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Hypertension and Stroke: 2005 Canadian Hypertension Educational Program Recommendations

Published online by Cambridge University Press:  02 December 2014

J.M. Boulanger ,
Michael D. Hill  and
on behalf of the CHEP (Canadian Hypertension Educational Program)
J.M. Boulanger*
Affiliation:
Canadian Hypertension Educational Program, Foothills Hospital, Calgary, Alberta, Canada
Michael D. Hill
Affiliation:
Canadian Hypertension Educational Program, Foothills Hospital, Calgary, Alberta, Canada
*
c/o Michael Hill, Foothills Hospital, Room 1242A, 1403 - 29th Street NW, Calgary, Alberta, Canada T2N 2T9
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Abstract:

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Background:

Hypertension is the most important modifiable cause of stroke. The Canadian Hypertension Educational Program, representing Canada's experts in the field of hypertension, publishes annual evidence-based recommendations on the diagnosis and treatment of hypertension.

Methods:

We present the 2005 Canadian Hypertension Educational Program guidelines regarding the management of hypertension in patients with stroke.

Results:

The diagnosis of hypertension should be expedited and can be made as early as the second visit in patients with stroke. Unless contraindicated, a combination of angiotensin-converting-enzyme (ACE) inhibitors and diuretics is the preferred therapy in these patients. A target blood pressure below 140/90mmHg for non-diabetic patients, below 130mmHg/80mmHg for diabetic patients and below 125mmHg/75mmHg for those with renal disease and proteinuria (³ 1 gram per day) should be reached. Lifestyle interventions may be as effective as medication and should be used in conjunction with medical management. Waist circumference should be less than 102cm for men and 88cm for women. There remains uncertainty about the management of high blood pressure in the context of acute stroke.

Conclusions:

A combination of ACE-inhibitors and diuretics is recommended in hypertensive stroke patients. Blood pressure should be maintained below 140/90 mmHg.

Résumé:

RÉSUMÉ: Contexte:

L’hypertension est la cause modifiable la plus importante de l’accident vasculaire cérébral (AVC). L’hypertension est la cause principale de l’AVC. Le Groupe de travail du Programme éducatif canadien sur l’hypertension (PÉCH) est formé d’experts canadiens dans le domaine de l’hypertension. Il publie à chaque année des recommandations fondées sur des données probantes sur le diagnostic et le traitement de l’hypertension.

Méthodes:

Nous présentons les recommandations 2005 du PÉCH sur la prise en charge de l’hypertension chez les patients ayant subi un AVC.

Résultats:

Le diagnostic de l’hypertension doit être accéléré chez les patients ayant subi un AVC. Il peut même être fait à la deuxième visite d’évaluation de la pression artérielle chez ces patients. Le traitement de choix chez ces patients est l’association d’un inhibiteur de l’enzyme de conversion de l’angiotensine (ECA) et d’un diurétique, à moins qu’il n’existe des contre-indications à ce traitement. Les valeurs cibles de pression artérielle sont de moins de 140/90 mmHg chez les patients qui ne sont pas diabétiques, de moins de 130/80 mmHg chez les diabétiques et de moins de 125/75 mmHg chez les patients atteints de néphropathie ayant une protéinurie (> 1 gr par jour). Les interventions axées sur le mode de vie peuvent être aussi efficaces que la médication et devraient être utilisées en association avec la médication. Le tour de taille devrait être de moins de 102 cm chez l’homme et de moins de 88 cm chez la femme. La prise en charge d’une pression artérielle élevée dans le contexte d’un AVC aigu demeure controversée.

Conclusions:

L’association d’un ECA et d’un diurétique est recommandée chez les patients ayant subi un AVC et la pression artérielle devrait être maintenue sous 140/90 mmHg.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 4 , November 2005 , pp. 403 - 408
Copyright
Copyright © The Canadian Journal of Neurological 2005

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