PowerPoint Presentation

An opportunity to improve the Prevention and Control of Hypertension in Canada

Presenters NameInstitutionDatePan Canadian Hypertension FrameworkThis presentation is intended to be given by a person familiar with the Hypertension Framework and with the epidemiology of hypertension in Canada. Supplementary slides are available at www.hypertension.ca that can expand this presentation. The content for the recommendations slides comes from framework paper and could be cut and paste into additional slides for a more detailed presentation1ContentsNeed for a National Hypertension FrameworkHypertension Framework OverviewOverview of prioritized actions Highlight what organizations can do to contribute to the vision, goals and implementation of prioritized actions

Global Leading Risks for Death, 2010Systolic blood pressure > 115 mmHgGlobal Burden of Disease Study 2010 , Lancet 2012; 380: 222460Increased blood pressure is the leading risk for death and disability globally according to the Global Burden of Disease Study published in 2012 3Blood Pressure as a Cardiovascular Risk4Attributable Risk Overall of heart and stroke*Stroke 60-70%*Heart failure 50%Heart attack 25%Kidney failure 20%DementiaSexual dysfunction* Systolic blood pressure greater than 115 mmHgThis slide shows the proportion of different vascular diseases that are related to high blood pressure. Note that for some of them the risk is indicated for systolic blood pressure above 115 mm Hg, while for heart failure, heart attack and kidney failure the risk indicated on this slide is for the current definition of hypertension ( >140/90 mm Hg).Blood Pressure & CVD Risk Lewington et al. Prospective Studies Collaboration. Lancet. 2002;360:1903-13.

Data from study by Lewington et al. (2002) which examined effects of blood pressure and mortality in 1 million adults Shows the relationship between increasing blood pressure and stroke death. It shows that there is a log-linear relationship between systolic blood pressure and stroke death in different age groups. The data for cardiac mortality is very similar and is also presented in the same manuscript.5Hypertension Prevalence in Canada Source: Public Health Agency of Canada using CCDSS Data Report from the Canadian Chronic Disease Surveillance System (CCDSS) reveals that 22.7% of adults aged over 20 years has hypertension and that the prevalence increases with age. Hypertension affects over 1 in 5 adult Canadians (an estimated 7.4 million people in 2012/13) and another 1 in 5 have high normal blood pressureIt is estimated that over 90% of people will develop hypertension if they live an average lifespan (based on data from Framingham Heart Study)

6Hypertension Treatment and Control Rates CHMS: Canadian Health Measures Survey* F Too unreliable to be published (data with a coefficient of variation (CV) greater than33.3%; suppressed due to extreme sampling variability)Canada has the highest reported national rates of treatment (80%) and control of hypertension (66%) 17% of population are unaware and include mainly younger and especially menPrevalence rate has remained relatively stable over past 2 decades Some of the success can be attributed to Canadian Hypertension Education Program (CHEP), which develops evidence-based recommendations and educational materials for health care professionals and the public and can be downloaded on Hypertension Canada website7Attributable 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 countriesIn 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;123:933-944Gaziano TA et al, J Hyperten 2009;27:1472;-77Almost half of all people in Canada over age 60 are taking drugs to control blood pressure. In 2010, there were over 80,000,000 antihypertensive prescriptions at cost of over $3 billionWithout proper intervention, the cost of chronic diseases to the health system, and the economy will increase

8Pan 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

It is a useful resource that will highlight opportunities to align services and initiatives, reduce duplication and guide the efficient allocation of health resources Endorsed by several health professional organizations as basis for collaborative action.9Pan Canadian Hypertension Framework:Framework membershipNorm Campbell (chair)Eric Young (Vice-chair)Michael AdamsOliver BaclicDenis DrouinJudi FarrellJeff ReadingJanusz KaczorowskiRichard LewanczukHeidi LiepoldMargaret Moy Lum-KwongSheldon TobeBarbara LegowskiSecretariatSelina AlluDenis DrouinJudi FarrellBarbara LegowskiNorm Campbell Eric YoungTara Duhaney (as of 2012) 10Target Audiences All potential stakeholders in hypertension prevention and control :non governmental organizations government organizations health care professional organizationsscientific organizations

12Hypertension Framework: VisionThe people of Canada havethe 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 1213Expanded 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 113Framework Development

1415Proposed Targets for 2020 (1)ObjectiveCurrentlyin 20201. The prevalence of hypertension among adults in Canada19%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 recommendations62-82%90%Objectives were based on opinions of committee and developed by a semi-quantitative process assessing the potential impact of current and proposed interventions if fully implemented

Provides standards by which federal/provincial/community programs and activities can be measured

1516ObjectiveCurrentlyin 20206. Canadians initially diagnosed with hypertension will become normotensive through lifestyle therapy8-10%40%7. People unable to be successfully treated for hypertension through lifestyle therapy have appropriate drug therapy80%87%8. People with hypertension have their blood pressure under control66%78%9. Aboriginal populations have similar rates for blood pressure health indicators as the general populationCurrent 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 populationObjectives for 2020 (2)Re: Objectives 9 & 10, it is clear that there is an absence of data on incidence and prevalence rates across Canada, within some of the provinces, and within cities and subpopulations

16Overarching RecommendationsBuild healthy public policyRe-orient/redesign the health services delivery systemBuild partnerships to create supportive environments and evolve the healthcare system Strengthen community actionDevelop personal skills for better self-managementImprove decision support Optimize information systems

171718Research RecommendationsA foundational role for research is integrated into the 7 core recommendationsThe role for independent research is recognized An increasingly and potentially dominant role for strategic team-based research is recognized. Multiple critical research gaps identified in an ad-hoc assessmentDevelopment of a Comprehensive Research Strategy is recommended with CIHR research pillars (biomedical, clinical, health services and population)Develop/support networks of researchers and collaborations to identify and address specific gaps and research opportunities18

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 endorsementIdentify where they fit in the Framework and what actions can be taken to contribute to the vision, goals and implementation of prioritized recommendationsSign onto the statement of support

1920Priority RecommendationsBuild Healthy Public PolicyDevelop 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

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 and diet (including the recommended dietary reference intakes for nutrients and especially sodium).

