Transcript hypertension overview

Best Practices in the Prevention and
Control of Hypertension Globally and
Putting Evidence into Practice
Mark Niebylski, PhD, MBA, MS
October 22, 2014
World Hypertension League
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Disclosure Statement of Financial Interest
I, Mark Niebylski, DO NOT have a financial
interest/arrangement or affiliation with any healthcare
related companies that could be perceived as a real or
apparent conflict of interest in the context of the
subject of this presentation. I am contracted with the
World Hypertension League dedicated to the
prevention and control of hypertension globally.
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Objectives
• Review of a State of the Art Program – the Canadian
effort
• Using lessons learned implement Knowledge
translation to other populations
• Development of a Hypertension Resource Center
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The Canadian Effort to Prevent and Control Hypertension.
Can Other Countries adopt Canadian Strategies?
Current Opinion in Cardiology 2010:25:366-372.
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Changes in Management of Hypertension in Canada
CHHS 1985-1992
CHMS 2007/8
Treated and controlled
Aware Not Treated
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Treated not Controlled
Not Aware
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4
43
21
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* As presented22
at the Canadian Cardiovascular Congress Oct 2007
Increase in total antihypertensive prescriptions
2600
2500
2400
2300
2200
2100
2000
1900
1800
1700
1600
1500
1400
1300
1200
1100
1000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
year
Increasing intensity of therapy over time
Increase in use of 2 or
more drugs
(21% to 40%)
Decreased
discontinuation of
antihypertensive drugs
50%
50%
40%
40%
40%
30%
20%
30%
20%
21%
10%
10%
0%
0%
1994
35%
2002
p<0.0001
21%
1994
2002
Hypertension 2005;45:1113-1118
NPHS (1994-2002): More Lifestyle Changes After
Hypertension Diagnosis Are Needed
Age Standardized Rates of Lifestyle Change After a Hypertension
Diagnosis
80
+1.4%
-2.4%
Percent
60
40
-1.6%
-0.1%
20
0
Smoking
BMI 25+
A
Inactive
Alcohol 9+
B
Can J Cardiol 2008;24;3:199-204.
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Cost in Canada
• 7.5 million hypertensive adult Canadians in a adult population of
26.4 million adults
• In 2010, 80 million antihypertensive prescriptions costing over
$3.0 billion with linear increases annually.
• Almost half of all people in Canada over age 60 are taking drugs to
control blood pressure
• Hypertension is the most common reason for an adult to visit a
physician with over 21 million visits for hypertension in 2009
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Canadian Hypertension Education
Program (CHEP) Concept Development
• Poor hypertension control in Canada relative to United States
led in the late 1990s to extensive discussions on how to
improve blood pressure control
• CHEP in 2000 a more rigorous annually updated
recommendations program with Team-based approach
• An evolving and extensive knowledge translation and
dissemination program
• In 2003, a formal outcomes program added
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Hypertension Canada
(WHL operations mirrored after this effort)
Steering or Expert Committees
Evidence-Based Recommendations
Terms of Reference
Implementation
Task Force
Outcomes
Research
Task Force
Public policy
Oversight for National Hypertension
Strategy
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Evidence Based Recommendations
Task Force Subgroups
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Office Measurement of BP
Follow-up of BP
Risk Assessment
Self-measurement of BP
Ambulatory BP Monitoring
Routine Laboratory Testing
Echocardiography
Lifestyle Modification
Pharmacotherapy of Hypertension in Patients Without Other Compelling Indications
Pharmacotherapy for Hypertension in patients with Cardiovascular Disease
Diabetes and Hypertension
Renal and Renovascular Hypertension
Endocrine forms of Hypertension
Adherence Strategies for Patients
Vascular Protection
Hypertension and Stroke
The Annual Process
• Subgroups systematically review the literature using a Cochrane
librarian and supplemented search with personal files Application of an
evidence-based grading scheme
• Use of a Central Review Committee comprised of methodologists to
improve consistency of grading
• 1 day conference to discuss recommendations and evidence
• Periodic teleconferences and presentations when appropriate
• Selection of theme and next steps
• National presentation of draft recommendations
• Voting and ratification of recommendations
• Development and revision of educational material
• Dissemination and Evaluation
Implementation
• The need to engage the public and patients
– to understand the need for prevention, screening, diagnosis,
treatment and control
• The need to engage ALL health care professionals
– To ensure the public and patients receive consistent
information
• The active participation of those directly involved in the
management of hypertension (key individuals and
organizations)
• The active participation of those who oversee the health
care system.
