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Individuals with hypertension should lower and maintain their blood pressure levels through lifestyle modification and/or pharmacotherapy. To determine whether perception of blood pressure control is related to behaviours and intentions for improving blood pressure, data from 6142 Canadians age 20+ years with self-reported hypertension were analysed. Relationships between perception of control, current behaviours for blood pressure control and intentions to improve these behaviours were examined. Although individuals who reported uncontrolled blood pressure were equally likely to report engaging in lifestyle behaviours for blood pressure control, they were more likely to indicate an intention to improve their health, compared with those who reported well-controlled/low blood pressure. These individuals were also less likely to report having enough information to control their blood pressure. In addition, they were less likely to report having been advised to take antihypertensive medication, and to be taking and adhering to medications. Individuals who perceive their blood pressure as uncontrolled have intentions to make health-enhancing changes but may lack the information to do so. The study highlights the potential need for programmes/services to help those with uncontrolled blood pressure make lifestyle changes and/or take appropriate medication. [ABSTRACT FROM AUTHOR]

Background: Epigenetic modifications, particularly DNA methylation (DNAm) in cord blood, are an important biological marker of how external exposures during gestation can influence the in-utero environment and subsequent offspring development. Despite the recognized importance of DNAm during gestation, comparative studies to determine the consistency of these epigenetic signals across different ethnic groups are largely absent. To address this gap, we first performed epigenome-wide association studies (EWAS) of gestational age (GA) using newborn cord blood DNAm comparatively in a white European (n = 342) and a South Asian (n = 490) birth cohort living in Canada. Then, we capitalized on established cord blood epigenetic GA clocks to examine the associations between maternal exposures, offspring characteristics and epigenetic GA, as well as GA acceleration, defined as the residual difference between epigenetic and chronological GA at birth., Results: Individual EWASs confirmed 1,211 and 1,543 differentially methylated CpGs previously reported to be associated with GA, in white European and South Asian cohorts, respectively, with a similar distribution of effects. We confirmed that Bohlin's cord blood GA clock was robustly correlated with GA in white Europeans (r = 0.71; p = 6.0 × 10 -54 ) and South Asians (r = 0.66; p = 6.9 × 10 -64 ). In both cohorts, Bohlin's clock was positively associated with newborn weight and length and negatively associated with parity, newborn female sex, and gestational diabetes. Exclusive to South Asians, the GA clock was positively associated with the newborn ponderal index, while pre-pregnancy weight and gestational weight gain were strongly predictive of increased epigenetic GA in white Europeans. Important predictors of GA acceleration included gestational diabetes mellitus, newborn sex, and parity in both cohorts., Conclusions: These results demonstrate the consistent DNAm signatures of GA and the utility of Bohlin's GA clock across the two populations. Although the overall pattern of DNAm is similar, its connections with the mother's environment and the baby's anthropometrics can differ between the two groups. Further research is needed to understand these unique relationships., (© 2024. The Author(s).)

Objective: We conducted a multicenter study to assess treatments and outcomes in a national cohort of infants with congenital ovarian cysts., Summary Background Data: Wide variability exists in the treatment of congenital ovarian cysts. The effects of various treatment strategies on outcomes, specifically ovarian preservation, are not known., Methods: Female infants diagnosed with congenital intra-abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centers were retrospectively evaluated. Sonographic characteristics, median time to cyst resolution, incidence of ovarian preservation, and predictors of surgery were evaluated. Subgroup analyses were performed in patients with complex cysts and cysts ≥40 mm in diameter., Results: The study population included 189 neonates. Median gestational age at diagnosis and median maximal prenatal cyst diameter were 33 weeks and 40 mm, respectively. Cysts resolved spontaneously in 117 patients (62%), 14 (7%) prenatally, and the remainder at a median age of 124 days. Intervention occurred in 61 patients (32%), including prenatal aspiration (2, 3%), ovary sparing resection (14, 23%), or oophorectomy (45, 74%). Surgery occurred at a median age of 7.4weeks. Independent predictors of surgery included postnatal cyst diameter ≥40 mm [odds ratio (OR) 6.19, 95% confidence interval (CI) 1.66-35.9] and sonographic complex cyst character (OR 63.6, 95% CI 10.9-1232). There was no significant difference in the odds of ovarian preservation (OR 3.06, 95% CI 0.86 -13.2) between patients who underwent early surgery (n = 22) and those initially observed for at least 3 months (n = 131)., Conclusions: Most congenital ovarian cysts are asymptomatic and spontaneously resolve. Early surgical intervention does not increase ovarian preservation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: The origin of congenital abdominal cysts in the female fetus often dictates management. While most arise from the ovary and are often managed non-operatively, some are non-ovarian and are frequently removed. We analyzed a national sample of female infants with congenital abdominal cysts to elucidate prenatal and postnatal factors associated with the diagnosis of a non-ovarian cyst., Methods: A retrospective cohort study of female infants who were prenatally diagnosed with abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centres was performed. Clinical characteristics, pre- and postnatal sonographic findings, and cyst trajectories were compared between patients with proven ovarian etiology and those with cysts arising from other organs., Results: Of 185 infants with prenatally diagnosed abdominal cysts, 22 (12%) were non-ovarian, five of which had clear non-ovarian organ of origin on prenatal ultrasound. Comparison of the other 17 cysts with 163 congenital ovarian cysts showed the following factors to be associated with a non-ovarian origin: earlier gestational age at diagnosis (23.5 vs 33.5 weeks, p <0.001), smaller diameter on first prenatal ultrasound (15.8 vs. 39.7 mm, p <0.001), change in sonographic character from simple to complex (87% vs 22%, p <0.001), and postnatal sonographic characteristics of complex cyst (87% vs. 48%, p = 0.004)., Conclusion: Clear organ of origin, diagnosis earlier in gestation, smaller initial prenatal cyst diameter, and sonographic cyst character change differentiate congenital non-ovarian cysts from their ovarian counterparts. These characteristics may be used to guide diagnosis and management., (Copyright © 2022. Published by Elsevier Inc.)

