Control Rates of Hypertension in North America

Leenen, Frans H. H.; Schiffrin, Ernesto L.

doi:10.1161/hypertensionaha.110.157818

Cited by 18 publications

(6 citation statements)

References 10 publications

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“…30 Finally, as there is debate over the appropriate blood pressure targets for people with diabetes, 31 we used a definition of 140/90 mm Hg to define hypertension control for all people for our primary analysis, but we also reported prevalence and control rates if 130/80 mm Hg was used for people with diabetes.…”

Section: Researchmentioning

confidence: 99%

Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades

McAlister¹,

Wilkins²,

Joffres³

et al. 2011

CMAJ

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232

177

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Section: Researchmentioning

confidence: 99%

Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades

McAlister¹,

Wilkins²,

Joffres³

et al. 2011

CMAJ

Self Cite

232

177

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“…2010; Chobanian, 2009]. By all measures thus far, hypertension, a major risk factor for premature cardiovascular morbidity and mortality, remains poorly controlled in North America, the UK, and the EU [Leenen and Schiffrin, 2010].…”

Section: Status Of Prevention Performancementioning

confidence: 99%

Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention

Kones

2010

Therapeutic Advances in Cardiovascular Disease

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Americans are under assault by a fierce epidemic of obesity, diabetes, and cardiovascular disease, of their own doing. Lowered death rates from heart disease and reduced rates of smoking are seriously threatened by the inexorable rise in overweight and obesity. Latest data indicate that 32% of children are overweight or obese, and fewer than 17% exercise sufficiently. Over 68% of adults are overweight, 35% are obese, nearly 40% fulfill criteria for the metabolic syndrome, 8-13% have diabetes, 34% have hypertension, 36% have prehypertension, 29% have prediabetes, 15% of the population with either diabetes, hypertension, or dyslipidemia are undiagnosed, 59% engage in no vigorous activity, and fewer than 5% of the US population qualifies for the American Heart Association (AHA) definition of ideal cardiovascular health. Health, nutrition, and exercise illiteracy is prevalent, while misinformation and unrealistic expectations are the norm. Half of American adults have at least one cardiovascular risk factor. Up to 65% do not have their conventional risk biomarkers under control. Of those patients with multiple risk factors, fewer than 10% have all of them adequately controlled. Even when patients are treated according to evidence-based protocols, about 70% of cardiac events remain unaddressed. Undertreatment is also common. Poor patient adherence, probably well below 50%, adds further difficulty in reducing cardiovascular risk. Available data indicate that only a modest fraction of the total cardiovascular risk burden in the population is actually now being eliminated. A fresh view of these issues, a change in current philosophy, leading to new and different, multimechanistic methods of prevention may be needed. Adherence to published guidelines will improve substantially outcomes in both primary and secondary prevention. Primordial prevention, which does not allow risk values to appear in a population, affords more complete protection than subsequent partial reversal of elevated risk factors or biomarkers. Current evidence supports recent calls for massive educational programs supporting primordial prevention, individual responsibility and pride in achieving population-wide ideal cardiovascular health through lifestyle modification. Environmental and social changes will be necessary, along with major supportive adjustments in the food industry and the assistance of the media. Cooperation is critical to the success of such an initiative.

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“…2 Rates of hypertension control in both the United States and Canada have improved to 450%; however, millions of people still remain uncontrolled and at higher risk, particularly in the younger population. 3 Barriers to achieving higher rates of control include people who do not feel that hypertension is a serious concern and do not adhere to prescribed lifestyle and medical therapy, and physicians and other healthcare providers who do not consistently apply clinical practice guidelines or lack the skills and knowledge needed to counsel their patients about needed lifestyle modifications and adherence strategies. [4][5][6] A systems approach that includes the health system delivery model and enhanced interprofessional patient care management should be able to bridge these care gaps without overwhelming a primary care physician's time and ability to manage acute illness in addition to chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups

et al. 2013

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The Heart and Stroke Foundation of Ontario's Hypertension Management Initiative (HMI) was a pragmatic implementation of clinical practice guidelines for hypertension management in primary care clinics. The HMI was a prospective delayed phase cohort study of 11 sites enrolling patients in two blocks starting 9 months apart in 2007. The intervention was an evidence-informed chronic disease management program consisting of an interprofessional educational intervention with practice tools to implement the Canadian Hypertension Education Program's clinical practice guidelines. This study compares the change in blood pressure (BP) from baseline to 9 months after the intervention between groups. In the immediate intervention group, the mean BP at baseline was 134.6/79.1 mm Hg (18.2/11.5) and in the delayed intervention group 134.2/77.1 mm Hg (18.9/11.8). The fall in BP in the immediate intervention group from baseline to 9 months after the intervention was 7.3/3.6 mm Hg (95% confidence interval (CI): 5.9-8.7/2.6-4.5) and in the delayed group 8.1/3.3 mm Hg (95% CI: 7.0-9.3/2.5-4.1) (all P<0.0001 were compared from baseline to the end of 9 months of the program in both groups). This study is the first to demonstrate that implementation of an interprofessional knowledge integration initiative for the control of hypertension can rapidly lead to lower BP levels.

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Control Rates of Hypertension in North America

Cited by 18 publications

References 10 publications

Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades

Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades

Is prevention a fantasy, or the future of medicine? A panoramic view of recent data, status, and direction in cardiovascular prevention

Hypertension management initiative prospective cohort study: comparison between immediate and delayed intervention groups

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