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Campbell NRC, Padwal R, Tsuyuki RT, Leung AA, Bell A, Kaczorowski J, Tobe SW. Ups and downs of hypertension control in Canada: critical factors and lessons learned. Rev Panam Salud Publica 2022; 46:e141. [PMID: 36071924 PMCID: PMC9440728 DOI: 10.26633/rpsp.2022.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022] Open
Abstract
As the leading risk for death, population control of increased blood pressure represents a major challenge for all countries of the Americas. In the early 1990’s, Canada had a hypertension control rate of 13%. The control rate increased to 68% in 2010, accompanied by a sharp decline in cardiovascular disease. The unprecedented improvement in hypertension control started around the year 2000 when a comprehensive program to implement annually updated hypertension treatment recommendations started. The program included a comprehensive monitoring system for hypertension control. After 2011, there was a marked decrease in emphasis on implementation and evaluation and the hypertension control rate declined, driven by a reduction in control in women from 69% to 49%. A coalition of health and scientific organizations formed in 2011 with a priority to develop advocacy positions for dietary policies to prevent and control hypertension. By 2015, the positions were adopted by most federal political parties, but implementation has been slow. This manuscript reviews key success factors and learnings. Some key success factors included having broad representation on the program steering committee, multidisciplinary engagement with substantive primary care involvement, unbiased up to date credible recommendations, development and active adaptation of education resources based on field experience, extensive implementation of primary care resources, annual review of the program and hypertension indicators and developing and emphasizing the few interventions important for hypertension control. Learnings included the need for having strong national and provincial government engagement and support, and retaining primary care organizations and clinicians in the implementation and evaluation.
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Affiliation(s)
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ross T. Tsuyuki
- Faculty of Pharmacology, University of Alberta, Edmonton, Canada
| | | | - Alan Bell
- Department of Family Medicine, University of Toronto, Toronto, Canada
| | - Janusz Kaczorowski
- Department of Family Medicine, University of Montreal and CRCHUM, Montreal, Canada
| | - Sheldon W Tobe
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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2
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Fan L, Cai J. Integrated hypertension management and national hypertension discipline promotion in China. Chin Med J (Engl) 2022; 135:00029330-990000000-00071. [PMID: 35861305 PMCID: PMC9532026 DOI: 10.1097/cm9.0000000000002020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Luyun Fan
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jun Cai
- State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Salman LA, Cohen JB. Updates in hypertension: new trials, targets and ways of measuring blood pressure. Curr Opin Nephrol Hypertens 2022; 31:258-264. [PMID: 35249970 PMCID: PMC9035088 DOI: 10.1097/mnh.0000000000000791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Several recent trials and observational studies have identified critical areas that can help to improve the management and measurement of blood pressure in patients with hypertension. RECENT FINDINGS High-quality trial evidence supports intensive SBP lowering to 110-130 mmHg in older patients, potassium- based salt substitution in patients without chronic kidney disease, and chlorthalidone for the management of hypertension in patients with chronic kidney disease. In addition, population-based studies indicate enormous underdiagnosis of primary aldosteronism as well as greater sustained intensification of antihypertensive therapy in older patients by maximizing medication dosage rather than adding new agents. The prevalence of hypertension is stable worldwide, though is generally improving in high-income countries and worsening in low-income countries. Furthermore, although cuffless blood pressure devices have the potential to improve access to blood pressure measurement, they have not yet demonstrated sufficient accuracy for clinical use. SUMMARY Growing evidence supports intensive blood pressure lowering, sodium reduction, targeted antihypertensive treatment and appropriate screening for secondary hypertension to optimize blood pressure control and reduce the risk of target organ damage from hypertension. Future studies are needed to identify ways to improve our ability to implement these findings in routine clinical practice.
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Affiliation(s)
- Liann Abu Salman
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordana B. Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021; 398:957-980. [PMID: 34450083 PMCID: PMC8446938 DOI: 10.1016/s0140-6736(21)01330-1] [Citation(s) in RCA: 1076] [Impact Index Per Article: 358.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING WHO.
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Jeemon P, Séverin T, Amodeo C, Balabanova D, Campbell NRC, Gaita D, Kario K, Khan T, Melifonwu R, Moran A, Ogola E, Ordunez P, Perel P, Piñeiro D, Pinto FJ, Schutte AE, Wyss FS, Yan LL, Poulter NR, Prabhakaran D. World Heart Federation Roadmap for Hypertension - A 2021 Update. Glob Heart 2021; 16:63. [PMID: 34692387 PMCID: PMC8447967 DOI: 10.5334/gh.1066] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
The World Heart Federation (WHF) Roadmap series covers a large range of cardiovascular conditions. These Roadmaps identify potential roadblocks and their solutions to improve the prevention, detection and management of cardiovascular diseases and provide a generic global framework available for local adaptation. A first Roadmap on raised blood pressure was published in 2015. Since then, advances in hypertension have included the publication of new clinical guidelines (AHA/ACC; ESC; ESH/ISH); the launch of the WHO Global HEARTS Initiative in 2016 and the associated Resolve to Save Lives (RTSL) initiative in 2017; the inclusion of single-pill combinations on the WHO Essential Medicines' list as well as various advances in technology, in particular telemedicine and mobile health. Given the substantial benefit accrued from effective interventions in the management of hypertension and their potential for scalability in low and middle-income countries (LMICs), the WHF has now revisited and updated the 'Roadmap for raised BP' as 'Roadmap for hypertension' by incorporating new developments in science and policy. Even though cost-effective lifestyle and medical interventions to prevent and manage hypertension exist, uptake is still low, particularly in resource-poor areas. This Roadmap examined the roadblocks pertaining to both the demand side (demographic and socio-economic factors, knowledge and beliefs, social relations, norms, and traditions) and the supply side (health systems resources and processes) along the patient pathway to propose a range of possible solutions to overcoming them. Those include the development of population-wide prevention and control programmes; the implementation of opportunistic screening and of out-of-office blood pressure measurements; the strengthening of primary care and a greater focus on task sharing and team-based care; the delivery of people-centred care and stronger patient and carer education; and the facilitation of adherence to treatment. All of the above are dependent upon the availability and effective distribution of good quality, evidence-based, inexpensive BP-lowering agents.
