Pan Canadian Hypertension

Framework
An opportunity to improve the
Prevention and Control of Hypertension
in Canada

Presenters Name
Institution
Date
Contents
 Need for a National Hypertension Framework
 Hypertension Framework Overview
 Overview of prioritized actions
 Highlight what organizations can do to contribute
to the vision, goals and implementation of
prioritized actions
Global Leading Risks for Death, 2010

Systolic blood
pressure > 115
mmHg

Global Burden of Disease Study 2010 , Lancet 2012; 380: 2224–60

 Blood Pressure as a Cardiovascular
Risk
Attributable Risk
 Overall ½ of heart and stroke*
 Stroke 60-70%*
 Heart failure 50%
 Heart attack 25%
 Kidney failure 20%
 Dementia
 Sexual dysfunction

* Systolic blood pressure greater than 115 mmHg

4
Blood Pressure & CVD Risk

Lewington et al. Prospective Studies Collaboration. Lancet. 2002;360:1903-13.

 Hypertension Prevalence in Canada
Prevalence of Hypertension in Canada by Age Group, 2009
80
72.5 71.2
70 68.1

62
Hypertension Prevalence %

60
53.4

50
43.5

40
33.4

30
23.2

20
15.1
9.5
10 5.8
3.5
0.6 1.8
0
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Age

Source: Public Health Agency of Canada using CCDSS Data

Hypertension Treatment and Control Rates

70% 66%
64%

60%

50%
43%
40%
1985-1992

30% 2007-2008

21% 22% 2009-2011

20% 16% 17%
13% 14% 15%

10%
4% F*

0%
Treatet, BP controlled Treated, BP not controlled Aware, BP not treated Not Aware

* F Too unreliable to be published (data with a coefficient of variation (CV) greater than 33.3%; suppressed due to extreme
sampling variability)

CHMS: Canadian Health Measures Survey

 Attributable Cost of Hypertension
 Globally estimated to consume 10% of health care costs in
developed countries. Indirect costs estimated at $ 3.6
trillion (USD in 2001) –estimated to be 4.5 to 15% of GDP in
high income countries
 In Canada, direct cost is $3,072 per person per year, and
indirect cost is $854.
 Antihypertensive prescription consume estimated 13% of
total drug costs in Canada.

Campbell et al, CJC 2012 (in press)

Heidenreich PA et al Circulation 2011;123:933-944
Gaziano TA et al, J Hyperten 2009;27:1472;-77
 Pan Canadian Hypertension Framework
 Public Health Agency of Canada contract to
Hypertension Canada

 Co-funded by CIHR Canada Chair in

Hypertension Prevention and Control

 Intent is to guide decision-making, planning

and alignment of efforts for the prevention
and control of hypertension in Canada

 Outlines set of 10 objectives and 7

recommendations to be implemented and
operationalized by 2020
Pan Canadian Hypertension Framework:
Framework membership
Norm Campbell (chair) Secretariat
Eric Young (Vice-chair) Selina Allu
Michael Adams Denis Drouin
Oliver Baclic Judi Farrell
Denis Drouin Barbara Legowski
Judi Farrell Norm Campbell
Jeff Reading Eric Young
Janusz Kaczorowski Tara Duhaney (as of 2012)
Richard Lewanczuk
Heidi Liepold
Margaret Moy Lum-Kwong
Sheldon Tobe
Barbara Legowski
Target Audiences
 All potential stakeholders in
hypertension prevention and
control :
- non governmental
organizations
- government organizations
- health care professional
organizations
- scientific organizations
Hypertension Framework: Vision
 The people of Canada have…
- the healthiest blood pressure distribution,
- lowest prevalence and the highest rates of awareness,
treatment and control of hypertension, and
- the lowest burden of disease associated with blood
pressure
…of any nation in the world.
 Uses the Expanded Chronic Disease Management
Model

12
 Expanded Chronic Care Model:
Integrating Population Health Promotion

Adapted from Edward H. Wagner, MD, MPH, Chronic Disease Management. Originally published: Effective Clinical Practice, Aug/Sept 1998, Vol 1
13
Framework Development
Proposed Targets for 2020 (1)
Objective Currently in 2020
1. The prevalence of hypertension among adults in
19% 13%
Canada

2. Adults in Canada are aware of the risk of

developing hypertension and of the lifestyle ? 90%
factors that influence blood pressure.

3. Adults in Canada are aware that high blood

pressure increases the risk of major vascular
? 85%
disease (stroke, heart attack, dementia, kidney
failure, heart failure).

4. People in Canada who have hypertension are

83% 95%
aware of their condition.