Use a whole-of-government approach full and comprehensive power of government instruments across sectors to ensure that children grow up in environments that support and facilitate healthy eating and regular physical activity, that they remain smoke free, avoid high risk alcohol consumption and generally maintain a mindset that has health and well being as a priority.

All governments adequately fund a comprehensive cross-ministry platform for healthy living initiatives that integrates major chronic disease and health promotion strategies, involving all major government departments that can impact on health.

Governments routinely conduct health impact analyses of all major proposed government policies that from a population perspective will affect the main modifiable risk factors for healthy living (e.g. transportation policies, alcohol regulation).

Governments analyze and where necessary revise current policies that directly or indirectly affect healthy living (e.g. reconsider subsidies to food supply processes that contribute to production of unhealthy foods or transportation policies that promote sedentary behaviour over public transport or active transport).

Governments exercise their full regulatory power to protect and promote health where voluntary approaches are likely to or have been shown to be ineffective.

Implement the 2010 Sodium Reduction Strategy for Canada and aggressively pursue the interim national goal of reducing the average population sodium consumption to 2,300 mg sodium by 2016.

In advance of 2016 Health Canada convene a working group to develop and implement the recommendations on how to achieve the ultimate target of 95% of people in Canada consuming less than 2,300 mg for sodium.

Relevant federal agencies apply strategies to deal with the globalization of food production, processing and marketing and become involved in the international coordination of efforts to ensure that positive changes in the food sector e.g. what is achieved in Canada, results in healthier foods for the populations of the world.

Ensure all governments (federal, provincial, territorial, regional, municipal) and health authorities identify leaders for vascular health blood pressure lowering and control of hypertension with specific responsibility and resources for implementing and integrating aspects of this strategy into relevant other chronic disease and health strategies that are within the mandate of their government or organization while avoiding uncoordinated efforts that risk mixing messaging and losing opportunities for leveraged actions.

Health authorities set targets for processes and outcomes that will reduce hypertension and its risk factors, closely monitor these and adjust interventions as needed for targets to be met.

F/P/T structures coordinate federal, provincial, territorial action on important health promotion and disease prevention policies. Municipalities also apply coordinating mechanisms to their policy development processes.

Enhance tobacco reduction strategies in all jurisdictions of Canada and include a review of the provision of smoking cessation medication and access to provincial and national quit lines and web sites.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.

Ancillary Policies: ** A Health Care and Scientific Health Organization Policy Consensus Statement on Restricting Unhealthy Food and Beverage Marketing to Children has been developed under the guidance of the Hypertension Advisory Committee and outlines recommendations for government and non-governmental organizations, including industry, to implement and support policies that effectively restrict unhealthy food marketing to children

21Policy 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. 2223Priority RecommendationsBuild 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 promotionEngage all levels of government, health organizations and healthcare professionals, non-government organizations, academics, relevant institutions and corporations/businesses.

Governments collaborate to develop on a pan-Canadian governance and funding model to coordinate, monitor and report on the implementation of the recommendations in this Framework and its alignment with the Integrated Pan-Canadian Healthy Living Strategy, the Canadian Heart Health Strategy, and the Sodium Reduction Strategy for Canada, given their potential combined impact on blood pressure.Adequately fund all agents of processes and products proven to have positive cost-effective impacts on hypertension prevention, treatment and control.

Expand and maintain the partnerships critical for healthcare professionals to be trained and maintain competencies for optimal blood pressure management.

To provide up-to-date resources in clinical and community settings to assist in blood pressure lowering, hypertension case finding and management.

For all schools and postgraduate and continuing education programs for healthcare professionals to have access to high standard and consistent up-to-date Canadian hypertension educational material and that the provision of the material is linked to program accreditation standards.

To develop forums for healthcare professional schools (e.g. medicine, nursing, pharmacy) and continuing health education programs to share best practices in delivering training to prevent and control hypertension using standardized educational approaches and materials.

Develop a forum for provincial and territorial ministries of health and health regions to share best practices in health services delivery for blood pressure lowering and the prevention, case finding, treatment and control of hypertension.

Develop a forum for non-government stakeholders that contribute to high blood pressure prevention and control to share best practices.

Develop international collaborations and a forum to share best practices in hypertension prevention and control with other countries.

Sustain the position of Canadian Chair in Hypertension Prevention and Control with the responsibility and accountability for leading the implementation of this Framework.

24Past Hypertension StrategiesChockalingam 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. 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.

The2013Canadian 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.

25Supporting Publications ContdHypertension Prevention and Control in Canada. J Am Soc Hypertens (JASH). 2008;2:97-105CHEP A Unique Canadian Knowledge Translation Program. Can J Cardiol.2007;23:551-555Canada Chair in Hypertension Prevention and Control. A pilot project. Can J Cardiol 2007;23:557-565The Outcomes Research Task Force, Canadian Hypertension Education Program. Can J Cardiol. 2006; 22:556-558Implementation of Recommendations on Hypertension: The Canadian Hypertension Education Program. Can J Cardiol. 2006; 22: 595-598.

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