Background: In a recent high-profile case study, we used functional magnetic resonance imaging (fMRI) to monitor improvements in motor function related to neuroplasticity following rehabilitation for severe traumatic brain injury (TBI). The findings demonstrated that motor function improvements can occur years beyond current established limits. The current study extends the functional imaging investigation to characterize neuromodulation effects on neuroplasticity to further push the limits., Methods: Canadian Soldier Captain (retired) Trevor Greene (TG) survived a severe open-TBI when attacked with an axe during a 2006 combat tour in Afghanistan. TG has since continued intensive daily rehabilitation to recover motor function, experiencing an extended plateau using conventional physical therapy. To overcome this plateau, we paired translingual neurostimulation (TLNS) with the continuing rehabilitation program., Results: Combining TLNS with rehabilitation resulted in demonstrable clinical improvements along with corresponding changes in movement evoked electro-encephalography (EEG) activity. High-density magneto-encephalography (MEG) characterized cortical activation changes in corresponding beta frequency range (27 Hz). MEG activation changes corresponded with reduced interhemispheric inhibition in the post-central gyri regions together with increased right superior/middle frontal activation suggesting large scale network level changes., Conclusions: The findings provide valuable insight into the potential importance of non-invasive neuromodulation to enhance neuroplasticity mechanisms for recovery beyond the perceived limits of rehabilitation.

Background: DREAM-GLOBAL (Diagnosing hypertension-Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging-based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness., Objective: The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership., Methods: The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant's own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership., Results: In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension., Conclusions: In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership., Trial Registration: Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226., (©Jordan Andrea Barsky, Rebekah Hunter, Colin McAllister, Karen Yeates, Norm Campbell, Peter Liu, Nancy Perkins, Diane Hua-Stewart, Marion A Maar, Sheldon W Tobe. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 09.12.2019.)

Introduction: Unhealthy foods are widely available in public settings across Canada, contributing to diet-related chronic diseases, such as obesity. This is a concern given that public facilities often provide a significant amount of food for consumption by vulnerable groups, including children and seniors. Healthy food procurement policies, which support procuring, distributing, selling, and/or serving healthier foods, have recently emerged as a promising strategy to counter this public health issue by increasing access to healthier foods. Although numerous Canadian health and scientific organizations have recommended such policies, they have not yet been broadly implemented in Canada., Methods: To inform further policy action on healthy food procurement in a Canadian context, we: (1) conducted an evidence synthesis to assess the impact of healthy food procurement policies on health outcomes and sales, intake, and availability of healthier food, and (2) hosted a consensus conference in September 2014. The consensus conference invited experts with public health/nutrition policy research expertise, as well as health services and food services practitioner experience, to review evidence, share experiences, and develop a consensus statement/recommendations on healthy food procurement in Canada., Results: Findings from the evidence synthesis and consensus recommendations for healthy food procurement in Canada are described. Specifically, we outline recommendations for governments, publicly funded institutions, decision-makers and professionals, citizens, and researchers., Conclusion: Implementation of healthy food procurement policies can increase Canadians' access to healthier foods as part of a broader vision for food policy in Canada., Competing Interests: The authors declare that they have no conflicts of interest.

Reducing dietary salt/sodium is one of the most cost-effective interventions to improve population health. There are five initiatives in the Americas that independently developed targets for reformulating foods to reduce salt/sodium content. Applying selection criteria, recommended by the Pan American Health Organization (PAHO)/World Health Organization (WHO) Technical Advisory Group on Dietary Salt/Sodium Reduction, a consortium of governments, civil society, and food companies (the Salt Smart Consortium) agreed to an inaugural set of regional maximum targets (upper limits) for salt/sodium levels for 11 food categories, to be achieved by December 2016. Ultimately, to substantively reduce dietary salt across whole populations, targets will be needed for the majority of processed and pre-prepared foods. Cardiovascular and hypertension organizations are encouraged to utilize the regional targets in advocacy and in monitoring and evaluation of progress by the food industry., (© 2015 Wiley Periodicals, Inc.)

