Under Pressure: Hypertension Canada’s Latest Guideline for Primary Care

This is one guideline you want to read closely. Take a close look at targets, exceptions, and how to treat.

BONUS EXAM TIP: See the official sample CCFP exam questions which feature this guideline

Diagnosis and Definition

BP Measurement: Use a validated automated device with standardized technique.
Confirm Diagnosis: Out-of-office BP monitoring (home or ambulatory) is preferred.
Definition: Hypertension is defined as BP ≥130/80 mm Hg.

Treatment Recommendations

Lifestyle: Essential for all adults.
When to Start Drug Therapy:
- Adults with BP ≥140/90 mm Hg.
- Adults with SBP 130−139 mm Hg IF high cardiovascular risk (e.g., diabetes, CKD, CVD, age ≥75).
Treatment Target: Aim for Systolic BP <130 mm Hg (if tolerated).
First-Line Pharmacotherapy: Start with low-dose 2-drug combination (ideally single-pill): ACEI or ARB PLUS a thiazide/thiazide-like diuretic or a CCB.
Step-Up Therapy:
- Uncontrolled on 2 drugs → Use 3-drug combo (ACEI/ARB + thiazide/thiazide-like + dihydropyridine CCB).
- Still uncontrolled → Consider Spironolactone.
- Resistant hypertension → Evaluate for secondary causes.

Special Considerations

β-blockers: Not first-line unless specific indication (e.g., heart failure, post-MI).
ACEIs/ARBs: Avoid in pregnancy; counsel patients of childbearing potential on teratogenic risk.
Thiazides: Chlorthalidone vs. Hydrochlorothiazide have similar efficacy; Chlorthalidone has a higher risk of hypokalemia.

References