New recommendations urge physicians to diagnose and manage hypertension more quickly to prevent complications. It now takes up to 6 months from initial presentation to diagnosis, which delays treatment and increases the possibility of complications.
The 2005 Canadian Hypertension Education Program (CHEP) Recommendations advocate quicker diagnosis in physicians' offices and by the use of home and ambulatory blood pressure monitors (www.hypertension.ca). The recommendations set out an algorithm for expedited diagnosis based on blood pressure levels and, if appropriate, other medical conditions.
For example, diagnosing level 1 (mild) hypertension (systolic 140–160, diastolic 90–100) would entail 2 visits to a physician and 1 week of home blood pressure monitoring or 24 hours of ambulatory monitoring.
“We now know from a number of studies that complications from high blood pressure can occur sooner than we would have thought,” says Feldman (Lancet 2004;363:2022-31).
About 43% of Canadians with hypertension are never diagnosed. Among the 23% of Canadian adults who are diagnosed with hypertension, only 16% are treated and controlled.
This “substantial gap” in detection and diagnosis must be addressed, says Dr. Ross Feldman, co-chair of the CHEP recommendations task force.
Feldman acknowledges the current debate over the accuracy of blood pressure monitoring equipment (CMAJ 2002;166[9]:1145-8) and advises purchasing equipment that is endorsed by a reputable organizations and teaching patients how to use it properly.
The 2005 recommendations also support the “increasingly held belief” that, in general, no single class of antihypertensive drug provides substantial benefits over others. The important thing is to lower blood pressure. “People have made big deals about mostly secondary endpoints. The CHEP network decided it's more important to lower blood pressure.”
The move to expedite diagnosis follows a Lancet study (2005;365:217-23) predicting that 1 in 3 adults — 1.56 billion people — will have hypertension by 2025.
The CHEP guidelines are funded through the Canadian Hypertension Society by Health Canada and 12 pharmaceutical companies. — Barbara Sibbald, CMAJ