New protocol update for hypertension

Prevention and interprofessional collaboration are the two key principles of the new national medical protocol (NMP) for medication adjustment and monitoring in adults with primary hypertension, recently published by the National Institute of Excellence in Health and Social Services (INESSS). As a reminder, this protocol applies to adults with a blood pressure (BP) greater than or equal to 130/80 mmHg measured using a validated automated blood pressure monitor under ideal conditions.To ensure this protocol aligns with the latest scientific data and best practice trends for optimal monitoring of individuals receiving antihypertensive treatment, several changes have been made: 1. Emphasis on the importance of adopting and maintaining healthy lifestyle habitsClinicians are encouraged to inquire about the latest lifestyle changes in their patients and to reinforce and maintain healthy lifestyle habits at each follow-up visit—such as a healthy, low-salt diet, regular physical activity, reducing or eliminating harmful substances, getting enough sleep, and reducing stress.The appendices to the National Blood Program (NBP) include a list of foods and substances that can influence blood pressure.In addition, INESSS recommends primary care refer their patients to other relevant professionals (kinesiologists, nutritionists, psychologists) if necessary.2. The removal of the beta-blocker and non-dihydropyridine calcium channel blocker (DHP-CCB) classes.3. The addition of the mineralocorticoid inhibitor or aldosterone receptor antagonist class. Recommended when the combination of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), a diuretic, and a CCB is insufficient to achieve therapeutic targets.The PMN appendices include a list of drug interactions, a decision-making algorithm for adjusting and monitoring prescribed antihypertensive medication, and information on available strengths of antihypertensive drugs.Finally, a section on information to be provided to patients, including several hyperlinks to additional resources, has also been added to the protocol.INESSS also updated the group prescription template associated with this protocol to include in its indications all individuals whose medication adjustment and follow-up are not included in their individual antihypertensive prescription. This template allows, when required, for the initiation and monitoring of laboratory tests for these individuals (without, however, allowing for medication adjustments).A referral form template for community pharmacists is also available on the Institute's website.Finally, given that the national medical protocol is applicable only after a pharmacological treatment has been prescribed, INESSS has produced a new reference guide to support frontline prescribers in their decisions regarding the initiation of treatment for hypertension.This article has been translated from its original French and first appeared on our sister site Profession Santé.

New protocol update for hypertension

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