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Hypertension as a Public Health Risk

Hypertension as a Public Health Risk. 2011 C anadian H ypertension E ducation P rogram Recommendations. The full slide set of the 2011 CHEP Recommendations are available at www.hypertension.ca. What’s Still Important in 2011.

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Hypertension as a Public Health Risk

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  1. Hypertensionas a Public Health Risk 2011 Canadian Hypertension Education Program Recommendations

  2. The full slide set of the 2011 CHEP Recommendations are available atwww.hypertension.ca

  3. What’s Still Important in 2011 • Keep up to date on the prevention and control of hypertension • Register for automatic email notification of new hypertension resources for you and your patients, at: www.htnupdate.ca • Have your patients sign up at www.myBPsite.ca to access latest hypertension resources

  4. Overview • What is hypertension? • Age-related blood pressure creep and hypertension is common • High blood pressure is a significant risk factor for morbidity and mortality • Hypertension is costly • Hypertension keeps bad company • Hypertension can be prevented or delayed • The complications of hypertension are ameliorated by effective therapy • Healthy public policies reduce the risk of hypertension

  5. Proportion of Deaths Attributable to Leading Risk Factors Worldwide (2000) High blood pressure Tobacco High cholesterol Underweight Unsafe sex Systolic blood pressure greater than 115 mmHg High BMI Physical inactivity Alcohol Indoor smoke from solid fuels Iron deficiency 0 1 2 3 4 5 6 7 8 Attributable Mortality WHO 2000 Report. Lancet. 2002;360:1347-1360.

  6. Hypertension as a Risk Factor Hypertension is a significant risk factor for: • cerebrovascular disease • coronary artery disease • congestive heart failure • renal failure • peripheral vascular disease • dementia • atrial fibrillation • erectile dysfunction

  7. Men Women 150 150 130 130 PP PP 110 110 80 80 70 70 30-39 40-49 50-59 60-69 70-79 30-39 40-49 50-59 60-69 70-79 80 80 Age Age Blood Pressure Distribution in the Population According to Age PP=Pulse Pressure. Adapted from : Third National Health and Nutrition. Examination Survey, Hypertension 1995;25:305-13.

  8. European Society of Hypertension Classification of Blood Pressure The category pertains to the highest risk blood pressure *ISH=Isolated Systolic Hypertension. J Hypertens 2007;25:1105-87.

  9. JNC VII (American) Classification of Blood Pressure The category pertains to the highest risk blood pressure *ISH=Isolated Systolic Hypertension. JAMA 2003;289:2560-72.

  10. Blood Pressure and Risk of Stroke Mortality Lancet 2002;360:1903-13.

  11. Blood Pressure and Risk of Ischemic Heart Disease (IHD) Mortality Lancet 2002;360: 1903-13.

  12. Effect of SBP and DBP onAge-Adjusted CAD Mortality: MRFIT CAD Death Rate per 10,000 Person-years 80.6 48.3 43.8 38.1 37.4 34.7 31.0 25.3 25.8 25.2 24.9 24.6 23.8 160+ 16.9 13.9 12.6 12.8 11.8 20.6 140-159 10.3 11.8 8.8 120-139 8.5 9.2 Systolic BP (mmHg) <120 100+ 90-99 80-89 75-79 70-74 <70 Diastolic BP (mmHg) Neaton et al. Arch Intern Med 1992; 152:56-64.

  13. Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease Cumulative incidence of cv events in men without hypertension according to baseline blood pressure (130-139) mmHg (121-129) mmHg (< 120) mmHg N Engl J Med 2001;345:1291-7.

  14. 135 The Concept of Masked Hypertension 200 180 True hypertensive Masked HTN 160 Home/Ambulatory SBP mmHg 140 True Normotensive 120 White Coat HTN 100 100 120 140 160 180 200 Office SBP mmHg Derived from Pickering et al. Hypertension 2002: 40: 795-796

  15. The Prognosis of White Coat and Masked Hypertension Prevalence is approximately 10% of the adult population Odds Ratio of a Cardiovascular Event J Hypertension 2007;25:2193-2198.

