Hypertension (Canada)

Top 10 priorities

1. What healthy lifestyle habits or combination of habits can reduce or eliminate the need for antihypertensive agents?
2. Does treating stress influence blood pressure and what is the optimal prescription?
3. What is the best treatment strategy for different types of hypertension including those with a family history of hypertension and for men vs. women?
4. Do treatment strategies based on control of out-of-office blood pressure (home blood pressure monitoring or 24-hour ambulatory blood pressure monitoring) provide an advantage over strategies based on conventional office blood pressure control?
5. What are the optimal educational tools, strategies and technologies to improve patient motivation and health behaviour change for hypertension?
6. What are the optimal thresholds for starting and stopping antihypertensive agents?
7. What is the optimal prescription of exercise emphasizing alternatives to walking/running for older individuals with or without arthritis or other health problems?
8. What hypertension management strategies are most effective for patients of Aboriginal descent or other ethnic or racial groups?
9. What natural and alternative treatments are safe and effective for reducing blood pressure and don’t adversely interact with antihypertensive agents?
10. What is the optimal role of different health care providers and caregivers in providing support to patients with hypertension?

The remaining questions discussed at the workshop were (in no order of priority):

• How can patients be screened for masked hypertension at the physician’s office? (Masked hypertension is where the blood pressure is high at home but not high at the physician’s office.)
• How can the health care practitioner help educate patients on hypertension and proper monitoring of blood pressure between appointments?
• What are the best strategies and tools to use to improve compliance with medications, regular blood pressure monitoring, and compliance with long term lifestyle changes?
• What are the best hypertension management options for people who cannot or will not exercise?
• What are the best strategies for lowering salt intake in diets?
• What is the expected effect on blood pressure for [a given amount of] the following: salt reduction, quitting smoking, weight loss, stress management, exercise, and DASH diet compliance?
• What role does a healthy diet play in managing blood pressure with or without medication?
• Which specific foods and nutrients should be avoided to prevent adverse interactions with blood pressure medications and increase blood pressure?
• Which specific foods and/or supplements are most effective in reducing blood pressure and the number of antihypertensive medications needed to manage hypertension?
• How should we choose the medication(s) for maximum benefit and minimum side effects for each individual person living with hypertension?
• Is there an ideal time to take medication, and if so, does this time need to be consistent every day?
• What are the long-term benefits and risks of antihypertensive medications?
• What are the optimal medications to reduce blood pressure variability (when blood pressure readings are very different in the same day or vary from doctor visit to doctor visit) or what is the optimal medication management approach for patients with very variable blood pressures?
• Does significant weight loss or healthy lifestyle determine the need for ongoing blood pressure medications?
• What are the optimum blood pressure treatment thresholds and targets for young adults?