2006 CANADIAN HYPERTENSION EDUCATION PROGRAM RECOMMENDATIONS

2006 marks the seventh consecutive year that CHEP has updated recommendations for the diagnosis, management and treatment of hypertension. This year CHEP focused on adherence to antihypertensive therapy.

THE NEW KEY MESSAGE IDENTIFIED IN THE 2006 RECOMMENDATIONS IMPROVE PATIENT ADHERENCE TO ANTIHYPERTENSIVE THERAPY.

Adherence with an antihypertensive prescription can be improved by a multi- pronged approach including:

A. Assist your patient to adhere

Teach patients to take their pills on a regular schedule associated with a routine daily activity e.g. brushing teeth.
Simplify medication regimens using long-acting once-daily medications.
Utilize fixed-dose combination medications.
Utilize unit-of-use packaging, e.g. blister packaging.

B. Assist your patient to get more involved in his/her treatment.

Encourage greater patient responsibility/autonomy in regular monitoring of their blood pressure.
Educate patients and patient's families about their disease/ treatment regimens verbally and in writing.

C. Improve your management in the office and beyond.

Assess adherence to non- pharmacological and pharmacological therapy at every visit.
Encourage adherence to therapy by healthcare practitioner-based telephone contact, particularly over the first three months of therapy.
Coordinate with work-site healthcare givers, if available, to improve monitoring of hypertension management.

OLD, BUT STILL REALLY IMPORTANT MESSAGES OF CHEP

I. MEASURE BLOOD PRESSURE IN ALL ADULTS AT ALL APPROPRIATE VISITS.

Many Canadians with hypertension remain undetected; therefore measure blood pressure in all adults at all appropriate visits.

II. THE DIAGNOSIS OF HYPERTENSION CAN BE EXPEDITED

For patients with hypertensive urgencies/emergencies a diagnosis of CHEP Recommendations for the Management of Hypertension 2006 hypertension can be made at an initial hypertension-related visit.
For patients with blood pressure ≥ 140/90 mm Hg and with one of the following: a) target organ damage b) chronic kidney disease c) diabetes mellitus or d) BP ≥ 180/110, a diagnosis of hypertension can be made at a second visit.
For patients with BP between 160-179/100-109 (and not already diagnosed based on the criteria above), a diagnosis can be made at a third visit.

III. ASSESS AND MANAGE GLOBAL CARDIOVASCULAR RISK

Most hypertensive patients have multiple cardiovascular risks, in addition to hypertension, that require assessment and management. Aspirin should be considered in controlled hypertensive patients. Statins are recommended in hypertensive patients with established cardiovascular disease or the presence of >3 other cardiovascular risks.

IV. LIFESTYLE MODIFICATIONS ARE THE CORNERSTONE OF ANTIHYPERTENSIVE THERAPY

Lifestyle changes recommended by CHEP to reduce blood pressure include:

Maintaining a diet low in salt and saturated fats and high in fresh fruit and vegetables and low fat dairy products (DASH diet).
30 to 60 minutes of continuous or accumulated moderate intensity dynamic exercise (walking, as well as jogging, cycling or swimming) 4-7 days of the week.
Weight reduction in those who are overweight.
Reduction in alcohol consumption in those who drink more than two drinks/day
Smoking cessation to reduce cardiovascular risk.

V. TREAT TO TARGET

The current recommended target to reduce blood pressure is:

In general < 140 mm Hg systolic and < 90 mm Hg diastolic
In patients with diabetes OR chronic kidney disease < 130/80 mm Hg

VI. USE COMBINATIONS OF MEDICATIONS AND LIFESTYLE MODIFICATION TO ACHIEVE BLOOD PRESSURE TARGETS.

Most patients require two or more drugs to achieve recommended blood pressure targets. Using lifestyle modification can reduce the number and doses of medications that are required for blood pressure control and should be recommended for all hypertensive patients.

The full recommendations, implementation tools, patient information and links can be found at www.hypertension.ca

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