Medical Bulletin 27/May/2025 - Video

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. Hundemer

CMAJ May 2025, 197 (20) E549-E564; DOI: 10.1503/cmaj.241770

New Protein-Based Blood Test May Speed Up Rare Disease Diagnosis

A new blood-based test could significantly accelerate the diagnosis of rare genetic diseases in babies and children, according to research presented at the annual conference of the European Society of Human Genetics. The method, developed by Dr. Daniella Hock and her team at the University of Melbourne, Australia, offers a fast, minimally invasive alternative to current diagnostic approaches, with results available in under three days.

While rare diseases are individually uncommon, they collectively affect about 300 million people worldwide. With more than 7,000 rare conditions linked to mutations in over 5,000 genes, diagnosing these diseases remains a challenge. Current testing methods are often slow, disease-specific, and lack sensitivity, leaving nearly half of suspected patients undiagnosed after years of invasive procedures and inconclusive results.

Dr. Hock's team has developed a proteomic test that analyzes thousands of proteins from just 1ml of blood. Unlike traditional genetic tests that examine DNA, this test sequences proteins—the functional products of genes—allowing scientists to see the downstream effects of genetic mutations. “The test is applicable to potentially thousands of different diseases, and it can even be used to detect new ones by providing the evidence needed to confirm that a genetic change is the likely cause of the disease,” says Dr. Hock.

“When the test is also performed on blood samples from parents we call it trio analysis. In recessively inherited conditions, this helps considerably in differentiating between carriers, who only have one copy of the defective gene, and the affected individual who carries two copies,” she adds.

For patients, a molecular diagnosis allows faster access to treatment and can end prolonged uncertainty. Families gain access to reproductive options like prenatal or preimplantation genetic testing. Health systems also benefit through cost savings by streamlining diagnosis and enabling early, targeted care.

“Our new test can identify more than 8,000 proteins in peripheral blood mononuclear cells (PBMCs) covering more than 50% of known Mendelian and mitochondrial disease genes, as well as enable us to discover new disease genes,” says Dr. Hock.

Reference: Santos Gonzalez F, Hock DH, Thorburn DR, Mordaunt D, Williamson NA, Ang CS, Stroud DA, Christodoulou J, Goranitis I. A micro-costing study of mass-spectrometry based quantitative proteomics testing applied to the diagnostic pipeline of mitochondrial and other rare disorders. Orphanet J Rare Dis. 2024 Nov 29;19(1):443. doi: 10.1186/s13023-024-03462-w. PMID: 39609890; PMCID: PMC11605922.

Can One Vitamin Really Help Reverse Cellular Aging?

A major clinical trial has found that daily Vitamin D3 supplementation may help slow down biological aging at the cellular level. The study, published in the American Journal of Clinical Nutrition and part of the VITAL sub-study led by Mass General Brigham, observed more than a thousand adults over four years. Researchers concluded that Vitamin D3 could prevent the equivalent of nearly three years of aging compared to a placebo.

The findings highlight the role of Vitamin D3 in protecting telomeres, the protective caps on the ends of chromosomes that naturally shorten with age.

Countering natural biological age at the cellular level involves targeting internal cellular processes rather than just external signs of aging. As people age, their cells experience telomere shortening, oxidative stress, and mitochondrial decline. By preserving telomere length and supporting mitochondrial function, Vitamin D3 contributes to healthier cellular aging. It’s not just about looking younger, but also about functioning like a younger person internally.

Vitamin D3, also known as cholecalciferol, is a fat-soluble vitamin vital for calcium absorption and bone health. It is famously called the sunshine vitamin because the body produces it naturally when exposed to sunlight, particularly UVB rays.

Despite its benefits, Vitamin D deficiency is widespread and underdiagnosed, especially among older adults. Natural sources of Vitamin D include fatty fish, fortified foods, egg yolks, and mushrooms. While no nutrient can stop the aging process entirely, adequate Vitamin D3 levels may help slow the clock—with consistent effort and smart choices being key.

Reference: Zhu, H., Manson, J. E., Cook, N. R., Bekele, B. B., Chen, L., Kane, K. J., ... & Dong, Y. (2025). Vitamin D3 and Marine Omega-3 Fatty Acids Supplementation and Leukocyte Telomere Length: 4-Year Findings from the VITAL Randomized Controlled Trial. The American Journal of Clinical Nutrition.