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. Abstract CMAJ 2008;178(11):1441-9From the University of Ottawa Heart Institute (Leenen, McInnis, Turton, Nemeth, Fodor), Ottawa, Ont.; Statistics Canada (Dumais, Stratychuk), Ottawa, Ont.; and the Heart and Stroke Foundation of Ontario (Moy LumKwong), Toronto, Ont.

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BackgroundNon-communicable chronic diseases are the leading causes of mortality globally, and nearly 80% of these deaths occur in low- and middle-income countries (LMICs). In high-income countries (HICs), inequitable distribution of resources affects poorer and otherwise disadvantaged groups including Aboriginal peoples. Cardiovascular mortality in high-income countries has recently begun to fall; however, these improvements are not realized among citizens in LMICs or those subgroups in high-income countries who are disadvantaged in the social determinants of health including Aboriginal people. It is critical to develop multi-faceted, affordable and realistic health interventions in collaboration with groups who experience health inequalities. Based on community-based participatory research (CBPR), we aimed to develop implementation tools to guide complex interventions to ensure that health gains can be realized in low-resource environments.MethodsWe developed the I-RREACH (Intervention and Research Readiness Engagement and Assessment of Community Health Care) tool to guide implementation of interventions in low-resource environments. We employed CBPR and a consensus methodology to (1) develop the theoretical basis of the tool and (2) to identify key implementation factor domains; then, we (3) collected participant evaluation data to validate the tool during implementation.ResultsThe I-RREACH tool was successfully developed using a community-based consensus method and is rooted in participatory principles, equalizing the importance of the knowledge and perspectives of researchers and community stakeholders while encouraging respectful dialogue. The I-RREACH tool consists of three phases: fact finding, stakeholder dialogue and community member/patient dialogue. The evaluation for our first implementation of I-RREACH by participants was overwhelmingly positive, with 95% or more of participants indicating comfort with and support for the process and the dialogue it creates.ConclusionsThe I-RREACH tool was designed to (1) pinpoint key domains required for dialogue between the community and the research team to facilitate implementation of complex health interventions and research projects and (2) to identify existing strengths and areas requiring further development for effective implementation. I-RREACH has been found to be easily adaptable to diverse geographical and cultural settings and can be further adapted to other complex interventions. Further research should include the potential use of the I-RREACH tool in the development of blue prints for scale-up of successful interventions, particularly in low-resource environments.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0257-6) contains supplementary material, which is available to authorized users.

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The Ontario Blood Pressure (ON-BP) survey is a communitybased, cross-sectional study using direct observations performed in 2006 to assess the current prevalence of hypertension and its management in the province of Ontario, Canada. In this survey, prevalence of hypertension increased from 3% in the age group of 20-39 years to 52% in the age group of 60-79 years, fairly similar to the 1992 Canadian Heart Health Survey. However, a marked improvement in the management of hypertension is apparent. At the time of the 1992 Canadian Heart Health Survey only 33% of hypertensives were treated and only 13% had their BP controlled to <140/90 mm Hg by drug therapy. 1 In contrast, the ON-BP reports a treatment rate of 82% and a control rate of 66%. 2 Consistent with these marked improvements, recent studies examining administrative databases in Ontario over the period [1994][1995][1996][1997][1998][1999][2000][2001][2002] showed marked increases in the number of prescriptions for antihypertensive drugs and the use of multiple antihypertensive medications. 3,4 Similar increases in use of antihypertensive drugs were noted in longitudinal national surveys. 5,6 None of these studies actually measured BP and could not relate drug class utilization to extent of BP control.The Canadian Hypertension Educational Program was initiated in 1999 and includes annually updated evidenced-based recommendations for the management of hypertension. At the time of the ON-BP survey the Canadian Hypertension Educational Program guidelines recommended all major drug classes except α-blockers, as first-line agents, and as combination therapy thiazide diuretics with an angiotensin-converting enzyme inhibitor (ACE), AT 1 -receptor blocker (ARB), calcium channel blocker (CCB), or β-blocker (BB). 7 From a public health perspective it is essential to understand to what extent such guidelines are actually being followed and particularly how different drug classes affect treatment and control rates.To date there has not been a community-based survey of the magnitude of ON-BP in Canada examining the utilization patterns of different classes of antihypertensive medications and their impact on BP control. This study had the following objectives: (i) extent of monotherapy vs. 2+ drug therapy in relation to control rates; (ii) utilization of specific drug classes as monotherapy or in combination and their impact on BP control;