Abstract-ThisKey Words: hypertension Ⅲ high blood pressure Ⅲ quality of care Ⅲ recommendations Ⅲ guidelines H ypertension is a common and prominent risk factor for premature disability and death. 1,2 It is a leading cause of stroke, congestive heart failure, and other cardiovascular diseases. Stroke deaths parallel the prevalence of hypertension. 3 Approximately 50% of cardiovascular disease can be attributed to suboptimal blood pressure because of its strong casual relationship. 4 Many individuals with hypertension are unaware of their condition, and those that are aware are often untreated or undertreated. 3,[5][6][7] Hypertension is a global issue and has led the World Health Organization to declare that suboptimal blood pressure is the leading risk for death in women and the second leading risk for death in men in developed countries. 4,8 There is large variability in the prevalence of hypertension and treatment and control rates of hypertension in Westernized countries. 3 The prevalence of hypertension is lower and the treatment and control rate for hypertension is higher in North America than in Europe. 3 The reasons for different rates of treatment and control of hypertension are poorly understood. Although the World Health Organization has recommended that treatment and control of hypertension is a global health priority, there is no consensus on how this should be accomplished.There is substantial evidence that physicians frequently do not follow hypertension management guidelines and that current physician practice patterns represent a major barrier to the treatment and control of hypertension. 9,9 -20 Based on a low rate of treatment of those who were aware of having hypertension (Figure 1), an effort to improve the treatment and control of hypertension in Canada by healthcare professionals, the Canadian Hypertension Education Program (CHEP), was formed in 1999. 21,22 The program annually updates evidence-based hypertension management recommendations and has an extensive knowledge translation program to assist healthcare professionals to adopt and implement these recommendations. Canada has regular national health questionnaire surveys that assess the diagnosis and pharmacotherapy of hypertension and, thus, presents a (nϭ28 344); consequently all of the analyses for that cycle are based only on the subsample, which was weighted to represent the Canadian population as a whole. Participants were asked whether they had hypertension diagnosed by a healthcare professional and whether they were prescribed antihypertensive medications in the previous month (Table). There were very small changes in the questions over the surveys. 25 Those who reported hypertension or treatment for hypertension were considered to be diagnosed hypertensive individuals. Prevalence rates and corresponding CIs were age standardized to the year 2003 and weighted to reflect the size of the adult Canadian population (Ϸ21.5 million adult Canadians). To account for the survey design effect, coefficients of variation and P values were...

The HUI2 measure of HRQL in older persons at risk for institutionalization appears to reflect health status at a point in time and to be responsive to changes in health status over time.

Background: The heterogeneity evident among home care clients highlights the need for greater understanding of the clinical and social determinants of multi-dimensional health-related quality of life (HRQL) indices and of potential sex-differences in these determinants. We examined the relative contribution of social and clinical factors to HRQL among older home care clients and explored whether any of the observed associations varied by sex.