Report from the Canadian Chronic Disease Surveillance System: Hypertension in Canada, 2010

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Adults with Diagnosed Hypertension (Prevalence)¹

• In 2006/07, nearly 6 million Canadians aged 20years and older, ² or more than 1 in 5, had diagnosed hypertension (approximately 5.9 million adults; 3.2 million women and 2.7 million men, crude prevalence).
• The prevalence rate of hypertension among Canadians aged 20 years and older was 22.7% in 2006/07 (24.0% for women and 21.3% for men, crude prevalence) (Table 1). This prevalence is consistent but somewhat higher than the self-reported value reported from the 2007/08 Canadian Community Health Survey (19.4%). Self-reported hypertension values may be lower because approximately 5% of people who report drug treatment for hypertension do not report having hypertension in Canadian self-report surveys, possibly because they think that they do not have hypertension or that their hypertension has been cured when their blood pressure is controlled using medication or lifestyle modification.¹³ These surveys also sample only the household population, whereas, CCDSS includes all Canadians residing in the provinces and territories with the previously noted exceptions.
• After accounting for changes in the age distribution in the population over time, the age-standardized prevalence rate of diagnosed hypertension increased from 12.9% in 1998/99 to 19.6% in 2006/07 (Figure 1). One likely contributor to this rise in hypertension prevalence is the decline in mortality among people with hypertension and other cardiovascular diseases, as noted in other studies.^{17 18} Large reductions in mortality rates from stroke, heart failure, and acute myocardial infarction were found to be significantly associated with increases in antihypertensive prescriptions, especially after the initiation of the Canadian Hypertension Education Program (CHEP) in 1999, a program developed to improve the management of hypertension.¹⁸ Before 1999, total antihypertensive prescriptions among Ontarians newly treated for hypertension were increasing by 2% per year, but after 1999 they were increasing at a rate of 10% per year.¹⁹
• Age-specific prevalence rates were similar between men and women for those under age 50. However, rates for women were increasingly higher than men from age 55 onwards. (Table 2 and Figure 2) This is consistent with other surveys that have found higher rates of hypertension in men in younger ages and higher rates in women in older ages.^{20 21}
• In Canada, the age-standardized prevalence rates of hypertension were highest in the Atlantic provinces and lowest in the west and north (Yukon, Northwest Territories, and British Columbia) (Figure 3). This is similar to the east-west gradient reported in other studies of obesity and diabetes trends across the country.^{22 23} Crude prevalence rates are presented in Table 3.

Figure 1 - Text Equivalent

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Figure 2 - Text Equivalent

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Figure 3 - Text Equivalent

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Table 1. Prevalence Rates, Incidence Rates, and Number of Cases of Diagnosed Hypertension, by Year and Sex, Canada,* 1998/99 to 2006/07