Accurate blood pressure measurement is critical to properly identify and treat individuals with hypertension. In 2005, the Canadian Hypertension Education Program produced a revised algorithm to be used for the diagnosis of hypertension. Subsequent annual reviews of the literature have identified 2 major deficiencies in the current diagnostic process. First, auscultatory measurements performed in routine clinical settings have serious accuracy limitations that have not been overcome despite great efforts to educate health care professionals over several years. Thus, alternatives to auscultatory measurements should be used. Second, recent data indicate that patients with white coat hypertension must be identified earlier in the process and in a systematic manner rather than on an ad hoc or voluntary basis so they are not unnecessarily treated with antihypertensive medications. The economic and health consequences of white coat hypertension are reviewed. In this article evidence for a revised algorithm to diagnose hypertension is presented. Protocols for home blood pressure measurement and ambulatory blood pressure monitoring are reviewed. The role of automated office blood pressure measurement is updated. The revised algorithm strongly encourages the use of validated electronic digital oscillometric devices and recommends that out-of-office blood pressure measurements, ambulatory blood pressure monitoring (preferred), or home blood pressure measurement, should be performed to confirm the diagnosis of hypertension., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Arsenic is a known carcinogen found globally in groundwater supplies due to natural geological occurrence. Levels exceeding the internationally recognized safe drinking water standard of 10 μg/L have been found in private drinking water supplies in many parts of Canada and the United States. Emerging epidemiological evidence confirms groundwater arsenic to be a significant health concern, even at the low to moderate levels typically found in this region. These findings, coupled with survey data reporting limited public adherence to testing and treatment guidelines, have prompted calls for improved protective measures for private well users. The purpose of this review is to assess current jurisdictional provisions for private well water protection in areas where arsenic is known to naturally occur in groundwater at elevated levels. Significant limitations in risk management approaches are identified, including inconsistent and uncoordinated risk communication approaches, lack of support mechanisms for routine water testing and limited government resources to check that testing and treatment guidelines are followed. Key action areas are discussed that can help to build regulatory, community and individual capacity for improved protection of private well water supplies and enhancement of public health.

The accuracy of the Nutrition Facts table (NFt) has a significant impact on Canadian efforts to reduce dietary sodium and monitor sodium content in foods. This study assessed the accuracy of sodium (and calories, trans fat, saturated fat, sugar) reported on the NFt for selected foods and beverages in Canada. The Canadian Food Inspection Agency (CFIA) sampled over 1000 foods and beverages from supermarkets, bakeries, and restaurants across Canada between January 2006 and December 2010. The samples were analyzed in CFIA laboratories. Results were requested for products with ≥1 of the following nutrients tested: sodium, calories, saturated fat, trans fat, and sugar. Differences between the label and laboratory values were calculated for each product. Overall, 16.7% (n = 169) of products were "unsatisfactory" with laboratory values exceeding ±20% of the NFt value. Sodium had the highest number of unsatisfactory products (n = 49, 18.4%) and trans fat had the lowest number of unsatisfactory products (n = 16, 4.3%). The proportion of unsatisfactory products for saturated fat, calories, and sugar was 15.8%, 14.2%, and 12.9%, respectively. All of the unsatisfactory products had excess nutrient content relative to the NFt. Sodium and calories were consistently underreported (p < 0.05), while NFt values for the other nutrients were not statistically different than laboratory values. Increased monitoring of NFt sodium values is recommended in order to increase consumer confidence in this nutrition tool, to encourage industry to accurately report nutrient content and to continue using the NFt to guide research, education, and policy development.

Maggot debridement is the deliberate use of larvae known to consume only necrotic tissue. A retrospective quality improvement analysis of maggot debridement therapy (MDT) was conducted among patients with devitalized tissue or gangrene attending a Canadian foot and leg ulcer clinic who received MDT between January 2001 and June 2006. MDT was applied every 48 hours until >90% of necrotic tissue was debrided. The authors identified MDT patients in the clinic database and reviewed their medical records for age, gender, presence of diabetes or peripheral arterial disease (PAD), type of wound, number of maggot applications required, wound outcomes, and nursing visit costs (week before, during, and after MDT) and noted patient experiences. Records of 68 patients (average age 71, range 22 to 95, years) were identified and abstracted. Of those, 44% had leg ulcers and 67% had both diabetes and PAD. The majority (39, 58%) of wounds required three debridement sessions. All but one patient achieved debridement of >90% of necrotic tissue in 2 to 10 days. Most wounds (56) healed with follow-up moist wound care. Only one patient withdrew from MDT. No other patient or safety concerns were documented. Total nursing visits for all patients the week before and then after MDT were 307 and 102, respectively. These findings confirm results of previous reports about the effectiveness of MDT for wound debridement. Randomized, controlled clinical studies are needed to confirm the efficacy and cost-effectiveness of MDT compared to other debridement modalities.

Introduction: The Survey on Living with Chronic Diseases in Canada--hypertension component (SLCDC-H) is a 20-minute cross-sectional telephone survey on hypertension diagnosis and management. Sampled from the 2008 Canadian Community Health Survey (CCHS), the SLCDC-H includes Canadians (aged ≥ 20 years) with self-reported hypertension from the ten provinces., Methods: The questionnaire was developed by Delphi technique, externally reviewed and qualitatively tested. Statistics Canada performed sampling strategies, recruitment, data collection and processing. Proportions were weighted to represent the Canadian population, and 95% confidence intervals (CIs) were derived by bootstrap method., Results: Compared with the CCHS population reporting hypertension, the SLCDC-H sample (n = 6142) is slightly younger (SLCDC-H mean age: 61.2 years, 95% CI: 60.8-61.6; CCHS mean age: 62.2 years, 95% CI: 61.8-62.5), has more post-secondary school graduates (SLCDC-H: 52.0%, 95% CI: 49.7%-54.2%; CCHS: 47.5%, 95% CI: 46.1%-48.9%) and has fewer respondents on hypertension medication (SLCDC-H: 82.5%, 95% CI: 80.9%-84.1%; CCHS: 88.6%, 95% CI: 87.7%-89.6%)., Conclusion: Overall, the 2009 SLCDC-H represents its source population and provides novel, comprehensive data on the diagnosis and management of hypertension. The survey has been adapted to other chronic conditions--diabetes, asthma/chronic obstructive pulmonary disease and neurological conditions. The questionnaire is available on the Statistics Canada website; descriptive results have been disseminated by the Public Health Agency of Canada.

