High blood pressure - the silent killer - is taking a hit from a new, ground-breaking treatment program from the Heart and Stroke Foundation of Ontario.
Last Sunday, in New York City, Dr. Sheldon Tobe, Chair of the Canadian Hypertension Education Program (CHEP) and a long-standing Heart and Stroke Foundation researcher, unveiled a new and powerful tool in the management of hypertension at the American Society of Hypertension (ASH) Scientific Meeting -The Heart&Stroke Hypertension Management Program.
"Diagnosing high blood pressure (hypertension) and lowering it in one patient is relatively simple," says Dr. Tobe. "But keeping the pressure down in hypertensives across the entire country has proven to be a formidable challenge for patients and healthcare systems."
To test and quantify the efficacy of the Hypertension Management Program, a three-year demonstration phase was launched in 11 primary care sites (10 family health teams and one community health centre) in communities across Ontario, including Beamsville, Brighton, Deep River, Dryden, Kitchener, Mount Forest, North Bay, Shelburne, Toronto, Vermillion Bay, and Windsor.
The Hypertension Management Program consists of healthcare provider education and tools as well as patient specific tools to facilitate blood pressure management and control by providers and self-management by patients. After the initial intervention at the start of the study, the Family Health Teams continued delivering the program on their own.
"More than 3,600 patients participated in the Canadian study and blood pressure fell quickly. Remarkably after three years, patients with a diagnosis of hypertension had sustained average blood pressure reductions of 6.4/3.8 mmHg," said Dr. Tobe. The Heart&Stroke Hypertension Management Program has resulted in 41% more people in these 11 primary-care centres across Ontario keeping their high blood pressure under control.
Even modest reductions in blood pressure can dramatically decrease the incidence of cardiovascular disease.
- A reduction of 5 mm Hg in systolic in blood pressure translates into:
- A 14% drop in stroke mortality
- A 9% drop in coronary heart disease and
- A 7% reduction in overall mortality
- It has been shown that effective blood pressure control can reduce the incidence of stroke by up to 40%!
"This study is showing us that in hypertension, a simple inexpensive education intervention can lead to the sustained achievement of blood pressure control for at least three years," Dr. Tobe says.
Dr. Mel Cescon of the New Vision Family Health Team in Kitchener says, "Our team was able to transfer and adapt this protocol to the diagnosis and early treatment of other chronic conditions such as diabetes."
The Canadian program will assist family physicians and healthcare providers in achieving those elusive, sustained, reductions in hypertension. Supported in large part by the Ontario government, the Heart and Stroke Foundation of Ontario collaborated with the Ontario College of Family Physicians, the Registered Nurses' Association of Ontario and the Ontario Pharmacists' Association to create the program.
FINANCIAL BENEFITS
In 2005, cardiovascular disease cost Canada more than $21 billion a year in healthcare and lost productivity. That number is expected to climb to more than $28 billion by 2020.
The U.S. Agency for Healthcare Quality and Research has reported that Americans spent $29 billion for prescription cardiovascular drugs alone in 2008.
"Getting hypertension under control is one way of greatly reducing the hemorrhage of taxpayers' money," said Dr. Tobe. "For patients in the Canadian and American healthcare systems, for care-givers and administrators alike, the implementation of the Heart&Stroke Hypertension Management Program will prove beneficial financially and in terms of public health. It is imperative that we get guideline-based programs like this into everyday primary care practice right across North America."
BEST EVIDENCE POINTS THE WAY
The new protocol is guided by best practice principles.
The Heart&Stroke Hypertension Management Program demonstrates that an evidence-informed inter-professional primary healthcare provider educational intervention can successfully integrate into the practice of primary care clinicians to improve the management and control of hypertension in their patients.
A GLOBAL PERSPECTIVE
According to the World Health Organization, hypertension is a major cause of disability and is the leading risk factor for premature death, causing an estimated 7.5 million deaths per year globally. More than one third of the world's population suffers from high blood pressure and cardiovascular disease.
The number of baby boomers headed for the high risk years for cardiovascular disease is expected to create unique stress on healthcare systems all over the world.
"These made-in-Canada results should give healthcare professionals, healthcare economists and everyone with high blood pressure cause to rejoice," said David Sculthorpe, CEO of the Heart and Stroke Foundation of Ontario.
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