Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children

Doreen M Rabi; Kerry A McBrien; Ruth Sapir-Pichhadze; Meranda Nakhla; Sofia B Ahmed; Sandra M Dumanski; Sonia Butalia; Alexander A Leung; Kevin C Harris; Lyne Cloutier; Kelly B Zarnke; Marcel Ruzicka; Swapnil Hiremath; Ross D Feldman; Sheldon W Tobe; Tavis S Campbell; Simon L Bacon; Kara A Nerenberg; George K Dresser; Anne Fournier; Ellen Burgess; Patrice Lindsay; Simon W Rabkin; Ally P H Prebtani; Steven Grover; George Honos; Jeffrey E Alfonsi; JoAnne Arcand; François Audibert; Geneviève Benoit; Jesse Bittman; Peter Bolli; Anne-Marie Côté; Janis Dionne; Andrew Don-Wauchope; Cedric Edwards; Tabassum Firoz; Jonathan Y Gabor; Richard E Gilbert; Jean C Grégoire; Steven E Gryn; Milan Gupta; Fady Hannah-Shmouni; Robert A Hegele; Robert J Herman; Michael D Hill; Jonathan G Howlett; Gregory L Hundemer; Charlotte Jones; Janusz Kaczorowski; Nadia A Khan; Laura M Kuyper; Maxime Lamarre-Cliche; Kim L Lavoie; Lawrence A Leiter; Richard Lewanczuk; Alexander G Logan; Laura A Magee; Birinder K Mangat; Philip A McFarlane; Donna McLean; Andre Michaud; Alain Milot; Gordon W Moe; S Brian Penner; Andrew Pipe; Alexandre Y Poppe; Evelyne Rey; Michael Roerecke; Ernesto L Schiffrin; Peter Selby; Mike Sharma; Ashkan Shoamanesh; Praveena Sivapalan; Raymond R Townsend; Karen Tran; Luc Trudeau; Ross T Tsuyuki; Michel Vallée; Vincent Woo; Alan D Bell; Stella S Daskalopoulou

doi:10.1016/j.cjca.2020.02.086

Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children

Can J Cardiol. 2020 May;36(5):596-624. doi: 10.1016/j.cjca.2020.02.086.

Authors

Doreen M Rabi¹, Kerry A McBrien², Ruth Sapir-Pichhadze³, Meranda Nakhla⁴, Sofia B Ahmed⁵, Sandra M Dumanski⁵, Sonia Butalia⁶, Alexander A Leung⁷, Kevin C Harris⁸, Lyne Cloutier⁹, Kelly B Zarnke¹⁰, Marcel Ruzicka¹¹, Swapnil Hiremath¹², Ross D Feldman¹³, Sheldon W Tobe¹⁴, Tavis S Campbell¹⁵, Simon L Bacon¹⁶, Kara A Nerenberg¹⁷, George K Dresser¹⁸, Anne Fournier¹⁹, Ellen Burgess²⁰, Patrice Lindsay²¹, Simon W Rabkin²², Ally P H Prebtani²³, Steven Grover²⁴, George Honos²⁵, Jeffrey E Alfonsi¹⁸, JoAnne Arcand²⁶, François Audibert²⁷, Geneviève Benoit²⁸, Jesse Bittman²⁹, Peter Bolli³⁰, Anne-Marie Côté³¹, Janis Dionne³², Andrew Don-Wauchope³³, Cedric Edwards¹¹, Tabassum Firoz³⁴, Jonathan Y Gabor³⁵, Richard E Gilbert³⁶, Jean C Grégoire³⁷, Steven E Gryn¹⁸, Milan Gupta³⁸, Fady Hannah-Shmouni³⁹, Robert A Hegele¹⁸, Robert J Herman⁴⁰, Michael D Hill⁴¹, Jonathan G Howlett⁴², Gregory L Hundemer¹¹, Charlotte Jones⁴³, Janusz Kaczorowski⁴⁴, Nadia A Khan²⁹, Laura M Kuyper²⁹, Maxime Lamarre-Cliche⁴⁵, Kim L Lavoie⁴⁶, Lawrence A Leiter⁴⁷, Richard Lewanczuk⁴⁸, Alexander G Logan⁴⁹, Laura A Magee⁵⁰, Birinder K Mangat²⁹, Philip A McFarlane⁵¹, Donna McLean⁵², Andre Michaud⁵³, Alain Milot⁵⁴, Gordon W Moe⁵⁵, S Brian Penner⁵⁶, Andrew Pipe⁵⁷, Alexandre Y Poppe⁵⁸, Evelyne Rey⁵⁹, Michael Roerecke⁶⁰, Ernesto L Schiffrin⁶¹, Peter Selby⁶², Mike Sharma⁶³, Ashkan Shoamanesh⁶⁴, Praveena Sivapalan⁶⁵, Raymond R Townsend⁶⁶, Karen Tran²⁹, Luc Trudeau⁶⁷, Ross T Tsuyuki⁶⁸, Michel Vallée⁶⁹, Vincent Woo⁷⁰, Alan D Bell⁷¹, Stella S Daskalopoulou⁷²

