The impact of the Canadian Hypertension Education Programme in its first decade.

TLDR: The prevalence of hypertension is increasing faster than previously predicted and the underlying demographic shifts over the past decade in the form of an ageing population with worsening levels of obesity and reduced physical activity are not surprising.

Abstract: High blood pressure remains a major risk factor for premature death and disability.1 Worldwide, 62% of strokes and 49% of myocardial infarctions have been attributed to suboptimal blood pressure control and two-thirds of this attributable burden occur in middle-aged individuals (45–69 years).2 Hypertension is already the number one reason for primary care physician visits in Canada3 and the prevalence of hypertension is increasing faster than previously predicted.4 Although part of this increase in prevalence reflects lowering of the blood pressure thresholds for diagnosis of hypertension and increasing recognition of hypertension by physicians, there is also evidence that this increase has been at least partially driven by increasing incidence and decreasing mortality over the past decade.4,5 The increasing incidence is not surprising given the underlying demographic shifts over the past decade in the form of an ageing population with worsening levels of obesity and reduced physical activity. Lowering of systolic blood pressure prevents cardiovascular events both in younger and older patients.6,7 To that end, it is worth noting that approximately one half of the global burden of hypertensive disease occurs in those with systolic blood pressure levels between 130 and 150 mmHg.2 Furthermore, even those hypertensive individuals who are treated and have their blood pressures well controlled still exhibit an increased risk of stroke and myocardial infarction compared with age- and sex-matched controls, possibly due to the undertreatment of their other atherosclerotic risk factors (particularly hyperlipidaemia).8 Since the mid-1970s, there have been national efforts in Canada to educate healthcare professionals and the general public about hypertension prevention, diagnosis, and treatment. However, as of the early 1990s, these efforts appeared to have had little impact.9 As a result, various organizations including Blood Pressure Canada, the Heart and Stroke Foundation …