Canadian Journal of Cardiology

Epidemiology of Hypertension in Canada: An Update

Published:August 15, 2015DOI:



      High blood pressure (BP) is the leading cause of death and disability in the world. The objective of this analysis was to perform a detailed update of the epidemiology of hypertension in Canada.


      Five population-based data sources were analyzed. We used the Canadian Health Measures Survey to determine the latest directly measured prevalence, awareness, and control estimates (2012-2013); the National Population Health Survey, and Canadian Community Health Survey to assess crude and age-standardized self-reported prevalence (1994-2013); the Canadian Chronic Disease Surveillance System to assess administrative data–ascertained prevalence and mortality trends (1998-2010); and Intercontinental Medical Statistics Health data to examine antihypertensive drug–prescribing trends and costs (2007-2014).


      In 2012-2013, the prevalence of hypertension (defined as drug treatment for high BP or BP ≥ 140/90 mm Hg) in Canadian adults was 22.6%, and the proportion of disease controlled was 68.1%. In Canadians with diabetes, the prevalence (defined as drug treatment or BP ≥ 130/80 mm Hg) was 67.1%, and 60.1% of cases were controlled. Self-reported hypertension prevalence has increased by approximately 2-fold over nearly 2 decades. Age-standardized mortality rates are falling in hypertensive Canadians (from 9.4 to 7.9 deaths per 1000 individuals), but to a lesser extent than in nonhypertensive individuals. Total antihypertensive drug prescription volume has increased steadily since 2007 amid falling drug costs.


      Hypertension prevalence in Canada continues to rise. Increased use of antihypertensive drugs and improvements in control are apparent. Coordinated efforts to further improve the treatment and control of hypertension in Canada are needed.



      L’hypertension est la principale cause de décès et d’incapacité dans le monde. L’objectif de cette analyse était de réaliser une mise à jour approfondie de l’épidémiologie de l’hypertension au Canada.


      Cinq sources de données de la population générale ont été analysées. Nous avons utilisé l’Enquête canadienne sur les mesures de la santé pour déterminer les plus récentes mesures directes de la prévalence, la sensibilisation et les estimations de la maîtrise (2012-2013); l’Enquête nationale sur la santé de la population et l’Enquête sur la santé dans les collectivités canadiennes pour évaluer la prévalence autodéclarée brute et standardisée selon l’âge (1994-2013); le Système canadien de surveillance des maladies chroniques pour évaluer les données administratives – la vérification de la prévalence et des tendances de la mortalité (1998-2010); et les données de l’Intercontinental Medical Statistics Health pour examiner les médicaments antihypertenseurs — les tendances et les coûts des ordonnances (2007-2014).


      En 2012-2013, la prévalence de l’hypertension (définie par le traitement pharmacologique de l'hypertension ou de la pression artérielle [PA] ≥ 140/90 mm Hg) chez les adultes canadiens était de 22,6 %, puis le pourcentage de maîtrise de la maladie était de 68,1 %. Chez les Canadiens souffrant de diabète, la prévalence (définie par le traitement pharmacologique ou la PA ≥ 130/80 mm Hg) était de 67,1 %, puis le pourcentage des cas qui maîtrisait la maladie était de 60,1 %. La prévalence de l’hypertension autodéclarée a approximativement doublé depuis près de 2 décennies. Les taux de mortalité standardisée selon l’âge diminuent chez les Canadiens hypertendus (de 9,4 à 7,9 décès par 1 000 individus), mais dans une proportion moindre que chez les individus non hypertendus. Le volume total d’ordonnances de médicaments antihypertenseurs a augmenté de manière constante depuis 2007, au moment de la baisse des coûts des médicaments.


