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Pan Canadian Hypertension Framework

Pan Canadian Hypertension Framework. An opportunity to improve the Prevention and Control of Hypertension in Canada Presenters Name Institution Date. Contents. Need for a National H ypertension F ramework Hypertension Framework Overview Overview of prioritized actions

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Pan Canadian Hypertension Framework

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  1. Pan Canadian Hypertension Framework An opportunity to improve the Prevention and Control of Hypertension in Canada Presenters Name Institution Date

  2. Contents • Need for a National Hypertension Framework • Hypertension Framework Overview • Overview of prioritized actions • Highlight what organizations can do to contribute to the vision, goals and implementation of prioritized actions

  3. Global Leading Risks for Death, 2010 Systolic blood pressure > 115 mmHg Global Burden of Disease Study 2010 , Lancet 2012; 380: 2224–60

  4. Blood Pressure as a Cardiovascular Risk Attributable Risk • Overall ½ of heart and stroke* • Stroke 60-70%* • Heart failure 50% • Heart attack 25% • Kidney failure 20% • Dementia • Sexual dysfunction * Systolic blood pressure greater than 115 mmHg

  5. Blood Pressure & CVD Risk Lewington et al. Prospective Studies Collaboration. Lancet. 2002;360:1903-13.

  6. Hypertension Prevalence in Canada Source: Public Health Agency of Canada using CCDSS Data

  7. Hypertension Treatment and Control Rates * F Too unreliable to be published (data with a coefficient of variation (CV) greater than 33.3%; suppressed due to extreme sampling variability) CHMS: Canadian Health Measures Survey

  8. Attributable Cost of Hypertension • Globally estimated to consume 10% of health care costs in developed countries. Indirect costs estimated at $ 3.6 trillion (USD in 2001) –estimated to be 4.5 to 15% of GDP in high income countries • In Canada, direct cost is $3,072 per person per year, and indirect cost is $854. • Antihypertensive prescription consume estimated 13% of total drug costs in Canada. Campbell et al, CJC 2012 (in press) HeidenreichPA et al Circulation 2011;123:933-944 GazianoTA et al, J Hyperten 2009;27:1472;-77

  9. Pan Canadian Hypertension Framework • Public Health Agency of Canada contract to Hypertension Canada • Co-funded by CIHR Canada Chair in Hypertension Prevention and Control • Intent is to guide decision-making, planning and alignment of efforts for the prevention and control of hypertension in Canada • Outlines set of 10 objectives and 7 recommendations to be implemented and operationalized by 2020

  10. Pan Canadian Hypertension Framework:Framework membership Norm Campbell (chair) Eric Young (Vice-chair) Michael Adams Oliver Baclic Denis Drouin Judi Farrell Jeff Reading Janusz Kaczorowski Richard Lewanczuk Heidi Liepold Margaret Moy Lum-Kwong Sheldon Tobe Barbara Legowski Secretariat Selina Allu Denis Drouin Judi Farrell Barbara Legowski Norm Campbell Eric Young Tara Duhaney (as of 2012)

  11. Target Audiences • All potential stakeholders in hypertension prevention and control : • non governmental organizations • government organizations • health care professional organizations • scientific organizations

  12. Hypertension Framework: Vision • The people of Canada have… • the healthiest blood pressure distribution, • lowest prevalence and the highest rates of awareness, treatment and control of hypertension, and • the lowest burden of disease associated with blood pressure …of any nation in the world. • Uses the Expanded Chronic Disease Management Model

  13. Expanded Chronic Care Model: Integrating Population Health Promotion Adapted from Edward H. Wagner, MD, MPH, Chronic Disease Management. Originally published: Effective Clinical Practice, Aug/Sept 1998, Vol 1

  14. Framework Development

  15. Proposed Targets for 2020 (1)

  16. Objectives for 2020 (2)

  17. Overarching Recommendations • Build healthy public policy •  Re-orient/redesign the health services delivery system • Build partnerships to create supportive environments and evolve the healthcare system • Strengthen community action • Develop personal skills for better self-management • Improve decision support • Optimize information systems

