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. 1. Introduction Hypertension is still a major contributor to mortality worldwide [1], and it is estimated that there are 970 million hypertensives worldwide and it is predicted to increase to 1.56 billion in the year 2025 [2]. The risk for a fail or morbid cardiovascular or cerebral vascular event starts at the systolic blood pressure of 115？mmHg and a diastolic blood pressure of 73？mmHg. Therefore, it is not surprising that hypertension accounts for about 60% of strokes and 50% of heart failure [3]. Considering that lowering of systolic blood pressure by 10？mmHg and diastolic blood pressure by 5？mmHg reduces the relative risk for a coronary artery event by 23% and a stroke by 40%, it follows that blood pressure is not optimally diagnosed and treated. There can be several reasons for this lack of diagnosing and proper control of hypertension [4]. The major factors are patient related, for example, poor adherence to treatments, physician-related inertia to properly inform the public of the danger of hypertension and the failure of physicians to diagnose, initiate, and treat blood pressure to achieve the recommended blood pressure goals. 2. The Canadian Situation A Canadian national survey conducted in Canada from 1985 to 1992 revealed that 45% of individuals were unaware of their blood pressure condition, 22% were aware of having hypertension but remained untreated, 21% were
References
[1]
A. Rodgers, P. Vaughan, T. Prentice, T. T. Edejer, and D. Evans, The World Health Report 2002, World Health Organization, Geneva, Switzerland, 2002.
[2]
P. M. Kearney, M. Whelton, K. Reynolds, P. Muntner, P. K. Whelton, and J. He, “Global burden of hypertension: analysis of worldwide data,” The Lancet, vol. 365, no. 9455, pp. 217–223, 2005.
[3]
C. M. M. Lawes, S. Vander der Hoorn, M. R. Law, P. Elliott, S. MacMahon, and A. Rodgers, “Blood pressure and the global burden of disease 2000. Part II: estimates of attributable burden,” Journal of Hypertension, vol. 24, no. 3, pp. 423–430, 2006.
[4]
D. R. Berlowitz, A. S. Ash, E. C. Hickey et al., “Inadequate management of blood pressure in a hypertensive population,” New England Journal of Medicine, vol. 339, no. 27, pp. 1957–1963, 1998.
[5]
M. R. Joffres, P. Ghadirian, J. G. Fodor, A. Petrasovits, A. Chockalingam, and P. Hamet, “Awareness, treatment, and control of hypertension in Canada,” American Journal of Hypertension, vol. 10, no. 10, pp. 1097–1102, 1997.
[6]
K. Wolf-Maier, R. S. Cooper, J. R. Banegas et al., “Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States,” Journal of the American Medical Association, vol. 289, no. 18, pp. 2363–2369, 2003.
[7]
R. D. Feldman, N. Campbell, P. Larochelle et al., “1999 Canadian recommendations for the management of hypertension,” Canadian Medical Association Journal, vol. 161, supplement 12, pp. S1–S17, 1999.
[8]
K. B. Zarnke, N. R. C. Campbell, F. A. McAlister, and M. Levine, “A novel process for updating recommendations for managing hypertension: rationale and methods,” Canadian Journal of Cardiology, vol. 16, no. 9, pp. 1094–1102, 2000.
[9]
D. Drouin, N. R. C. Campbell, and J. Kaczorowski, “Implementation of recommendations on hypertension: the Canadian Hypertension Education Program,” Canadian Journal of Cardiology, vol. 22, no. 7, pp. 595–598, 2006.
[10]
N. R. C. Campbell, R. Petrella, and J. Kaczorowski, “Public education on hypertension: a new initiative to improve the prevention, treatment and control of hypertension in Canada,” Canadian Journal of Cardiology, vol. 22, no. 7, pp. 599–603, 2006.
[11]
N. R. C. Campbell and J. Onysko, “The outcomes research task force and the Canadian Hypertension Education Program,” Canadian Journal of Cardiology, vol. 22, no. 7, pp. 556–558, 2006.
[12]
F. Leenen, J. Dumais, N. McInnis et al., “2006 ontario survey on the prevalence and control of hypertension (ON-BP),” Canadian Medical Association Journal, vol. 178, pp. 1441–1449, 2008.
[13]
N. R. C. Campbell, R. Brant, H. Johansen et al., “Increases in antihypertensive prescriptions and reductions in cardiovascular events in Canada,” Hypertension, vol. 53, no. 2, pp. 128–134, 2009.
[14]
B. R. Hemmelgarn, G. Chen, R. Walker et al., “Trends in antihypertensive drug prescriptions and physician visits in Canada between 1996 and 2006,” Canadian Journal of Cardiology, vol. 24, no. 6, pp. 507–512, 2008.
[15]
N. R. C. Campbell, F. A. McAlister, R. Brant et al., “Temporal trends in antihypertensive drug prescriptions in Canada before and after introduction of the Canadian hypertension education program,” Journal of Hypertension, vol. 21, no. 8, pp. 1591–1597, 2003.
[16]
C. I. Neutel and N. R. C. Campbell, “Antihypertensive medication use by recently diagnosed hypertensive Canadians,” Canadian Journal of Cardiology, vol. 23, no. 7, pp. 561–565, 2007.
[17]
F. A. McAlister, R. D. Feldman, K. Wyard, R. Brant, and N. R. C. Campbell, “The impact of the Canadian Hypertension Education Programme in its first decade,” European Heart Journal, vol. 30, no. 12, pp. 1434–1439, 2009.
[18]
K. Wilkins, N. R. Campbell, M. Joffres et al., “Blood pressure in Canadian adults,” Health Reports, vol. 21, no. 1, pp. 37–46, 2010.
[19]
N. R. C. Campbell and T. Sheldon, “The canadian effort to prevent and control hypertension: can other countries adopt canadian strategies?” Current Opinion in Cardiology, vol. 25, no. 4, pp. 366–372, 2010.