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Affiliation(s)
- Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandum, IN
| | | | - Celso Amodeo
- Universidade Federal de São Paulo (UNIFESP), São Paulo, BR
| | | | | | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Timisoara, RO
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Shimotsuke, Tochigi, JP
| | | | | | - Andrew Moran
- Columbia University and Resolve to Save Lives, New York, US
| | | | - Pedro Ordunez
- Pan American Health Organization, Washington, DC, US
| | - Pablo Perel
- London School of Hygiene & Tropical Medicine and World Heart Federation, Geneva, GB
| | | | - Fausto J. Pinto
- Santa Maria University Hospital (CHULN), CAML, CCUL, Lisboa, PT
| | - Aletta E. Schutte
- University of New South Wales; The George Institute for Global Health, Sydney, AU
| | - Fernando Stuardo Wyss
- Cardiovascular Technology and Services of Guatemala – CARDIOSOLUTIONS, Guatemala, GT
| | | | | | - Dorairaj Prabhakaran
- London School of Hygiene & Tropical Medicine, London, GB
- Public Health Foundation of India, Gurugram, IN
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Campbell NR, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020]. Rev Panam Salud Publica 2021; 44:e27. [PMID: 33643393 PMCID: PMC7905737 DOI: 10.26633/rpsp.2021.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm Rc Campbell
- Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary Alberta Canadá Departamento de Medicina, Departamento de Medicina, Fisiologia e Farmacologia e Ciências da Saúde da Comunidade, Instituto O'Brien de Saúde Pública e Instituto Cardiovascular Libin de Alberta, Universidade de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste Potchefstroom África do Sul Unidade de Hipertensão e Doença Cardiovascular, Equipe de Pesquisa de Hipertensão na África (HART, na sigla em inglês), Universidade Noroeste, Potchefstroom, África do Sul
| | - Cherian V Varghese
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - Pedro Ordunez
- Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde Washington, D.C. Estados Unidos Departamento de Doenças Não Transmissíveis e Saúde Mental, Organização Pan-Americana da Saúde, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto Liga de Hipertensão de Pequim Pequim China Instituto Liga de Hipertensão de Pequim, Pequim, China
| | - Taskeen Khan
- Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde Genebra Suíça Departamento de Doenças Não Transmissíveis, Organização Mundial da Saúde, Genebra, Suíça
| | - James E Sharman
- Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart Tasmânia Austrália Instituto Menzies para Pesquisa Médica, Universidade da Tasmânia, Hobart, Tasmânia, Austrália
| | - Paul K Whelton
- Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane Nova Orleans Estados Unidos Departamento de Epidemiologia e Medicina, Centro de Ciências da Saúde da Universidade de Tulane, Nova Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca Milão Itália Departamento de Medicina e Cirurgia, Universidade de Milão-Bicocca e Departamento de Ciências Cardiovasculares, Neurais e Metabólicas, e Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milão, Itália
| | - Michael A Weber
- Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn Nova York Estados Unidos Divisão de Medicina Cardiovascular, Universidade Estadual de Nova York, Centro Médico Downstate, Brooklyn, Nova York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidade Nacional de Córdoba Córdoba Argentina Sanatorio Allende, y Universidade Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco Califórnia Estados Unidos Resolve to Save Lives, Uma Iniciativa da Vital Strategies, Nova York, Estados Unidos e Kaiser Permanente do Norte da Califórnia, South San Francisco, Califórnia, Estados Unidos
| | - Andrew E Moran
- Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies Nova York Estados Unidos Controle Mundial de Hipertensão, Resolve to Save Lives, Uma iniciativa da Vital Strategies, Nova York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão São Paulo Brasil Grupo de Hipertensão, Hospital Alemão Oswaldo Cruz; Instituto do Coração (InCor); Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Venkata S Ram
- Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo Hyderabad Índia Escola de Medicina Sudoeste da Universidade do Texas, Dallas, Estados Unidos; Faculdade de Medicina e Hospitais Apollo, Hyderabad, Índia; Universidade Macquarie, Faculdade de Medicina e Ciências da Saúde, Sydney, Austrália; Liga Mundial de Hipertensão, Escritório Regional do Sudeste Asiático, Hyderabad, Índia
| | - Michael Brainin
- Universidade do Danúbio Krems Áustria Universidade do Danúbio, Krems, Áustria
| | - Mayowa O Owolabi
- Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana Universidade de Ibadan Nigéria Centro de Excelência para Doenças Não Transmissíveis da Aliança de Universidades de Pesquisa Africana, Universidade de Ibadan, Nigéria
| | - Agustin J Ramirez
- Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro Buenos Aires Argentina Unidade de Hipertensão Arterial e Doenças Metabólicas, Hospital Universitário, Fundação Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedade Latino-americana de Hipertensão Porto Alegre Brasil Sociedade Latino-americana de Hipertensão, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão São Paulo Brasil Hospital das Clínicas da Universidade de São Paulo; Instituto do Coração (InCor); e Sociedade Brasileira de Hipertensão, São Paulo, Brasil
| | - Daniel T Lackland
- Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul Charleston Estados Unidos Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul, Charleston, Estados Unidos
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Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang XH, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Plavnik FL, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. [São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020]. Rev Panam Salud Publica 2021; 45:e26. [PMID: 33643404 PMCID: PMC7905751 DOI: 10.26633/rpsp.2021.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 11/24/2022] Open
Abstract
About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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Affiliation(s)
- Norm RC Campbell
- Departamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de CalgaryCalgary, AlbertaCanadáDepartamento de Medicina, Fisiología y Farmacología y Ciencias de la Salud de la Comunidad, Instituto O’Brien para Salud Pública e Instituto Cardiovascular Libin de Alberta, Universidad de Calgary, Calgary, Alberta, Canadá
| | - Aletta E Schutte
- Unidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad NoroccidentalPotchefstroomSudáfricaUnidad para la Hipertensión y las Enfermedades Cardiovasculares, Equipo de Investigación de la Hipertensión en África (HART), Universidad Noroccidental, Potchefstroom, Sudáfrica
| | - Cherian V Varghese
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - Pedro Ordunez
- Departamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la SaludWashington, D.C.Estados UnidosDepartamento de Enfermedades no Transmisibles y Salud Mental, Organización Panamericana de la Salud, Washington, D.C., Estados Unidos
| | - Xin-Hua Zhang
- Instituto de la Liga de Beijing contra la HipertensiónBeijingChinaInstituto de la Liga de Beijing contra la Hipertensión, Beijing, China
| | - Taskeen Khan
- Departamento de Enfermedades no Transmisibles, Organización Mundial de la SaludGinebraSuizaDepartamento de Enfermedades no Transmisibles, Organización Mundial de la Salud, Ginebra, Suiza
| | - James E Sharman
- Instituto Menzies de Investigación Médica, Universidad de TasmaniaHobartTasmaniaAustraliaInstituto Menzies de Investigación Médica, Universidad de Tasmania, Hobart, Tasmania, Australia
| | - Paul K Whelton
- Departamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de TulaneNueva OrleansEstados UnidosDepartamentos de Epidemiología y Medicina, Centro de Ciencias Médicas de la Universidad de Tulane, Nueva Orleans, Estados Unidos
| | - Gianfranco Parati
- Departamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San LucaMilánItaliaDepartamento de Medicina y Cirugía, Universidad de Milán-Bicocca, y Departamento de Ciencias Cardiovasculares, Neurales y Metabólicas, Instituto Auxológico Italiano, IRCCS, Hospital San Luca, Milán, Italia
| | - Michael A Weber
- División de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico DownstateBrooklynNueva YorkEstados UnidosDivisión de Medicina Cardiovascular, Universidad Estatal de Nueva York, Centro Médico Downstate, Brooklyn, Nueva York, Estados Unidos
| | - Marcelo Orías
- Sanatorio Allende, y Universidad Nacional de CórdobaCórdobaArgentinaSanatorio Allende, y Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Marc G Jaffe
- Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridionalCaliforniaEstados UnidosResolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos y Kaiser Permanente de California del Norte, San Francisco meridional, California, Estados Unidos
| | - Andrew E Moran
- Control Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital StrategiesNueva YorkEstados UnidosControl Mundial de la Hipertensión, Resolve to Save Lives, una iniciativa de Vital Strategies, Nueva York, Estados Unidos
| | - Frida Liane Plavnik
- Grupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de HipertensiónSan PabloBrasilGrupo de Hipertensión, Hospital Alemão Oswaldo Cruz; e Instituto del Corazón (InCor); y Sociedad Brasileña de Hipertensión, San Pablo, Brasil)
| | - Venkata S Ram
- Escuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital ApolloHyderabadIndiaFacultad de Medicina y Ciencias de la Salud de la Universidad de MacquarieSydneyAustraliaOficina Regional de Asia Meridional de la Liga Mundial de la HipertensiónHyderabadIndiaEscuela de Medicina Sudoeste de la Universidad de Texas, Estados Unidos; Colegio Médico y Hospital Apollo, Hyderabad, India; Facultad de Medicina y Ciencias de la Salud de la Universidad de Macquarie, Sydney, Australia; Oficina Regional de Asia Meridional de la Liga Mundial de la Hipertensión, Hyderabad, India
| | - Michael Brainin
- Universidad del DanubioKremsAustriaUniversidad del Danubio, Krems, Austria
| | - Mayowa O Owolabi
- Centro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no TransmisiblesUniversidad de IbadanNigeriaCentro de Excelencia de las Universidades Africanas de Investigación sobre las Enfermedades no Transmisibles, Universidad de Ibadan, Nigeria
| | - Agustin J Ramirez
- Unidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación FavaloroBuenos AiresArgentinaUnidad de Hipertensión Arterial y Enfermedades Metabólicas, Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina
| | - Eduardo Barbosa
- Sociedad Latinoamericana de la Hipertensión, Artery LatamPorto AlegreBrasilSociedad Latinoamericana de la Hipertensión, Artery Latam, Porto Alegre, Brasil
| | - Luiz Aparecido Bortolotto
- Hospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de HipertensiónSan PabloBrasilHospital de Clínicas, Universidad de San Pablo; Instituto del Corazón; y Sociedad Brasileña de Hipertensión, San Pablo, Brasil
| | - Daniel T Lackland
- División de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, CharlestonCarolina del SurEstados UnidosDivisión de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, Charleston, Carolina del Sur, Estados Unidos
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8
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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18:785-802. [PMID: 34050340 PMCID: PMC8162166 DOI: 10.1038/s41569-021-00559-8] [Citation(s) in RCA: 451] [Impact Index Per Article: 150.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
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9
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Change of education strategy associated with slippage in Canadian hypertension awareness treatment and control rates. J Hum Hypertens 2021; 35:1054-1056. [PMID: 33767391 PMCID: PMC7993069 DOI: 10.1038/s41371-021-00519-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
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10
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Gao Q, Peng L, Min W, Nie J, Wang A, Shi Y, Shi H, Teuwen DE, Yi H. Regularity of Clinical Visits and Medication Adherence of Patients with Hypertension or Diabetes in Rural Yunnan Province of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249297. [PMID: 33322671 PMCID: PMC7764382 DOI: 10.3390/ijerph17249297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 01/13/2023]
Abstract
Chronic diseases can be controlled through effective self-management. The purpose of this study is to explore the regularity of clinical visits and medication adherence of patients with hypertension or diabetes (PWHD), and its association with the first experience with care and individual factors in rural Southwestern China. This cross-sectional study was carried out in Yunnan province in 2018 and recruited 292 PWHD and 122 village clinics from 122 villages in 10 counties. Participants were interviewed using a structured questionnaire. Results show around 39% of hypertensive and 25% of diabetic patients neither visited physicians nor took medicine regularly during the preceding three months of the interview date. The regression results further indicated that individual characteristics of the PWHD, including patient age, health status, and economic level, as well as their first experience with care, were significantly associated with their regular healthcare behavior. In addition to providing medical services, on average each sample village clinic, with around two physicians, simultaneously managed 180 hypertensive and 45 diabetic patients. This study revealed the need for further reforms in terms of improving self-management and thus recommends an increase in the quantity and the quality of human resources in the primary healthcare realm in rural China.
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Affiliation(s)
- Qiufeng Gao
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Lanxi Peng
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Wenbin Min
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Jingchun Nie
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Aiqin Wang
- School of Economics and Finance, Xi’an Jiaotong University, Xi’an 710061, China
- Correspondence:
| | - Yaojiang Shi
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710127, China; (Q.G.); (L.P.); (W.M.); (J.N.); (Y.S.)
| | - Haonan Shi
- Business Department Center of Red Cross Society of China, Beijing 100007, China;
| | - Dirk E. Teuwen
- Corporate Societal Responsibility, UCB, 1070 Brussels, Belgium;
| | - Hongmei Yi
- China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing 100871, China;
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11
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Campbell NRC, Ordunez P, Giraldo G, Rodriguez Morales YA, Lombardi C, Khan T, Padwal R, Tsuyuki RT, Varghese C. WHO HEARTS: A Global Program to Reduce Cardiovascular Disease Burden: Experience Implementing in the Americas and Opportunities in Canada. Can J Cardiol 2020; 37:744-755. [PMID: 33310142 DOI: 10.1016/j.cjca.2020.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/14/2022] Open
Abstract
Globally, cardiovascular diseases (CVDs) are the leading cause of death. Viewed as a threat to the global economy, the United Nations included reducing noncommunicable diseases, including CVDs, in the 2030 sustainable development goals, and the World Health Assembly agreed to a target to reduce noncommunicable diseases 25% by the year 2025. In response, the World Health Organisation led the development of HEARTS, a technical package to guide governments in strengthening primary care to reduce CVDs. HEARTS recommends a public health and health system approach to introduce highly simplified interventions done systematically at a primary health care level and has a focus on hypertension as a clinical entry point. The HEARTS modules include healthy lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, CVD risk-based management, team-based care, systems for monitoring, and an implementation guide. There are early positive global experiences in implementing HEARTS. Led by the Pan American Health Organisation, many national governments in the Americas are adopting HEARTS and have shown early success. Unfortunately, in Canada hypertension control is declining in women since 2010-2011 and the dramatic reductions in rates of CVD seen before 2010 have flattened when age adjusted and increased for rates that are not age adjusted, and there are marked increases in absolute numbers of Canadians with adverse CVD outcomes. Several steps that Canada could take to enhance hypertension control are outlined, the core of which is to implement a strong governmental nongovernmental collaborative strategy to prevent and control CVDs, focusing on HEARTS.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Pedro Ordunez
