Original Title: Protocoles médicaux nationaux et ordonnances associées (mise à jour juillet 2019): hypertension artérielle

Authors' objectives: The Ministère de la Santé et des Services sociaux (MSSS) gave the Institut national d’excellence en santé et en services sociaux (INESSS) the task of hosting and updating the current Québec medical protocols and the current prescription templates. Given that the present versions of the Québec medical protocol and the individual adjustment prescription (IAP) template for first-line antihypertensive medication expire in June 2019, the MSSS’s Direction nationale des soins et services infirmiers, following a prioritization exercise, asked INESSS to update them.

Authors' results and conclusions: RESULTS: The data search yielded 1760 items, of which four clinical practice guidelines containing clinical practice recommendations regarding the first-line pharmacological treatment of hypertension in patients 18 years of age and older were selected. Four of these items were considered to be of sufficient methodological quality for use, based on the AGREE GRS instrument. In addition, the document entitled “Prise en charge systématisée des personnes atteintes d’hypertension artérielle”, published by the Société québécoise d’hypertension artérielle (SQHA), was selected for its contextual data. The updating led to few changes to the medical protocol and the IAP. The main changes are as follows: allowing a downward adjustment of antihypertensives in the event of clinically significant adverse effects and indicating on the IAP the treatment goals, the blood pressure measurement and the indication for initiating a first or a second drug. The prescriber must indicate the conditions for using a second antihypertensive that might be administered. CONCLUSIONS: This update of the medical protocol on adjusting antihypertensive medication is based on clinical practice recommendations enriched with the experiential knowledge of different experts and clinicians and with extracted contextual aspects. At the conclusion of an analysis involving the triangulation of data from these different sources, the update enabled us to determine the relevance of keeping, removing or modifying the existing information or adding, when necessary, new information.

Authors' methods: We conducted a systematic literature search covering the period from April 2016 to January 2018 for items concerning individuals 18 years of age and over with uncomplicated hypertension. Best practice guidelines, expert consensuses, consensus conference reports, guidance documents and any other item containing clinical recommendations were considered for the purpose of identifying recommendations regarding the parameters assessed for adjusting first-line antihypertensives. These parameters were the adjustment details (dosage and adjustment interval), laboratory tests, contraindications and adverse effects, and the precautions and drug interactions that one should be aware of when making a dosage adjustment. The data were analyzed from the perspective of contextualizing the practice in Québec, using mainly legislative, regulatory and organizational contextual elements specific to Québec and the experiential knowledge of the different stakeholders consulted.

Project Status: Completed

URL for protocol: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/hypertension-arterielle.html

Year Published: 2019

URL for published report: https://www.inesss.qc.ca/thematiques/medicaments/protocoles-medicaux-nationaux-et-ordonnances-associees/hypertension-arterielle.html

English language abstract: There is no English language summary available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en santé et en services sociaux (INESSS)