Refocusing on hypertension control in Canada

Leung, Alexander A. C.; Bell, Alan; Tsuyuki, Ross T.; Campbell, Norman R.C.

doi:10.1503/cmaj.210140

Cited by 11 publications

(13 citation statements)

References 10 publications

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“…36 Patient attitudes toward medical care are shifting; this may account for the decline in blood pressure control, as has been observed in Canada among people who do not have diabetes. [37][38][39] Use of statins and of ACE inhibitors or ARBs may have been similarly affected. The COVID-19 pandemic, which was underway shortly before the index date of our 2020 cross-section, may have worsened target achievement, though it does not explain the improvement in HbA 1c targets from 2015 to 2020.…”

Section: Discussionmentioning

confidence: 99%

Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Nandiwada

Manca

Yeung

et al. 2023

CMAJ

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Treatment targets for glycated hemoglobin (HbA 1c ), blood pressure and low-density lipoprotein cholesterol (LDL-C), and prescription of statins and of angiotensin-converting-enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for patients with diabetes mellitus are recommended to reduce the risks of cardiovascular and microvascular complications. [1][2][3][4][5] The achievement of targets in Canada in more than 1 province was last evalu ated in 2013. At the time, HbA 1c , LDL-C and blood pressure targets were met for 50%, 57% and 36% of adults, respectively, with only 13% of adults meeting all 3 targets. 6,7 Women with diabetes have a disproportionately high relative increase in cardiovascular risk, [8][9][10][11][12] which may be partially explained by lower use of medications that reduce the risk of cardio vascular disease. [13][14][15][16] Few studies have tracked sex-and age-related differences in the achievement of diabetes targets. Updated information about sex-and age-related trends in target achievement in Canada will inform efforts to reduce cardiovascular risk among all eligible patients with diabetes. We aimed to describe the prevalence of diabetes measurements, and the frequency of target achievement and use of statins and ACE inhibitors or ARBs among adults with type 2 diabetes seen in primary care across 5 Canadian provinces in 2015 and 2020, and to evaluate the effect of age and sex on target achievement, adjusting for cardiovascular comorbidities.

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Section: Discussionmentioning

confidence: 99%

Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Nandiwada

Manca

Yeung

et al. 2023

CMAJ

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“…70 Although the specific reasons for this reduction are unknown, explanations include the loss of federal government support for hypertension surveillance, a fall in hypertension guideline implementation efforts, and the loss of industry sponsorship for education initiatives as generic medications have become more widely used. 71 Importantly, in the effort to understand why ASCVD outcomes worsen in any population, there is a paucity of data on the eff ectiveness of specific interventions to implement clinical practice guidelines and their effect on improving ASCVD patient outcomes.…”

Section: Gaps In Knowledgementioning

confidence: 99%

Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2022 update

Jain

Stone²,

Agarwal³

et al. 2022

CMAJ

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The goal of the Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) process is to give all Canadian health care providers easy access to a comprehensive and practical set of harmonized guideline recommendations. Clinicians claim that there are too many guidelines with too many individual recommendations to be practical and accessible for primary care; that their patients' multimorbidity requires them to access many guidelines at the same time; and that at least in the past, some of the recommendations were not harmonized and seemed contradictory. 1 Established in 2008 to address these issues, C-CHANGE produces a guideline that is a subset of recommendations chosen from guidelines developed by Canada's cardiovascular-focused guideline groups. It is designed to help clinicians formulate comprehensive treatment plans for use by all members of the health care team to address multimorbidity, as recommended by the Canadian Heart Health Strategy and Action Plan. 2 This fourth update was necessitated by recent changes to the guidelines included in previous updates and the addition of guidelines from 3 guideline groups new to the C-CHANGE process (Canadian Cardio vascular Society/Canadian Heart Rhythm Society guideline for the management of atrial fibrillation, Health Canada's Dietary Guideline and the Canadian Consensus Conference on Diagnosis and Treatment of Dementia) (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.220138/tab-related -content), thus increasing the comprehensiveness from the 2011, 1 2014 3 and 2018 4 versions to a total of 11 guideline groups.The Global Burden of Diseases survey identified that the risk factors accounting for the largest percentage of disabilityadjusted life-years in Canada included tobacco use, dietary factors, high body mass index (BMI), high fasting blood glucose,

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“…Plus récemment, toutefois, les taux de maîtrise de l'hypertension chez les femmes ont diminué 70 . Les raisons exactes de cette réduction sont inconnues, mais on pourrait les expliquer par l'abandon par le gouvernement fédéral des programmes de surveillance de l'hypertension, un relâchement dans les efforts de mise en oeuvre des lignes directrices sur l'hypertension et la perte des commandites de l'industrie pour les initiatives éducatives en raison de l'utilisation accrue des médicaments génériques 71 . Fait à noter, on cherche à comprendre pourquoi les complications de la MCVAS se sont aggravées, toutes populations confondues, mais on dispose de trop peu de données sur l'efficacité des diverses interventions et sur leur capacité d'améliorer les conséquences de la MCVAS pour mettre en oeuvre des lignes directrices de pratique clinique.…”

Section: Lacunes Dans Les Connaissancesunclassified

Ligne directrice C-CHANGE pour l’harmonisation des lignes directrices nationales de prévention et de prise en charge des maladies cardiovasculaires en contexte de soins primaires au Canada: mise à jour 2022

Jain

Stone²,

Agarwal³

et al. 2023

CMAJ

View full text Add to dashboard Cite

show abstract

Refocusing on hypertension control in Canada

Cited by 11 publications

References 10 publications

Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Achievement of treatment targets among patients with type 2 diabetes in 2015 and 2020 in Canadian primary care

Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2022 update

Ligne directrice C-CHANGE pour l’harmonisation des lignes directrices nationales de prévention et de prise en charge des maladies cardiovasculaires en contexte de soins primaires au Canada: mise à jour 2022

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