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Gloria Giraldo
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Yenny A Rodriguez Morales
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Cintia Lombardi
- Department of Non-Communicable Diseases and Mental Health, Pan American Health Organisation, Washington, DC, USA
| | - Taskeen Khan
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ross T Tsuyuki
- Departments of Pharmacology and Medicine (Cardiology) and EPICORE Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cherian Varghese
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
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12
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Campbell NRC, Dattani S, Bell A, Gelfer M, Cloutier L, Petrella R, Lindsay P, Leung AA, McLean D, Kaczorowski J, Tsuyuki RT. Urgent need to increase the rates of diagnosing, treating and controlling hypertension in older women: A call for action. Can Pharm J (Ott) 2020; 153:264-269. [PMID: 33110465 DOI: 10.1177/1715163520947006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Norm R C Campbell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Shelita Dattani
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alan Bell
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Mark Gelfer
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Lyne Cloutier
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Robert Petrella
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Patrice Lindsay
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Alexander A Leung
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Donna McLean
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Janusz Kaczorowski
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
| | - Ross T Tsuyuki
- Departments of Medicine (Campbell, Leung), Physiology and Pharmacology (Campbell) and Community Health Sciences (Campbell, Leung), University of Calgary, Calgary, AB.,Canadian Pharmacists Association (Dattani), Ottawa, ON.,Department of Family and Community Medicine (Bell), University of Toronto, Toronto, ON.,Department of Family Practice (Gelfer, Petrella), University of British Columbia, Vancouver, BC.,Department of Nursing (Cloutier), Université du Québec, Trois-Rivières, Québec.,Heart & Stroke Foundation of Canada (Lindsay), Toronto, ON.,Faculty of Nursing (McLean), MacEwan University, Edmonton, AB.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal and CRCHUM, Montreal, Québec; EPICORE Centre (Tsuyuki), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB
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13
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Valdés González Y, Campbell NRC, Pons Barrera E, Calderón Martínez M, Pérez Carrera A, Morales Rigau JM, Afonso de León JA, Pérez Jiménez V, Landrove Rodríguez O, DiPette DJ, Giraldo G, Orduñez P. Implementation of a community-based hypertension control program in Matanzas, Cuba. J Clin Hypertens (Greenwich) 2020; 22:142-149. [PMID: 31967722 DOI: 10.1111/jch.13814] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 11/30/2022]
Abstract
Increased blood pressure is a leading risk factor for death worldwide, and improving the control of hypertension is a major health goal to reduce non-communicable disease. Thus, in 2016, as part of a regional effort between the Pan American Health Organization and Cuban Ministry of Public Health to reduce cardiovascular risk and disease, a community demonstration project was implemented to enhance hypertension control. The intervention project was in a population of 25 868 people served by the Carlos Verdugo Martínez Polyclinic in Matanzas, Cuba. The project implemented interventions currently recommended in the World Health Organization HEARTS modules, including a standardized clinical training program with certification for blood pressure measurement, routine screening for hypertension in clinics and in the community, a simple directive pharmacologic treatment algorithm, and a registry with performance reporting and feedback. Qualitative and quantitative program monitoring and evaluation was established. In a 2010 national survey, the prevalence of hypertension and the rate of hypertension control were estimated to be 31% and 36%, respectively. Following less than one year of the full implementation of the program, the prevalence of hypertension, proportion of the hypertensive population registered as having hypertension, proportion of those drug-treated who were controlled, and estimated population rate of control were 30%, 90%, 68%, and 58%, respectively. Based on these positive results, the program has been expanded to include another demonstration program initiated in a second region. In addition, preliminary efforts to disseminate and scale-up aspects of the program to the full Cuban population have started.
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Affiliation(s)
- Yamilé Valdés González
- National Technical Advisory Commission on Hypertension, University Hospital "General Calixto García", Havana, Cuba
| | - Norm R C Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada
| | | | | | | | - José Manuel Morales Rigau
- 6Department of Noncommunicable Diseases, Hygiene, Epidemiology and Microbiology Provincial Center, Matanzas, Cuba
| | | | | | | | - Donald J DiPette
- Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Gloria Giraldo
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Pedro Orduñez
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
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14
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Potts H, Baatarsuren U, Myanganbayar M, Purevdorj B, Lkhagvadorj BU, Ganbat N, Dorjpalam A, Boldbaatar D, Tuvdendarjaa K, Sampilnorov D, Boldbaatar K, Dashtseren M, Batsukh B, Tserengombo N, Unurjargal T, Palam E, Bosurgi R, So G, Campbell NRC, Bungert A, Dashdorj N, Dashdorj N. Hypertension prevalence and control in Ulaanbaatar, Mongolia. J Clin Hypertens (Greenwich) 2020; 22:103-110. [PMID: 31913578 DOI: 10.1111/jch.13784] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/28/2022]
Abstract
This study examines the prevalence, awareness, treatment, and control of hypertension in Ulaanbaatar, Mongolia, using both the American Heart Association and conventional thresholds (130/80 and 140/90 mm Hg, respectively). In this randomized cross-sectional study, two-stage cluster sampling was used to obtain a sample of 4515 individuals aged ≥20 years. Hypertension was defined by the use of antihypertensives in the last 2 weeks or a blood pressure at or above the thresholds of 140/90 and 130/80 mm Hg. The mean age of the participants was 41.1 ± 14.0 years and 54.5% were women. Hypertension prevalence was 25.6% (using 140/90 mm Hg) and 46.5% (using 130/80 mm Hg). Prevalence increased with age and below 50 years men were consistently more likely to be hypertensive. Among hypertensive participants, the rates of awareness, treatment, and control were 69.7%, 46.8%, and 24.0% (using 140/90 mm Hg) and 49.1%, 25.8%, and 6.4% (using 130/80 mm Hg, respectively). Men had lower rates of awareness, treatment, and control compared with women, with the most pronounced differences at younger ages. This study shows that awareness, treatment, and control rates in Ulaanbaatar are better than in most low- and middle-income countries but are still suboptimal. The largest "care gap" was in young men where a regulatory requirement for annual workplace blood pressure screening has the potential to enhance care. A major hypertension control program has just been initiated in Ulaanbaatar.
