Increasing rates of high blood pressure (hypertension) and associated risks are a significant concern according to a new national Heart & Stroke survey* of almost 1,000 health experts across the country. Lack of awareness, prevention, detection and treatment – often made worse by the pandemic – were identified by the health community as essential areas for improvement to address hypertension.
Almost eight million adults in Canada are affected by high blood pressure – about one in four. This number will only rise as the population ages; risk of hypertension increases with age. At the same time, more people are being diagnosed at an earlier age. It also comes with a hefty price tag as the annual cost associated with high blood pressure is $13.9 billion.
High risk and low awareness
According to our survey, eight in 10 health professionals are worried about high blood pressure in Canada as it is the number one risk factor for stroke and a major risk factor for heart disease. More than seven in 10 health professionals worry that people do not understand what the condition is, or the risks associated with it. Additionally, more than seven in 10 health professionals expressed concern that people do not realize when they develop high blood pressure because there are usually no warning signs – in fact it is often referred to as the “silent killer.”
“Hypertension is like an on-ramp to stroke and heart disease, so we have a tremendous opportunity here to catch people before they are too far down that road by raising awareness, supporting prevention, and improving access to screening and management,” says Dr. Patrice Lindsay, Director, Health Systems, Heart & Stroke. “If we can prevent high blood pressure or manage it through changes to lifestyle and medication, we can dramatically reduce stroke and heart disease.”
Declining treatment and control
Canada has been a leader in hypertension awareness, treatment and control but unfortunately this has declined over 10 years, especially for women. The respondents to our survey acknowledged this trend: seven in 10 identified a lack of high blood pressure screening practices and six in 10 noted inadequate treatment and control as areas of concern. Further, seven in 10 health professionals are worried that the people at highest risk for high blood pressure are often those who face inequities, including barriers to treatment and support.
Heather Evans had her first two heart attacks at age 39 and has spent the last 19 years learning how to manage her heart disease. This includes controlling her high blood pressure. She now measures her blood pressure regularly and takes medication to control it, tries to keep stress under control and avoid salt and caffeine, eats lots of vegetables and fruit, and works out several times a week. “I changed all those things for blood pressure. It’s a big part of heart disease — a huge part,” says Heather.
Increased challenges due to the pandemic
Our survey also revealed that disruptions to people’s lives, including their ability to access health care during the pandemic, has impacted blood pressure, putting them at risk.
- More than eight in 10 health professionals believe lifestyle risk factors (e.g., lack of physical activity, unhealthy diet, not managing stress) that negatively affect blood pressure increased due to the pandemic and more than six in 10 believe equity deserving groups are facing an even greater increase.
- Eight in 10 health professionals are afraid there has been an increase in undiagnosed new cases and that more people with existing high blood pressure have not been adequately managing and controlling their condition due to the pandemic – not surprising due to the documented decrease in doctor visits.
- Over half of health professionals are concerned that more people have developed high blood pressure than would have normally been the case during the pandemic due to increased lifestyle risk factors, lack of regular in-person check-ups, increase in stress and inability to prioritize existing health conditions due to other challenges and concerns.
The way forward
The health professionals surveyed identified several key areas to best support people who have or are at risk of developing high blood pressure:
- Ensure access to regular care and follow-up with health professionals.
- Ensure access to routine blood pressure screening in the community and/or by primary care including pharmacists and community paramedicine.
- Address the social determinants of health (e.g., education, literacy, income, shelter, social supports, access to nutritious foods and physical activity).
- Increase public awareness of the importance of monitoring blood pressure.
- Ensure access to culturally safe and appropriate lifestyle modification programs and supports.
- Ensure universal access to medication, including high blood pressure medications.
Advancing research is also key to better understanding risk factors, especially those that cannot be controlled like age, ethnicity, family history and gender.
Dr. Kara Nerenberg, a Heart & Stroke funded researcher, is examining high blood pressure disorders that can occur during pregnancy to assess women’s risk of developing stroke or heart disease later in life. She believes more work needs to be done around the social determinants of health to address and prevent cardiovascular risk. “We are starting to better understand how ethnicity, financial status, education, social roles, sex and gender intersect to play a role in people’s health journey, including their heart and brain health, and this will help us develop better interventions.”
Heart disease and stroke are the number one killer globally, and two of the three leading causes of death in Canada. Today, more than 3.5 million people across the country of all ages, ethnicities and genders are living with heart disease, stroke and vascular cognitive impairment.
*Heart & Stroke (in cooperation with Environics Research) conducted an online, national, bilingual survey of 982 health professionals (nurses, paramedics/first responders, doctors, rehabilitation specialists, researchers, health system leaders, educators and therapists). The survey was carried out June 20 – August 3, 2022.
