disease risk. Carotid artery functional assessments allow for identification of subclinical vascular dysfunction. This cross-sectional study measured carotid artery functional indices in healthy women with a recent pregnancy complicated by PE, versus women with a prior uncomplicated pregnancy. Women with a history of PE (N = 30) or an uncomplicated pregnancy (N = 30), were recruited between 6 months and 5 years postpartum. Left and right carotid artery ultrasound measured carotid intima media thickness, plaque burden, peak systolic velocity, end diastolic flow velocity and carotid far-wall circumferential strain (FWCS). Carotid FWCS is inversely related to vessel stiffness, where a decrease in FWCS indicates increased vessel stiffness. Right-side FWCS did not differ between women with a history of PE versus normotensive pregnancy. Left carotid artery FWCS was lower in formerly preeclamptic women after adjustment for diameter, pulse pressure, and heart rate compared to women following an uncomplicated pregnancy (3.35 ± 1.08 × 10-3 vs. 4.46 ± 1.40 × 10-3 ; p = 0.003). Those with prior severe PE had the greatest decrease in FWCS adjusted to diameter, pulse pressure, and heart rate compared to healthy controls (p = 0.02). Adjusted FWCS and total serum cholesterol were independent indicators of PE history when present in a logistic regression model with confounding variables including age, body mass index, and resting blood pressure. Further investigation is needed to elucidate if FWCS can be used as a risk stratification tool for future cardiovascular disease following a pregnancy complicated by PE. A history of PE is associated with decreased left FWCS (increased left carotid artery stiffness).
... Four international recommendations on high blood pressure were published in 2017, 2018 and 2020, and form the basis for hypertensive patient management: the Canadian and American recommendations published in 2017 [4,5], the European recommendations published in 2018 [3] and the International Society of Hypertension in 2020 [6]. The questions of the relevance within guidelines and discrepancies between them have been extensively commented upon [7][8][9]. ...
Article
Full-text available
High blood pressure is the number one killer in the world. About 1.5 billion people suffered from hypertension in 2010, and these numbers are increasing year by year. The basics of the management of high blood pressure are described in the Canadian, American, International and European guidelines for hypertension. However, there are similarities and differences in the definition, measurement and management of blood pressure between these different guidelines. According to the Canadian guidelines, normal blood pressure is less than 140/90 mmHg (systolic blood pressure/diastolic blood pressure). The AHA and ESC estimate normal blood pressure to be less than 120/80 mmHg (systolic blood pressure/diastolic blood pressure). Regarding treatments, the AHA, ISH and ESC are also in agreement about dual therapy as the first-line therapy, while Canadian recommendations retain the idea of monotherapy as the initiation of treatment. When it comes to measuring blood pressure, the four entities agree on the stratification of intervention in absolute cardiovascular risk.
... Hypertension is the leading cause of death and disability in Canada and globally. Apart from a wide choice of pharmacological agents, multiple lifestyle modifications, in particular an increase in potassium intake by diet or as a supplement, have been shown to be efficacious in reducing blood pressure (BP) [1][2][3]. An increase in dietary potassium is recommended by the World Health Organization [4], the American Heart Association/ American College of Cardiology [5], and Hypertension Canada [6,7]. ...
... Globally, hypertension is the leading risk factor for mortality, accounting for 13% of death, and also being the leading cause of disability worldwide, according to the Global Burden of Disease studies [14][15][16]. Research on lifestyle habits to reduce blood pressure, without involving pharmacotherapy has been identified as a top research priority by Hypertension Canada [1]. ...
Article
Full-text available
Background High blood pressure is the leading cause of cardiovascular disease worldwide. The prevalence of high blood pressure is steadily rising as the population grows amongst older adults with the ageing population. Therapeutical treatments are widely available to decrease blood pressures, in addition to many lifestyle options, such as dietary changes and exercise. There is a marked preference amongst patients, as reiterated by Hypertension Canada, for more research into non-therapeutic methods for controlling blood pressure or to reduce the burden of taking many pills to control high blood pressure. Indeed, effective options do exist, especially with diet, specifically decreasing sodium and increasing potassium intake. Current public health outreach primarily focusses on sodium intake, even though potassium intake remains low in the Western world. Excellent data exist in published research that increasing potassium intake, either via dietary modification or supplements, reduces blood pressure and reduces risk of cardiovascular outcomes such as stroke. However, the advice most often provided by medical professionals is to ‘eat more fruits and vegetables’ which has little impact on patient outcomes. Methods We propose to do a clinical trial in two stages with an adaptive trial design. In the first stage, participants with high blood pressure and proven low potassium intake (measured on the basis of a 24-h urine collection) will get individually tailored dietary advice, reinforced by weekly supportive phone/email support. At 4 weeks, if there has not been a measured increase in potassium intake, participants will be prescribed an additional potassium supplement. Testing will be conducted again at 8 weeks, to confirm the efficacy of the potassium supplement. Final measurements will be planned at 52 weeks to observe and measure the persistence of the effect of diet or additional supplement. Concurrent measurements of sodium intake, blood pressure, participant satisfaction, and safety measures will also be done. Discussion The results of the study will help determine the most effective method of increasing potassium intake, thus reducing blood pressure and need for blood pressure-lowering medicines, and at the same time potentially increasing participant satisfaction. The current guidelines recommend changes in diet, not a potassium supplement, to increase potassium intake; hence, the two-stage design will only add supplements if the most rigorous dietary advice does not work. Trial registration This study has been registered on ClinicalTrials.gov NCT03809884 . Registered on January 18, 2019
... Amongst the adjustable factors, hypertension represents about 90% of myocardial infarction events [2]. Hypertension affects approximately 40% of adults globally [3] and has increased in the number of diagnoses in children and adolescents over the past few years [4]. It is well recognized that beneficial changes in lifestyle improve blood pressure (BP) and are commonly described as alternatives to the pharmacotherapies [5]. ...
