title: Outcomes among 3.5 million newly diagnosed hypertensive Canadians.
abstract: BACKGROUND
  This population-based study assessed rates of all-cause mortality, myocardial infarction, heart failure, and stroke for up to 12 years of follow-up in 3.5 million Canadian adults newly diagnosed with hypertension.
  
  
  METHODS
  Hypertension cohort, outcomes, and covariates were defined using validated case definitions applied to inpatient and outpatient administrative health databases. Factors associated with each outcome were identified using Cox proportional hazards models.
  
  
  RESULTS
  Of 3,531,089 adults newly diagnosed with hypertension and without a previous history of cardiovascular disease, 29.4% were younger than 50 years of age; 48.2% were male, and 17.2% resided in a rural area. Over a median follow-up length of 6.1 years, the crude all-cause mortality rate was 22.4 per 1000 person-years. The incidence of hospitalized myocardial infarction (8.4 per 1000 person-years) and hospitalized heart failure (8.5 per 1000 person-years) was higher than stroke (6.9 per 1000 person-years). The incidence rate for any cardiovascular hospitalization was 19.3 per 1000 person-years. Older age, male sex, lower income, rural residence, and a higher number of Charlson comorbidities were each independently associated with a higher risk of mortality and incident cardiovascular disease hospitalizations.
  
  
  CONCLUSIONS
  In a nationally-representative incident cohort of hypertensive adults we have demonstrated higher mortality rates and poorer outcomes for the elderly, males, and those living in rural or low income locations. Innovative approaches to the provision of care for these high-risk individuals will lead to improved patient outcomes.
authors: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. hquan@ucalgary.ca
authors: Hude
authors: H
authors: Quan
authors: Guanmin
authors: G
authors: Chen
authors: Karen
authors: K
authors: Tu
authors: Gillian
authors: G
authors: Bartlett
authors: Debra A
authors: DA
authors: Butt
authors: Norm R C
authors: NR
authors: Campbell
authors: Brenda R
authors: BR
authors: Hemmelgarn
authors: Michael D
authors: MD
authors: Hill
authors: Helen
authors: H
authors: Johansen
authors: Nadia
authors: N
authors: Khan
authors: Lisa M
authors: LM
authors: Lix
authors: Mark
authors: M
authors: Smith
authors: Larry
authors: L
authors: Svenson
authors: Robin L
authors: RL
authors: Walker
authors: Andy
authors: A
authors: Wielgosz
authors: Finlay A
authors: FA
authors: McAlister
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D055815:Young Adult