Response

We thank Dr Peter Loveridge for his comment¹ on our call to action in controlling hypertension in older women in the October issue of Canadian Family Physician.² The article is not meant to be a criticism of Canadian primary care physicians. We recognize, congratulate, and participate directly, as clinicians as well as academics, in the stalwart work being done in primary care. We pointed out the declining control and awareness of hypertension in a specific high-risk segment of the population—namely, women older than age 60—as a symptom of a weakness in the health care system.

We are advocating for a rational, organized strategy that uses proven algorithms, team approaches, and registries to achieve blood pressure targets. These interventions (including algorithms with specified drugs and doses) are now a World Health Organization best practice.³ We are certainly not advocating for aggressive blood pressure management in the frail or physically declining population where the goal is short-term quality of life and not prolonging life or preventing major cardiovascular complications that occur with aging. However, for a healthy, asymptomatic 80-year-old woman with a systolic blood pressure of 160 mm Hg or more, controlling her blood pressure is the intervention most likely to prolong life and prevent disability.

Controlling hypertension has some of the strongest evidence in all clinical medicine to prevent premature death and major disability at a population level. World Health Organization best-practice approaches³ are being used in several high- and middle-income countries around the world, with success rates that are superseding the control rates in Canada for older women. This involves participation from all levels of government, all health care professionals, and the public. In fact, family physicians and other primary care disciplines are a core part of our guideline and the dissemination process at Hypertension Canada. We also note that the call to action is supported by the College of Family Physicians of Canada, the Canadian Nurses Association, and the Canadian Pharmacists Association, and is coauthored by primary care physicians in academic and clinical practices.

We understand the difficulties of clinical practice in our current environment, especially with the pandemic, as well as the difficulties in advocating for, adapting to, and incorporating the paradigm shifts in the health care system that are needed to optimize care for Canadians.

• Copyright© 2021 the College of Family Physicians of Canada