Introduction
Hypertension, or high blood pressure, is a chronic disease affecting millions worldwide. Often referred to as the “silent killer” because it may show no symptoms, hypertension can lead to serious health complications such as stroke, kidney failure, and heart attack (FDA, 2021). Early detection of hypertension is crucial. Some lifestyle decisions, including a poor diet and a sedentary lifestyle, have led to the emergence of the disease. In Canada, hypertension is a significant public health concern owing to its increased prevalence in the older population. According to the recent Statistics Canada report, the rate of hypertension among seniors in Canada was estimated to be 51.2% in 2016- 2019 (Statistics Canada, 2021). Hypertension is a significant risk variable for numerous other illnesses, including stroke, heart attack, and kidney disease. It can also lead to an increased risk of falls and fractures (Barr et al., 2003). In Canada, the rate of hypertension among seniors is rising at an alarming rate, a concerning health issue.
Hypertension as Chronic Disease
The main risk factor for early cardiovascular deaths and morbidity has been identified as high blood pressure worldwide. Programs targeted at efficiently controlling hypertension are thus anticipated to greatly influence patient outcomes because coronary heart disease is the main contributor to early morbidity and mortality worldwide. In addition, it has been expected that
maximizing high blood pressure management will reduce 49% and 62% of cardiac events and cardiovascular disease mortality. The principles of managing chronic diseases have recently attained significant acceptability and are being implemented in various countries, including Canada (Campbell et al., 2006). A healthcare delivery system known as Chronic Disease Management (CDM) helps people with chronic illnesses maintain as much health and functionality as possible. Commonly, CDM is compassionate and empathetic, with healthcare professionals, the health service, and the general public working together to support the patient's long-term wellness and well-being. The idea that patients ought to be willing members in their treatment, knowledgeable about their condition, and involved in choice processes is inherent in CDM. At least one persistent health issue is reported by 30% of Canadians, and the percentage rises to over 75% for people who are 65 years old. According to projections, one in 4 Canadian will be seniors by 2030 (Employment and Social Development Canada, 2021), thus, raising the burden of chronic illness on our healthcare systems.
Whom Does Hypertension Affect?
Hypertension has affected a large percentage of the population in Canada. It is estimated that about 4.1 million or 65.7% of Canadian seniors (65+) were living with diagnosed hypertension in 2016–2017. Between 2000–2001 and 2016–2017, the age-standardized prevalence of diagnosed hypertension in seniors increased from 48.6% to 65.7% (Government of Canada, 2021).
Figure 1: Age-standardized prevalence of diagnosed hypertension, 65+ years, Canada, 2000–2001 to 2016–2017 (Government of Canada, 2021).
Hypertension is a common problem in Canada and is more prevalent among senior populations. The prevalence of hypertension is highest among individuals aged 60 and over. This is likely due to age-related vascular structure and function changes like 'Arterial Stiffening' caused by the stiffening and thickening of walls of arteries with age.
Figure 2: The prevalence of diagnosed hypertension increased with age and, at 83.4%, was the highest among those aged 85+ in 2016–2017 (Government of Canada, 2021).
There are still many obstacles to overcome despite a good prevalence of late-life high blood pressure in older persons. According to a 2010 study by the Institute of Medicine (IOM), high blood pressure is a condition that is usually ignored by the wider populace and devalued by the medical community. Although high blood pressure is the second largest mortality cause, it is still largely preventable, easy to detect, and affordable to treat. It is appropriately referred to as a disregarded condition (Gazit et al., 2021). For senior patients, it is essential to conduct a thorough examination and follow all recommended treatment plans. Enhancing our knowledge of how high blood pressure treatment affects elderly outcomes is crucial since diseases such as hypertension significantly impact the dangers of hospitalization, comorbidity, and death across Canada.
Among seniors, the Age-standardized mortality rates (per 100,000) due to hypertension increased by 11.8% from 45.7 in 2000 to 51.1 in 2017. The number of deaths due to hypertension rose from 1,560 in 2000 to 3,115 in 2017 (Government of Canada, 2021).
Figure 3: Age-standardized mortality rates and several deaths due to hypertension, 65+ years, Canada, 2000–2017 (Government of Canada, 2021).
