Background

Under the priority topic of Hypertension, the College of Family Physicians of Canada (CFPC)
establishes the following as key objectives to understand for candidates seeking its Certification
in the College of Family Physicians of Canada (CCFP) designation:

1. Screen for hypertension.

2. Use correct technique and equipment to measure blood pressure.
3. Make the diagnosis of hypertension only after multiple BP readings (i.e. at different times
and during different visits).
4. In patients with an established diagnosis of hypertension, assess and re-evaluate
periodically the overall cardiovascular risk and end-organ complications:
a. Take an appropriate history.
b. Do the appropriate physical examination.
c. Arrange appropriate laboratory investigations.
5. In appropriate patients with hypertension (e.g. young patients requiring multiple
medications, patients with an abdominal bruit, patients with hypokalemia in the absence
of diuretics):
a. Suspect secondary hypertension.
b. Investigate appropriately.
6. Suggest individualized lifestyle modifications to patients with hypertension (e.g. weight
loss, exercise, limit alcohol consumption, dietary changes).
7. In a patient diagnosed with hypertension, treat the hypertension with appropriate
pharmacologic therapy (e.g. consider the patient’s age, concomitant disorders, other
cardiovascular risk factors).
8. Given a patient with the signs and symptoms of hypertensive urgency or crisis, make the
diagnosis and treat promptly.
9. In all patients diagnosed with hypertension, assess response to treatment, medication
compliance, and side effects at follow-up visits.

Methods

A search of Ovid MEDLINE was conducted using the following search terms (Table 1). Results
were restricted to primarily Canadian literature. All Ovid MEDLINE entries from 1946 were
included in the search without restriction on publication date.
 Table 1. Ovid MEDLINE search terms used to identify potentially relevant records.

# Search Terms Results

1 (hypertension and (guideline or 153
recommendations) and
canada).ab.
2 ("family physician" and canada 15
and hypertension).ab.
3 ("primary care" and hypertension 105
and canada).ab.
4 ((diagnosis or treatment or 53
management) and hypertension
and (guideline or
recommendation) and canada).ab.
5 ("secondary hypertension" and 2
canada and diagnosis).ab.
6 (hypertension and (urgency or 50
crisis or emergency) and
canada).ab.
7 1 or 2 or 3 or 4 or 5 or 6 294

Ovid MEDLINE: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE®
Daily and Ovid MEDLINE® <1946-Present>

Following the initial database search, duplicate records were removed. Records were then
screened for systematic reviews, meta-analyses, and clinical practice guidelines with
applicability to relevant CFPC objectives and Canadian practice settings. Publications which
have been superseded by more current publications (i.e. where a guideline has been updated or
replaced) were also excluded. See Figure 1 for the PRISMA flow diagram illustrating this.
 Figure 1. PRISMA diagram outlining identification of studies included in qualitative
review.

Lastly, searches were conducted to identify other relevant information from UpToDate, the
Canadian Task Force on Preventative Care, and Canadian Cardiovascular Society. Search of
the Canadian Cardiovascular Society site only yielded publications already identified through
database search.

References from Database Search

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1801976
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5. Hiremath S, Sapir-Pichhadze R, Nakhla M, Gabor JY, Khan NA, Kuyper LM, Ruzicka M,
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8. Saini P, Betcherman L, Radhakrishnan S, Etoom Y. [Paediatric hypertension for the