  18. Research Recommendations A foundational role for research is integrated into the 7 core recommendations • The role for independent research is recognized • An increasingly and potentially dominant role for strategic team-based research is recognized. • Multiple critical research gaps identified in an ad-hoc assessment • Development of a Comprehensive Research Strategy is recommended with CIHR research pillars (biomedical, clinical, health services and population) • Develop/support networks of researchers and collaborations to identify and address specific gaps and research opportunities

  19. Progress and Actions to Support Framework Operationalization • HSFC/CIHR Chair in Hypertension Prevention and Control (Dr. Norm Campbell) • Priority to advance policies to improve healthy eating environment • Established intersectoralleadership committee, the Hypertension Advisory Committee, to support implementation of the Framework recommendations. • National government and non-governmental organizational support and endorsement • Identify where they fit in the Framework and what actions can be taken to contribute to the vision, goals and implementation of prioritized recommendations • Sign onto the statement of support

  20. Priority Recommendations Build Healthy Public Policy • Develop one comprehensive multi-sector strategy whose goal is for people in Canada to meet the nationally recommended benchmarks for physical activity, smoke free environments and diet (including the recommended dietary reference intakes for nutrients,especially sodium). • Recognizes the need for an all of government approach

  21. Policy opportunities (1) • Setting targets and timelines for reducing sodium, saturated and trans fatty acids, and free sugars in processed foods with close government monitoring and oversight. • Restricting unhealthy food and beverage marketing to children • Implementing healthy food procurement policies. • Implementing clear transparent conflict of interest guidelines to ensure public health food policies are free of commercial bias.

  22. Policy Opportunities (2) • Mandated clear easy to understand food package labeling with health implications. • Taxing foods that have added sodium, saturated and trans fatty acids, and free sugars to recuperate health and other societal costs. • Reducing the cost and increasing the availability of healthy food. • Defining ‘unhealthy’ foods. • Monitoring and evaluation of the health of our food environment.

  23. Priority Recommendations Build partnerships to create supportive environments and evolve the healthcare system • Expand and maintain the partnerships whose contributions have been integral to the current Canadian successes in lowering and controlling hypertension. • Build new partnerships to better integrate disease management with population health promotion • Engage all levels of government, health organizations and healthcare professionals, non-government organizations, academics, relevant institutions and corporations/businesses.

  24. Past Hypertension Strategies • Chockalingam A, Campbell NRC, Ruddy T, Taylor G, Stewart P. National High Blood Pressure Prevention and Control Strategy. Can J Cardiol. 2000:16:1087-1093. • Federal Provincial Advisory Committee (E MacLeod, H Colburn, D MacLean, G Sinclair) The Prevention and Control of High Blood Pressure 1983. Health and Welfare Canada 1986.

  25. Supporting Publications • A framework for discussion on how to improve prevention, management and control of hypertension in Canada. Can J Cardiol. 2012;28:262-69. • The 2013 Canadian Hypertension Education Program Recommendations for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol. 2013;29:528-542. • The Canadian effort to prevent and control hypertension: Can other countries adopt Canadian strategies? CurrOpinCardiol. 2010;25:366–372. • Hypertension: Are you and your patients up to date? Can J Cardiol. 2010;26:261-4.

  26. Supporting Publications Cont’d • Hypertension Prevention and Control in Canada. J Am SocHypertens (JASH). 2008;2:97-105 • CHEP – A Unique Canadian Knowledge Translation Program. Can J Cardiol.2007;23:551-555 • Canada Chair in Hypertension Prevention and Control. A pilot project. Can J Cardiol2007;23:557-565 • The Outcomes Research Task Force, Canadian Hypertension Education Program. Can J Cardiol. 2006; 22:556-558 • Implementation of Recommendations on Hypertension: The Canadian Hypertension Education Program. Can J Cardiol. 2006; 22: 595-598.

  27. Questions

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