Background: It is unclear whether blood pressure control varies across the spectrum of atherosclerotic risk., Methods: We used data from nonpregnant adults who had fasted laboratory samples drawn for the 2007-2009 cycle of the Canadian Health Measures Survey (CHMS) or the 2005-2008 US National Health and Nutrition Examination Survey (NHANES)., Results: The 1692 CHMS subjects and 3541 NHANES participants were demographically similar (aged a mean of 45 years), although NHANES participants exhibited higher obesity rates (33.8% vs. 22.2%, P < 0.001). Over 80% of CHMS and NHANES subjects with hypertension had at least 1 other cardiovascular risk factor. As the number of atherosclerotic risk factors increased, hypertension prevalence increased, but blood pressure control rates improved (from 48% among hypertensives with no other risk factors in CHMS to 77% among those with 3 or more risk factors, and from 35% to 53% in NHANES). However, the converse was not true: The distribution of Framingham risk scores for those subjects with "controlled hypertension" was nearly identical to the distribution among those adults with uncontrolled hypertension in both CHMS and NHANES and substantially higher than scores in normotensive subjects., Conclusions: Although control of blood pressure was better in patients with multiple atherosclerotic risk factors, hypertensives with controlled blood pressures exhibited risk-factor profiles similar to those of participants with uncontrolled blood pressures. This suggests the need, in educational messaging and therapy decision making, for an increased focus on total atherosclerotic risk rather than just blood pressure control., (Copyright © 2013 Canadian Cardiovascular Society. All rights reserved.)

Background: South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population., Methods: South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar's test (proportions) and paired t-tests (continuous measures)., Results: Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff., Conclusions: SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer-led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.

Background: In Canada, as elsewhere, control of hypertension in older persons who are using antihypertensive medication is more likely in men than in women. The reasons for the observed difference are not known., Data and Methods: Data are from cycle 1 of the 2007 to 2009 Canadian Health Measures Survey (CHMS). The CHMS includes a comprehensive questionnaire, automated blood pressure (BP) measures, and a variety of biological and anthropometric assessments. Frequencies, means, cross-tabulations and multivariate models were produced to study differences between the sexes in hypertension control in a weighted sample representative of the household population aged 60 to 79., Results: The prevalence of hypertension was nearly equal among older men (60%) and women (59%), and the percentage of those with hypertension who were receiving pharmaceutical treatment was not statistically different (84% and 89%, respectively). However, despite current treatment, hypertension was uncontrolled in a substantially higher percentage of women (30%) than men (17%). The difference persisted when age, socio-economic status, co-morbidity, category of medication, anthropometry, and other correlates of hypertension were taken into account., Interpretation: The factors considered in the analysis do not account for the advantage to older men in hypertension control. The findings underscore the importance of efforts to control blood pressure in older women.

Increased blood pressure is a leading risk for premature death and disability. The causes of increased blood pressure are intuitive and well known. However, the fundamental basis and means for improving blood pressure control are highly integrated into our complex societal structure both inside and outside our health system and hence require a comprehensive discussion of the pathway forward. A group of Canadian experts was appointed by Hypertension Canada with funding from Public Health Agency of Canada and the Heart and Stroke Foundation of Canada, Canadian Institute for Health Research (HSFC-CIHR) Chair in Hypertension Prevention and Control to draft a discussion Framework for prevention and control of hypertension. The report includes an environmental scan of past and current activities, proposals for key indicators, and targets to be achieved by 2020, and what changes are likely to be required in Canada to achieve the proposed targets. The key targets are to reduce the prevalence of hypertension to 13% of adults and improve control to 78% of those with hypertension. Broad changes in government policy, research, and health services delivery are required for these changes to occur. The Hypertension Framework process is designed to have 3 phases. The first includes the experts' report which is summarized in this report. The second phase is to gather input and priorities for action from individuals and organizations for revision of the Framework. It is hoped the Framework will stimulate discussion and input for its full intended lifespan 2011-2020. The third phase is to work with individuals and organizations on the priorities set in phase 2., (Copyright © 2012 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Background: Hypertension is a leading risk factor for cardiovascular diseases. Our objectives were to examine the prevalence and incidence of diagnosed hypertension in Canada and compare mortality among people with and without diagnosed hypertension., Methods: We obtained data from linked health administrative databases from each province and territory for adults aged 20 years and older. We used a validated case definition to identify people with hypertension diagnosed between 1998/99 and 2007/08. We excluded pregnant women from the analysis., Results: This retrospective population-based study included more than 26 million people. In 2007/08, about 6 million adults (23.0%) were living with diagnosed hypertension and about 418,000 had a new diagnosis. The age-standardized prevalence increased significantly from 12.5% in 1998/99 to 19.6% in 2007/08, and the incidence decreased from 2.7 to 2.4 per 100. Among people aged 60 years and older, the prevalence was higher among women than among men, as was the incidence among people aged 75 years and older. The prevalence and incidence were highest in the Atlantic region. For all age groups, all-cause mortality was higher among adults with diagnosed hypertension than among those without diagnosed hypertension., Interpretation: The overall prevalence of diagnosed hypertension in Canada from 1998 to 2008 was high and increasing, whereas the incidence declined during the same period. These findings highlight the need to continue monitoring the effectiveness of efforts for managing hypertension and to enhance public health programs aimed at preventing hypertension.

