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Resistant hypertension is associated with cardiovascular morbidity and mortality. The objective of this study was to estimate the prevalence of apparent treatment-resistant hypertension in Canadian adults and examine the characteristics of those affected.A nationally representative cross-sectional study was conducted with the use of Canadian Health Measures Survey (2007-2017) data. The frequency of respondents with uncontrolled blood pressure despite 3 or more antihypertensive medications of different drug classes (and at least 1 agent being a diuretic), or treatment with 4 or more agents regardless of blood pressure, was determined.A total of 245,700 people were identified to have apparent treatment-resistant hypertension, representing 5.3% (95% confidence interval [CI] 4.5%-6.2%) of adults treated for hypertension in Canada. Respondents who had uncontrolled blood pressure with 3 or more antihypertensive drugs were more likely women (55.8%, 95% CI 41.1%-70.4%), 70 years of age or older (45.3% 95% CI 32.8%-57.9%), and overweight or obese (84.2%, 95% CI 72.3%-96.1%). Respondents with apparent treatment-resistant hypertension also had a high likelihood of chronic kidney disease (36.0%, 95% CI 21.4%-50.6%), diabetes (35.2%, 95% CI 21.7%-48.7%), dyslipidemia (68.0%, 95% CI 55.2%-80.8%), and history of heart attack (9.9%, 95% CI 4.8%-15.1%) or stroke (7.1%, 95% CI 0-14.4%).Despite being prescribed at least 3 antihypertensive drugs, a considerable proportion of Canadians, especially women, have difficulty achieving blood pressure control, predisposing them to a higher risk of cardiovascular complications and death.

Background: Home blood pressure monitoring is increasingly used for pregnant individuals; however, there are no guidelines on such monitoring in this population. We assessed current practices in the prescription and use of home blood pressure monitoring in pregnancy. Methods: We conducted a systematic review and meta-analysis of observational studies and randomized controlled trials (RCTs). We conducted a structured search through the MEDLINE (from 1946), Embase (from 1974) and CENTRAL (from 2018) databases up to Oct. 19, 2020. We included trials comparing office and home blood pressure monitoring in pregnant people. Outcomes included patient education, home blood pressure device, monitoring schedule, adherence, diagnostic thresholds for home blood pressure, and comparison between home and office measurements of blood pressure. Results: We included in our review 21 articles on 19 individual studies (1 RCT, 18 observational) that assessed home and office blood pressure in pregnant individuals (n = 2843). We observed variation in practice patterns in terms of how home monitoring was prescribed. Eight (42%) of the studies used validated home blood pressure devices. Across all studies, measurements were taken 3 to 36 times per week. Third-trimester home blood pressure corresponding to office blood pressure of 140/90 mm Hg after application of a conversion factor ranged from 118 to 143 mm Hg (systolic) and from 76 to 92 mm Hg (diastolic), depending on the patient population and methodology. Systolic and diastolic blood pressure values measured at home were lower than office values by 4 (95% confidence interval [CI] −6 to −3) mm Hg and 3 (95% CI −4 to −2) mm Hg, respectively. Interpretation: Many issues related to home blood pressure monitoring in pregnancy are currently unresolved, including technique, monitoring schedule and target values. Future studies should prioritize the use of validated home measuring devices and standardized measurement schedules and should establish treatment targets. PROSPERO registration: CRD42020147352

Background Hypertension continues to be the leading cause of preventable death and disability. The objective of this study was to examine hypertension prevalence, awareness, treatment, and control for women and men in Canada over the last decade. Methods A nationally representative, cross-sectional study was conducted using the Canadian Health Measures Survey (2007-2017). Using blood pressure readings from each respondent, along with a self-reported history of high blood pressure and active medications, the rates of hypertension prevalence, awareness, treatment, and control were calculated for women and men. Results A total of 5,794,641 people were identified to have hypertension from 2007 to 2017, representing 23.1% (95% confidence interval [CI], 21.9%-24.2%) of the Canadian adult population with no appreciable change in prevalence over the decade. Overall awareness, treatment, and control were 83.5% (95% CI, 81.5%-85.4%), 78.9% (95% CI, 76.2%-81.6%), and 65.4% (95% CI, 62.4%-68.4%), respectively, with no significant changes in men from 2007 to 2017. Conversely, in women, substantial deteriorations in awareness (72.2% [95% CI, 64.1%-80.2%] in 2016-2017 vs 85.0% [95% CI, 82.4%-87.7%] in 2007-2015), treatment (65.2% [95% CI, 57.6%-72.8%] vs 82.2% [95% CI, 79.4%-85.1%]), and control (49.2% [95% CI, 39.7%-58.7%] vs 67.0% [95% CI, 63.9%-70.1%]) were found. Conclusions After plateauing early in the 2000s, Canadian hypertension treatment and control rates have declined in the past decade, largely in women. Renewed collaborative efforts by key stakeholders are urgently needed to address this increase in preventable risk for cardiovascular disease.

