History & Background
Canada has a long history of developing hypertension recommendations.
The first national recommendations were developed by a committee sponsored by Health and Welfare Canada. They reviewed evidence up to 1977 for the usefulness of pharmacotherapy and the stepped-care approach.
Subsequently, the Canadian Hypertension Society sponsored the creation of several sets of recommendations. In 1984, a large multidisciplinary committee met to address three major issues:
- To determine if all hypertensive patients without target organ damage should be treated.
- To review proper measurement of blood pressure & the diagnosis of hypertension.
- To address relative effectiveness & cost-effectiveness of treatment with diuretics, beta-blockers, sodium restriction & weight loss.
In 1985, the CHS sponsored recommendations for management of hypertension in the elderly.
In 1989, the CHS developed updated recommendations.
These early recommendations processes were primarily funded by national and provincial grants. While these early processes created a template for the Canadian Hypertension Education Program recommendations process, no methodologies were published.
In 1990, the Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention & Control (CCHBPPC) now known as Blood Pressure Canada co-sponsored the development of non-pharmacologic recommendations for hypertension management. This process used a panel consensus approach.
In 1993, the Canadian Hypertension Society published updated recommendations. This was the first time evidence-based medicine methodology for creating the recommendations was published. The process which involved four panels: diagnosis, pharmacotherapy, hypertension in the elderly & diabetic hypertension.
In 1997, another evidence-based approach was used to issue recommendations on the management of hypertension during pregnancy. This process was sponsored by the Canadian Hypertension Society & the Society of Obstetrics & Gynecology.
In 1999, two separate processes following the 1993 evidence-based methodology took place. One was sponsored by the Canadian Hypertension Society & the Canadian Coalition for High Blood Pressure Prevention & Control and focused on lifestyle modifications to prevent & control hypertension. The other was sponsored by a multidisciplinary group of organizations headed by the Canadian Hypertension Society.
Over the course of this period, discussions between several organizations focused on why the recommendations were not improving blood pressure control. It was agreed that for the recommendations to be successful they would need to be evidence-based, up-to-date, associated with credible organizations and most importantly, associated with an extensive and sustained implementation program.
In 2000, the Canadian Hypertension Education Program (CHEP) was born. The CHEP program has annually updated, disseminated and evaluated the hypertension recommendations since 2000.
For more information see: A Brief History of Canadian Hypertension Recommendations
Norm Campbell, Denis Drouin, & Ross Feldman
Originally published in Hypertension Canada March 2005 Bulletin No. 82