Background: Analyses of medication databases indicate marked increases in prescribing of antihypertensive drugs in Canada over the past decade. This study was done to examine the trends in the prevalence of hypertension and in control rates in Canada between 1992 and 2009., Methods: Three population-based surveys, the 1986-1992 Canadian Heart Health Surveys, the 2006 Ontario Survey on the Prevalence and Control of Hypertension and the 2007-2009 Canadian Health Measures Survey, collected self-reported health information from, and measured blood pressure among, community-dwelling adults., Results: The population prevalence of hypertension was stable between 1992 and 2009 at 19.7%-21.6%. Hypertension control improved from 13.2% (95% confidence interval [CI] 10.7%-15.7%) in 1992 to 64.6% (95% CI 60.0%-69.2%) in 2009, reflecting improvements in awareness (from 56.9% [95% CI 53.1%-60.5%] in 1992 to 82.5% [95% CI 78.5%-86.0%] in 2009) and treatment (from 34.6% [95% CI 29.2%-40.0%] in 1992 to 79.0% [95% CI 71.3%-86.7%] in 2009) among people with hypertension. The size of improvements in awareness, treatment and control were similar among people who had or did not have cardiovascular comorbidities Although systolic blood pressures among patients with untreated hypertension were similar between 1992 and 2009 (ranging from 146 [95% CI 145-147] mm Hg to 148 [95% CI 144-151] mm Hg), people who did not have hypertension and patients with hypertension that was being treated showed substantially lower systolic pressures in 2009 than in 1992 (113 [95% CI 112-114] v. 117 [95% CI 117-117] mm Hg and 128 [95% CI 126-130] v. 145 [95% CI 143-147] mm Hg)., Interpretation: The prevalence of hypertension has remained stable among community-dwelling adults in Canada over the past two decades, but the rates for treatment and control of hypertension have improved markedly during this time.

Background: The management of cardiovascular risk factors such as hypertension and dyslipidemia is poorly described in many communities, and the benefits associated with tighter control remain unknown. We used data from the 2007 MyHealthCheckup survey to document the treatment gaps and estimated the potential benefits of better adherence to recommended guidelines., Methods: Cardiovascular risk factors, lifestyle habits, and prescribed medications were evaluated among Canadian adults recruited primarily in pharmacies. The Cardiovascular Life Expectancy Model was used to estimate the potential benefits of optimally treating hypertension or dyslipidemia (defined as not smoking, regular physical activity, an acceptable body weight, and maximal medication as needed)., Results: Among 2674 screened individuals, 1266 (47%) were receiving pharmacotherapy for either dyslipidemia or hypertension, including 772 (61%) and 656 (63%), respectively, who remained above treatment targets. Among those above lipid or blood pressure targets, 27% and 22%, respectively, were optimally treated. The average increased life expectancy or life-years gained associated with making appropriate lifestyle changes included 2.2 to 4.7 years from smoking cessation, 0.7 to 1.1 years from regular exercise, and 0.4 to 0.7 years from weight reduction. The life-years gained following better risk factor treatment included maximal pharmacotherapy for elevated blood pressure (0.6-0.8), low-density lipoprotein cholesterol (0.5-0.6), and the ratio of total cholesterol to high-density lipoprotein cholesterol (0.3-0.4). Years of life free of cardiovascular disease would be similarly increased., Conclusions: Better treatment of cardiovascular risk factors could result in a substantial reduction in morbidity and mortality among Canadians. Given current physician prescribing and patient habits, lifestyle modification should be considered a priority before additional medications are prescribed., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: To examine trends in the treatment of diabetes using the biannual interviews of the longitudinal National Population Health Survey (NPHS), 1994-2004 as they relate to changes in Clinical Practice Guidelines (CPGs)., Methods: A sample of 17 276 Canadians 18 years and older was selected for repeated interviews at two-year intervals from 1994 to 2004 for the NPHS. The population used for this study includes all respondents aged 40 to 79 for any of the cycles., Results: CPGs issued by the Canadian Diabetes Association in 1998 and 2004 recommend a stepwise introduction of lifestyle changes, to be followed by single then multiple oral antidiabetic agents (OA), and finally insulin until adequate control is achieved. While the use of OA increased, only a small proportion indicated diet or physical exercise as part of their treatment; those with no drug treatment reported less diet modification and physical exercise. Antihypertensives and statin use in Canadians with diabetes increased to double that of Canadians overall, but remained underutilized., Conclusion: This study provides an update on the treatment of diabetes in Canada between 1994 and 2004. While some changes in diabetes treatment were compatible with CPGs, there is room for improvement, especially in lifestyle modifications.

Background: Canadians with hypertension are recommended to use home blood pressure monitoring (HBPM) on a regular basis., Objectives: To characterize the use of HBPM among Canadian adults with hypertension., Methods: Respondents to the 2009 Survey on Living with Chronic Diseases in Canada who reported diagnosis of hypertension by a health professional (n=6142) were asked about blood pressure monitoring practices, sociodemographic characteristics, management of hypertension and blood pressure control., Results: Among Canadian adults with hypertension, 45.9% (95% CI 43.5% to 48.3%) monitor their own blood pressure at home, 29.7% (95% CI 41.1% to 46.3%) receive health professional instruction and 35.9% (95% CI 33.5% to 38.4%) share the results with their health professional. However, fewer than one in six Canadian adults diagnosed with hypertension monitor their own blood pressure at home regularly, with health professional instruction, and communicate results to a health professional. Regular HBPM was more likely among older adults (45 years of age and older); individuals who believed they had a plan for how to control their blood pressure; and those who had been shown how to perform HBPM by a health professional - with the latter factor most strongly associated with regular HBPM (prevalence rate ratio 2.8; 95% CI 2.4 to 3.4)., Conclusions: Although many Canadians with hypertension measure their blood pressure between health care professional visits, a minority do so according to current recommendations. More effective knowledge translation strategies are required to support self-management of hypertension through home measurement of blood pressure.

