title: Increases in antihypertensive prescriptions and reductions in cardiovascular events in Canada.
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 >or=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.
authors.affiliation: Department of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, Alberta, Canada. hyperten@ucalgary.ca
authors.forename: Norm R C
authors.initials: NR
authors.lastname: Campbell
authors.forename: Rollin
authors.initials: R
authors.lastname: Brant
authors.forename: Helen
authors.initials: H
authors.lastname: Johansen
authors.forename: Robin L
authors.initials: RL
authors.lastname: Walker
authors.forename: Andreas
authors.initials: A
authors.lastname: Wielgosz
authors.forename: Jay
authors.initials: J
authors.lastname: Onysko
authors.forename: Ru-Nie
authors.initials: RN
authors.lastname: Gao
authors.forename: Christie
authors.initials: C
authors.lastname: Sambell
authors.forename: Stephen
authors.initials: S
authors.lastname: Phillips
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006306:Health Surveys; D006333:Heart Failure / Q000401:mortality / Q000517:prevention & control; D006760:Hospitalization / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D009313:National Health Programs / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055553:Prescription Drugs / Q000627:therapeutic use*; D011634:Public Health / Q000639:trends; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control; D014944:World Health Organization
chemical_list: D000959:Antihypertensive Agents; D055553:Prescription Drugs