Hypertension Management – Improving screening, identification, and management of hypertension for adult patients in Ontario

Hypertension is a leading risk factor for mortality and morbidity and contributor to cardiovascular disease drug costs in Canada.1,2,3 Cardiovascular disease is the highest ranking diagnostic category for drug expenditures in Canada.4 In 2007, 21.1 million visits to community physicians were attributed to hypertension.3 Each increase of 20 mmHg in systolic blood pressure for people ages 40-69 years old is associated with a doubling of mortality rates for stroke and ischemic heart disease.5

Hypertension is also referred to as the ‘silent killer’, affecting 21.3% of the adult population in Ontario (23.8% of men and 19.0% of women).6 Prevalence increases with age, from 3.4% among people 20–39 years of age to 51.6% among those 60–79 years of age.6 With the current demographic changes due to the aging of the ‘Baby Boomer’ generation, provincial health plans are grappling with how to plan for the ‘silver tsunami.’

According to the Heart and Stroke Foundation of Ontario 2006 Ontario Survey on the Prevalence and Control of Hypertension (ON-BP), there has been a significant improvement in the treatment and control rate since the Canadian Heart Health Survey: among those with hypertension, 65.7% are treated and controlled.6 However, one-third of Ontarians with hypertension are still not treated and their blood pressure is not well controlled. In a recently published study of hypertension management in Ontario primary care practices, screening, treatment, and control rates were 92.5%, 86.4% and 44.9% respectively.7

REFERENCES

  1. Public Health Agency of Canada (PHAC): Report from the Canadian Chronic Disease Surveillance System: Hypertension in Canada, 2010. Ottawa, ON: PHAC.
  2. Robitaille, C., Dai, S., Waters, C. Loukine, L., Bancej, C. Quach, S., et al. Diagnosed hypertension in Canada: Incidence, prevalence, and associated mortality. CMAJ, 2012; 184 (1): E49-E56.
  3. PHAC. Tackling Heart Disease and Stroke in Canada, 2009.
  4. Health Canada: Economic Burden of Illness in Canada, 2005-2008 . Ottawa, Health Canada; 2014. Ref Type: Report
  5. Lewington, S., Clarke, R., Qizilbash, N., Peto, R., & Collins, R. Age specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet, 2002; 360: 1903-13.
  6. Leenen, FH., Dumais, J., McInnis, NH., Turton, P., Stratychuk, L, Nemeth, K., Lum-Kwong, MM., Fodor, G. Results of the Ontario survey on the prevalence and control of hypertension. CMAJ, 2008; 178(11):1441-1449.
  7. Tu, K., Cauch-Dudek, K., Chen, Z. Comparison of primary care physician payment models in the management of hypertension. Can Fam Physician, 2009; 55:719-27.

Vascular Health Primary Care Work Group
Last Updated: February 3, 2017