Implementation
• Develop resources that actively engage people
• Remove all identified barriers to accessing resources
• Agreement of other national organizations to
harmonize hypertension recommendations
• Networks of health care professional organizations
and training schools
Key messages
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Know the current blood pressure of all your patients
Encourage the use of approved devices and proper technique to measure
blood pressure at home
Assess and manage CV risk in hypertensives including: high dietary
sodium intake, smoking, dyslipidemia, dysglycemia, abdominal obesity,
unhealthy eating, and physical inactivity.
Sustained lifestyle modification is the cornerstone for the prevention and
control of hypertension and the management of CV disease.
Treat blood pressure to <140/90 mmHg In people with diabetes target to
<130/80 mmHg and more than one drug is usually required including
diuretics to achieve BP targets
The need to evaluate
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To determine how well the program is working
To assess where care gaps remain
To ensure the sustained enthusiasm of those contributing
Standardized evaluation and nomenclature
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Results from Best Practices?
Improvements in awareness
Improvements in treatment
Changes mirror Committee recommendations
Increasing intensity of therapy over time
Improvements in BP control
Improvements in outcomes
Expand model to CVD risk or other chronic non communicable
diseases /risks especially in low to middle income nations
More countries aiming for 70% control
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Dedicated to the Assessment, Prevention, and Control of Hypertension Globally
Prevention and Control of
Hypertension: Developing a Global
Agenda
Campbell, Norm RC, Niebylski, Mark, and World Hypertension Executive “ Prevention and control
of hypertension: Developing a Global Agenda”, Current Opinion in Cardiology, Vol 29, No. 4, 2014
http://www.whleague.org/images/WHL_PCH_Developing_a_global_agenda.pdf
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The WHL is a charitable organization comprised of national and regional hypertension societies
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Dedicated to the Assessment, Prevention, and Control of Hypertension Globally
“An epidemic of chronic nocommunicable diseases in threatening national
healthcare systems’ sustainability and the economy of many countries.
Increased blood pressure is the leading risk for premature death and disability
and accounts for approximately 10% of healthcare spending. Four of nine
recent United Nations’ targets for reducing chronic noncommunicable
diseases relate directly or indirectly to hypertension.”1
Campbell, N, Niebylski, M. “Prevention and Control of Hypertension: Developing a Global Agenda.” Current Opinion Vol 29, No. 4, 2014.
http://www.whleague.org/images/WHL_PCH_Developing_a_global_agenda.pdf
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The WHL is a charitable organization comprised of national and regional hypertension societies
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Dedicated to the Assessment, Prevention, and Control of Hypertension Globally
Recommended public health actions for national hypertension organizations
Increase awareness that hypertension is largely preventable but is a constant threat to wellbeing as the world’s leading risk for death
and disability
Increase awareness that hypertension is largely caused by unhealthy eating (especially high dietary salt), physical inactivity, obesity,
Advocate for effective healthy public policies that if implemented could largely prevent hypertension from occurring
 Most important is for countries and communites to have an effective and comprehensive strategy to reduce dietary salt and to
ensure a healthy food supply
 Increase awareness that hypertension can be inexpensively, easily detected and clinically managed
 Communites need programs for all adults to have regular blood pressure assessments linked to effective hypertension
management
 Affordable antihypertensive drugs accessible to all
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The WHL is a charitable organization comprised of national and regional hypertension societies
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Dedicated to the Assessment, Prevention, and Control of Hypertension Globally
Key aspects of effective health care systems that national hypertension organizations can advocate for
1. Ensure regular blood pressure checks are provided to the adult population utilizing community resources
2. Ensure those indentifed with high readings are informed and linked to people who can make a diagnosis and
provide effective treatment
3. Make affordable antihypertensive drugs accessible to all
4. Monitor and evaluate the system to ensure people with hypertension are being identifed, treated and controlled to
national standards
5. Ensure the health care system facilitates and supports the development and implementation of health public policy
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The WHL is a charitable organization comprised of national and regional hypertension societies
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Dedicated to the Assessment, Prevention, and Control of Hypertension Globally
Thank YOU, our Members, Partners, and Volunteers!!!
Resource Center evolving on our website: www.whleague.org
 Journal of Clinical Hypertension as home journal of WHL (open access)
 BP Train the Trainer Module
 BP Screening video – evidence based (translation into other languages)
 Power point slide sets adoptible to target Populations (exa: fact sheets; how to use GBDS specific to your
nation)
 Recent publications, quarterly newsletter, success stories
 2015 WHL awards and recognition for notable achievements accepting nominations until Feb 2015
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The WHL is a charitable organization comprised of national and regional hypertension societies
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