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33747305

9. Rabi DM, McBrien KA, Sapir-Pichhadze R, Nakhla M, Ahmed SB, Dumanski SM, Butalia
S, Leung AA, Harris KC, Cloutier L, Zarnke KB, Ruzicka M, Hiremath S, Feldman RD,
Tobe SW, Campbell TS, Bacon SL, Nerenberg KA, Dresser GK, Fournier A, Burgess E,
Lindsay P, Rabkin SW, Prebtani APH, Grover S, Honos G, Alfonsi JE, Arcand J,
Audibert F, Benoit G, Bittman J, Bolli P, Cote AM, Dionne J, Don-Wauchope A, Edwards
C, Firoz T, Gabor JY, Gilbert RE, Gregoire JC, Gryn SE, Gupta M, Hannah-Shmouni F,
 Hegele RA, Herman RJ, Hill MD, Howlett JG, Hundemer GL, Jones C, Kaczorowski J,
Khan NA, Kuyper LM, Lamarre-Cliche M, Lavoie KL, Leiter LA, Lewanczuk R, Logan
AG, Magee LA, Mangat BK, McFarlane PA, McLean D, Michaud A, Milot A, Moe GW,
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10. Butalia S, Audibert F, Cote AM, Firoz T, Logan AG, Magee LA, Mundle W, Rey E, Rabi
DM, Daskalopoulou SS, Nerenberg KA. [Hypertension Canada's 2018 Guidelines for the
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11. Grenier J, Goodman SG, Leiter LA, Langer A, Teoh H, Bhatt DL, Cheng AYY, Tan MK,
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Athanasiadis A, Dagklis T. [Chronic hypertension in pregnancy: synthesis of influential
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References from Other Sources

1. Basile, J, Bloch, MJ. Overview of hypertension in adults. In: Bakris, GL, White, WB,
Forman, JP, Law, K editors. UpToDate. Waltham, MA: UpToDate; 2023 [cited 2023 Sep
14]. Available from: https://www.uptodate.com/contents/overview-of-hypertension-in-
adults

2. Mann, JFE, Flack, JM. Choice of drug therapy in primary (essential) hypertension. In:
Bakris, GL, White, WB, Forman, JP, Law, K editors. UpToDate. Waltham, MA:
UpToDate; 2023 [cited 2023 Sep 14]. Available from:
https://www.uptodate.com/contents/choice-of-drug-therapy-in-primary-essential-
hypertension

3. Management of severe asymptomatic hypertension (hypertensive urgencies) in adults.

In: Bakris, GL, White, WB, Forman, JP, editors. UpToDate. Waltham, MA: UpToDate;
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https://www.uptodate.com/contents/management-of-severe-asymptomatic-hypertension-
hypertensive-urgencies-in-adults

4. Varon, J, Elliott, WJ. Management of severe asymptomatic hypertension (hypertensive

urgencies) in adults. In: Bakris, GL, White, WB, Forman, JP, editors. UpToDate.
Waltham, MA: UpToDate; 2023 [cited 2023 Sep 14]. Available from:
https://www.uptodate.com/contents/management-of-severe-asymptomatic-hypertension-
hypertensive-urgencies-in-adults

5. Varon, J, Elliott, WJ. Evaluation and treatment of hypertensive emergencies in adults. In:
Bakris, GL, White, WB, Forman, JP, editors. UpToDate. Waltham, MA: UpToDate; 2023
[cited 2023 Sep 14]. Available from: https://www.uptodate.com/contents/evaluation-and-
treatment-of-hypertensive-emergencies-in-adults

6. Textor, S. Evaluation of secondary hypertension. In: Bakris, GL, White, WB, Forman, JP,
editors. UpToDate. Waltham, MA: UpToDate; 2023 [cited 2023 Sep 14]. Available from:
https://www.uptodate.com/contents/evaluation-of-secondary-hypertension

7. Mann, JFE, Hilgers, KF. Goal blood pressure in adults with hypertension. In: Bakris, GL,
White, WB, Kasner, SE, Nathan, DM, Forman, JP, Law, K, editors. UpToDate. Waltham,
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8. Lindsay P, Connor Gorber S, Joffres M, Birtwhistle R, McKay D, Cloutier L; Canadian

Task Force on Preventive Health Care (CTFPHC). Recommendations on screening for
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e393-400. PMID: 24029505; PMCID: PMC3771717. Available from:
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PRISMA Diagram Generation Tool

1. Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022).

PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow
diagrams, with interactivity for optimised digital transparency and Open Synthesis
Campbell Systematic Reviews, 18, e1230. https://doi.org/10.1002/cl2.1230