Fiscal Year		Prevalence Rate (%)			Incidence Rate (per 1,000)
		Women	Men	Total	Women	Men	Total
Source: Public Health Agency of Canada, using CCDSS data files contributed by provinces and territories as of September, 2009. * Data for Nunavut were unavailable. Data for Québec were also unavailable. However, the number of cases for Québec was estimated by applying the Canadian age-specific rates of diagnosed hypertension weighted to the Québec population.
1998/99	Crude Rates	15.3	12.3	13.8	25.6	22.1	23.8
	Cases	1,781,304	1,365,617	3,146,921	258,613	219,782	478,396
	Population	11,645,517	11,088,924	22,734,441	10,122,826	9,943,090	20,065,916
1999/00	Crude Rates	16.8	13.7	15.3	25.2	22.4	23.8
	Cases	1,984,800	1,541,232	3,526,032	253,673	221,841	475,514
	Population	11,794,275	11,238,530	23,032,805	10,063,148	9,919,139	19,982,286
2000/01	Crude Rates	18.3	15.1	16.7	25.6	23.2	24.4
	Cases	2,185,146	1,720,683	3,905,830	257,052	230,727	487,779
	Population	11,968,953	11,419,133	23,388,086	10,040,859	9,929,176	19,970,035
2001/02	Crude Rates	19.5	16.3	18.0	25.1	23.1	24.1
	Cases	2,375,007	1,894,157	4,269,164	252,047	229,238	481,284
	Population	12,157,311	11,609,975	23,767,286	10,034,351	9,945,055	19,979,406
2002/03	Crude Rates	20.7	17.5	19.1	24.8	22.9	23.9
	Cases	2,555,268	2,061,378	4,616,647	249,154	228,254	477,408
	Population	12,341,930	11,792,606	24,134,536	10,035,816	9,959,482	19,995,297
2003/04	Crude Rates	21.7	18.5	20.2	24.1	22.5	23.3
	Cases	2,723,285	2,220,505	4,943,790	241,987	224,521	466,509
	Population	12,537,082	11,996,925	24,534,007	10,055,784	10,000,941	20,056,726
2004/05	Crude Rates	22.6	19.5	21.1	23.2	22.4	22.8
	Cases	2,877,956	2,375,826	5,253,782	233,435	225,121	458,557
	Population	12,729,881	12,189,561	24,919,442	10,085,360	10,038,856	20,124,217
2005/06	Crude Rates	23.4	20.4	22.0	22.7	22.8	22.7
	Cases	3,025,193	2,532,606	5,557,799	229,887	229,974	459,860
	Population	12,930,898	12,387,986	25,318,884	10,135,592	10,085,353	20,220,945
2006/07	Crude Rates	24.0	21.3	22.7	21.6	22.7	22.1
	Cases	3,161,283	2,687,181	5,848,464	220,128	229,900	450,029
	Population	13,152,159	12,601,762	25,753,921	10,211,005	10,144,481	20,355,486

Table 1 - Text Equivalent

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Table 2. Prevalence Rates, Incidence Rates, and Number of Cases of Diagnosed Hypertension, by Sex and Age Group, Canada,* 2006/07

Age Group		Prevalence Rate (%)			Incidence Rate (per 1,000)
		Women	Men	Total	Women	Men	Total
Source: Public Health Agency of Canada, using CCDSS data files contributed by provinces and territories as of September, 2009. * Data for Nunavut were unavailable. Data for Québec were also unavailable. However, the number of cases for Québec was estimated by applying the Canadian age-specific rates of diagnosed hypertension weighted to the Québec population.
20 to 24	Crude Rates	0.5	0.6	0.6	1.8	2.2	2.0
	Cases	6,049	6,811	12,859	1,968	2,552	4,520
	Population	1,118,706	1,154,031	2,272,737	1,114,625	1,149,772	2,264,398
25 to 29	Crude Rates	1.7	1.8	1.8	3.0	3.6	3.3
	Cases	19,849	20,150	39,999	3,339	3,998	7,337
	Population	1,136,351	1,131,680	2,268,031	1,119,841	1,115,528	2,235,369
30 to 34	Crude Rates	3.3	3.7	3.5	4.8	6.3	5.6
	Cases	38,209	42,285	80,494	5,326	7,021	12,348
	Population	1,149,220	1,144,965	2,294,185	1,116,337	1,109,702	2,226,039
35 to 39	Crude Rates	5.4	6.2	5.8	7.8	10.2	9.0
	Cases	66,168	77,056	143,223	9,132	11,900	21,032
	Population	1,231,521	1,237,898	2,469,419	1,174,485	1,172,742	2,347,227
40 to 44	Crude Rates	8.9	9.9	9.4	13.2	15.2	14.2
	Cases	125,456	141,165	266,621	17,036	19,742	36,778
	Population	1,404,160	1,419,310	2,823,470	1,295,740	1,297,887	2,593,627
45 to 49	Crude Rates	14.6	15.4	15.0	20.3	22.2	21.3
	Cases	204,370	215,809	420,179	24,828	26,955	51,783
	Population	1,400,517	1,404,849	2,805,366	1,220,975	1,215,995	2,436,970
50 to 54	Crude Rates	23.1	23.2	23.1	29.3	31.8	30.5
	Cases	287,059	285,892	572,951	28,898	31,152	60,050
	Population	1,244,669	1,234,522	2,479,191	986,508	979,782	1,966,290
55 to 59	Crude Rates	33.6	33.0	33.3	38.8	42.9	40.9
	Cases	365,949	354,998	720,947	29,223	32,340	61,563
	Population	1,089,324	1,075,714	2,165,038	752,599	753,055	1,505,654
60 to 64	Crude Rates	44.0	42.8	43.4	52.5	57.6	55.0
	Cases	368,882	350,900	719,782	26,012	28,619	54,631
	Population	838,580	819,559	1,658,139	495,710	497,278	992,988
65 to 69	Crude Rates	54.6	51.9	53.3	68.8	70.6	69.7
	Cases	359,115	320,562	679,678	22,079	22,568	44,648
	Population	657,957	617,542	1,275,499	320,921	319,548	640,469
70 to 74	Crude Rates	63.8	59.9	61.9	82.6	78.9	80.8
	Cases	363,189	304,282	667,471	18,580	17,485	36,065
	Population	569,572	508,323	1,077,895	224,963	221,526	446,489
75 to 79	Crude Rates	70.4	65.4	68.2	92.2	85.6	89.0
	Cases	355,346	263,909	619,255	15,162	13,072	28,235
	Population	504,721	403,535	908,256	164,537	152,698	317,235
80 to 84	Crude Rates	75.1	68.8	72.6	93.7	86.9	90.7
	Cases	304,933	181,092	486,025	10,462	7,803	18,265
	Population	406,117	263,105	669,222	111,646	89,817	201,463
85+	Crude Rates	74.0	65.5	71.3	72.1	67.9	70.5
	Cases	296,709	122,271	418,979	8,082	4,693	12,775
	Population	400,744	186,729	587,473	112,117	69,151	181,268
Total	Crude Rates	24.0	21.3	22.7	21.6	22.7	22.1
	Cases	3,161,283	2,687,182	5,848,465	220,128	229,900	450,028
	Population	13,152,159	12,601,762	25,753,921	10,211,005	10,144,481	20,355,486