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Affiliation(s)
- Harry Potts
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Uurtsaikh Baatarsuren
- Onom Foundation, Ulaanbaatar, Mongolia.,Mongolian Society of Hypertension, Ulaanbaatar, Mongolia
| | | | | | | | | | | | | | - Khulan Tuvdendarjaa
- Onom Foundation, Ulaanbaatar, Mongolia.,Mongolian Society of Hypertension, Ulaanbaatar, Mongolia
| | - Dulmaa Sampilnorov
- Onom Foundation, Ulaanbaatar, Mongolia.,Mongolian Society of Hypertension, Ulaanbaatar, Mongolia
| | - Khatantuul Boldbaatar
- Onom Foundation, Ulaanbaatar, Mongolia.,Mongolian Society of Hypertension, Ulaanbaatar, Mongolia
| | - Myagmartseren Dashtseren
- Mongolian Society of Hypertension, Ulaanbaatar, Mongolia.,Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Batbold Batsukh
- Mongolian Society of Hypertension, Ulaanbaatar, Mongolia.,First Central Hospital of Mongolia, Ulaanbaatar, Mongolia
| | - Namkhaidorj Tserengombo
- Mongolian Society of Hypertension, Ulaanbaatar, Mongolia.,UB Songdo Hospital, Ulaanbaatar, Mongolia
| | - Tsolmon Unurjargal
- Mongolian Society of Hypertension, Ulaanbaatar, Mongolia.,Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.,University Hospital, Ulaanbaatar, Mongolia
| | - Enkhtuya Palam
- National Center for Public Health, Ulaanbaatar, Mongolia
| | | | | | - Norm R C Campbell
- Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada.,O'Brien Institute for Public Health, Calgary, AB, Canada.,University of Calgary, Calgary, AB, Canada
| | | | | | - Naranjargal Dashdorj
- Onom Foundation, Ulaanbaatar, Mongolia.,Mongolian Society of Hypertension, Ulaanbaatar, Mongolia.,The Liver Center, Ulaanbaatar, Mongolia
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15
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Campbell NRC, Schutte AE, Varghese CV, Ordunez P, Zhang X, Khan T, Sharman JE, Whelton PK, Parati G, Weber MA, Orías M, Jaffe MG, Moran AE, Liane Plavnik F, Ram VS, Brainin M, Owolabi MO, Ramirez AJ, Barbosa E, Bortolotto LA, Lackland DT. São Paulo call to action for the prevention and control of high blood pressure: 2020. J Clin Hypertens (Greenwich) 2019; 21:1744-1752. [PMID: 31769155 PMCID: PMC8030388 DOI: 10.1111/jch.13741] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/05/2019] [Indexed: 01/11/2023]
Affiliation(s)
- Norm R. C. Campbell
- Department of Medicine, Physiology and Pharmacology and Community Health SciencesO'Brien Institute for Public Health and Libin Cardiovascular Institute of AlbertaUniversity of CalgaryCalgaryABCanada
| | - Aletta E. Schutte
- MRC Unit for Hypertension and Cardiovascular DiseaseHypertension in Africa Research Team (HART)North‐West UniversityPotchefstroomSouth Africa
| | - Cherian V. Varghese
- Department of Non‐Communicable DiseasesWorld Health OrganizationGenevaSwitzerland
| | - Pedro Ordunez
- Department of Non‐Communicable and Mental HealthPan American Health OrganizationWashingtonDCUSA
| | | | - Taskeen Khan
- Department of Non‐Communicable DiseasesWorld Health OrganizationGenevaSwitzerland
| | - James E. Sharman
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTASAustralia
| | - Paul K. Whelton
- Departments of Epidemiology and MedicineTulane University Health Sciences CenterNew OrleansLAUSA
| | - Gianfranco Parati
- Department of Medicine and SurgeryUniversity of Milano‐Bicocca & Istituto Auxologico ItalianoIRCCSMilanItaly
- Department of Cardiovascular, Neural and Metabolic SciencesSan Luca HospitalMilanItaly
| | - Michael A. Weber
- Division of Cardiovascular MedicineDownstate Medical CenterState University of New YorkBrooklynNYUSA
| | - Marcelo Orías
- Department of NephrologySanatorio AllendeCórdobaArgentina
- Universidad Nacional de CórdobaCórdobaArgentina
| | - Marc G. Jaffe
- Resolve to Save Lives, An Initiative of Vital StrategiesNew YorkNYUSA
- Kaiser Permanente Northern CaliforniaSouth San FranciscoCAUSA
| | - Andrew E. Moran
- Global Hypertension ControlResolve to Save Lives, An initiative of Vital StrategiesNew YorkNYUSA
| | - Frida Liane Plavnik
- Hypertension GroupHospital Alemão Oswaldo CruzSão PauloBrazil
- Heart Institute (InCor)São PauloBrazil
- Brazilian Society of HypertensionSão PauloBrazil
| | - Venkata S. Ram
- University of Texas Southwestern Medical SchoolDallasTXUSA
- Apollo Medical College and HospitalsHyderabadIndia
- Faculty of Medicine and Health SciencesMacquarie UniversitySydneyNSWAustralia
- World Hypertension LeagueSouth Asia Regional OfficeHyderabadIndia
| | | | - Mayowa O. Owolabi
- African Research Universities Center of Excellence for Non‐communicable DiseasesUniversity of IbadanIbadanNigeria
| | - Augstin J. Ramirez
- Arterial Hypertension an Metabolic UnitUniversity HospitalFavaloro FoundationBuenos AiresArgentina
| | - Eduardo Barbosa
- Latin American Society of HypertensionArtery LatamPorto AlegreBrazil
| | - Luiz Aparecido Bortolotto
- Director of Hypertension UnitHospital das Clínicas FMUSP‐ SPHeart Institute (InCor)São PauloBrazil
- Brazilian Society of HypertensionSão PauloBrazil
| | - Daniel T. Lackland
- Division of Translational Neurosciences and Population StudiesMedical University of South CarolinaCharlestonSCUSA
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16
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Frieden TR, Varghese CV, Kishore SP, Campbell NRC, Moran AE, Padwal R, Jaffe MG. Scaling up effective treatment of hypertension-A pathfinder for universal health coverage. J Clin Hypertens (Greenwich) 2019; 21:1442-1449. [PMID: 31544349 DOI: 10.1111/jch.13655] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 01/21/2023]
Abstract
High blood pressure is the world's leading cause of death, but despite treatment for hypertension being safe, effective, and low cost, most people with hypertension worldwide do not have it controlled. This article summarizes lessons learned in the first 2 years of the Resolve to Save Lives (RTSL) hypertension management program, operated in coordination with the World Health Organization (WHO) and other partners. Better diagnosis, treatment, and continuity of care are all needed to improve control rates, and five necessary components have been recommended by RTSL, WHO and other partners as being essential for a successful hypertension control program. Several hurdles to hypertension control have been identified, with most related to limitations in the health care system rather than to patient behavior. Treatment according to standardized protocols should be started as soon as hypertension is diagnosed, and medical practices and health systems must closely monitor patient progress and system performance. Improvement in hypertension management and control, along with elimination of artificial trans fat and reduction of dietary sodium consumption, will improve many aspects of primary care, contribute to goals for universal health coverage, and could save 100 million lives worldwide over the next 30 years.