5. Those with hypertension are attempting to

62-82% 90%
follow appropriate lifestyle recommendations

15
Objectives for 2020 (2)
Objective Currently in 2020
6. Canadians initially diagnosed with hypertension
will become normotensive through lifestyle 8-10% 40%
therapy

7. People unable to be successfully treated for

hypertension through lifestyle therapy have 80% 87%
appropriate drug therapy

8. People with hypertension have their blood

pressure “under control”
66% 78%

9. Aboriginal populations have similar rates for

blood pressure health indicators as the general Current status unknown for
population physically measured BP
indicators, a higher prevalence
10. Populations at higher risk have similar rates for of diagnosed hypertension is
blood pressure health indicators as the general reported.
population
16
Overarching Recommendations
1. Build healthy public policy
2. Re-orient/redesign the health services delivery
system
3. Build partnerships to create supportive
environments and evolve the healthcare system
4. Strengthen community action
5. Develop personal skills for better self-
management
6. Improve decision support
7. Optimize information systems
17
Research Recommendations
A foundational role for research is integrated into the 7 core
recommendations
1. The role for independent research is recognized
2. An increasingly and potentially dominant role for strategic
team-based research is recognized.
3. Multiple critical research gaps identified in an ad-hoc
assessment
4. Development of a Comprehensive Research Strategy is
recommended with CIHR research pillars (biomedical, clinical,
health services and population)
5. Develop/support networks of researchers and collaborations to
identify and address specific gaps and research opportunities

18
 Progress and Actions to Support Framework
Operationalization
 HSFC/CIHR Chair in Hypertension Prevention
and Control (Dr. Norm Campbell)
 Priority to advance policies to improve
healthy eating environment
 Established intersectoral leadership
committee, the Hypertension Advisory
Committee, to support implementation of
the Framework recommendations.
 National government and non-governmental
organizational support and endorsement
 Identify where they fit in the Framework and
what actions can be taken to contribute to
the vision, goals and implementation of
prioritized recommendations
 Sign onto the statement of support
Priority Recommendations
Build Healthy Public Policy
 Develop one comprehensive multi-sector strategy
whose goal is for people in Canada to meet the
nationally recommended benchmarks for physical
activity, smoke free environments and diet (including
the recommended dietary reference intakes for
nutrients, especially sodium).
 Recognizes the need for an all of government
approach

20
Policy opportunities (1)
 Setting targets and timelines for reducing
sodium, saturated and trans fatty acids,
and free sugars in processed foods with
close government monitoring and
oversight.
 Restricting unhealthy food and beverage
marketing to children
 Implementing healthy food procurement
policies.
 Implementing clear transparent conflict of
interest guidelines to ensure public health
food policies are free of commercial bias.
Policy Opportunities (2)
 Mandated clear easy to understand food package
labeling with health implications.
 Taxing foods that have added sodium, saturated and
trans fatty acids, and free sugars to recuperate
health and other societal costs.
 Reducing the cost and increasing the availability of
healthy food.
 Defining ‘unhealthy’ foods.
 Monitoring and evaluation of the health of our food
environment.
Priority Recommendations
Build partnerships to create supportive environments and
evolve the healthcare system
 Expand and maintain the partnerships whose
contributions have been integral to the current Canadian
successes in lowering and controlling hypertension.
 Build new partnerships to better integrate disease
management with population health promotion
 Engage all levels of government, health organizations
and healthcare professionals, non-government
organizations, academics, relevant institutions and
corporations/businesses.

23
Past Hypertension Strategies
 Chockalingam A, Campbell NRC, Ruddy T, Taylor G,
Stewart P. National High Blood Pressure Prevention and
Control Strategy. Can J Cardiol. 2000:16:1087-1093.

 Federal Provincial Advisory Committee (E MacLeod, H

Colburn, D MacLean, G Sinclair) The Prevention and
Control of High Blood Pressure 1983. Health and
Welfare Canada 1986.

24
 Supporting Publications
 A framework for discussion on how to improve prevention,
management and control of hypertension in Canada. Can J
Cardiol. 2012;28:262-69.

 The 2013 Canadian Hypertension Education Program

Recommendations for Blood Pressure Measurement,
Diagnosis, Assessment of Risk, Prevention, and Treatment of
Hypertension. Can J Cardiol. 2013;29:528-542.

 The Canadian effort to prevent and control hypertension: Can

other countries adopt Canadian strategies? Curr Opin Cardiol.
2010;25:366–372.

 Hypertension: Are you and your patients up to date? Can J

Cardiol. 2010;26:261-4.
 Supporting Publications Cont’d
 Hypertension Prevention and Control in Canada. J Am Soc Hypertens
(JASH). 2008;2:97-105
 CHEP – A Unique Canadian Knowledge Translation Program. Can J
Cardiol.2007;23:551-555
 Canada Chair in Hypertension Prevention and Control. A pilot project.
Can J Cardiol 2007;23:557-565
 The Outcomes Research Task Force, Canadian Hypertension Education
Program. Can J Cardiol. 2006; 22:556-558
 Implementation of Recommendations on Hypertension: The Canadian
Hypertension Education Program. Can J Cardiol. 2006; 22: 595-598.
Questions