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Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study
  1. Michel Joffres1,
  2. Emanuela Falaschetti2,
  3. Cathleen Gillespie3,
  4. Cynthia Robitaille4,
  5. Fleetwood Loustalot3,
  6. Neil Poulter5,
  7. Finlay A McAlister6,
  8. Helen Johansen7,
  9. Oliver Baclic8,
  10. Norm Campbell9
  1. 1Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  2. 2Imperial Clinical Trial Unit, School of Public Health, Imperial College London, London, UK
  3. 3Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  4. 4Centre for Chronic Disease Prevention, Public Health Agency of Canada, Ottawa, Ontario, Canada
  5. 5International Centre for Circulatory Health, Imperial College London, London, UK
  6. 6Division of General Internal Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
  7. 7Department of Community Medicine and Epidemiology, University of Ottawa, Epidemiology & Community Medicine, Ottawa, Ontario, Canada
  8. 8Public Health Agency of Canada, Ottawa, Ontario, Canada
  9. 9Departments of Medicine, Community Health Sciences and of Physiology and Pharmacology, Libin Cardiovascular Institute, University of Calgary, Canada Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
  1. Correspondance to Dr Michel Joffres; mjoffres{at}


Objective Comparison of recent national survey data on prevalence, awareness, treatment and control of hypertension in England, the USA and Canada, and correlation of these parameters with each country stroke and ischaemic heart disease (IHD) mortality.

Design Non-institutionalised population surveys.

Setting and participants England (2006 n=6873), the USA (2007–2010 n=10 003) and Canada (2007–2009 n=3485) aged 20–79 years.

Outcomes Stroke and IHD mortality rates were plotted against countries’ specific prevalence data.

Results Mean systolic blood pressure (SBP) was higher in England than in the USA and Canada in all age–gender groups. Mean diastolic blood pressure (DBP) was similar in the three countries before age 50 and then fell more rapidly in the USA, being the lowest in the USA. Only 34% had a BP under 140/90 mm Hg in England, compared with 50% in the USA and 66% in Canada. Prehypertension and stages 1 and 2 hypertension prevalence figures were the highest in England. Hypertension prevalence (≥140 mm Hg SBP and/or ≥90 mm Hg DBP) was lower in Canada (19·5%) than in the USA (29%) and England (30%). Hypertension awareness was higher in the USA (81%) and Canada (83%) than in England (65%). England also had lower levels of hypertension treatment (51%; USA 74%; Canada 80%) and control (<140/90 mm Hg; 27%; the USA 53%; Canada 66%). Canada had the lowest stroke and IHD mortality rates, England the highest and the rates were inversely related to the mean SBP in each country and strongly related to the blood pressure indicators, the strongest relationship being between low hypertension awareness and stroke mortality.

Conclusions While the current prevention efforts in England should result in future-improved figures, especially at younger ages, these data still show important gaps in the management of hypertension in these countries, with consequences on stroke and IHD mortality.

  • Epidemiology
  • Public Health

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