high blood pressure (hypertension) in canada: stats, impact and resources
hypertension, the clinical term for consistently high blood pressure, is the most common chronic disease in canada and the most expensive single diagnosis in the country.
11 minute read
between 2012-2015, approximately 24 per cent of men and 23 per cent of women between the ages of 20 and 79 were diagnosed with hypertension in canada.
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what is high blood pressure (hypertension)?
hypertension, the clinical term for consistently high blood pressure, is the most common chronic disease in canada and the most expensive single diagnosis in the country because of the sheer number of people who have it.
high blood pressure (hypertension) is also one of the leading causes for hospitalization. and when you look at the bigger context, the condition is typically not just one problem. hypertension causes heart disease, dementia (it damages the small blood vessels in the brain), vision problems and kidney damage, and it’s associated with rising metabolic disorders like obesity and diabetes.
unless you’re getting your blood pressure checked or checking it yourself with a cuff device at home or at a pharmacy, you wouldn’t know you have it – there are no clear signs or symptoms.
“the problem with hypertension is it goes hand-in-hand with obesity and diabetes. we’ve seen in the last 10 years an epidemic of obesity and diabetes which at some point will trigger hypertension,” says cardiologist dr. diego delgado of toronto’s university health network and professor at the university of toronto. he has treated heart patients for 25 years.
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high blood pressure (hypertension) stats in canada
according to a 2023 report from statistics canada, hypertension affects almost one in four canadian adults and is a leading risk factor for cardiovascular disease and premature death. the number is expected to rise as the population ages because risk increases with age.
the most recent national survey covering all facets of hypertension in canada was conducted in 2019, looking back at data from 2012-2015. the report shows:
- approximately 24 per cent of men and 23 per cent of women between the ages of 20 and 79 were diagnosed with high blood pressure (hypertension).
- in the 70 to 79 age group, 71 per cent of men and 69 per cent of women were identified as hypertensive, which is nearly triple the rate found in the 40 to 59 age group, where 25 per cent of men and 21 per cent of women were hypertensive.
- between the periods of 2007-2009 and 2012-2015, the overall high blood pressure (hypertension) rates among individuals aged 20 to 79 stayed relatively constant, at around 23 per cent based on crude estimates and 18 per cent when adjusted for age
in the world health organization’s 2023 hypertension profile for canada, it highlights control rates of 61 per cent. more detailed data among men and women aged 30-79 shows:
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men
- 80 per cent diagnosed
- 76 per cent treated
- 64 per cent controlled
women
- 75 per cent diagnosed
- 71 per cent treated
- 57 per cent controlled
additional who modelling says that canada’s aspirational control rates could contribute to the avoidance of 52,000 deaths by 2040.
as the outreach organization hypertension canada reports, more than 90 per cent of canadians will develop high blood pressure (hypertension) if they live an average lifespan. and alarmingly, more people are being diagnosed at an earlier age.
in the global view, canadians are at an advantage because canada has one of the lowest rates of hypertension and the highest rate of hypertension control. but trends are changing. canada is now facing its lowest rates of treatment and control in more than a decade, experts say.
“after plateauing early in the 2000s, canadian hypertension treatment and control rates have declined in the past decade, largely in women. renewed collaborative efforts by key stakeholders are urgently needed to address this increase in preventable risk for cardiovascular disease,” researchers note in the canadian journal of cardiology.
other research led by the same authors showed that hypertension control rates in women declined from 68.9 per cent in 2012 to 2013 to 49.2 per cent in 2016 to 2017 while the rate was sustained in men.
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heart and stroke has put resources into investigating the gap in research, diagnosis and care for women in heart and brain health which has shaped public awareness. national polling data revealed that nearly 40 per cent of people in canada don’t realize that heart disease and stroke are the leading cause of premature death in women. these are still viewed more as a men’s health problem, which is something that needs to change, researchers say.
impact of hypertension on canadian society
the antihypertensive medications to keep it controlled are not expensive, but the volume of those prescriptions is part of the exploding costs to the healthcare system. in 2010, the annual cost linked to hypertension was estimated at $13.9 billion with the total expected to rise to $20.5 billion by 2020, according to statistics canada.
resources and support available for high blood pressure (hypertension) in canada
the three main associations in canada representing hypertension are:
“we have incredible campaigns to treat and manage hypertension, but i think there is still much more to do from the primary care point of view and education in schools,” delgado says, noting the lack of access to family doctors for continuity of care and regular blood pressure checks.
