A landmark research study that tracked 3.5 million Canadians with high blood pressure for up to 12 years has found that men, the elderly and people living in low-income or rural areas generally have poorer health outcomes than other segments of the population.
Anyone who lives with untreated high blood pressure faces increased risks from heart attack, heart failure and stroke, but now researchers have pinpointed the specific segments of the population at greatest risk of those health outcomes.
“Because the study is so large, and is based on health records from six provinces, it offers an accurate portrait of what is happening to Canadians with hypertension,” says Dr. Hude Quan, the lead author of the paper, and a member of the Libin Cardiovascular Institute of Alberta, which is supported by Alberta Health Services (AHS) and the University of Calgary.
“Until now we haven’t had benchmark information on the overall state of the population, but these findings will enable us to determine in the future whether our prevention and treatment approaches in addressing hypertension are having an impact,” says Dr. Quan, who is also a U of C professor and co-chair of the Quality Improvement Committee of the AHS Cardiovascular Health & Stroke Strategic Clinical Network.
High blood pressure or hypertension – sometimes called a silent killer because it has no warning signs or symptoms – is a condition of increased force against the walls of the arteries as blood flows through them. If left untreated, it can seriously impact cardiovascular function, and lead to heart attack, heart failure and stroke.
Risk factors include age, family history, obesity, high salt intake, high fat intake, physical inactivity, smoking, alcohol intake, stress and diabetes.
The study, published this month by the Canadian Journal of Cardiology, found the mortality rate among hypertensive Canadians from all causes was 22.4 per 1,000 person years, meaning about 22 deaths would be expected among 1,000 hypertensive persons observed for one year.
Researchers speculate that health outcomes could be poorer for the elderly due to what are called co-morbidities, or additional diseases or health conditions. Hypertensive men may fare worse than women because of negative lifestyle factors, such as smoking or alcohol consumption, and it’s well established that low-income populations generally have poorer overall health than those in higher socio-economic groups.
Dr. Norman Campbell, one of the study’s co-authors and a member of the Libin Cardiovascular Institute, says one of the interesting findings in the paper is the apparent “sad reversal” that’s taken place among the rural population.
“A generation ago it was the people who worked on farms who would be the healthiest, but now, with increased mechanization and poorer diets, they’re among the unhealthiest,” he says.
“Although treatment and control of hypertension in Canada has improved over the last decade, at least one in five Canadians has high blood pressure,” says Dr. Campbell, who is also a U of C professor. “Globally, almost one in three has hypertension and it’s the leading cause of disability worldwide.”
Dr. Blair O’Neill, clinical co-director of the AHS Cardiovascular Health & Stroke Strategic Clinical Network, welcomes the findings.
“The important thing is what we do with this data,” he says. “One focus of the clinical networks is to foster research that positively impacts patients. Studies like these will help inform the design of new programs to help improve the quality of health care in Alberta.”
Strategic Clinical Networks, comprised of health care professionals, researchers, community leaders and policy makers, are focused on specific areas of health and are working to enhance the patient journey, improve outcomes and standardize care delivery across the province.
Of the 3.5 million people included in the research study, 29.4 per cent were younger than 50, 35.6 per cent were aged 50-64, and 35 per cent were 65 or older. Males made up 48.2 per cent of the sample.
Gurmit Kaur Sarpal, a 63-year-old Calgarian, knows full well the importance of making lifestyle changes to help bring hypertension under control. Diagnosed with high blood pressure 20 years ago, Sarpal says she realized she had to do something to deal with the stress and depression she felt. She enrolled in an eight-week Better Choices, Better Health program offered by AHS, which teaches about the healthy benefits of lifestyle choices like diet, exercise and meditation.
“I’m still on low doses of medication for high blood pressure, but I now have a much greater sense of well-being,” she says. “I’m eating better and I exercise at least twice a week.”
The study included anonymized data from Alberta, British Columbia, Manitoba, Nova Scotia, Newfoundland and Labrador, and Ontario.
The paper is a product of the HOST group, or the Hypertension Outcome and Surveillance Team, which is comprised of researchers from across Canada. The Canadian Institutes of Health Research, the Libin Cardiovascular Institute of Alberta and Hypertension Canada supported the project.
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than 3.8 million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.
Story by Gregory Harris courtesy of Alberta Health Services
Related media coverage
“Research Project gets to the Heart of Hypertension” Calgary CTVNews
VIDEO-“Hypertension Study” Global Calgary
PODCAST-Interview with Norman Campbell Calgary Eyeopener