Objectives To examine health-related quality of life (HRQL) and cognitive and functional status before and after emergency surgical care in elderly adults. Design Six-month prospective cohort study. Setting Acute care and emergency surgery service at a single, academic tertiary care center, Edmonton, Alberta, Canada. Participants Admitted individuals aged 65 and older (mean age 77.8 ± 7.9, 52% female) or their surrogates. Measurements Abbreviated Mental Test Score-4 (AMTS), Barthel Index, Vulnerable Elders Survey (VES-13), and EuroQol-5 Dimensional Scale (EQ-5D) completed by participants or their surrogates within 24 hours of admission to the hospital and 6 months after discharge. Paired t-tests and McNemar tests were used to assess the difference between baseline and 6 months. Results One hundred fifty-five consecutive individuals (including 16 surrogates) were enrolled. Sixteen (10%) died within 6 months of discharge, and 116 (75%, including 18 surrogates) completed a follow-up assessment 6 months after discharge. Cognitive status improved substantially over 6 months, with 72 (52%) of participants having AMTS scores showing cognitive impairment at baseline and four (4%) having AMTS scores showing cognitive impairment at 6 months (P < .001). There was no statistically significant change from baseline on the Barthel Index, VES-13, or EQ-5D. Conclusion There was significant cognitive improvement in older adults after surgical hospitalization. HRQL improved back to age-matched population norms. These results suggest that elderly adults admitted for emergency surgery have good cognitive, functional, and HRQL outcomes.

The Canadian Hypertension Education Program reviews the hypertension literature annually and provides detailed recommendations regarding hypertension diagnosis, assessment, prevention, and treatment. This report provides the updated evidence-based recommendations for 2015. This year, 4 new recommendations were added and 2 existing recommendations were modified. A revised algorithm for the diagnosis of hypertension is presented. Two major changes are proposed: (1) measurement using validated electronic (oscillometric) upper arm devices is preferred over auscultation for accurate office blood pressure measurement; (2) if the visit 1 mean blood pressure is increased but < 180/110 mm Hg, out-of-office blood pressure measurements using ambulatory blood pressure monitoring (preferably) or home blood pressure monitoring should be performed before visit 2 to rule out white coat hypertension, for which pharmacologic treatment is not recommended. A standardized ambulatory blood pressure monitoring protocol and an update on automated office blood pressure are also presented. Several other recommendations on accurate measurement of blood pressure and criteria for diagnosis of hypertension have been reorganized. Two other new recommendations refer to smoking cessation: (1) tobacco use status should be updated regularly and advice to quit smoking should be provided; and (2) advice in combination with pharmacotherapy for smoking cessation should be offered to all smokers. The following recommendations were modified: (1) renal artery stenosis should be primarily managed medically; and (2) renal artery angioplasty and stenting could be considered for patients with renal artery stenosis and complicated, uncontrolled hypertension. The rationale for these recommendation changes is discussed.

Hospitals reduce staffing levels and services on weekends. This raises the question of whether weekend discharges may be inadequately prepared and thus at higher risk for adverse events postdischarge.To compare death or nonelective readmission rates 30 days after weekend versus weekday discharge.Retrospective cohort.All teaching hospitals in Alberta, Canada.General internal medicine (GIM) discharges (only 1 per patient).Analyses were adjusted for demographics, comorbidity, and length of stay based on a previously validated index.Of 7991 patients (mean age, 62.1 years; 51.9% male; mean Charlson 2.56; 57.5% LACE ≥10) discharged from 7 teaching hospitals, 1146 (14.3%) were discharged on a weekend. Although they had substantially shorter lengths of stay (5.64 days, 95% confidence interval [CI]: 5.35-5.93 vs 7.86 days, 95% CI: 7.71-8.00, adjusted P value 0.0001) and were less likely to be discharged with homecare support (10.9% vs 19.3%) or to long-term care facilities (3.1% vs 7.8%), patients discharged on weekends exhibited similar rates of death or readmission at 30 days compared to those discharged on weekdays (10.6% vs 13.2%, adjusted odds ratio [aOR]: 0.94, 95% CI: 0.77-1.16), even among the 4591 patients deemed to be at high risk for postdischarge events based on LACE (length of hospital stay, acuity of admission, comorbidity burden quantified using the Charlson Comorbidity Index, and emergency department visits in the 6 months prior to admission) score ≥10 (16.8% vs 16.5% for weekday discharges, aOR: 1.09 [95% CI: 0.85-1.41]).GIM patients discharged from teaching hospitals on weekends have shorter lengths of stay and exhibit similar postdischarge outcomes as patients discharged on weekdays.

