Scope of this summary
Measure and confirm
- Use a validated automated device, an appropriate cuff and standardized technique.
- Base decisions on repeated, optimally measured blood pressure rather than a single casual value.
- Use out-of-office measurement when appropriate to identify white-coat or masked hypertension.
- The 2025 primary-care guideline defines hypertension at blood pressure ≥130/80 mm Hg when measured optimally.
Risk-based treatment thresholds
The guideline recommends pharmacologic treatment when blood pressure is ≥140/90 mm Hg. For systolic blood pressure 130–139 mm Hg, medication is recommended when cardiovascular risk is high according to the source pathway.
For adults receiving treatment, the recommended systolic target is <130 mm Hg when tolerated. Apply contraindications, frailty, adverse effects, orthostatic symptoms and individual goals rather than treating the number in isolation.
When medication is indicated
The guideline generally favours low-dose two-drug therapy, ideally in a single-pill combination. Recommended foundational classes include an ACE inhibitor or ARB, a thiazide or thiazide-like diuretic, and a long-acting dihydropyridine calcium-channel blocker.
This summary deliberately omits product selection and dosing. Check contraindications, pregnancy potential, kidney function, electrolytes, interactions, provincial formularies and the complete source.
Follow-up essentials
- Reassess blood pressure, tolerability and adherence after starting or changing therapy.
- Review cardiovascular risk and comorbidities rather than using blood pressure alone.
- Escalate suspected secondary, resistant or urgent presentations to the appropriate pathway.
Older thresholds are stale
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Hypertension CanadaHypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary careCMAJ · DOI 10.1503/cmaj.241770 · published 2025-05-26 · accessed 2026-08-20view source
- Hypertension CanadaGuidelines: Recommendationslive recommendation page checked 2026-08-20 · accessed 2026-08-20view source
From guidance to deliberate practice and evidence
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