What are the Canadian hypertension (HTN) treatment targets?

Canadian Hypertension Treatment Targets

According to the Canadian Hypertension Education Program (CHEP), the general blood pressure treatment target for most hypertensive patients is <140/90 mmHg, with lower targets of <130/80 mmHg for patients with diabetes or chronic kidney disease. 1

General Population Targets

The Canadian guidelines provide specific blood pressure targets based on patient characteristics:

• General population: <140/90 mmHg 1
• Elderly patients (>80 years): <150/90 mmHg, with initiation of therapy when systolic BP >160 mmHg 1
• Fit elderly patients (<80 years): <140 mmHg systolic 1
• Frail elderly: Treatment targets at clinician discretion 1

Special Populations

Different targets apply for patients with specific comorbidities:

• Diabetes mellitus: <130/80 mmHg 1
• Chronic kidney disease (CKD): <140/90 mmHg generally 1
• CKD with proteinuria: <130 mmHg systolic 1

First-Line Pharmacological Therapy Recommendations

Canadian guidelines recommend specific first-line agents based on patient characteristics:

• General population: Thiazide diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs) 1
• Black population: Thiazide diuretics or CCBs 1
• Non-diabetic CKD: ACEIs or ARBs, especially with proteinuria 1
• Diabetes: ACEIs or ARBs (with CKD), or thiazides/CCBs/ACEIs/ARBs (without CKD) 1

Important Considerations for Blood Pressure Measurement

For accurate blood pressure readings:

• Measure BP in both arms at the initial visit (a difference >10 mmHg between arms indicates increased cardiovascular risk) 2
• Ensure proper patient positioning with back supported, legs uncrossed, and arm at heart level 2
• Allow patient to rest for at least 5 minutes before measurement 1
• Use appropriately sized cuff (bladder should cover at least 80% of arm circumference) 1

Common Pitfalls to Avoid

• Incorrect cuff size: Using a cuff that's too small can falsely elevate readings
• White coat hypertension: Consider home BP monitoring or ambulatory BP monitoring if suspected
• Masked hypertension: May be identified through home or ambulatory monitoring
• Orthostatic hypotension: Check for postural drops, especially in elderly patients
• Inadequate rest period: Failure to allow sufficient rest before measurement can lead to falsely elevated readings

Treatment Algorithm

1. Confirm hypertension diagnosis with multiple readings
2. Assess global cardiovascular risk and presence of target organ damage
3. Implement appropriate lifestyle modifications
4. Initiate pharmacotherapy based on BP level and patient characteristics
5. Titrate medication to reach target BP (<140/90 mmHg for most; <130/80 mmHg for diabetes/CKD)
6. Consider combination therapy if BP is ≥20/10 mmHg above target
7. Monitor regularly (monthly after medication changes, every 3-5 months when controlled)

The Canadian guidelines align with several international guidelines in recommending <140/90 mmHg as the general target, though they maintain a lower target of <130/80 mmHg for diabetes, which differs from some other guidelines that have moved to <140/90 mmHg for all patients 1.