Table 2 - Text Equivalent

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Table 3. Prevalence Rates, Incidence Rates, and Number of Cases of Diagnosed Hypertension, by Sex, Province and Territory, Canada,* 2006/07

Province/Territory		Prevalence Rate (%)			Incidence Rate (per 1,000)
		Women	Men	Total	Women	Men	Total
Source: Public Health Agency of Canada, using CCDSS data files contributed by provinces and territories as of September, 2009. * Data for Nunavut and Québec were unavailable. YT: Yukon, NT: Northwest Territories, BC: British Columbia, AB: Alberta, SK: Saskatchewan, MB: Manitoba, ON: Ontario, NB: New Brunswick, NS: Nova Scotia, PE: Prince Edward Island, NL: Newfoundland and Labrador.
YT	Crude Rates	17.3	17.0	17.1	28.4	30.0	29.2
	Cases	2,135	2,162	4,297	299	327	626
	Population	12,367	12,739	25,106	10,531	10,904	21,435
NT	Crude Rates	13.0	12.9	12.9	14.6	16.1	15.4
	Cases	2,012	2,160	4,172	200	239	439
	Population	15,474	16,782	32,256	13,662	14,861	28,523
BC	Crude Rates	22.5	20.3	21.4	22.9	24.3	23.6
	Cases	385,332	333,112	718,444	31,143	32,598	63,741
	Population	1,712,349	1,639,990	3,352,339	1,358,160	1,339,476	2,697,636
AB	Crude Rates	20.6	18.7	19.6	18.6	20.8	19.7
	Cases	263,410	235,205	498,615	19,291	21,793	41,084
	Population	1,281,442	1,261,103	2,542,545	1,037,323	1,047,691	2,085,014
SK	Crude Rates	26.8	22.9	24.9	22.0	23.5	22.8
	Cases	102,865	84,983	187,848	6,315	6,888	13,203
	Population	383,915	370,939	754,854	287,365	292,844	580,209
MB	Crude Rates	25.7	22.0	23.9	21.5	23.4	22.4
	Cases	116,654	95,111	211,765	7,410	8,096	15,506
	Population	454,193	432,843	887,036	344,949	345,828	690,777
ON	Crude Rates	23.7	21.4	22.6	20.6	21.5	21.0
	Cases	1,254,002	1,087,005	2,341,007	84,870	87,653	172,523
	Population	5,295,333	5,070,185	10,365,518	4,126,201	4,070,833	8,197,034
NB	Crude Rates	27.8	23.7	25.8	24.3	25.6	24.9
	Cases	84,281	67,938	152,219	5,447	5,737	11,184
	Population	303,167	286,259	589,426	224,333	224,058	448,391
NS	Crude Rates	29.6	25.6	27.7	24.9	26.3	25.6
	Cases	117,346	93,801	211,147	7,105	7,375	14,480
	Population	396,074	367,022	763,096	285,833	280,596	566,429
PE	Crude Rates	27.3	23.0	25.2	22.8	24.9	23.9
	Cases	15,381	12,216	27,597	958	1,044	2,002
	Population	56,363	53,094	109,457	41,940	41,922	83,862
NL	Crude Rates	29.4	27.3	28.4	31.1	33.0	32.0
	Cases	60,477	52,529	113,006	4,649	4,780	9,429
	Population	205,433	192,676	398,109	149,605	144,927	294,532

