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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

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Blood Pressure & CVD Risk Lewington et al. Prospective Studies Collaboration. Lancet. 2002;360:1903-13.

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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.

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Questions