      La prévalence de l’hypertension au Canada continue de s’accroître. L’augmentation de l’utilisation des médicaments antihypertenseurs et les améliorations concernant la maîtrise sont évidentes. Il est nécessaire de coordonner les efforts pour améliorer davantage le traitement et la maîtrise de l’hypertension au Canada.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        A global brief on hypertension. Silent killer, global public health crisis.
        2013 (Available at:) (Accessed February 1, 2015)
        • Lim S.S.
        • Vos T.
        • Flaxman A.D.
        • et al.
        A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010.
        Lancet. 2012; 380: 2224-2260
        • Haroun M.
        • Jaar B.G.
        • Hoffman S.C.
        • et al.
        Risk factors for chronic kidney disease: a prospective study of 23,534 men and women in Washington County, Maryland.
        J Am Soc Nephrol. 2003; 14: 2934-2941
        • Nagai M.
        • Hoshide S.
        • Kario K.
        Hypertension and dementia.
        Am J Hypertens. 2009; 23: 116-124
        • Rapsomaniki R.
        • Timmis A.
        • George J.
        • et al.
        Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people.
        Lancet. 2014; 383: 1899-1911
        • Lewington S.
        • Clarke R.
        • Qizilbash N.
        • et al.
        • Prospective Studies Collaboration
        Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
        Lancet. 2002; 360: 1903-1913
        • Lawes C.M.
        • Vander Hoorn S.
        • Rodgers A.
        • for the International Society of Hypertension
        Global burden of blood-pressure-related disease, 2001.
        Lancet. 2008; 371: 1513-1518
        • Julius S.
        • Nesbitt S.D.
        • Egan B.M.
        • et al.
        Feasibility of treating prehypertension with an angiotensin-receptor blocker.
        N Engl J Med. 2006; 354: 1685-1697
        • Heidenreich P.A.
        • Trogdon J.G.
        • Khavjou O.A.
        • et al.
        Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.
        Circulation. 2011; 123: 933-944
        • Weaver C.G.
        • Clement F.M.
        • Campbell N.R.C.
        • et al.
        Healthcare costs attributable to hypertension.
        Hypertension. 2015; 66: 502-508
        • Gaziano T.A.
        • Bitton A.
        • Anand S.
        • Weinstein M.C.
        The global cost of nonoptimal blood pressure.
        J Hypertens. 2009; 27: 1472-1477
        • Quan H.
        • McAlister F.A.
        • Khan N.
        The many faces of hypertension in Canada.
        Curr Opin Cardiol. 2014; 29: 354-359
        • Statistics Canada
        Overview of the Canadian Health Measures Survey.
        2010 (Available at:) (Accessed May 20, 2015)
        • Tremblay M.
        • Wolfson M.
        • Connor Gorber S.
        Canadian Health Measures Survey: rationale, background and overview.
        Health Rep. 2007; 18: 7-20
        • Bryan S.
        • Saint-Pierre Larose M.
        • Campbell N.
        • Clarke J.
        • Tremblay M.
        Resting blood pressure and heart rate measurement in the Canadian Health Measures Survey, cycle 1.
        Health Rep. 2010; 21: 1-8
      1. Statistics Canada. Canadian Community Health Survey 3.1 Overview. Available at: Accessed February 15, 2015.

        • Statistics Canada
        National Population Health Survey: household component, longitudinal (NPHS).
        2012 (Available at:) (Accessed March 7, 2015)
        • Quan H.
        • Smith M.
        • Bartlett-Esquilant G.
        • et al.
        Mining administrative health databases to advance medical science: geographical considerations and untapped potential in Canada.
        Can J Cardiol. 2012; 28: 152-154
        • Quan H.
        • Khan N.
        • Hemmelgarn B.R.
        • et al.
        Validation of a case definition to define hypertension using administrative data.
        Hypertension. 2009; 54: 1423-1428
        • Statistics Canada
        Canadian Health Measures Survey (CHMS) data user guide: cycle 1.
        April 2011 (Available at:) (Accessed May 22, 2015)
        • Rust K.F.
        • Rao J.N.K.
        Variance estimation for complex surveys using replication techniques.
        Stat Methods Med Res. 1996; 5: 281-310
        • Myers M.G.
        Eliminating the human factor in office blood pressure measurement.
        J Clin Hypertens. 2014; 16: 83-86
        • McAlister F.A.
        • Wilkins K.
        • Joffres M.
        • et al.
        Changes in the rates of awareness, treatment and control of hypertension in Canada over the past two decades.
        CMAJ. 2011; 183: 1007-1013
        • National Institute for Health and Clinical Excellence
        Type 2 diabetes: the management of type 2 diabetes.
        May 2009 (Available at:) (Accessed May 22, 2015)
        • James P.A.
        • Oparil S.
        • Carter B.L.
        • et al.
        2014 Evidence-based guideline for the management of high blood pressure in adults.
        JAMA. 2014; 311: 507
        • Joffres M.
        • Falaschetti E.
        • Gillespie C.
        • et al.
        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.
        BMJ Open. 2013; 3: e003423
        • Guo F.
        • He D.
        • Zhang W.
        • Walton R.G.
        Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010.
        J Am Coll Cardiol. 2012; 60: 599-606
        • Wang J.
        • Zhang L.
        • Wang F.
        • Liu L.
        • Wang H.
        • for the China National Survey of Chronic Kidney Disease Working Group
        Prevalence, awareness, treatment, and control of hypertension in China: results from a national survey.
        Am J Hypertens. 2014; 27: 1355-1361
        • Twells L.K.
        • Gregory D.M.
        • Reddigan J.
        • Midodzi W.K.
        Current and predicted prevalence of obesity in Canada: a trend analysis.
        CMAJ Open. 2014; 2: E18-26
        • Shields M.
        • Carroll M.
        • Ogden C.
        Adult obesity prevalence in Canada and the United States.
        NCHS Data Brief. 2011; 56: 1-8
      2. Statistics Canada. Distribution of the household population by adult body mass index (BMI) Health Canada (HC) classification, by sex and age group. Available at: Accessed March 26, 2015.

