Results of the Ontario Survey on the Prevalence and Control of Hypertension

Background

Available information on the prevalence and management of hypertension in the Canadian population dates back to 1986–1992 and probably does not reflect the current status of this major risk factor for cardiovascular disease. We sought to evaluate the current prevalence and management of hypertension among adults in the province of Ontario.

Methods

Potential respondents from randomly selected dwellings within target neighbourhoods in 16 municipalities were contacted at their homes to request participation in the study. For potential respondents who agreed to participate, blood pressure was measured with an automated device. Estimation weights were used to obtain representative estimates of population parameters. Responses were weighted to the total adult population in Ontario of 7 996 653.

Results

From 6436 eligible dwellings, contact was made with 4559 potential participants, of whom 2992 agreed to participate. Blood pressure measurements were obtained for 2551 of these respondents (age 20–79 years). Hypertension, defined as systolic blood pressure of 140 mm Hg or more, diastolic blood pressure of 90 mm Hg or more, or treatment with an antihypertensive medication, was identified in 21.3% of the population overall (23.8% of men and 19.0% of women). Prevalence increased with age, from 3.4% among participants 20–39 years of age to 51.6% among those 60–79 years of age. Hypertension was more common among black people and people of South Asian background than among white people; hypertension was also associated with higher body mass index. Among participants with hypertension, 65.7% were undergoing treatment with control of hypertension, 14.7% were undergoing treatment but the hypertension was not controlled, and 19.5% were not receiving any treatment (including 13.7% who were unaware of their hypertension). The extent of control of hypertension did not differ significantly by age, sex, ethnic background or comorbidities.

Interpretation

In Ontario, the overall prevalence of hypertension is high in the older population but appears not to have increased in recent decades. Hypertension management has improved markedly among all age groups and for both sexes.Hypertension is a major risk factor for premature cardiovascular morbidity and mortality. Epidemiologic studies have indicated that, for people 40–69 years of age, each increase of 20 mm Hg in usual systolic blood pressure is associated with a doubling of mortality rates for stroke and ischemic heart disease.¹ In 2002 the World Health Organization estimated that at least 50% of cases of cardiovascular disease and at least 75% of strokes were caused by elevated blood pressure.² At the same time, randomized clinical trials have demonstrated that these risks can be markedly reduced by antihypertensive drug therapy. The substantial burden of suffering associated with hypertension, combined with the availability of feasible and accurate means of detection and a clear benefit from treatment have led to worldwide recommendations for hypertension screening and management.Currently available Canadian data on the prevalence and management of hypertension are based on Canadian Heart Health Surveys that took place between 1986 and 1992. At that time, 22% of adult Canadians had hypertension, but only 16% of these had their blood pressure treated and controlled.³ These data are clearly out of date, and there has been no way of assessing the impact of changes in lifestyle, including higher rates of obesity and a sedentary lifestyle, on the prevalence of hypertension or determining whether hypertension management has improved with the widespread use of newer classes of antihypertensive drugs such as calcium antagonists and blockers of the renin–angiotensin system.We sought to evaluate the current prevalence and management of hypertension among adults in the province of Ontario.