Refocusing on hypertension control in Canada
Alexander A. Leung, Alan Bell, Ross T. Tsuyuki and Norman R.C. Campbell
https://www.cmaj.ca/content/193/23/E854
KEY POINTS
- Treatment of hypertension is highly effective for reducing cardiovascular morbidity, preventable disability and death across age groups.
- National rates of hypertension treatment and control have worsened in the last decade.
- Hypertension control should again be made a national priority, with optimization of clinical care using global best practices and re-engagement with government.
Canada has been an international leader in hypertension care, but this appears to be changing. After more than 60 years of declining rates of cardiovascular death, trends are now reversing, along with reduced rates of detection, treatment and control of hypertension.1–3 According to a survey conducted in 2007–2009, 82% of Canadians with hypertension were treated and 69% were controlled; by comparison, survey data from 2016–17 showed that only 72% of affected adults were treated and a mere 58% were adequately controlled.2 In the most recent cycle of a national survey, fewer than two-thirds of women reported being treated for hypertension and fewer than half were controlled for hypertension.2 During the same period, clinical practice guidelines from Hypertension Canada became more intensive, with lower recommended targets for systolic blood pressure in selected high-risk patients with no distinctions between women and men with respect to treatment indications or blood pressure goals. Although the specific reasons underlying the changes in national hypertension treatment and control are unknown, we suggest several plausible explanations, including the loss of federal government support for hypertension surveillance, waning emphasis on implementation and evaluation of hypertension guidelines and termination of industry sponsorship for education initiatives as generic medications became more widely used.2