Blood pressure awareness and control rates in Canadians are slipping alarmingly, particularly among women

In a new study that draws attention to a growing cardiovascular health concern, investigators report that an increasing number of Canadians, particularly women, are unaware that they have high blood pressure, and they are not getting treatment to control their hypertension. The study appears in the Canadian Journal of Cardiology, published by Elsevier.

“The results of this study should serve as a serious warning that high blood pressure remains one of the leading public health threats in Canada, as in all other developed countries. The widening disparity between how women and men are treated is concerning, particularly as high blood pressure continues to be the leading cause of preventable heart attacks, strokes, and premature death in our country,” stated lead investigator Alexander A. Leung, MD, MPH, assistant professor in the departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.

Canada has been a world-leader in hypertension care, outperforming other Western countries over many years. Between 1990 and 2007, the management of hypertension improved due to a strong publicly funded primary healthcare system, the success of a coordinated national strategic plan, and a collaboration among national hypertension organizations on guideline implementation and evaluation. In recent years, however, developments have emerged with the potential to adversely impact hypertension care, including declining federal government support for surveillance and implementation, a refocusing of non-governmental organizations away from implementation of hypertension recommendations, and declining industry support as patented drugs were replaced by generics.

This study was based on a national survey conducted by Statistics Canada from 2007 to 2017. In addition to conducting in-person interviews, the study also included carefully performed blood pressure checks. Using the results, the investigators were able to estimate how many people were affected by high blood pressure, along with the number who were aware of their condition, appropriately treated, and adequately controlled.

Nearly a quarter of Canadian adults (or 5.8 million people) suffer from hypertension. While prevalence remained stable over 10 years, the researchers found a noticeable plunge in the percentage of people who were aware that they had high blood pressure, in the percentage of people treated with medications, and in the percentage of people achieving good blood pressure control, which were especially marked in 2016 to 2017. For the first time in decades, less than 75 percent of people with high blood pressure were treated and less than 60 percent of people were controlled.

Dr. Leung noted, “This means that hundreds of thousands of people living with high blood pressure do not even know they have a problem, a large number are not receiving adequate treatment, and as a result, many people are suffering from preventable deaths and disability from heart attacks and strokes. Consistent with our findings, public data sources also indicate a rise in cardiovascular disability and death in Canada in the same period.”

Importantly, women were impacted much more than men, driving the overall decline. While the prevalence of hypertension did not differ significantly between men and women, a smaller number of women were taking antihypertensive medications compared to men, and among those who were treated, blood pressure was less commonly controlled. While treatment and control rates remained generally stable for men (at around 79 percent for treatment and 67 percent for control), treatment in women has declined to 65 percent and control to 49 percent.

“The results of this study should serve as a serious warning that high blood pressure remains a major public health threat in Canada,” said Dr. Leung.  “We should not be complacent about national blood pressure control, but urgently re-engage the public, doctors, and policy makers in government about the importance of blood pressure treatment and control for people of all ages and genders.”

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Notes for editors
The article is “Worsening Hypertension Awareness, Treatment, and Control Rates in Canadian Women Between 2007 and 2017,” by Alexander A. Leung, MD, MPH, Jeanne V.A. Williams, MSc, Finlay A. McAlister, MD, MSc, Norman R.C. Campbell, MD, and Raj S. Padwal, MD, MSc, for Hypertension Canada’s Research and Evaluation Committee (https://doi.org/10.1016/j.cjca.2020.02.092). It appears in the Canadian Journal of Cardiology, volume 36, issue 5 (May 2020) published by Elsevier.

Full text of the articles is available to credentialed journalists upon request. Contact Eileen Leahy at +1 732 238 3628or cjcmedia@elsevier.com to obtain copies. Journalists wishing to speak to the study’s authors should contact Kelly Johnston, Cumming School of Medicine, University of Calgary, at +1 403 220 5012, +1 403 617 8691 (mobile), or kelly.johnston2@ucalgary.ca.

About the Canadian Journal of Cardiology
The Canadian Journal of Cardiology is the official journal of the Canadian Cardiovascular Society. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice. www.onlinecjc.ca

About the Editor-in-Chief
Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray’s Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com