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Affiliation(s)
- Thomas R Frieden
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York
| | | | - Sandeep P Kishore
- Icahn School of Medicine at Mount Sinai Arnhold Institute for Global Health, New York, New York.,Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Andrew E Moran
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York.,Columbia University, New York, New York
| | - Raj Padwal
- University of Alberta, Edmonton, Alberta, Canada
| | - Marc G Jaffe
- Resolve to Save Lives, an initiative of Vital Strategies, New York, New York
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Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys. Lancet 2019; 394:639-651. [PMID: 31327564 PMCID: PMC6717084 DOI: 10.1016/s0140-6736(19)31145-6] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/15/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment, and control, and how they have changed over time, in high-income countries. METHODS We used data from people aged 40-79 years who participated in 123 national health examination surveys from 1976 to 2017 in 12 high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the proportion of participants with hypertension, which was defined as systolic blood pressure of 140 mm Hg or more, or diastolic blood pressure of 90 mm Hg or more, or being on pharmacological treatment for hypertension, who were aware of their condition, who were treated, and whose hypertension was controlled (ie, lower than 140/90 mm Hg). FINDINGS Data from 526 336 participants were used in these analyses. In their most recent surveys, Canada, South Korea, Australia, and the UK had the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were less than 25% in most countries and age and sex groups. Over the time period assessed, hypertension awareness and treatment increased and control rate improved in all 12 countries, with South Korea and Germany experiencing the largest improvements. Most of the observed increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries. In their most recent surveys, Canada, Germany, South Korea, and the USA had the highest rates of awareness, treatment, and control, whereas Finland, Ireland, Japan, and Spain had the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were less than 70%. INTERPRETATION Hypertension awareness, treatment, and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in high-quality hypertension programmes. There is substantial variation across countries in the rates of hypertension awareness, treatment, and control. FUNDING Wellcome Trust and WHO.
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18
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Campbell NRC, Zhang XH. Hypertension in China: Time to Transition From Knowing the Problem to Implementing the Solution. Circulation 2019; 137:2357-2359. [PMID: 29844071 DOI: 10.1161/circulationaha.118.034028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Norman R C Campbell
- Departments of Medicine, Physiology and Pharmacology and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Canada (N.R.C.C.).
| | - Xin-Hua Zhang
- Beijing Hypertension League Institute, China (X.-H.Z.)
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Tan ST, Quek RYC, Haldane V, Koh JJK, Han EKL, Ong SE, Chuah FLH, Legido-Quigley H. The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore. Int J Equity Health 2019; 18:1. [PMID: 30606218 PMCID: PMC6318975 DOI: 10.1186/s12939-018-0897-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background In Singapore, the burden of hypertension disproportionately falls on the elderly population of low socio-economic status. Despite availability of effective treatment, studies have shown high prevalence of sub-optimal blood pressure control in this group. Poor hypertension management can be attributed to a number of personal factors including awareness, management skills and overall adherence to treatment. However, these factors are also closely linked to a broader range of community and policy factors. This paper explores the perceived social and physical environments of low socio-economic status and elderly patients with hypertension; and how the interplay of factors within these environments influences their ability to mobilise resources for hypertension management. Methods In-depth interviews were conducted in English, Chinese, Chinese dialects and Malay with 20 hypertensive patients of various ethnic backgrounds. Purposive sampling was adopted for recruitment of participants from a previous community health screening campaign. Interviews were translated into English and transcribed verbatim. We deductively analysed leveraging on the Social Model of Health to identify key themes, while inductive analysis was used simultaneously to allow sub-themes to emerge. Results and discussion Our finding shows that financing is an overarching topic embedded in most themes. Despite the availability of multiple safety nets, some patients were left out and lacked capital to navigate systems effectively, which resulted in delayed treatment or debt. The built environment played a significant role in enabling patients to access care easily and lead a more active lifestyle. A closer look is needed to enhance the capacity of patients with mobility challenges to enjoy equitable access. Furthermore, the establishment of community based elderly centres has enabled patients to engage in meaningful and healthy social activities. In contrast, participants’ descriptions showed that their communication with healthcare professionals remained brief, and that personalised and meaningful interactions that are context and culturally specific are essential to advocate for patients’ overall treatment adherence and lifestyle modification. Conclusion Elderly patients with hypertension from lower socio-economic background have various unmet needs in managing their hypertension and other comorbidities. These needs are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.
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Affiliation(s)
- Sok Teng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Rina Yu Chin Quek
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Joel Jun Kai Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Emeline Kai Lin Han
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Fiona Leh Hoon Chuah
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2 #10-01, Tahir Foundation Building, Singapore, 117549, Singapore. .,London School of Hygiene and Tropical Medicine, WC1H 9SH, London, UK.
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Maslakpak MH, Rezaei B, Parizad N. Does family involvement in patient education improve hypertension management? A single-blind randomized, parallel group, controlled trial. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1537063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Masumeh Hemmati Maslakpak
- Department of Medical Surgical Nursing, Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Behrooz Rezaei
- Department of Medical Surgical Nursing, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Department of Medical-Surgical Nursing, Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, Iran
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Padwal R, Campbell NRC. Blood Pressure Control in Canada: Through the Looking-Glass Into a Glass Half Empty? Am J Hypertens 2017; 30:223-225. [PMID: 28057628 DOI: 10.1093/ajh/hpw152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Diabetes Institute, Edmonton, Alberta, Canada
- Mazankowski Heart Institute, Edmonton, Alberta, Canada
| | - Norm R. C. Campbell
- Departments of Medicine, Community Health Sciences and Physiology and Pharmacology, O’Brien Institute of Public Health and Libin Cardiovascular Institute, University of Calgary, Calgary Alberta, Canada
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Schiffrin EL, Campbell NR, Feldman RD, Kaczorowski J, Lewanczuk R, Padwal R, Tobe SW. Hypertension in Canada: Past, Present, and Future. Ann Glob Health 2016; 82:288-99. [DOI: 10.1016/j.aogh.2016.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Dolan E, O'Brien E. Is It Daily, Monthly, or Yearly Blood Pressure Variability that Enhances Cardiovascular Risk? Curr Cardiol Rep 2016; 17:93. [PMID: 26351017 DOI: 10.1007/s11886-015-0649-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Variability is a phenomenon common to most biological processes that we can measure and is a particular feature of blood pressure (BP). Variability causes concern for many physicians regarding its clinical meaning and potential impact on cardiovascular risk. In this review, we assess the role of different time periods of blood pressure variability (BPV) in cardiovascular risk stratification. We review the indices of BPV derived from ambulatory blood pressure measurement (ABPM), home blood pressure measurement (HBPM), or at the clinic setting with the intention of providing a clear message for clinical practice. BPV, either derived from ABPM or HBPM, does not consistently augment cardiovascular risk prediction over and beyond that of average BP, particularly in low-risk individuals. That said, it would seem that certain medications such as calcium channel blockers may have a beneficial effect on visit-to-visit BPV and perhaps reduce the associated cardiovascular risk. This highlights the benefits in using combination therapy which might couple a number of therapeutic benefits such as the reductions of mean blood pressure and BPV. Overall, we should remain aware that the average BP level remains the main modifiable risk factor derived from BP measurements and continue to improve the control of hypertension and adverse health outcomes.
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Affiliation(s)
- Eamon Dolan
- Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland
| | - Eoin O'Brien
- Conway Institute, University College Dublin, Belfield, Dublin, Ireland.