Article
Objectives We studied the effects of oral L-arginine on post-exercise blood pressure (BP). Update Throughout October 2020 and February 2021, the electronic databases Medline, Web of Science, CINAHL, Embase, Cochrane, Bireme, Open Gray, MedRxiv, Clinical Trials and Scopus were considered. The terms enforced to search randomized, double-blind and placebo-controlled clinical trials were, “Arginine” AND “Post-exercise”. Three studies were involved in the meta-analysis, the original results of the three studies demonstrated a trend related to L-arginine intervention. The 95% CI ranged from −7.94 to −2.14 with a combined effect size of −5.04 for systolic BP and −4.96 to −0.97 with a combined effect size of −2.96 for diastolic BP. Perspectives and projects Our meta-analysis revealed a combined effect size of 3.40 (P = 0.0007) for systolic BP and 2.91 (P = 0.004) for diastolic BP supportive of L-arginine intervention. Conclusions Our review delivers evidence that oral L-arginine supplementation has the potential to reduce post-exercise systolic and diastolic BP in hypertensive patients.
... Second, drug therapy through use of the chemical and synthetic agents including diuretics, sympathetic and vasodilatative drugs, beta blockers, calcium channel blockers and aldosterone antagonists (De Wet et al., 2016;Leung et al., 2017;Niazi et al., 2019). Some of chemical drugs may lead to potential adverse side effects and some of them fail to meet patients all needs, thus the need for new molecules arises today with acuity. ...
Article
Full-text available
The incidence of hypertension is very high in human societies and its treatment is the most important priority in many countries. Knowledge of the plants that are used may provide insight on their properties, for further exploration. This study aimed to collect the knowledge on traditional medicine for the treatment of hypertension in different regions of Morocco. We reviewed 145 research publications based on data from the six explored regions of Morocco published until August 2021 in various journals. This was achieved using literature databases: Google, Google Scholar, PubMed, Medline, Science Direct and Researchgate. The findings of this study indicated that 23 plants have been reported to possess antihypertensive activities in in vivo / in vitro experiments, while 81 plants had not been studied for such an activity. Plants from the Lamiaceae, Asteraceae and Apiaceae families were used most often. Leaves were the plant parts used most often. Decoction was the main preparation method. Twenty three plants have been explored experimentally for their antihypertensive activity. This review provides baseline data for plant species used to treat hypertension in Morocco and provides new areas of research on the antihypertensive effect of these plants.
... Systemic arterial hypertension, the leading cause of global disease burden and overall health loss, affects over two-fifths of the adult population worldwide [1][2][3][4]. Given the progressive ageing of the world population and considering the rapidly growing prevalence of uncontrolled hypertension, the evolution of cognitive impairment is increasingly becoming a prominent health threat. ...
Article
Full-text available
Abstract Background The evolution of cognitive impairment of vascular origin is increasingly becoming a prominent health threat particularly in this era where hypertension is the leading contributor of global disease burden and overall health loss. Hypertension is associated with the alteration of the cerebral microcirculation coupled by unfavorable vascular remodeling with consequential slowing of mental processing speed, reduced abstract reasoning, loss of linguistic abilities, and attention and memory deficits. Owing to the rapidly rising burden of hypertension in Tanzania, we sought to assess the prevalence and correlates of cognitive impairment among hypertensive patients attending a tertiary cardiovascular hospital in Tanzania. Methodology A hospital-based cross-sectional study was conducted at Jakaya Kikwete Cardiac Institute, a tertiary care public teaching hospital in Dar es Salaam, Tanzania between March 2020 and February 2021. A consecutive sampling method was utilized to recruit consented hypertensive outpatients during their scheduled clinic visit. General Practitioner Assessment of Cognition (GPCOG) Score was utilized in the assessment of cognitive functions. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student’s T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with cognitive impairment. Odd ratios with 95% confidence intervals and p-values are reported. All tests were 2-sided and p