New Hypertension Guideline Targets Better Care in Primary Practice

A newly published guideline from Hypertension Canada aims to improve hypertension diagnosis and treatment in primary care, including by family physicians, nurses, nurse practitioners, and pharmacists. The guideline, the first of two, appears in the Canadian Medical Association Journal (CMAJ) and will also be republished in Canadian Family Physician and the Canadian Pharmacists Journal, with a summary featured in Canadian Nurse.

Hypertension is the leading modifiable risk factor for heart disease and death.

The guideline aligns with the World Health Organization’s HEARTS framework, a global initiative to improve cardiovascular health. In regions of the United States where this approach was implemented, hypertension control rates improved from 44% to 90% over a decade.

Focused on primary care needs, the guideline provides updated evidence-based recommendations on BP assessment, hypertension diagnosis, lifestyle modifications, and pharmacologic treatment, including for hard-to-treat hypertension. Medication selection factors include efficacy, cost, availability, and resilience to drug shortages.

One major update is the adoption of lower BP thresholds for diagnosis and treatment.

The guideline was developed by a multidisciplinary team, including family physicians, pharmacists, a nurse practitioner, hypertension specialists, a methodologist, and four patient partners with lived experience. A second, more comprehensive guideline will follow, addressing complex hypertension cases such as resistant hypertension.

“As primary care is where most hypertension is managed, supporting primary care practitioners to better diagnose and manage this disease will improve hypertension care at the population level and benefit people in Canada,” says Dr. Ross Tsuyuki, past president, Hypertension Canada. “We hope these practical recommendations will help with implementing hypertension care in everyday clinical practice.”

Reference: Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care

Rémi Goupil, Ross T. Tsuyuki, Nancy Santesso, Kristin A. Terenzi, Jeffrey Habert, Gemma Cheng, Stephanie C. Gysel, Jill Bruneau, Alexander A. Leung, Norman R.C. Campbell, Ernesto L. Schiffrin, Gregory L. HundemerCMAJ May 2025, 197 (20) E549-E564; DOI: 10.1503/cmaj.241770