OLD BUT STILL VERY IMPORTANT MESSAGES OF CHEP
Measure Blood Pressure in All Adults at All Appropriate Visits
For many Canadians with hypertension, the condition remains undetected; therefore, measure blood pressure in all adults at all appropriate visits.
Expedite the Diagnosis of Hypertension
For patients with hypertensive urgencies or emergencies, hypertension can be diagnosed at an initial hypertension-related visit. For patients with blood pressure of 140/90 mm Hg or above and with 1 of 4 other indicators—target organ damage, chronic kidney disease, diabetes mellitus, or blood pressure of 180/110 mm Hg or above—the diagnosis can be made at the second visit. For patients with blood pressure of 160-179/100-109 mm Hg and with no diagnosis of hypertension according to the criteria above, the diagnosis can be made at the third visit. The diagnosis of hypertension can also be made if self-measured blood pressure (average > 135/85 mm Hg, based on duplicate readings taken twice a day for 1 week, ignoring the first day) or ambulatory blood pressure (daytime ambulatory blood pressure > 135/85 mm Hg or 24-h blood pressure > 130/80 mm Hg) is elevated after the second office visit.
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Assess and Manage Global Cardiovascular Risk
Most hypertensive patients have multiple cardiovascular risks, in addition to hypertension, that require assessment and management. Acetylsalicylic acid should be considered for patients with controlled hypertension. Statins are recommended for hypertensive patients with established cardiovascular disease or at least 3 other cardiovascular risks.
Emphasize that Lifestyle Modifications Form the Cornerstone of Antihypertensive Therapy
Lifestyle modifications should be encouraged, as they are safe and inexpensive, they can lower blood pressure and prevent hypertension, and (when combined with drug therapy) they may result in better blood pressure control and improved quality of life. Many of the individual lifestyle modifications listed below, if successfully adopted, may lead to blood pressure changes of a magnitude comparable to that achieved by single-drug therapy. Although each lifestyle factor typically has a modest effect, the combined effects may be substantial. From a public health perspective, even a small reduction in blood pressure translates into a significant, beneficial effect on the occurrence of hypertension and its complications.
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The following lifestyle changes are recommended by CHEP to reduce blood pressure:
• diet low in salt and saturated fats and high in fresh fruit and vegetables and low-fat dairy products (the DASH diet)
• 30 to 60 min of continuous or accumulated moderate-intensity dynamic exercise (walking, jogging, cycling, or swimming) on 4 to 7 days each week
• weight reduction for those who are overweight
• reduction of alcohol consumption for those who drink more than 2 drinks/day.
• smoking cessation to reduce global cardiovascular risk