Background: Directly measured blood pressure (BP) data have not been collected in Canada since the Canadian Heart Health Surveys, conducted between 1985 and 1992. Because hypertension is often asymptomatic, a large proportion of those with the condition are unaware of it., Data and Methods: These analyses use BP and heart rate (HR) data from cycle 1 of the 2007-2009 Canadian Health Measures Survey (CHMS) for respondents aged 6 to 79 years. Methods and quality assurance and control procedures are explained. Logistical and feasibility issues that arose during data collection are discussed. The reasons for repeating a series of measures are given. Between- and within- series variations and inter-tester variability are assessed., Results: The BP and HR of almost all respondents who attended the examination centre were measured. Only one series of measurements was taken for 88% of respondents. The series was repeated for around 5% with variability in their BP or HR measurements. About 3% had HR or BP values above the screening cut-offs for the fitness tests. Almost 35% of respondents with HR or BP values above the screening cut-offs after their first series had values below the cut-points after the second series; a further 3% had values below after the third series. Within a series of six measurements, BP decreased until about the fourth measure, after which it remained stable. Mean BP and HR values indicated no inter-tester variability., Interpretation: The protocol for measuring BP and HR by oscillometry in the CHMS appears to have produced reliable estimates. No benefit to repeating the series of six measurements a third time for screening purposes is evident. Four measurements may be sufficient to provide reliable BP and HR data. Oscillometry appears to eliminate inter-tester variability.

The present article represents the 2009 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult.

Background: In 1999, the Canadian Hypertension Education Program (CHEP) was launched to develop and implement evidence-based hypertension guidelines., Objectives: To determine temporal trends in antihypertensive drug prescribing and physician visits for hypertension in Canada, and correlate these trends with CHEP recommendations., Methods: Longitudinal drug data (Intercontinental Medical Statistics [IMS] CompuScript database; IMS Health Canada) were used to examine prescriptions over an 11-year period (1996 to 2006) for five major cardiovascular drug classes. The IMS Canadian Disease and Therapeutic Index database was used to determine trends in physician office visits for hypertension., Results: Prescriptions for antihypertensive agents increased significantly over the 11-year period (4054% for angiotensin receptor blockers, 127% for thiazide diuretics, 108% for angiotensin-converting enzyme inhibitors, 87% for beta-blockers and 55% for calcium channel blockers). Time series analyses demonstrated increases in the growth rate for all drug classes, with the greatest annual change in prescriptions occurring during the 1999 to 2002 time period (except in angiotensin receptor blockers). An increase in prescriptions for fixed-dose combination products occurred, which was temporally related to the change in CHEP recommendations encouraging their use in 2001. The proportion of physician office visits for hypertension increased significantly from 4.9% in 1995 to 6.8% in 2005 (P<0.001)., Conclusions: The largest increase in antihypertensive drug prescribing occurred in the period immediately following implementation of CHEP (1999 to 2002). Although prescribing rates are still increasing, the rate of change has decreased, suggesting that the treatment market for hypertension may be becoming saturated. The impact of these changes on blood pressure control and clinical outcomes remains to be determined.

Lifestyle modification should be an important part of therapy when hypertension is first diagnosed, with or without starting antihypertensive medication. The objective of the present study was to determine the extent to which recently diagnosed hypertensive Canadians modify their lifestyles and to examine how lifestyle modification relates to antihypertensive medication use. The longitudinal National Population Health Survey in Canada was conducted between 1994 and 2002, including five interview cycles at two-year intervals. During this time, 1281 persons reported hypertension in one cycle but not in the previous cycle, and were considered to be new hypertensive patients. Information collected included body mass index, smoking, alcohol consumption, physical inactivity and medication use. The main lifestyle modification associated with newly diagnosed hypertensive patients was smoking cessation, with a 18.6% relative risk reduction (RRR). A smaller change was seen in decreasing physical inactivity (RRR 6.2%). Persons not taking antihypertensive medication were not more likely to make lifestyle improvements. Paradoxically, new hypertensive patients showed increased numbers in the obese category (RRR -9.6%). Weight gain was especially marked among antihypertensive medication users and largest in female beta-blocker users (RRR -36.6%). If confirmed, this needs to be considered when prescribing to overweight people. In general, a greater effort is required to manage hypertension by lifestyle risk modification with or without antihypertensive medication.

Since the 1990s, reports of Q fever in Nova Scotia, Canada, have declined. Passive surveillance for Q fever in Nova Scotia and its neighboring provinces in eastern Canada indicates that the clinical manifestation of Q fever in the Maritime provinces is pneumonia and that incidence of the disease may fluctuate.