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“we’re also seeing more and more younger people with hypertension who are not aware they have it. so people between the ages of 18 and 35, they come in for a cardiovascular assessment to make sure their heart is okay or to join a sport activity and find out they have hypertension.”
the most rewarding part of his work treating high blood pressure these days is seeing some of his younger patients turn their health around by doing the things we all need to be doing for disease prevention.
adopting healthy habits like nutritious eating, limiting alcohol, quitting smoking, regular physical exercise and weight loss, they are able to control their blood pressure to the point that they don’t require any treatment. “that’s the most gratifying part to see patients put the effort and energy in themselves to the point that i don’t even need to start medication,” delgado says.
however, following through with these healthy interventions successfully is a challenge because of how we live. modern life is increasingly more sedentary and more reliant on processed foods.
what we know for certain is that early detection and treatment of high blood pressure significantly reduces these serious outcomes.
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but less recognized is the fact that women have unique risk factors that need to be studied and understood so that health-care providers will screen them appropriately and check their blood pressure. one example is that women can develop high blood pressure during pregnancy (about seven per cent of pregnancies in canada) that can increase risk of hypertension in later years. hypertension canada published guidelines for hypertension management in pregnancy in 2018.
another difference for women is that the hormone estrogen has a protective effect on women’s heart and brain health. women who have gone through menopause may have a greater risk of hypertension because of changing hormone levels and weight gain, the mayo clinic notes.
the future of high blood pressure (hypertension) in canada: lifestyle, nutrition and the need for more education
experts are concerned that public knowledge about hypertension isn’t sufficient at a time when we’re asking individuals to take charge of their health and self-advocate to relieve some of the pressure on our overtaxed healthcare system.
do people know that if they are black or southeast asian, because of genetic predisposition that is not fully understood, or if they have a family history of hypertension they are at higher risk for the disease?
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convoluting the problem, if they don’t have a primary care provider, are they being screened for hypertension?
there’s also a strong case for socioeconomic determinants contributing to lower control rates. factors like lack of education about hypertension, hurdles to accessing care, limited funds to buy healthy, fresh food or purchase a home blood pressure cuff to self-monitor all play a role.
dr. norm campbell from the libin cardiovascular institute of alberta at the university of calgary and past chair of hypertension canada is working to improve hypertension control in canada. he says part of the solution is getting policymakers on board to create positive change – something that isn’t easy these days because public health is highly focused on infectious diseases like covid-19 and influenza.
“they haven’t really paid much attention to conditions like hypertension which doesn’t make sense when you consider how much death and disability it causes,” he says. “we could be taking steps to save money and improve health.”
campbell co-authored papers that outline the merits of the nationwide hypertension control program that canada launched in 2000. it brought in annually updated management recommendations that became part of standardised primary care resources and training.
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a monitoring and evaluation system was put in place to identify any gaps or problems. and everyone was on board, with multiple government and nongovernment organizations contributing to hypertension education for the public and a national strategy to reduce dietary sodium. after 2012, as health priorities and interests shifted, the program’s implementation and evaluation protocols were markedly reduced.
now campbell is trying to form a national coalition to advocate for a hypertension control strategy to get canadians’ health back on track.
“our control rates are going down. but around the world, countries are generally improving their hypertension control. because it’s such a global problem, world health organization (who) has developed some packages on how to actually improve blood pressure. but canada has not adopted them,” says campbell, who has acted as a consultant for who and other international organizations. he also was awarded the order of canada in 2014 as a champion of the prevention and control of hypertension – he’s passionate about making positive change.