Determinants of Hypertension
It is crucial to note that co-existing diseases such as diabetes and kidney diseases, age, family history, unhealthy diet, high sodium intake, excessive use of alcohol and tobacco, inactivity, and obesity, are the main risk factors causing the most significant attributable proportion of hypertension-related deaths in the common populace (Wilkins et al., 2010). The very high levels of knowledge and utilization of antihypertensive medication among hypertensive individuals in this cohort exemplify that all these health issues were not connected to hypertensive regulation rates. It has been found that those with a sedentary lifestyle are more likely to develop hypertension than those who are physically active. Furthermore, diets high in salt and fat and low in fruits and vegetables have been associated with higher blood pressure. Additionally, obesity and being overweight are also significant risk factors for developing hypertension. Socioeconomic factors also play a primary path in the development of hypertension in Canada. Studies have found that those with lower income, education levels, and employment status are more likely to have a higher blood pressure than those with higher income, education levels, and employment status (Mourtzinis, 2021).
Multilevel Model of Hypertension
A multilevel hypertension model can partly explain this alarming trend in Canada. Patient-reported findings across all hypertension facilities can be used to standardize the data gathered across Canada. This would be accomplished through a multifaceted strategy to enhance national consistency and uptake and create an adaptive, scalable, and efficient way for patient-reported outcomes (PROs). The research recommends starting with a pan-Canadian assessment of the 44 health sciences programs in Canada to determine how each practice employs hospital outcomes, as this technique is still in its early stages. To ensure seamless adaptation of standardized pan-Canadian approaches into local structures and procedures, they advise including frontline care professionals when implementing system-level adjustments.
Figure 4: Multi-level approach to building a pan-Canadian system (Caissie et al., 2018).
Best Practices for Management and Prevention of Hypertension
It is important to prevent hypertension and maintain healthy blood pressure levels. Some
of the current and best practices for preventing this disease are through healthy Eating Habits.
Reducing their intake of sodium, saturated fat, and alcohol can also help lower blood pressure
(WHO, 2021). Maintaining a Healthy Weight is also good since being overweight or obese
increases your risk for hypertension. Patients should Maintain a healthy weight through regular
exercise, and a healthy diet can reduce the risk of hypertension (Barr et al., 2003). Regular
physical activity and monitoring Blood Pressure can help reduce the risk of hypertension.
Patients should aim for at least 30 minutes of moderate-intensity exercises, such as walking,
jogging, or biking, five days per week. They should also check their blood pressure at least once
a year or more often if they are at risk for hypertension.
Future Directions
Artificial Intelligent (AI) based technology should eventually allow patients to take control of their care. Apple, a wearable algorithm that can identify irregular heartbeat, has already received FDA approval. Other AI-based mobile applications are being created to diagnose illnesses of the retina, including diabetes mellitus, time-of-life macular degeneration, and skin conditions and rashes (Wilkins et al., 2010). Other artificial intelligence (AI) powered smartphone apps track medication compliance and ask users to record themselves taking their prescription medicine. AI-based digital assistants could, in the future, support patients in managing chronic diseases like hypertension. Applying AI to multisensory data, including nutrition, exercise, sleep, intestinal bacteria activity, drugs, and more, could produce recommendations and encourage a healthy lifestyle (Gazit et al., 2021). Given the widespread use of smart speakers (like Amazon Alexa), cellphones, and wristbands, it is simple to see how continuous coaching may be offered to people at their places of residence, employment, and leisure, providing a comprehensive, preventive strategy.
Fig 4: future recommendation and transformation on high blood pressure as a chronic disease (Dzau & Balatbat, 2019).
Conclusion
Hypertension is among the most significant global health problems and the main factor in deaths globally. The prevalence of hypertension must be addressed through comprehensive global action if health indicators are to be improved globally. The cardiovascular field needs change. Its development will rely on the successful integration of biotechnological and biomedical research, digital information, and new distribution systems for health, together with an appropriate portion health plan. According to the points raised, treatment provision will probably alter more than the therapy, regionally and nationally, during the next ten years. Health Canada recommends that all adults over 40 receive regular blood pressure checks and that those with high blood pressure engage in lifestyle modifications, such as quitting smoking and becoming more physically active. Evidence suggests that dietary changes, such as reducing sodium intake and increasing fruit and vegetable consumption, can help lower blood pressure levels.
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