Hypertension
Cutoff is now ≥130/80 on every method. Stop 135/85 automated office blood pressure. Diabetes Canada still prints <130/80; that is a Canada conflict, not the Québec rule.
Diagnose
- INESSS Institut national d'excellence en santé et services sociaux
- HC Hypertension Canada
- DC Diabetes Canada
| Decision | Guideline |
|---|---|
| Diagnose | ≥130/80 Validated automated device.
INESSS 2026 opens in a new tabCMAJ opens in a new tabHypertension Canada diagnosis opens in a new tab |
| How to measure | 5 minutes seated rest 3 readings at 1-minute intervals.
Average all. CMAJ opens in a new tabINESSS 2026 |
| Confirm | Do not diagnose on a single reading Confirm with home blood pressure or ambulatory monitoring. If out-of-office is not feasible, repeat standardized office blood pressure at another visit. |
| Start drugs | ≥140/90 any risk: start drugs
|
| <130 | Systolic <130Systolic target is under 130 mm Hg if tolerated.
No diastolic target once systolic is at goal.
Isolated diastolic above 80 with systolic already under 130 is uncommon and does not clearly raise event risk;
lifestyle first, and drug intensification only after shared decision because the evidence is lacking.
|
| Diabetes | Systolic <130, no diastolic Diabetes is high cardiovascular risk, so drugs from 130–139. INESSS 2026 |
| 135/85 | Do not use 135/85 INESSS 2026 |
High cardiovascular risk
Drugs from systolic 130–139- INESSS Institut national d'excellence en santé et services sociaux
- HC Hypertension Canada
| Decision | Guideline |
|---|---|
| Age | ≥75 |
| Cardiovascular disease | Coronary disease, heart failure, stroke, peripheral artery disease, atrial fibrillation, aneurysm Coronary disease, heart failure, stroke, peripheral artery disease Box 1 does not list atrial fibrillation or aneurysm. Hypertension Canada 2025 |
| Diabetes | Type 1 or type 2 |
| Kidney disease | eGFR <60 or uACR ≥3 mg/mmol |
| Score | Framingham ≥20% Framingham opens in a new tabINESSS 2026 opens in a new tabCMAJ opens in a new tab |
Investigate
After the diagnosis is confirmedBaseline tests for risk and end-organ damage. Repeat lipids and glucose on the usual screening interval, not at every visit.
- INESSS Institut national d'excellence en santé et services sociaux
- HC Hypertension Canada
| Decision | Guideline |
|---|---|
| Blood | Sodium, potassium, creatinine, eGFR
Already drawn
CMAJ opens in a new tabINESSS 2026 |
| Urine | Dipstick or urinalysis, plus uACR |
| Electrocardiogram | 12-lead electrocardiogram |
Treat
Lifestyle first. Then combination drugs. INESSS 2026 reminder names classes only. Hypertension Canada 2025 publishes a suggested start below. Titration and renal adjustment stay in the official protocol.
- INESSS Institut national d'excellence en santé et services sociaux
- HC Hypertension Canada
| Decision | Guideline |
|---|---|
| Lifestyle | First-line for everyone Food, sodium, activity, alcohol, nicotine, sleep, stress.
|
| First drugs | ACE inhibitor or angiotensin receptor blocker plus a thiazide
Two of three classes
CMAJ opens in a new tabHypertension Canada 2025 |
| Still high | Add a dihydropyridine calcium channel blocker
|
| Resistant | Spironolactone and/or refer Check renin and aldosterone before spironolactone. |
| Do not | No beta-blocker first-line Uncomplicated hypertension.
|
| Drug | Dose | Duration |
|---|---|---|
| Irbesartan / hydrochlorothiazide | 150/12.5 mg PO DIE (half of 300/25 mg) | Ongoing |
Follow-up
- INESSS Institut national d'excellence en santé et services sociaux
- HC Hypertension Canada
| Decision | Guideline |
|---|---|
| Follow-up | Every 3–4 weeks while titrating
|
Reviewed 24 August 2026 against the official sources below.
Sources
Blue square: Québec · red round: Canada. The code names the body; each section's key gives its full name.