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Campbell NRC, Feldman RD. Hypertension in Canada and the Global Context. The Wine Is Vintage and the Glass Is Two-Thirds Full, but Is the Bottle Empty? Can J Cardiol 2016; 32:609-11. [PMID: 26900109 DOI: 10.1016/j.cjca.2015.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Norman R C Campbell
- Departments of Medicine, Community Health Sciences, Physiology, and Pharmacology, and the O'Brien Institute of Public Health, and Libin Cardiovascular Institute of Alberta at the University of Calgary, Calgary, Alberta, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
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Kastner M, Estey E, Bhattacharyya O. Better guidelines for better care: enhancing the implementability of clinical practice guidelines. Expert Rev Pharmacoecon Outcomes Res 2014; 11:315-24. [DOI: 10.1586/erp.11.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tsuyuki RT, Campbell N. Hypertension: Silent and/or ignored / L’hypertension silencieuse ou ignorée. Can Pharm J (Ott) 2013; 146:61-4. [DOI: 10.1177/1715163513482713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mozheyko M, Eregin S, Vigdorchik A, Hughes D. A cross-sectional survey of hypertension diagnosis and treatment practices among physicians in Yaroslavl Region, Russia. Adv Ther 2012. [PMID: 23203238 DOI: 10.1007/s12325-012-0064-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In Russia, cardiovascular (CV) mortality is the leading cause of death. With the prevalence of hypertension in adults reaching 40%, hypertension is a key priority for health authorities to improve its prevention, diagnosis, and treatment. This requires an evaluation of current clinical practices in order to develop specific improvement initiatives. METHODS This cross-sectional survey was conducted in 39 outpatient institutions of Yaroslavl region from April to May 2011. A total of 180 physicians (154 general practitioners [GPs]; 26 cardiologists) completed diaries on 10 consecutive patients whose visits were related to hypertension. This survey was approved by the Department of Health and Pharmacy of Yaroslavl region. RESULTS A total of 1,794 diaries (1,525 from GPs; 269 from cardiologists) were analyzed. The majority of patients were women (60%), mean age was 60 years, and most (97%) were on antihypertensive therapy. Mean blood pressure (BP) was 151/90 mmHg and goal BP (<140/90 mmHg) was achieved in 17% of patients. The distribution of patients' systolic BP (SBP) was: 20% controlled (<140 mmHg), 44% SBP 140-159 mmHg, 26% SBP 160-179 mmHg, and 10% SBP≥180 mmHg. The most common CV risk factors included left ventricular hypertrophy (72% of patients), abdominal obesity (54%), dyslipidemia (48%), family history of early CV events (33%), smoking (24%), and type 2 diabetes (21%). Heart diseases and cerebrovascular diseases were reported in 48% and 15% of patients, respectively, and regular alcohol consumption was mentioned by 37%. CONCLUSION The majority of patients with hypertension had additional CV risk factors and associated clinical conditions. Blood pressure control rates in Yaroslavl region are similar to those for Russia as a whole, but much lower than countries that have successfully implemented comprehensive hypertension intervention programs, such as Canada.
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Affiliation(s)
- Maria Mozheyko
- Yaroslavl Regional Clinical Hospital of War Veterans, Yaroslavl, Russia
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Campbell NRC, McAlister FA, Quan H. Monitoring and evaluating efforts to control hypertension in Canada: why, how, and what it tells us needs to be done about current care gaps. Can J Cardiol 2012; 29:564-70. [PMID: 22809887 DOI: 10.1016/j.cjca.2012.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 11/30/2022] Open
Abstract
Blood pressure surveillance, monitoring, and evaluation of programs to prevent and control hypertension are critical because increased blood pressure is a leading risk for premature death and disability. Since 2003, the Hypertension Outcomes Research Task Force has existed in Canada, with members who assist in the development and revision of surveys and conduct analyses that help guide hypertension programs. Although the Task Force has tracked a 5-fold increase in the control of hypertension (from 13% in 1985-1992 to 65% in 2007-2009), surveillance data also indicate that many "care gaps" remain. Fifty-four percent of people with diabetes and 34% of those without diabetes have blood pressure readings greater than their target. Treatment rates are high in those who are diagnosed (95%), but 17% of people with hypertension remain undiagnosed. Younger men (more so than women) are too often unaware of having hypertension. Although they are more likely to be aware of their diagnosis, older women are 2 times more likely to have uncontrolled hypertension than men; systolic blood pressure is high in over 80% of those with uncontrolled blood pressure (90% in women); and often people with hypertension are not provided comprehensive advice on healthy behaviours, or assisted in developing plans to control their blood pressure. Many current surveys do not have adequate statistical power to assess vulnerable populations; surveys of Aboriginal populations do not usually assess blood pressure, such that the burden of hypertension in these high risk populations cannot be assessed.
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Affiliation(s)
- Norm R C Campbell
- Department of Medicine, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada.
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Gee ME, Janssen I, Pickett W, McAlister FA, Bancej CM, Joffres M, Johansen H, Campbell NR. Prevalence, Awareness, Treatment, and Control of Hypertension Among Canadian Adults With Diabetes, 2007 to 2009. Can J Cardiol 2012; 28:367-74. [DOI: 10.1016/j.cjca.2011.08.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/03/2011] [Accepted: 08/03/2011] [Indexed: 11/28/2022] Open
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Gee ME, Campbell NRC, Gwadry-Sridhar F, Nolan RP, Kaczorowski J, Bienek A, Robitaille C, Joffres M, Dai S, Walker RL. Antihypertensive medication use, adherence, stops, and starts in Canadians with hypertension. Can J Cardiol 2012; 28:383-9. [PMID: 22522073 DOI: 10.1016/j.cjca.2012.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 01/23/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Some of the greatest barriers to achieving blood pressure control are perceived to be failure to prescribe antihypertensive medication and lack of adherence to medication prescriptions. METHODS Self-reported data from 6017 Canadians with diagnosed hypertension who responded to the 2008 Canadian Community Health Survey and the 2009 Survey on Living with Chronic Diseases in Canada were examined. RESULTS The majority (82%) of individuals with diagnosed hypertension reported using antihypertensive medications. The main reasons for not taking medications were either that they were not prescribed (42%) or that blood pressure had been controlled without medications (45%). Of those not taking antihypertensive medications in 2008 (n = 963), 18% had started antihypertensive medications by 2009, and of those initially taking medications (n = 5058), 5% had stopped. Of those taking medications in 2009, 89% indicated they took the medication as prescribed, and 10% indicated they occasionally missed a dose. Participants who were recently diagnosed, not measuring blood pressure at home, not having a plan to control blood pressure, or not receiving instructions on how to take medications were less likely to be taking antihypertensive medications; similar factors tended to be associated with stopping antihypertensive medication use. CONCLUSIONS Compatible with high rates of hypertension control, most Canadians diagnosed with hypertension take antihypertensive medications and report adherence. Widespread implementation of self-management strategies for blood pressure control and standardized instructions on antihypertensive medication may further optimize drug treatment.
