Elsevier

Canadian Journal of Cardiology

Volume 28, Issue 3, May–June 2012, Pages 262-269
Canadian Journal of Cardiology

Position statement
A Framework for Discussion on How to Improve Prevention, Management, and Control of Hypertension in Canada

https://doi.org/10.1016/j.cjca.2011.11.008Get rights and content

Abstract

Increased blood pressure is a leading risk for premature death and disability. The causes of increased blood pressure are intuitive and well known. However, the fundamental basis and means for improving blood pressure control are highly integrated into our complex societal structure both inside and outside our health system and hence require a comprehensive discussion of the pathway forward. A group of Canadian experts was appointed by Hypertension Canada with funding from Public Health Agency of Canada and the Heart and Stroke Foundation of Canada, Canadian Institute for Health Research (HSFC-CIHR) Chair in Hypertension Prevention and Control to draft a discussion Framework for prevention and control of hypertension. The report includes an environmental scan of past and current activities, proposals for key indicators, and targets to be achieved by 2020, and what changes are likely to be required in Canada to achieve the proposed targets. The key targets are to reduce the prevalence of hypertension to 13% of adults and improve control to 78% of those with hypertension. Broad changes in government policy, research, and health services delivery are required for these changes to occur. The Hypertension Framework process is designed to have 3 phases. The first includes the experts' report which is summarized in this report. The second phase is to gather input and priorities for action from individuals and organizations for revision of the Framework. It is hoped the Framework will stimulate discussion and input for its full intended lifespan 2011-2020. The third phase is to work with individuals and organizations on the priorities set in phase 2.

Résumé

L'élévation de la pression artérielle est le principal risque lié à la mort prématurée et à l'incapacité. Les causes de l'élévation de la pression artérielle sont intuitives et bien connues. Cependant, la base et les moyens fondamentaux pour améliorer la maîtrise de la pression artérielle sont fortement intégrés à la structure complexe de notre société tant à l'intérieur qu'à l'extérieur de notre système de santé et, en conséquence, nécessiteront une discussion sérieuse sur la marche à suivre. Un groupe d'experts canadiens a été désigné par Hypertension Canada qui bénéficie des fonds de l'Agence de la santé publique du Canada et de la chaire de la Fondation des maladies du cœur du Canada et des Instituts de recherche en santé du Canada (FMCC-IRSC) en prévention et contrôle de l'hypertension artérielle pour élaborer un cadre de discussion sur la prévention et la maîtrise de l'hypertension. Le rapport inclut une étude sur l'environnement des activités passées et courantes, les propositions comme principaux indicateurs et les objectifs à atteindre pour 2020, et les changements qui sont susceptibles d'être nécessaires au Canada pour atteindre les objectifs proposés. Les objectifs principaux de l'hypertension sont d'en réduire la prévalence à 13 % des adultes et d'en améliorer la maîtrise à 78 % chez ceux qui en sont atteints. Des changements d'envergure dans la politique gouvernementale, la recherche et l'offre des services de santé sont nécessaires pour que des changements surviennent. Le processus-cadre sur l'hypertension comporte 3 étapes. La première étape inclut le rapport des experts qui est résumé dans le présent rapport. La deuxième est de recueillir les commentaires et de connaître les priorités d'action des individus et des organisations dans la révision du cadre. Il est à souhaiter que le cadre stimulera la discussion et les commentaires tout au long de sa durée de 2011 à 2020. La troisième étape est de travailler avec les individus et les organisations sur l'ensemble des priorités de l'étape 2.

Section snippets

The Framework

Health is a shared responsibility extending from the individual, health care professionals and their organizations, nongovernment health organizations, communities, private sector, provincial, and federal governments. In that context, a decision was made to develop a discussion framework to engage early on, potential partners in determining and prioritizing actions to address hypertension. The Framework development process has 3 steps. The first step is the development of the discussion

Objective 1: To reduce the prevalence of hypertension among adults to 13%

The prevalence of hypertension among Canadian adults was 19% in 2007-2009. A reduction in the prevalence of hypertension can only be achieved by reducing population blood pressure. Table 3 identifies the major attributable risks for hypertension and hence the lifestyle factors for which intervention could have a substantive effect. For example, reducing dietary sodium in the Canadian diet from 3400 mg to 1700 mg per day alone could almost reduce the prevalence of hypertension sufficiently to

Build healthy public policy

Most chronic noncommunicable and communicable diseases have a common root in the key determinants of health.13, 18, 41 A failure of many western societies to address the determinants of health has led to predictions that this generation of young people will be the first since the onset of industrialization to have a shorter lifespan than their parents.42 Implementation of substantive governmental policies that would broadly impact the determinants of health is required to reverse this trend.

Discussion

Canada has had great success in the effort to prevent and control hypertension based both on the substantive capacity and focus it has developed in the effort to prevent and control hypertension as well as in the marked improvements in the rates of awareness, treatment, and control of hypertension.3, 48

The new discussion Framework suggests the adoption of a vision and objectives and also outlines recommendations that if aggressively pursued will achieve those objectives. The challenges are not

Funding Sources

Funded in part by a grant from the Public Health Agency of Canada and from the Heart and Stroke Foundation of Canada - Canadian Institute for Health Research Chair in Hypertension Prevention and Control.

Disclosures

S.T. has received honoraria for academic talks from Pfizer, Bristol-Myers, Sanofi-Aventis, Amgen, Roche, Merck, and Boehringer-Ingelheim; is an investigator on research projects sponsored by Abbott, AstraZeneca, Pfizer, Janssen, Novartis, Bristol-Myers, Sanofi-Aventis, Amgen, Roche, Merck and Boehringer-Ingelheim; and is a member of the Advisory Board for Pfizer, Merck, Abbott, Bristol-Myers, Sanofi-Aventis, Otsuka, and Takeda. N.C. received travel support from Boehringer-Ingelheim in 2010.

Acknowledgements

The authors acknowledge Oliver Baclic and Heidi Liepold (Ex officio members representing the Public Health Agency of Canada), and Jeff Reading as additional members of the Framework Development Committee.

References (48)

  • N.R. Campbell et al.

    The Outcomes Research Task Force and the Canadian Hypertension Education Program

    Can J Cardiol

    (2006)
  • Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks

    (2009)
  • Report from the Canadian Chronic Disease Surveillance System: Hypertension in Canada

    (2010)
  • F.A. McAlister et al.

    Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades

    CMAJ

    (2011)
  • K. Wilkins et al.

    Blood pressure in Canadian adults

    Health Rep

    (2010)
  • T.A. Gaziano et al.

    The global cost of nonoptimal blood pressure

    J Hypertens

    (2009)
  • P.A. Heidenreich et al.

    Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association

    Circulation

    (2011)
  • The Prevention and Control of High Blood Pressure in Canada

    Federal/Provincial Advisory Committee

    (1986)
    (1986)
  • A. Chockalingam et al.

    Canadian national high blood pressure prevention and control strategy

    Can J Cardiol

    (2000)
  • R.M. Califf

    A virtuous cycle to improve hypertension outcomes at a national level: linking public health and individualized medicine

    Hypertension

    (2009)
  • A.V. Chobanian

    Major improvements in the control of hypertension in Canada

    CMAJ

    (2011)
  • P.M. Kearney et al.

    Worldwide prevalence of hypertension: a systematic review

    J Hypertens

    (2004)
  • Canadian Heart Health Strategy and Action Plan - Building a Heart Healthy Canada

    (2009)
  • A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension

    (2011)
  • Cited by (0)

    See page 267 for disclosure information.

    View full text