Table 3 - Text Equivalent

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¹ Data for Nunavut and Québec were unavailable.
² Data for Nunavut were unavailable. Data for Québec were also unavailable. However, the number of cases for Québec was estimated by applying the Canadian age-specific rates for people with hypertension to the Québec population.
¹³ Tu K, Campbell NRC, Chen ZL, Cauch-Dudek KJ, McAlister FA. Accuracy of administrative databases in identifying patients with hypertension. Open Med. 2007 Apr 14;1 (1): E3-5.
¹⁷ Tu K, Chen Z, Lipscombe LL, for the Canadian Hypertension Education Program Outcomes Research Task Force. Mortality among patients with hypertension from 1995-2005: a population-based study. CMAJ. 2008 May 20;178 (11): 1436-40.
¹⁸ Campbell NRC, Brant R, Johansen H, Walker RL, Wielgosz A, Onysko J, et al for the Canadian Hypertension Education Program Outcomes Research Task Force. Increases in antihypertensive prescriptions and reductions in cardiovascular events in Canada. Hypertension. 2009 Feb;53 (2): 128-34.
¹⁹ Campbell NRC, Tu K, Brant R, Duong-Hua M, McAlister FA, for the Canadian Hypertension Education Program Outcomes Research Task Force. The impact of the Canadian Hypertension Education Program on antihypertensive prescribing trends. Hypertension. 2006 Jan; 47 (1): 22-8.
²⁰ Whelton PK, He J, Muntner P. Prevalence, awareness, treatment and control of hypertension in North America, North Africa, and Asia. J Hum Hypertens. 2004 Aug 18 (8): 545-51.
²¹ Langille DB, Joffres MR, MacPherson KM, Andreou P, Kirkland SA, MacLean DR. Prevalence of risk factors for cardiovascular disease in Canadians 55 to 74 years of age: results from the Canadian Heart Health Surveys, 1986-1992. CMAJ. 1999;161 (8 Suppl): S3-9.
²² Public Health Agency of Canada. Obesity in Canada: Snapshot. [Internet]. Ottawa: Public Health Agency of Canada; 2009 [cited 2009 Dec 7]. 6 p. Available from: www.phac-aspc.gc.ca/publicat/2009/oc/index-eng.php
²³ Public Health Agency of Canada. Report from the National Diabetes Surveillance System: Diabetes in Canada, 2009. [Internet] Ottawa: Public Health Agency of Canada; 2009. [cited 2010 Feb 15]. 28p. Available from: www.phac-aspc.gc.ca/publicat/2009/ndssdic-snsddac-09/index-eng.php

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