2000 Canadian Recommendations for the Management of Hypertension

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2000 Canadian Recommendations for the Management
of Hypertension
Jan 18, 2001
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2000 Canadian Recommendations for the Management
of Hypertension
Pharmacological Treatment
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Indications for PharmacotherapyAdults under 60
years
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Indications for PharmacotherapyAdults under 60
years
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Indications for PharmacotherapyAdults under 60
years
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Indications for PharmacotherapyAdults under 60
years (summary)
Consider prescription if Sustained diastolic
blood pressure of gt 90 mm Hg or Isolated
systolic hypertension of gt 160 mm Hg and No
other risk factors Prescribe if Target-organ
damage or CVD, or Concomitant diseases such as
diabetes mellitus or Other cardiovascular risk
factors Prescribe if Diastolic blood
pressure readings average gt 100 mm Hg,
regardless of other factors
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Indications for Pharmacotherapy Adults over 60
years
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Indications for PharmacotherapyDiabetics
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Indications for PharmacotherapyDiabetics
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Choice of Treatment
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(No Transcript)
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Standardized Therapy Algorithm Adults under 60
years
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Standardized Therapy AlgorithmAdults over 60
years
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Blood Pressure Treatment Targets
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Treatment of Hypertension With Associated Risk
Factors
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Treatment of Hypertension With Associated Risk
Factors
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Treatment of Hypertension with Diabetes
with Nephropathy
Alternate ARB
ACE-I
High dose diuretics, Alpha-blockers and Centrally
acting agents if autonomic neuropathy
Diabetes
without Nephropathy
ACE-I
Beta-blocker
Target BP
lt 130/80 mm Hg
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Treatment of Hypertension with Ischemic Heart
Disease
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Treatment of Hypertension with Peripheral
Vascular Diseases
Treatment of uncomplicated hypertension, hypertens
ion associated with other conditions or
concomitant risk factors.
mild
Atherosclerotic PVD
severe
May aggravate symptoms
Beta-blocker
ACE-I ?
Peripheral vascular disease
Renal artery stenosis
May induce renal insufficiency
ACE-I (use with caution)
Vasodilators
May have beneficial effects
Raynauds syndrome
Alpha-blockers, CCB, ACE-I, ARB
Beta-blocker
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Treatment of Hypertension with Systolic
Dysfunction
Physicians who are not yet experienced in the use
of beta-blockers should consider initiation of
treatment in conjunction with a physician
experienced in heart failure management-
particularly for NYHA Class III-IV patients.
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Treatment of Hypertension with Arrhythmia
May inhibit ventricular response
Atrial fibrillation and supraventricular
tachycardia
Beta-blocker Verapamil Diltiazem
Arrhythmia and conduction problems
Caution if systolic dysfunction is present
Beta-blocker Verapamil Diltiazem Clonidine Methyld
opa
Sinoatrial node dysfunction and atrioventricular
conduction problems
Avoid
Caution is recommended when diuretics are used
with class 1A, 1C or III antiarrythmic drugs
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Treatment of Hypertension with Airways Diseases
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Treatment of Hypertension with Cerebrovascular
Disease
Following a cerebrovascular accident
Treatment of uncomplicated hypertension, hypertens
ion associated with other conditions or
concomitant risk factors.
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Treatment of Hypertension with Left Ventricular
Hypertrophy
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Treatment of Hypertension with Non Diabetic
Renal Disease
Alternative therapy Dihydropyridine CCB
Renal disease
ACE-I
Bilateral renal artery stenosis
Additive therapy Diuretic
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Treatment of Hypertension with Gout
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Summary I
Regarding the treatment of Hypertension, the
recommendations endorse Individualized
therapy, primarily based on consideration of
concomitant risk factors or concurrent
diseases, both cardiovascular and
noncardiovascular
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Summary II
Regarding the treatment of Hypertension, the
recommendations endorse
The addition of long-acting dihydropyridine
calcium-channel blockers to thiazide diuretics,
beta-blockers and ACE inhibitors as first-line
therapy for adults under 60 years of age with
uncomplicated hypertension The addition of ACE
inhibitors to thiazide diuretics and long-acting
dihydropyridine calcium-channel blockers as
first-line therapy for adults older than 60 years
of age with uncomplicated hypertension
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Key messages
Lifestyle recommendations Treat to target
Work on adherence/compliance