Ushering in a New Era of Hypertension Canada Guidelines: A Roadmap of What Lies Ahead
Rémi Goupil, MD, MSc, Ross T. Tsuyuki, BSc(Pharm), PharmD, MSc, Kristin A. Terenzi, MD, Nancy Santesso, RD, PhD, and Gregory L. Hundemer, MD, MPH
Canadian Journal of Cardiology 41 (2025) 159e162;
Hypertension is a global health problem with an estimated prevalence of 32% worldwide and increasing. In fact, hypertension is the most common modifiable risk factor for cardiovascular disease and mortality. In Canada, hypertension treatment and control rates, although historically high relative to that in other countries, have declined over recent years, particularly among women. The hypertension attributable health care costs in Canada are steep; estimated at > CAD$20 billion in 2020.5 Improving the awareness, treatment, and control of hypertension at the population level requires a multipronged approach including health policy changes, public health education, enhanced access to primary care, promotion of preventive health measures, and effective clinical practice guidelines to inform optimal care.
Canada boasts a rich history of innovation in hypertension. The Canadian Hypertension Education Program was established in 1999 and later morphed into Hypertension Canada, which remains the country’s leading nonprofit organization dedicated solely to the prevention and control of hypertension and its complications. One of its main roles is to produce the Hypertension Canada guidelines, the nation’s clinical practice guidelines for the diagnosis, treatment, and control of hypertension which is fueled by a professional volunteer network of multidisciplinary hypertension experts and primary care professionals. Previously, the guidelines were updated on an annual basis, formulated through systematic reviews across more than 20 separate expert subgroups on a wide array of hypertension-related topics. Because of concern that this siloed approach might result in internal inconsistencies and unclear recommendations, a different approach involving narrowing the organizational structure to a small number of thematic sections was adopted
to formulate the most recent guidelines in 2020. Because of a number of issues including an overall organizational restructure within Hypertension Canada along with the COVID-19 pandemic, the guidelines have not been updated since 2020.
We view this lapse in time as a unique opportunity to reimagine what the guidelines should look like to best achieve the organization’s overarching mission of “advancing the health of Canadians by enabling the detection, prevention, and control of high blood pressure and its complications.” Because hypertension is a population-wide problem, we believe that a multifaceted approach is essential to maximize the effect of the guidelines. A single all-encompassing set of recommendations might fail to optimally serve many relevant parties. Informal feedback and an open forum session with primary care providers revealed that the comprehensive guidelines might be viewed as overwhelmingly complex and cumbersome to digest and implement into busy day-to-day clinical practice. This reality becomes even more evident for patients who might view the guidelines as not only overwhelming but also written in medical jargon that many find difficult to understand. Moreover, the previous strategy of updating all hypertension guidelines on an annual basis might lead to inefficiency, redundancy, and burnout among the multidisciplinary experts who formulate the recommendations. By focusing on specific hypertension themes upon which new practice-changing evidence becomes available, or those that are of high priority to our members, we might not only improve efficiency of guideline creation but also produce higher quality recommendations on the basis of the most up-to-date literature. In turn, we hope this will result in greater uptake of our recommendations…