Affiliations

¹ Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: ip3@ualberta.ca.
² Departments of Family Medicine and Community Health Services, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Division of Nephrology, Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
⁴ Department of Pediatrics and Centre for Outcomes Research and Evaluation, McGill University, and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
⁵ Department of Medicine, University of Calgary, Libin Cardiovascular Institute of Alberta, and Alberta Kidney Disease Network, Calgary, Alberta, Canada.
⁶ Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health, and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada.
⁷ Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁸ Children's Heart Centre, BC Children's Hospital, and Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
⁹ Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
¹⁰ O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
¹¹ Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹² University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹³ Winnipeg Regional Health Authority and the University of Manitoba, Winnipeg, Manitoba, Canada.
¹⁴ Department of Medicine, University of Toronto, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
¹⁵ Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
¹⁶ Department of Health, Kinesiology, and Applied Physiology, Concordia University, and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montréal, Quebec, Canada.
¹⁷ Division of General Internal Medicine, Departments of Medicine, Obstetrics and Gynecology, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
¹⁸ Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
¹⁹ Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada.
²⁰ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
²¹ Heart and Stroke Foundation of Canada, Ottawa, Ontario, Canada.
²² Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
²³ Division of Endocrinology and Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
²⁴ Department of Medicine, McGill University, Montreal, Quebec, Canada.
²⁵ Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
²⁶ Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada.
²⁷ Department of Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Quebec, Canada.
²⁸ Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
²⁹ Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
³⁰ McMaster University, Hamilton, Ontario, Canada.
³¹ Université de Sherbrooke, Sherbrooke, Quebec, Canada.
³² Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
³³ Department of Pathology and Molecular Medicine, McMaster University, Hamilton, and LifeLabs LP, Toronto, Ontario, Canada.
³⁴ Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
³⁵ Department of Cardiology, Selkirk Regional Health Centre, Selkirk, Manitoba, Canada.
³⁶ University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada.
³⁷ Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada.
³⁸ Department of Medicine, McMaster University, Hamilton, and Canadian Collaborative Research Network, Brampton, Ontario, Canada.
³⁹ Section on Endocrinology and Genetics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
⁴⁰ Division of General Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴¹ Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴² Departments of Medicine, Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴³ Department of Medicine, Southern Medical Program, University of British Columbia, Kelowna, British Columbia, Canada.
⁴⁴ Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Quebec, Canada.
⁴⁵ Institut de Recherches Cliniques de Montréal (IRCM), Université de Montréal, Montréal, Quebec, Canada.
⁴⁶ University of Quebec at Montreal (UQAM), Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada.
⁴⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
⁴⁸ Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
⁴⁹ Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada.
⁵⁰ Department of Women and Children's Health, St Thomas' Hospital, London, and Department of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.
⁵¹ Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵² Alberta Health Services and Covenant Health, Edmonton, Alberta, Canada.
⁵³ École des sciences infirmières, FMSS, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
⁵⁴ Department of Medicine, Université Laval, Québec, Quebec, Canada.
⁵⁵ St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵⁶ University of Manitoba, Winnipeg, Manitoba, Canada.
⁵⁷ Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁵⁸ Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada.
⁵⁹ Departments of Medicine and Obstetrics and Gynecology, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada.
⁶⁰ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁶¹ Department of Medicine, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
⁶² Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
⁶³ McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada.
⁶⁴ Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada.
⁶⁵ Division of General Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
⁶⁶ Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁶⁷ Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada.
⁶⁸ Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
⁶⁹ Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada.
⁷⁰ Division of Endocrinology and Metabolism, University of Manitoba, Winnipeg, Manitoba, Canada.
⁷¹ Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁷² Division of Internal Medicine, Department of Medicine, McGill University, and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.

PMID: 32389335
DOI: 10.1016/j.cjca.2020.02.086

Abstract

Hypertension Canada's 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.

Publication types

Practice Guideline
Research Support, Non-U.S. Gov't
Review

MeSH terms

Adult
Algorithms
Antihypertensive Agents / therapeutic use
Blood Pressure Monitoring, Ambulatory
Canada
Cardiovascular Diseases / complications
Cardiovascular Diseases / prevention & control
Child
Diabetes Complications
Drug Resistance
Female
Health Promotion
Heart Failure / complications
Humans
Hypertension / complications
Hypertension / diagnosis*
Hypertension / etiology
Hypertension / therapy*
Hypertrophy, Left Ventricular / complications
Medication Adherence
Preconception Care
Pregnancy
Pregnancy Complications, Cardiovascular / therapy
Renal Insufficiency, Chronic / complications
Risk Assessment
Stroke / complications
Telemedicine

Substances

Antihypertensive Agents