title: Community-based programs to improve prevention and management of hypertension: recent Canadian experiences, challenges, and opportunities.
abstract: High blood pressure (BP) is the greatest risk of ill health and an early death worldwide. It is a key factor in the development of atherosclerosis, the main cause of vascular and cerebrovascular diseases, and is causally linked to kidney failure and dementia. Healthy lifestyle choices coupled with effective, population-based prevention strategies, early detection, and optimal treatment and control of high BP can substantially reduce the burden of vascular and cerebrovascular diseases. Considering the projected increases in the risk factors responsible for these conditions, it is imperative that effective population-based prevention strategies are developed, evaluated, and scaled-up. Extensive and rigourous evidence supports the promotion of healthy lifestyle choices to maintain low BP and prevent associated chronic diseases. Community-based programs are the prime tool for implementing a population strategy of prevention. Their aim is to shift the distribution of risk factors to lower levels across entire populations. Despite their great potential and more than a 4-decade history, it remains unclear to what extent such programs can be effectively implemented, scaled-up and sustained. We provide a broad overview of community-based programs implemented to address cardiovascular disease risk factors, focus on the recent Canadian experience in this area, and highlight the main challenges and opportunities currently associated with them. Recent Canadian initiatives have shown encouraging results, some of them focusing on high-risk subgroups. These initiatives demonstrate feasibility and benefits of implementing community-based programs for the prevention and management of cardiovascular disease in Canada.
authors.affiliation: Department of Family Medicine, Université de Montréal, Montréal, Québec, Canada. janusz.kaczorowski@umontreal.ca
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Claudio
authors.initials: C
authors.lastname: Del Grande
authors.forename: Véronique
authors.initials: V
authors.lastname: Nadeau-Grenier
mesh_terms: D002170:Canada; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D003153:Community Health Services; D006293:Health Promotion; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000517:prevention & control* / Q000628:therapy; D015397:Program Evaluation; D012307:Risk Factors