A New Algorithm for the Diagnosis of Hypertension in Canada

Can J Cardiol. 2015 May;31(5):620-30. doi: 10.1016/j.cjca.2015.02.014. Epub 2015 Feb 19.


Accurate blood pressure measurement is critical to properly identify and treat individuals with hypertension. In 2005, the Canadian Hypertension Education Program produced a revised algorithm to be used for the diagnosis of hypertension. Subsequent annual reviews of the literature have identified 2 major deficiencies in the current diagnostic process. First, auscultatory measurements performed in routine clinical settings have serious accuracy limitations that have not been overcome despite great efforts to educate health care professionals over several years. Thus, alternatives to auscultatory measurements should be used. Second, recent data indicate that patients with white coat hypertension must be identified earlier in the process and in a systematic manner rather than on an ad hoc or voluntary basis so they are not unnecessarily treated with antihypertensive medications. The economic and health consequences of white coat hypertension are reviewed. In this article evidence for a revised algorithm to diagnose hypertension is presented. Protocols for home blood pressure measurement and ambulatory blood pressure monitoring are reviewed. The role of automated office blood pressure measurement is updated. The revised algorithm strongly encourages the use of validated electronic digital oscillometric devices and recommends that out-of-office blood pressure measurements, ambulatory blood pressure monitoring (preferred), or home blood pressure measurement, should be performed to confirm the diagnosis of hypertension.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms*
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure Determination / methods
  • Blood Pressure Determination / standards*
  • Blood Pressure Monitoring, Ambulatory / methods
  • Blood Pressure Monitoring, Ambulatory / standards
  • Canada
  • Female
  • Guidelines as Topic*
  • Health Education / standards
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Male
  • Risk Assessment
  • Self Care / methods
  • Self Care / standards


  • Antihypertensive Agents