To examine the prevalence of multimorbidity (≥2 chronic conditions) in severely obese patients and its associations with weight loss and health status over 2 years.In a prospective cohort including 500 severely obese adults, self-reported prevalence of 20 chronic conditions was calculated at baseline and 2 years. Multivariable logistic regression models were fitted to test the covariate-adjusted associations between ≥5% weight reduction and reduction in multimorbidity and the association between health status (visual analogue scale [VAS]) and reduction in multimorbidity over 2 years.After 2 years, mean weight change was -12.9 ±18.7 kg, 53% had ≥5% weight reduction, mean change in VAS was 11.5 ± 21.2, and 53.5% had ≥10% increase in VAS. Multimorbidity was reported in 95.4% and 92.8% patients at baseline and 2 years, respectively. Weight loss (≥5%) over 2 years was associated with reduction in multimorbidity (adjusted OR = 1.7, 95% CI 1.1-2.7). Reduction in multimorbidity was associated with clinically important improvements (≥10% increase in VAS) in health status (adjusted OR = 2.5, 95% CI 1.6, 4.0).Multimorbidity is common in severely obese patients. Having ≥5% weight reduction over 2 years was associated with a reduction in multimorbidity, which was also associated with improvements in health status.

To characterize health-related quality of life (HRQL) impairment in severely obese subjects, using several validated instruments.A cross-sectional analysis of 500 severely obese subjects was completed. Short-Form (SF)-12 [Physical (PCS) and Mental (MCS) component summary scores], EuroQol (EQ)-5D [Index and Visual Analog Scale (VAS)], and Impact of Weight on Quality of Life (IWQOL)-Lite were administered. Multivariable linear regression models were performed to identify independent predictors of HRQL.Increasing BMI was associated with lower PCS (-1.33 points per 5 kg/m(2) heavier; P0.001), EQ-index (-0.02; P0.001), EQ-VAS (-1.71; P = 0.003), and IWQOL-Lite (-3.72; P = 0.002), but not MCS (P = 0.69). The strongest predictors (all P0.005) for impairment in each instrument were: fibromyalgia for PCS (-5.84 points), depression for MCS (-7.49 points), stroke for EQ-index (-0.17 points), less than full-time employment for EQ-VAS (-7.06 points), and coronary disease for IWQOL-Lite (-10.86 points). Chronic pain, depression, and sleep apnea were associated with reduced HRQL using all instruments.The clinical impact of BMI on physical and general HRQL was small, and mental health scores were not associated with BMI. Chronic pain, depression, and sleep apnea were consistently associated with lower HRQL.

How well anthropometric indices such as body mass index (BMI), waist circumference, waist-stature ratio, and waist index correlate with direct measures of body composition (lean body mass, body fat) in men and women with chronic heart failure (CHF) has not been reported. Body composition was assessed by dual-energy x-ray absorptiometry in 140 patients with CHF. Age-adjusted Pearson correlations between each index and measures of body composition for men and women were calculated. Diagnostic accuracy of detecting obesity or high central fat was also examined. In men, all of the anthropometric indices except waist index were just as strongly correlated with lean body mass (correlation coefficients varied between 0.56 for waist-stature ratio to 0.74 for BMI) as with percentage of body fat (correlation coefficients varied between 0.72 for BMI to 0.79 for waist circumference). In women, all 4 anthropometric measures were unable to significantly differentiate between body fat and lean body mass. The positive likelihood ratios for the detection of obesity varied between 2.26 for waist circumference and 3.42 for BMI, waist-stature ratio, and waist index. Anthropometric indices do not accurately reflect body composition in patients with CHF, especially in women. When accurate assessment of body composition is required, direct measurements should be obtained.

To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, the degree of blood pressure elevation, the method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.MEDLINE searches were conducted from November 2007 to October 2008 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed full-text articles only.Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations were required to be supported by at least 70% of task force members. These guidelines will continue to be updated annually.