High blood pressure is one of the leading risk factors for death. Nevertheless, there is a lack of awareness of hypertension as a risk factor, as well as significant misconceptions about hypertension in the Canadian population. Furthermore, according to the Canadian Heart Health Surveys (1985 to 1992), 42% of hypertensive adult Canadians are unaware of their hypertensive status. A collaboration between Blood Pressure Canada, the Heart and Stroke Foundation of Canada, the Canadian Hypertension Society and the Canadian Hypertension Education Program has been formed to improve public and patient awareness and knowledge of hypertension. The effort will involve the translation of Canadian Hypertension Education Program recommendations for the prevention and management of hypertension to a public level with a broad and evolving dissemination strategy; the training of health professionals to speak to the public and patients on hypertension, coupled with opportunities to speak in forums organized in their local communities; and, media releases and information on hypertension in association with World Hypertension Day and the release of the annually updated public recommendations. Based on higher rates of awareness of hypertension in countries with sustained public education programs on hypertension, it is anticipated that this evolving program will result in improvement in the rates of awareness, treatment and control of hypertension and, ultimately, in lower cardiovascular disease rates in Canada. Public health programs that could reduce the prevalence of hypertension will be integrated into key public recommendations. The program outcomes will be monitored using Statistics Canada national surveys and by specific surveys examining hypertension knowledge in the Canadian population.

The present report is an update on the contribution of the Canadian Hypertension Education Program's (CHEP) Outcomes Research Task Force to the surveillance and monitoring efforts surrounding hypertension and hypertension-related conditions in Canada. Components of the program include advocating national physical measures surveys of blood pressure; analysis of national cross-sectional and longitudinal population-based health surveys that assess hypertension diagnosis and treatment; assessment of national and regional pharmacotherapy patterns using existing commercial databases; assessment of national and regional trends in hypertensive complications (stroke, myocardial infarction and congestive heart failure); development of a national system based on provincial administrative data to assess the incidence, prevalence and management of diagnosed hypertension; and assessing some aspects of CHEP implementation. Preliminary data support a large increase in the diagnosis and treatment of hypertension corresponding to the initiation of CHEP.

Purpose: The frequency of clinically diagnosed venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE) in medical-surgical critically ill patients is unclear. The objectives of this study were to estimate the prevalence and incidence of radiologically confirmed DVT and PE in medical-surgical intensive care unit (ICU) patients and to determine the impact of prophylaxis on the frequency of these events., Materials and Methods: In a retrospective observational cohort study in 12 adult ICUs, we identified prevalent cases (diagnosed in the 24 hours preceding ICU admission up to 48 hours post-ICU admission) and incident cases (diagnosed 48 hours or more after ICU admission and up to 8 weeks after ICU discharge) of upper or lower limb DVT or PE. Deep venous thrombosis was diagnosed by compression ultrasound or venogram. Each DVT was classified as clinically suspected or not clinically suspected in that the latter was diagnosed by scheduled screening ultrasonography. Pulmonary embolism was diagnosed by ventilation-perfusion lung scan, computed tomography pulmonary angiography, echocardiography, electrocardiography, or autopsy., Results: Among 12,338 patients, 252 (2.0%) patients had radiologically confirmed DVT or PE and another 47 (0.4%) had possible DVT or PE. Prevalent DVTs were diagnosed in 0.4% (95% confidence interval [CI], 0.3%-0.5%) of patients and prevalent PEs were diagnosed in 0.4% (95% CI, 0.3%-0.6%). Incident DVTs were diagnosed in 1.0% (95% CI, 0.8%-1.2%) of patients, and incident PEs were diagnosed in 0.5% (95% CI, 0.4%-0.6%). Of patients with incident VTE, 65.8% of cases occurred despite receipt of thromboprophylaxis for at least 80% of their days in ICU. The median (interquartile range) ICU length of stay was similar for patients with DVT (7 [3-17]) and PE (5 [2-8]). For all patients with VTE, ICU mortality was 16.7% (95% CI, 12.0%-21.3%) and hospital mortality was 28.5% (95% CI, 22.8%-34.1%)., Conclusions: Venous thromboembolism appears to be an apparently infrequent, but likely underdiagnosed problem, occurring among patients receiving prophylaxis. Findings suggest the need for increased suspicion among clinicians, renewed efforts at thromboprophylaxis, and evaluation of superior prevention strategies.

Background: The Canadian Heart Health Surveys were the last Canadian population-based physical measures surveys (conducted between 1988 and 1992) that determined that hypertension in Canada was poorly managed. Hypertension was undetected in almost one-half of all hypertensive Canadians surveyed, and only 13% of those with hypertension were treated and controlled to recommended blood pressure targets. The reasons for poor control are likely multifactorial; however, a lack of public awareness and understanding of hypertension may contribute to the epidemic of uncontrolled hypertension in Canada., Methods: A national telephone survey was conducted comprising 1001 randomly selected men and women older than 40 years of age to determine the level of public awareness, understanding and misconception of hypertension in Canada. The survey was balanced for region, age and sex., Results: Thirty-four per cent of respondents had been diagnosed with high blood pressure or hypertension by a health care professional, but only 58% of respondents had ever discussed their blood pressure with a physician, and only 44% were able to identify their own blood pressure or differentiate blood pressure levels considered to be above or below recommended targets. Overall, respondents had a poor understanding of the consequences of high blood pressure or hypertension. The majority were unaware of the association between hypertension and heart disease (80%), heart attack (66%), kidney disease (98%), damage to blood vessels (95%) and premature death (74%). Respondents also had limited knowledge of lifestyle issues affecting hypertension, despite 44% indicating that they were overweight and 18% identifying themselves as smokers. Almost two-thirds (63%) thought hypertension had clearly identifiable signs or symptoms, although they believed that hypertension was not a serious medical condition. Most respondents (59%) falsely believed that they would not develop hypertension and 38% thought that they would be able to control hypertension without the aid of a physician if they did have hypertension., Conclusions: While hypertension-related complications are preventable, lack of public awareness and misconceptions about hypertension and hypertensive complications are common and may, in part, be associated with ongoing inadequate Canadian awareness, treatment and control rates for hypertension. Increasing public awareness of hypertension using public education and health provider strategies should be a high national health priority.

