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Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children

Kara A Nerenberg, Kelly B Zarnke, Alexander A Leung, Kaberi Dasgupta, Sonia Butalia, Kerry McBrien, Kevin C Harris, Meranda Nakhla, Lyne Cloutier, Mark Gelfer, Maxime Lamarre-Cliche, Alain Milot, Peter Bolli, Guy Tremblay, Donna McLean, Raj S Padwal, Karen C Tran, Steven Grover, Simon W Rabkin, Gordon W Moe, Jonathan G Howlett, Patrice Lindsay, Michael D Hill, Mike Sharma, Thalia Field, Theodore H Wein, Ashkan Shoamanesh, George K Dresser, Pavel Hamet, Robert J Herman, Ellen Burgess, Steven E Gryn, Jean C Grégoire, Richard Lewanczuk, Luc Poirier, Tavis S Campbell, Ross D Feldman, Kim L Lavoie, Ross T Tsuyuki, George Honos, Ally P H Prebtani, Gregory Kline, Ernesto L Schiffrin, Andrew Don-Wauchope, Sheldon W Tobe, Richard E Gilbert, Lawrence A Leiter, Charlotte Jones, Vincent Woo, Robert A Hegele, Peter Selby, Andrew Pipe, Philip A McFarlane, Paul Oh, Milan Gupta, Simon L Bacon, Janusz Kaczorowski, Luc Trudeau, Norman R C Campbell, Swapnil Hiremath, Michael Roerecke, Joanne Arcand, Marcel Ruzicka, G V Ramesh Prasad, Michel Vallée, Cedric Edwards, Praveena Sivapalan, S Brian Penner, Anne Fournier, Geneviève Benoit, Janusz Feber, Janis Dionne, Laura A Magee, Alexander G Logan, Anne-Marie Côté, Evelyne Rey, Tabassum Firoz, Laura M Kuyper, Jonathan Y Gabor, Raymond R Townsend, Doreen M Rabi, Stella S Daskalopoulou
Canadian Journal of Cardiology 2018, 34 (5): 506-525
29731013
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.

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