Published Online
on December 29, 2008

A more recent version of this article appeared on February 1, 2009

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Submitted on July 18, 2008
Revised on August 8, 2008

Increases in Antihypertensive Prescriptions and Reductions in Cardiovascular Events in Canada

Norm R.C. Campbell^*; Rollin Brant; Helen Johansen; Robin L. Walker; Andreas Wielgosz; Jay Onysko; Ru-Nie Gao; Christie Sambell; Stephen Phillips; Finlay A. McAlister;; for the Canadian Hypertension Education Program Outcomes Research Task Force

From the Departments of Medicine (N.R.C.C., R.L.W.), Community Health Sciences (N.R.C.C.), and Pharmacology and Therapeutics (N.R.C.C.), and Libin Cardiovascular Institute (N.R.C.C.), University of Calgary, Calgary, Alberta, Canada; Department of Statistics (R.B.), University of British Columbia, Vancouver, British Columbia, Canada; Health Information and Research Division (H.J., C.S.), Statistics Canada, Ottawa, Ontario, Canada; Centre for Chronic Disease Prevention and Control (R.L.W., J.O., R-N.G.), Public Health Agency of Canada, Ottawa, Ontario, Canada; Ottawa Hospital (A.W.), University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine (S.P.), Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine (F.A.M.), University of Alberta, Edmonton, Alberta, Canada.

^* To whom correspondence should be addressed. E-mail: hyperten{at}ucalgary.ca.

Abstract—The Canadian Hypertension Education Program, an extensive professional education program to improve the management of hypertension, was started in 1999. There were very large increases in diagnosis and treatment of hypertension in the first 4 years after initiation of the program. The purpose of this study was to examine the association between the changes in antihypertensive therapy with changes in hospitalization and death from major hypertension-related cardiovascular diseases in Canada between 1992 and 2003. Using various national databases, Canadian standardized yearly mortality and hospitalization rates per 1000 for stroke, heart failure, and acute myocardial infarction were calculated for individuals aged 20 years and regressed against antihypertensive prescription rates. Changes in rates were examined in a time series analysis. There were significant reductions (P<0.0001) in the rate of death from stroke, heart failure, and myocardial infarction starting in 1999. There was also a reduction in hospitalization rate from stroke (P<0.0001) and heart failure (P<0.0001) but not myocardial infarction in 1999. The changes in death (P<0.001 for all 3 diseases) and hospitalization (P<0.0001 for stroke and heart failure; P=0.018 for acute myocardial infarction) were associated with the increases in antihypertensive prescriptions. This study demonstrates that the reduction in cardiovascular death and hospitalization rates is associated with an increase in antihypertensive prescriptions and that it coincides with the introduction of the Canadian Hypertension Education Program. The Canadian Hypertension Education Program educational model for improving health care could be adopted by other countries with well-developed professional and scientific societies.

Key words: hypertension • antihypertensive treatment • stroke • myocardial infarction • heart failure • epidemiology • clinical practice guideline

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