Objective: To provide updated, evidence-based recommendations regarding the role of lifestyle modification in the treatment and prevention of hypertension., Outcomes: Lifestyle modification interventions including exercise, weight reduction, alcohol consumption, dietary modification, intake of dietary cations and stress management are reviewed. Antioxidants and fish oil supplements are also reviewed, although specific recommendations cannot be made at present., Evidence: MEDLINE searches were conducted from January 2002 to September 2003 to update the 2001 recommendations for the management of hypertension. Supplemental searches in the Cochrane Collaboration databases were also performed. Reference lists were scanned, experts were contacted, and the personal files of the subgroup members and authors were used to identify additional published studies. All relevant articles were reviewed and appraised independently using prespecified levels of evidence by content and methodology experts., Recommendations: Key recommendations include the following: lifestyle modification should be extended to nonhypertensive individuals who are at risk for developing high blood pressure; 30 min to 45 min of aerobic exercise should be performed on most days (four to five days) of the week; an ideal body weight (body mass index 18.5 kg/m2 to 24.9 kg/m2) should be maintained and weight loss strategies should use a multidisciplinary approach; alcohol consumption should be limited to two drinks or fewer per day, and weekly intake should not exceed 14 standard drinks for men and nine standard drinks for women; a reduced fat, low cholesterol diet that emphasizes fruits, vegetables and low fat dairy products, and maintains an adequate intake of potassium, magnesium and calcium, should be followed; salt intake should be restricted to 65 mmol/day to 100 mmol/day in hypertensive individuals and less than 100 mmol/day in normotensive individuals at high risk for developing hypertension; and stress management should be considered as an intervention in selected individuals., Validation: All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Individuals with irreconcilable competing interests (declared by all members, compiled and circulated before the meeting) relative to any specific recommendation were excluded from voting on that recommendation. Only those recommendations achieving at least 70% consensus are reported here. These guidelines will continue to be updated annually.

Background: Hypertension is a major risk factor for death that affects many Canadians, but only 16% of hypertensive Canadians are treated and have their hypertension controlled. While the control rate is very low, the 2001 Canadian Hypertension Recommendations do not recommend that low risk hypertensive patients be started on pharmacotherapy, and pharmacotherapy is not recommended for people for whom there is no demonstrable benefit from randomized, controlled trails., Objectives: To determine the proportion of hypertensive patients who are appropriately managed according to the 2001 Canadian Hypertension Recommendations., Methods: Data from the Canadian Heart Health Survey, which surveyed a cross-sectional population (n=23,129) between 1986 and 1992, were used to determine the proportion of nondiabetic hypertensive patients who are managed according to the 2001 Canadian Hypertension Recommendations. Hypertensive patients not recommended to receive pharmacotherapy include those without risk factors and target organ damage, with a diastolic blood pressure of 90 to 99 mmHg and a systolic blood pressure of less than 160 mmHg. People with diastolic blood pressures of less than 90 mmHg who have systolic blood pressures of 140 to 159 mmHg are also not recommended to have pharmacotherapy. Patients prescribed antihypertensive therapy who had blood pressure controlled to less than 140/90 mmHg were assessed as having their hypertension managed appropriately, as were those who were not treated and were not recommended to be prescribed treatment., Results: There were 58,813 (1.7%) hypertensive patients who did not have target organ damage or additional risk factors, and had a systolic blood pressure of less than 160 mmHg and a diastolic blood pressure between 90 and 99 mmHg. Twenty four per cent of hypertensive persons (831,787) had a systolic blood pressure of 140 to 160 mmHg and a diastolic blood pressure of less than 90 mmHg. About 25% (23.6%+1.7%) of hypertensive Canadians in the Canadian Heart Health Survey are not recommended to be prescribed antihypertensive therapy according to the 2001 Canadian Hypertension Recommendations. Sixteen per cent of hypertensive patients were treated and had their blood pressures controlled (blood pressure less than 140/90 mmHg). Therefore, about 41% (ie, 16%+25%) of hypertensive patients are appropriately managed according to the 2001 Canadian Hypertension Recommendations., Conclusions: The results of the Canadian Heart Health survey indicate that there are a striking number of Canadians with untreated high blood pressure (59%) who probably do not have their hypertension managed according to the 2001 Canadian Hypertension Recommendations. Greater efforts are required to identify people with hypertension, and to ensure that they are managed according to the best available evidence.

Clinicians are exposed to numerous hypertension guidelines. However, their enthusiasm for these guidelines, and the impact of the guidelines, appears modest at best. Barriers to the successful implementation of a guideline can be identified at the level of the clinician, the patient or the practice setting; however, the shortcomings of the guidelines themselves have received little attention. In this paper, we review the hypertension guidelines that are most commonly encountered by Canadian clinicians: the "1999 Canadian Recommendations for the Management of Hypertension," "The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" in the United States and the "1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension." The key points of these guidelines are compared and the shortcomings that may impede their ability to influence practice are discussed. The main implications for future guideline developers are outlined.