  16. Long term follow-up of Normotensive, White Coat Hypertension, and Ambulatory Hypertension 8 Ambulatory Hypertension White Coat Hypertension 7 6 Normotensive group 5 Cumulative hazard of stroke (%) 4 3 2 p = 0.0013 1 0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Time to stroke (years) Hypertension. 2005;45(2):203-208.

  17. Benefits of Treating Hypertension • Younger than 60 (reducing BP 10/5-6 mmHg) • reduces the risk of stroke by 42% • reduces the risk of coronary event by 14% • Older than 60 (reducing BP 15/6 mmHg) • reduces overall mortality by 15% • reduces cardiovascular mortality by 36% • reduces incidence of stroke by 35% • reduces coronary artery disease by 18% Lancet 1990;335:827-38.Arch Fam Med 1995;4:943-50.

  18. Benefits of Treating to Target • Older than 60 with isolated systolic hypertension (SBP 160 mm Hg and DBP <90 mm Hg) • 42% reduction in the risk of stroke • 26% reduction in the risk of coronary events Lancet 1997;350:757-64.

  19. Correlation Between Reduction in SBP and Stroke or MI Stroke Myocardial Infarction Staessen et al. Lancet 2001;358:1305-15.

  20. Correlation Between Reduction in SBP and Cardiovascular Mortality or Events Cardiovascular mortality Cardiovascular events Staessen et al. Lancet 2001;358:1305-15.

  21. 45% Reductionin CVD 10% Reductionin BP + 10% Reductionin Total-C = 90% of Hypertensive Canadians have other Cardiovascular Risk factors Emberson et al. Eur Heart J. 2004;25:484-491.

  22. Treating Hypertension and Other Risk Factors Treatment Based on BP Treatment Based on Overall Absolute Risk(ASA, lipids, BP) Treatment Based on lipids (statin) 0 -5 -6 -6 -10 -8 -9 -10 -12 -15 Predicted Reduction in Major CVD (%) -17 -20 Treatment thresholds -25 Top 10% -30 -28 Top 20% -35 Top 30% -37 -40 Adapted from Emberson et al. Eur Heart J. 2004;25:484-491.

  23. Challenges to Hypertension Management: Public Perceptions • 44% of people could not identify a normal or a high blood pressure reading • 80% of people were unaware of the association between hypertension and heart disease • 63% believed that hypertension was not a serious condition • 38% of people thought they could control high blood pressure without the help of a health professional Can J Cardiol 2005;21:589-93.

  24. The Canadian Hypertension Education Program (CHEP) • Goal • To reduce the burden of cardiovascular disease in Canada through optimized hypertension management • Activities • Regularly updated evidence-based recommendations for the management of hypertension • Knowledge translation and exchange of the recommendations to support implementation • Regular evaluation and revision of the program • Assessment of patient outcomes

  25. Leading Diagnoses Resulting in Visits to Physician Offices in Canada 25 20 Routine medical exams Depression 15 Acute respiratory tract infection Million visits/year Diabetes Hypertension 10 5 0 Source: IMS HEALTH Canada 2002

  26. New Patient Resources for Hypertension Online • www.hypertension.ca/tools - Download current resources for the prevention and control of hypertension • www.htnupdate.ca -To keep up to date with the latest evidence and resources • www.myBPsite.ca - Have your patients sign up to access the latest hypertension resources • www.lowersodium.ca - Tools and resources for healthcare professionals to use in educating other healthcare professionals, the public or patients about the risks of high dietary sodium in Canada. • www.sodium101.ca -To access a simple to use demonstration of food sodium content for your patients • www.heartandstroke.ca/BP -To monitor home blood pressure and encourage self management of lifestyle • http://www.hypertension.qc.ca/ - Société Québécoise d’hypertension artérielle

  27. For your patients – ask them to sign up at www.myBPsite.ca for free access to the latest information & resources on HBP For health care professionals – sign up at www.htnupdate.ca for automatic updates and on current hypertension educational resources

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