An opportunity to improve the Prevention and Control of
Hypertension in Canada Presenters Name Institution Date Pan
Canadian Hypertension Framework
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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
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Global Leading Risks for Death, 2010 Systolic blood pressure
> 115 mmHg Global Burden of Disease Study 2010, Lancet 2012;
380: 222460
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Blood Pressure as a Cardiovascular Risk 4 Attributable Risk
Overall 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
Hypertension Prevalence in Canada Source: Public Health Agency
of Canada using CCDSS Data
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Hypertension Treatment and Control Rates CHMS: Canadian Health
Measures Survey * F Too unreliable to be published (data with a
coefficient of variation (CV) greater than 33.3%; suppressed due to
extreme sampling variability)
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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
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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
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Pan Canadian Hypertension Framework: Framework membership Norm
Campbell (chair) Eric Young (Vice-chair) Michael Adams Oliver
Baclic Denis Drouin Judi Farrell Jeff Reading Janusz Kaczorowski
Richard Lewanczuk Heidi Liepold Margaret Moy Lum-Kwong Sheldon Tobe
Barbara Legowski Secretariat Selina Allu Denis Drouin Judi Farrell
Barbara Legowski Norm Campbell Eric Young Tara Duhaney (as of
2012)
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Target Audiences All potential stakeholders in hypertension
prevention and control : - non governmental organizations -
government organizations - health care professional organizations -
scientific organizations
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12 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
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13 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
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Framework Development
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15 Proposed Targets for 2020 (1) ObjectiveCurrentlyin 2020 1.
The prevalence of hypertension among adults in Canada 19%13% 2.
Adults in Canada are aware of the risk of developing hypertension
and of the lifestyle factors that influence blood pressure. ?90% 3.
Adults in Canada are aware that high blood pressure increases the
risk of major vascular disease (stroke, heart attack, dementia,
kidney failure, heart failure). ?85% 4. People in Canada who have
hypertension are aware of their condition. 83%95% 5. Those with
hypertension are attempting to follow appropriate lifestyle
recommendations 62-82%90%
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16 ObjectiveCurrentlyin 2020 6. Canadians initially diagnosed
with hypertension will become normotensive through lifestyle
therapy 8-10%40% 7. People unable to be successfully treated for
hypertension through lifestyle therapy have appropriate drug
therapy 80%87% 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
population Current status unknown for physically measured BP
indicators, a higher prevalence of diagnosed hypertension is
reported. 10. Populations at higher risk have similar rates for
blood pressure health indicators as the general population
Objectives for 2020 (2)
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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
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18 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
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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
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20 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
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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.
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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.
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23 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.
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24 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.
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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;25:366372. Hypertension: Are you and your patients up to date?
Can J Cardiol. 2010;26:261-4.
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Supporting Publications Contd 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.