“these approaches can achieve much higher control rates at lower cost.”
the who’s hearts program offers simplified interventions that are done systematically at the primary care level, including lifestyle counselling, an algorithm for evidence-based treatment protocols, and systems for monitoring. the pan american health organization has helped governments in the americas implement hearts with a lot of success. a community intervention project in cuba in 2016, for instance, served a population of about 26,000 people and improved the hypertension control rate by almost 20 per cent in a year.
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campbell also flags the success of the kaiser permanente northern california hypertension program which has a similar framework that improved hypertension control – going from 44 per cent in 2000 to 90 per cent in 2013. this july, the american heart association recognized 21 kaiser permanente northern california hospitals with awards for delivering top cardiac and stroke care. severe heart attacks in patients have been reduced by 72 per cent with a team-based, preventive approach.
“they standardized the care as much as possible. they involved more than just doctors, they involved the nurses and other people in the clinic in the care,” he explains. “they did a very simple algorithm. the person comes in with hypertension, you start with this drug at this dose, so just very simple one-page instructions on how to control hypertension, very much like a clinical trial. they monitored each clinic and clinician and gave feedback on how well everyone was doing.”
canada does have hypertension guidelines in place, updated every five years, which are part of hypertension canada’s knowledge translation program to make sure clinicians and patients can access best practices. however, there’s no longer a concerted national strategy for hypertension control with government and other stakeholders involved.
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what is prevalent is the focus on providing individualized treatment in canada and adoption of new technology and procedures like renal denervation that targets overactive nerves that supply the kidneys so the artery relaxes and blood flow to the kidneys can be restored. delgado says two of his patients with hypertension that is resistant to medication control have benefitted from the novel procedure.
experts like campbell say a standardized treatment protocol is a critical first step in a large-scale hypertension program. establishing standardized drug- and dose-specific treatment protocols deliver results and facilitate the logistics of drug procurement, task sharing, staff training, data collection and quality reporting.
another big effort is required to create a healthy environment for canadians. for individuals trying to make healthy choices, the chips are stacked against us.
“when you look at the drivers of hypertension, about 80 per cent is due to nutrition,” campbell says. “if you throw in obesity, which is largely caused by excess calories in our society, then you have sodium, potassium, saturated fats – they all increase blood pressure. then there’s high alcohol consumption and low physical activity.”
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he talks about how industrialized society has created these serious health issues like obesity, diabetes, high cholesterol, hypertension, heart disease and much of cancer. “i don’t blame individuals because we’re surrounded by unhealthy foods and places where it’s difficult to be active safely and those types of things.”
the biggest impact is at the policy level regarding nutrition. he explains that governments must look long-term at the rewards of spending to create healthier environments. the significant upfront cost will pay off in reduced health costs.
canada does have a healthy eating strategy which, campbell says, “looks pretty good on paper, but there’s a lot of problems with slow and incomplete implementation. they’ve been talking about a ban on marketing unhealthy foods to children. because if they start developing high blood pressure in childhood, it’ll just increase.”
he points to actions like putting warning labels on unhealthy foods, taxing unhealthy foods to make them more costly or subsidizing healthy foods. then there’s really putting legs on the country’s healthy food procurement policy. “the government’s telling us to eat healthy, but they’re buying and selling foods that are unhealthy. now, they should be internally consistent. any public dollar should only be spent on something that’s consistent with canada’s healthy eating guide.”
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the same follow-through should be adopted in schools, community centres and businesses where concern for healthy eating should be reflected in what foods are sold on the premises. it makes sense that our built environments should encourage healthy eating and physical activity. some municipalities have banned unhealthy eating establishments from being close to schools and places where kids hang out, but adoption of these strategies is fragmented, he notes.
“you’re trying to create these environments that encourage healthy eating and encourage active living, and then it’s much easier for people to choose healthy options.”
sustained lifestyle modification is considered the cornerstone for the prevention and management of hypertension.
as campbell advises, “when people lower their blood pressure, they improve their health virtually immediately. if they have hypertension, take their medications consistently, work with their healthcare professional to get their pressures under control. it’s one of the biggest risks to their health and it can be controlled.”
know your blood pressure numbers! for more information on hypertension, visit hypertension canada, heart & stroke and pulmonary hypertension association of canada.
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