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Anthony H, Valinsky L, Inbar Z, Gabriel C, Varda S. Perceptions of hypertension treatment among patients with and without diabetes. BMC FAMILY PRACTICE 2012; 13:24. [PMID: 22448772 PMCID: PMC3353213 DOI: 10.1186/1471-2296-13-24] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/26/2012] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite the availability of a wide selection of effective antihypertensive treatments and the existence of clear treatment guidelines, many patients with hypertension do not have controlled blood pressure. We conducted a qualitative study to explore beliefs and perceptions regarding hypertension and gain an understanding of barriers to treatment among patients with and without diabetes. METHODS Ten focus groups were held for patients with hypertension in three age ranges, with and without diabetes. The topic guides for the groups were: What will determine your future health status? What do you understand by "raised blood pressure"? How should one go about treating raised blood pressure? RESULTS People with hypertension tend to see hypertension not as a disease but as a risk factor for myocardial infarction or stroke. They do not view it as a continuous, degenerative process of damage to the vascular system, but rather as a binary risk process, within which you can either be a winner (not become ill) or a loser. This makes non-adherence to treatment a gamble with a potential positive outcome. Patients with diabetes are more likely to accept hypertension as a chronic illness with minor impact on their routine, and less important than their diabetes. Most participants overestimated the effect of stress as a causative factor believing that a reduction in levels of stress is the most important treatment modality. Many believe they "know their bodies" and are able to control their blood pressure. Patients without diabetes were most likely to adopt a treatment which is a compromise between their physician's suggestions and their own understanding of hypertension. CONCLUSION Patient denial and non-adherence to hypertension treatment is a prevalent phenomenon reflecting a conscious choice made by the patient, based on his knowledge and perceptions regarding the medical condition and its treatment. There is a need to change perception of hypertension from a gamble to a disease process. Changing the message from the existing one of "silent killer" to one that depicts hypertension as a manageable disease process may have the potential to significantly increase adherence rates.
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Affiliation(s)
- Heymann Anthony
- Medical division, Maccabi Healthcare Services, Tel Aviv, Maccabi, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Maccabi, Israel
| | - Liora Valinsky
- Medical division, Maccabi Healthcare Services, Tel Aviv, Maccabi, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Maccabi, Israel
| | - Zucker Inbar
- Medical division, Maccabi Healthcare Services, Tel Aviv, Maccabi, Israel
- Ministry of Health, Jerusalem, Israel
| | - Chodick Gabriel
- Medical division, Maccabi Healthcare Services, Tel Aviv, Maccabi, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Maccabi, Israel
| | - Shalev Varda
- Medical division, Maccabi Healthcare Services, Tel Aviv, Maccabi, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Maccabi, Israel
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Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension. Can J Cardiol 2012; 28:375-82. [PMID: 22402028 DOI: 10.1016/j.cjca.2011.12.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/23/2011] [Accepted: 12/27/2011] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy. METHODS Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension). RESULTS Older age, lowest income, and less than high school education were associated with presence of hypertension. Men (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2) and adults < 60 years (OR, 1.7; 95% CI, 1.1-2.6) were more likely than others to be unaware. Among those aged 60+ years, women were more likely than men to have uncontrolled high blood pressure (OR, 2.4; 95% CI, 1.1-5.2) despite treatment. Elevated systolic blood pressure was the issue in over 90% of women and 80% of men with uncontrolled hypertension. Depending on the definition employed, 4.4% (95% CI, 2.4-6.4) to 7.8% (95% CI, 6.0-9.6) of the population with hypertension had resistant hypertension. CONCLUSIONS Messaging or interventions encouraging screening may be helpful for all younger Canadian adults and men; programs encouraging blood pressure control may help older women.
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Campbell N, Young ER, Drouin D, Legowski B, Adams MA, Farrell J, Kaczorowski J, Lewanczuk R, Moy Lum-Kwong M, Tobe S. A framework for discussion on how to improve prevention, management, and control of hypertension in Canada. Can J Cardiol 2012; 28:262-9. [PMID: 22284588 DOI: 10.1016/j.cjca.2011.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/02/2011] [Accepted: 11/08/2011] [Indexed: 10/14/2022] Open
Abstract
Increased blood pressure is a leading risk for premature death and disability. The causes of increased blood pressure are intuitive and well known. However, the fundamental basis and means for improving blood pressure control are highly integrated into our complex societal structure both inside and outside our health system and hence require a comprehensive discussion of the pathway forward. A group of Canadian experts was appointed by Hypertension Canada with funding from Public Health Agency of Canada and the Heart and Stroke Foundation of Canada, Canadian Institute for Health Research (HSFC-CIHR) Chair in Hypertension Prevention and Control to draft a discussion Framework for prevention and control of hypertension. The report includes an environmental scan of past and current activities, proposals for key indicators, and targets to be achieved by 2020, and what changes are likely to be required in Canada to achieve the proposed targets. The key targets are to reduce the prevalence of hypertension to 13% of adults and improve control to 78% of those with hypertension. Broad changes in government policy, research, and health services delivery are required for these changes to occur. The Hypertension Framework process is designed to have 3 phases. The first includes the experts' report which is summarized in this report. The second phase is to gather input and priorities for action from individuals and organizations for revision of the Framework. It is hoped the Framework will stimulate discussion and input for its full intended lifespan 2011-2020. The third phase is to work with individuals and organizations on the priorities set in phase 2.
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Affiliation(s)
- Norm Campbell
- Department of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
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Bolli P, Campbell NRC. Do recommendations for the management of hypertension improve cardiovascular outcome? The canadian experience. Int J Hypertens 2011; 2011:410754. [PMID: 22121473 PMCID: PMC3206377 DOI: 10.4061/2011/410754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 09/22/2011] [Indexed: 11/24/2022] Open
Abstract
The Canadian Hypertension Education Program (CHEP) was established in 1999 as a response to the result of a national survey that showed that a high percentage of Canadians were unaware of having hypertension with only 13% of those treated for hypertension having their blood pressure controlled. The CHEP formulates yearly recommendations based on published evidence. A repeat survey in 2006 showed that the percentage of treated hypertensive patients with the blood pressure controlled had risen to 65.7%. Over the first decade of the existence of the CHEP, the number of prescriptions for antihypertensive medications had increased by 84.4% associated with a significant greater decline in the yearly mortality from stroke, heart failure and myocardial infarction and a significant decrease in the hospitalization for stroke and heart failure. Therefore, the introduction of the CHEP and the yearly issue of updated recommendations resulted in a significant increase in the awareness, diagnosis and treatment of hypertension and in a significant reduction in stroke and cardiovascular morbidity and mortality. The CHEP model could serve as a template for its adoption to other regions or countries.
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Affiliation(s)
- Peter Bolli
- Ambulatory Internal Medicine Teaching Clinic, Department of Medicine, McMaster University, 80 King Street, Suite 2, Street Catharines (ON), Canada L2R 7G1
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Efforts to Reduce Sodium Intake in Canada: Why, What, and When? Can J Cardiol 2011; 27:437-45. [DOI: 10.1016/j.cjca.2011.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 04/19/2011] [Accepted: 04/21/2011] [Indexed: 01/11/2023] Open
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