Millions of Canadians at risk because of avoidable delays in diagnosis and treatment of high blood pressure

New guidelines released by the Canadian Heart and Stroke Foundation reveal the health of millions of Canadians is being placed at risk because of avoidable delays in diagnosis and treatment of high blood pressure (hypertension).

The number one risk factor for stroke and a major risk factor for heart disease, high blood pressure is a serious health threat. The new guidelines, developed by the Canadian Hypertension Education Program, are a wake-up call for primary health care providers to slash waiting times for diagnosis and treatment from months to days.

Currently it can take up to five months to diagnose and start treatment of hypertension. “This is an undesirably prolonged period of time for a patient to be exposed to the risk of heart disease or stroke from a risk factor that can be easily treated,” says Dr. Sheldon Tobe, nephrologist and spokesperson for the Foundation.

For all Canadians, the new guidelines recommend that diagnosis and treatment of hypertension can now take place as early as one month after an initial visit to a primary care physician or family doctor. According to the Heart and Stroke Foundation, in cases of people with severely elevated blood pressure, diagnosis and treatment could even take place at the initial visit.

The new guidelines alert Canadian primary care providers to recent studies demonstrating that people with mild, or moderately elevated, blood pressure can now have the diagnosis confirmed by several readings from a home blood pressure monitor as well as by 24 hours of ambulatory blood pressure monitoring, or by the physician at the return visit.

The guidelines also reflect a widespread concern in the cardiovascular community that hypertension among people in the age category of 18 to 35 is being under-diagnosed.

“Getting your blood pressure taken when you are 18, and knowing your numbers, should be a rite of passage, like getting a driver’s license,” says Dr. Ross Feldman, spokesperson for the Heart and Stroke Foundation. “This is especially urgent if there is a family history of high blood pressure, heart attack or stroke.”

“People are developing hypertension at a younger age,” he says. “Even 10 years ago data from the Canadian Heart Health Survey showed that 10% of young men aged 15 to 35 had hypertension. All the indicators suggest this figure is on the increase.”

And preliminary, observational, evidence shows that the earlier development of hypertension in part linked to obesity may be threatening the health of Canadian adolescents and younger teenagers.

A recent study of 3,589 youths aged 9, 13, and 16 years showed a significant increased incidence of elevated systolic blood pressure. Systolic hypertension, the pressure in the arterial system caused by the heart as blood is being pumped out, is increasingly being associated with overweight and obesity. The prevalence of high normal or elevated systolic blood pressure was 12%, 22% and 30% respectively among the boys and 12%, 19% and 17% among girls.

“Although this is an observational study, it is highly significant,” says Dr. Tobe, co-chair of the guidelines taskforce. He notes that in the United States the estimated number of people suffering from hypertension is increasing at twice the rate of population growth.

“The new guidelines are attainable but challenging. New approaches may have to be developed and implemented to make things easier for primary care providers to get this vital job done,” says Dr. Tobe.

The Heart and Stroke Foundation has launched the Blood Pressure Action Plan, which offers realistic strategies and on-going support to help individuals in preventing and controlling high blood pressure. Canadians can get a free, confidential risk assessment and action plan by going to www.heartandstroke.ca/actionplan.