hypertension as a public health risk 2011 canadian hypertension education program recommendations
TRANSCRIPT
Hypertensionas a Public Health Risk
2011 Canadian Hypertension Education Program Recommendations
The full slide set of the 2011 CHEP Recommendations
are available atwww.hypertension.ca
What’s Still Important in 2011
• Keep up to date on the prevention and control of hypertension
• Register for automatic email notification of new hypertension resources for you and your patients, at: www.htnupdate.ca
• Have your patients sign up at www.myBPsite.ca to access latest hypertension resources
Overview
• What is hypertension?
• Age-related blood pressure creep and hypertension is common
• High blood pressure is a significant risk factor for morbidity and mortality
• Hypertension is costly
• Hypertension keeps bad company
• Hypertension can be prevented or delayed
• The complications of hypertension are ameliorated by effective therapy
• Healthy public policies reduce the risk of hypertension
Proportion of Deaths Attributable to Leading Risk Factors Worldwide (2000)
WHO 2000 Report. Lancet. 2002;360:1347-1360.
Attributable Mortality0 87654321
High blood pressure
Tobacco
High cholesterol
Unsafe sex
High BMI
Physical inactivity
Alcohol
Indoor smoke from solid fuels
Iron deficiency
Underweight
Systolic blood pressure greater than 115 mmHg
Hypertension as a Risk Factor
Hypertension is a significant risk factor for:– cerebrovascular disease– coronary artery disease– congestive heart failure– renal failure– peripheral vascular disease– dementia– atrial fibrillation– erectile dysfunction
Adapted from : Third National Health and Nutrition. Examination Survey, Hypertension 1995;25:305-13.
30-39 40-49 50-59 60-69 70-79 80
70
80
110
130
150
Age
30-39 40-49 50-59 60-69 70-79 80
70
80
110
130
150
Age
Men Women
PPPP
Blood Pressure Distribution in the Population According to Age
PP=Pulse Pressure.
European Society of Hypertension Classification of Blood Pressure
Category Systolic Diastolic
Optimal <120 and / or <80
Normal <130 and / or <85
High-Normal 130-139 and / or 85-89
Grade 1 (mild hypertension ) 140-159 and / or 90-99
Grade 2 (moderate hypertension) 160-179 and / or 100-109
Grade 3 (severe hypertension) 180 and / or 110
Isolated Systolic Hypertension (ISH) 140 and <90
The category pertains to the highest risk blood pressure
*ISH=Isolated Systolic Hypertension.
J Hypertens 2007;25:1105-87.
JNC VII (American) Classification of Blood Pressure
Category Systolic Diastolic
Optimal <120 and / or <80
Normal <130 and / or <85
High-Normal 130-139 and / or 85-89
Stage 1 (mild hypertension ) 140-159 and / or 90-99
Stage 2 (moderate to severe hypertension)
160 and / or 100-109
Isolated Systolic Hypertension (ISH) 140 and <90
The category pertains to the highest risk blood pressure
*ISH=Isolated Systolic Hypertension.
JAMA 2003;289:2560-72.
Blood Pressure and Risk of Stroke Mortality
Lancet 2002;360:1903-13.
Blood Pressure and Risk of Ischemic Heart Disease (IHD) Mortality
Lancet 2002;360: 1903-13.
CAD Death Rate per 10,000 Person-years
100+ 90-99 80-89 75-79 70-74 <70<120
120-139
140-159
160+
Diastolic BP (mmHg)
Systolic BP (mmHg)
20.6
10.3 11.8 8.8 8.5 9.2
11.812.612.813.9
24.6 25.3 25.2 24.9
16.923.8
31.025.8
34.743.8
38.1
80.6
37.4
48.3
Neaton et al. Arch Intern Med 1992; 152:56-64.
Effect of SBP and DBP onAge-Adjusted CAD Mortality: MRFIT
Impact of High-Normal Blood Pressure on the Risk of Cardiovascular Disease
N Engl J Med 2001;345:1291-7.
Cumulative incidence of cv events in men without hypertension according to baseline blood pressure
(130-139) mmHg
(121-129) mmHg
(< 120) mmHg
The Concept of Masked Hypertension
Derived from Pickering et al. Hypertension 2002: 40: 795-796
Office SBP mmHg
Ho
me/
Am
bu
lato
ry S
BP
mm
Hg
Truehypertensive
TrueNormotensive White Coat HTN
Masked HTN
200
180
160
140
120
100
100 120 140 160 180 200
135
The Prognosis of White Coat and Masked Hypertension
0
0.5
1
1.5
2
2.5
Normal BP White coatHypertension
MaskedHypertension
Hypertension
J Hypertension 2007;25:2193-2198.
