Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study

Objective Comparison of recent national survey data on prevalence, awareness, treatment and control of hypertension in England, the USA and Canada, and correlation of these parameters with each country stroke and ischaemic heart disease (IHD) mortality. Design Non-institutionalised population surveys. Setting and participants England (2006 n=6873), the USA (2007–2010 n=10 003) and Canada (2007–2009 n=3485) aged 20–79 years. Outcomes Stroke and IHD mortality rates were plotted against countries’ specific prevalence data. Results Mean systolic blood pressure (SBP) was higher in England than in the USA and Canada in all age–gender groups. Mean diastolic blood pressure (DBP) was similar in the three countries before age 50 and then fell more rapidly in the USA, being the lowest in the USA. Only 34% had a BP under 140/90 mm Hg in England, compared with 50% in the USA and 66% in Canada. Prehypertension and stages 1 and 2 hypertension prevalence figures were the highest in England. Hypertension prevalence (≥140 mm Hg SBP and/or ≥90 mm Hg DBP) was lower in Canada (19·5%) than in the USA (29%) and England (30%). Hypertension awareness was higher in the USA (81%) and Canada (83%) than in England (65%). England also had lower levels of hypertension treatment (51%; USA 74%; Canada 80%) and control (<140/90 mm Hg; 27%; the USA 53%; Canada 66%). Canada had the lowest stroke and IHD mortality rates, England the highest and the rates were inversely related to the mean SBP in each country and strongly related to the blood pressure indicators, the strongest relationship being between low hypertension awareness and stroke mortality. Conclusions While the current prevention efforts in England should result in future-improved figures, especially at younger ages, these data still show important gaps in the management of hypertension in these countries, with consequences on stroke and IHD mortality.

[1]  R. Vasan,et al.  Blood Pressure Tracking Over the Adult Life Course: Patterns and Correlates in the Framingham Heart Study , 2012, Hypertension.

[2]  N. Campbell,et al.  A framework for discussion on how to improve prevention, management, and control of hypertension in Canada. , 2012, The Canadian journal of cardiology.

[3]  Taryn Krause,et al.  Management of hypertension in adults in primary care: NICE guideline. , 2012, The British journal of general practice : the journal of the Royal College of General Practitioners.

[4]  M. Tremblay,et al.  Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades , 2011, Canadian Medical Association Journal.

[5]  Fang Zhang,et al.  Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study , 2011, BMJ : British Medical Journal.

[6]  N. Lien,et al.  Availability of data assessing the prevalence and trends of overweight and obesity among European adolescents , 2010, Public Health Nutrition.

[7]  B. Egan,et al.  US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. , 2010, JAMA.

[8]  Mark S Tremblay,et al.  Blood pressure in Canadian adults. , 2010, Health reports.

[9]  Milton C Weinstein,et al.  The global cost of nonoptimal blood pressure , 2009, Journal of hypertension.

[10]  F. McAlister,et al.  The impact of the Canadian Hypertension Education Programme in its first decade. , 2009, European heart journal.

[11]  N J Wald,et al.  Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies , 2009, BMJ : British Medical Journal.

[12]  N. Lunet,et al.  Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries , 2009, Journal of hypertension.

[13]  J. Mindell,et al.  Continued Improvement in Hypertension Management in England: Results From the Health Survey for England 2006 , 2009, Hypertension.

[14]  G. Fodor,et al.  Comparison between an automated and manual sphygmomanometer in a population survey. , 2008, American journal of hypertension.

[15]  Karen Tu,et al.  Estimate of the benefits of a population-based reduction in dietary sodium additives on hypertension and its related health care costs in Canada. , 2007, The Canadian journal of cardiology.

[16]  E. Mervaala,et al.  Sodium intake and hypertension. , 2006, Progress in cardiovascular diseases.

[17]  Evangelos Kontopantelis,et al.  Pay-for-performance programs in family practices in the United Kingdom. , 2006, The New England journal of medicine.

[18]  F. McAlister.  The Canadian Hypertension Education Program--a unique Canadian initiative. , 2006, The Canadian journal of cardiology.

[19]  K. Reynolds,et al.  Global burden of hypertension: analysis of worldwide data , 2005, The Lancet.

[20]  K. Reynolds,et al.  Worldwide prevalence of hypertension: a systematic review , 2004, Journal of hypertension.

[21]  R. Collins,et al.  Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002, The Lancet.

[22]  C. Lenfant,et al.  National High Blood Pressure Education Program. , 1986, Journal of the American Optometric Association.

[23]  W. Elliott.  NICE clinical guideline 127: Hypertension: Clinical management of primary hypertension in adults , 2012 .

[24]  Vital signs: awareness and treatment of uncontrolled hypertension among adults--United States, 2003-2010. , 2012, MMWR. Morbidity and mortality weekly report.

[25]  W. Elliott.  US Trends in Prevalence, Awareness, Treatment, and Control of Hypertension, 1988-2008 , 2011 .

[26]  Million hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors--United States, 2011. , 2011, MMWR. Morbidity and mortality weekly report.

[27]  M. Tremblay,et al.  Canadian Health Measures Survey: rationale, background and overview. , 2007, Health reports.