Prevalence is approximately 10% of the adult population O
dd
s R
ati
o o
f a
C
ard
iov
as
cu
lar
Ev
en
t
Long term follow-up of Normotensive, White Coat Hypertension, and Ambulatory Hypertension
Hypertension. 2005;45(2):203-208.
Time to stroke (years)
0 1 2 3 1615141312114 105 6 7 8 9
Cu
mu
lati
ve h
azar
d o
f st
roke
(%
)
0
1
2
3
4
5
6
7
8White Coat
Hypertension
p = 0.0013
Normotensivegroup
AmbulatoryHypertension
Benefits of Treating Hypertension
• Younger than 60 (reducing BP 10/5-6 mmHg)
– reduces the risk of stroke by 42%
– reduces the risk of coronary event by 14%
• Older than 60 (reducing BP 15/6 mmHg)
– reduces overall mortality by 15%
– reduces cardiovascular mortality by 36%
– reduces incidence of stroke by 35%
– reduces coronary artery disease by 18%
Lancet 1990;335:827-38.Arch Fam Med 1995;4:943-50.
Benefits of Treating to Target
• Older than 60 with isolated systolic hypertension (SBP 160 mm Hg and DBP <90 mm Hg)– 42% reduction in the risk of stroke
– 26% reduction in the risk of coronary events
Lancet 1997;350:757-64.
Correlation Between Reduction in SBP and Stroke or MI
Staessen et al. Lancet 2001;358:1305-15.
Myocardial InfarctionStroke
Correlation Between Reduction in SBP and Cardiovascular Mortality or Events
Staessen et al. Lancet 2001;358:1305-15.
Cardiovascular mortality Cardiovascular events
Emberson et al. Eur Heart J. 2004;25:484-491.
10% Reduction
in BP
10% Reductionin Total-C+
45% Reduction
in CVD=
90% of Hypertensive Canadians have other Cardiovascular Risk factors
Treating Hypertension and Other Risk Factors
Adapted from Emberson et al. Eur Heart J. 2004;25:484-491.
Pre
dic
ted
Red
uct
ion
in
M
ajo
r C
VD
(%
)
Treatment Based on lipids
(statin)
Treatment Based on BP
Treatment Based on Overall Absolute Risk
(ASA, lipids, BP)
-6 -6
-17
-9 -8
-28
-12-10
-37-40
-35
-30
-25
-20
-15
-10
-5
0
Top 10%
Top 20%
Top 30%
Treatment thresholds
Challenges to Hypertension Management: Public Perceptions
• 44% of people could not identify a normal or a high blood pressure reading
• 80% of people were unaware of the association between hypertension and heart disease
• 63% believed that hypertension was not a serious condition
• 38% of people thought they could control high blood pressure without the help of a health professional
Can J Cardiol 2005;21:589-93.
The Canadian Hypertension Education Program (CHEP)
• Goal– To reduce the burden of cardiovascular disease in Canada
through optimized hypertension management
• Activities– Regularly updated evidence-based recommendations for the
management of hypertension – Knowledge translation and exchange of the
recommendations to support implementation– Regular evaluation and revision of the program – Assessment of patient outcomes
Mill
ion
vis
its/
year
0
5
10
15
20
25
Hyp
erte
nsi
on
Dep
ress
ion
Dia
bet
es
Ro
uti
ne
med
ical
ex
ams
Acu
te r
esp
irat
ory
tra
ct i
nfe
ctio
nSource: IMS HEALTH Canada 2002
Leading Diagnoses Resulting in Visits to Physician Offices in Canada
New Patient Resources for Hypertension Online
• www.hypertension.ca/tools - Download current resources for the prevention and control of hypertension
• www.htnupdate.ca -To keep up to date with the latest evidence and resources
• www.myBPsite.ca - Have your patients sign up to access the latest hypertension resources
• www.lowersodium.ca - Tools and resources for healthcare professionals to use in educating other healthcare professionals, the public or patients about the risks of high dietary sodium in Canada.
• www.sodium101.ca -To access a simple to use demonstration of food sodium content for your patients
• www.heartandstroke.ca/BP -To monitor home blood pressure and encourage self management of lifestyle
• http://www.hypertension.qc.ca/ - Société Québécoise d’hypertension artérielle
• For your patients – ask them to sign up at www.myBPsite.ca for free access to the latest information & resources on HBP
• For health care professionals – sign up at www.htnupdate.ca for automatic updates and on current hypertension educational resources