        • Bramlage P.
        • Pittrow D.
        • Wittchen H.-U.
        • et al.
        Hypertension in overweight and obese primary care patients is highly prevalent and poorly controlled.
        Am J Hypertens. 2004; 17: 904-910
        • Padwal R.S.
        • Sharma A.M.
        Prevention of cardiovascular disease: obesity, diabetes and the metabolic syndrome.
        Can J Cardiol. 2010; 26: 18C-20C
        • Padwal R.S.
        Obesity, diabetes, and the metabolic syndrome: the global scourge.
        Can J Cardiol. 2014; 30: 467-472
        • Gortmaker S.L.
        • Swinburn B.A.
        • Levy D.
        • et al.
        Changing the future of obesity: science, policy, and action.
        Lancet. 2011; 378: 838-847
        • Swinburn B.A.
        • Sacks G.
        • Hall K.D.
        • et al.
        The global obesity pandemic: shaped by global drivers and local environments.
        Lancet. 2011; 378: 804-814
        • Employment and Social Development Canada
        Canadians in context—aging population.
        August 2015 (Available at:) (Accessed March 7, 2015)
        • Sun Z.
        Aging, arterial stiffness, and hypertension.
        Hypertension. 2014; 65: 252-256
        • Campbell N.R.
        • Petrella R.
        • Kaczorowski J.
        Public education on hypertension: a new initiative to improve the prevention, treatment and control of hypertension in Canada.
        Can J Cardiol. 2006; 22: 599-603
        • Campbell N.R.C.
        Canada Chair in hypertension prevention and control: a pilot project.
        Can J Cardiol. 2007; 23: 557-560
        • Onysko J.
        • Maxwell C.
        • Eliasziw M.
        • et al.
        Large increases in hypertension diagnosis and treatment in Canada after a healthcare professional education program.
        Hypertension. 2006; 48: 853-860
        • Campbell N.R.C.
        • So L.
        • Amankwah E.
        • et al.
        • for the Canadian Hypertension Education Program Outcomes Research Task Force
        Characteristics of hypertensive Canadians not receiving drug therapy.
        Can J Cardiol. 2008; 24: 485-490
        • Gee M.E.
        • Bienek A.
        • McAlister F.A.
        • et al.
        Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension.
        Can J Cardiol. 2012; 28: 375-382
        • Colley R.C.
        • Garriguet D.
        • Janssen I.
        • et al.
        Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey.
        Statistics Canada, July 2014 (Available at:) (Accessed March 7, 2015)
        • Dasgupta K.
        • Quinn R.R.
        • Zarnke K.B.
        • et al.
        The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension.
        Can J Cardiol. 2014; 30: 485-501
        • Health Canada
        Sodium in Canada.
        June 2012 (Available at:) (Accessed March 7, 2015)
        • Huffman M.D.
        • Capewell S.
        • Ning H.
        • et al.
        Cardiovascular health behavior and health factor changes (1988-2008) and projections to 2020 results from the National Health and Nutrition Examination Surveys.
        Circulation. 2012; 125: 2595-2602
        • Gee M.E.
        • Janssen I.
        • Pickett W.
        • et al.
        Prevalence, awareness, treatment, and control of hypertension among Canadian adults with diabetes, 2007 to 2009.
        Can J Cardiol. 2012; 28: 367-374
        • Ferrannini E.
        • Cushman W.C.
        Diabetes and hypertension: the bad companions.
        Lancet. 2012; 380: 601-610
        • Chen G.
        • McAlister F.A.
        • Walker R.L.
        • Hemmelgarn B.R.
        • Campbell N.R.C.
        Cardiovascular outcomes in Framingham participants with diabetes: the importance of blood pressure.
        Hypertension. 2011; 57: 891-897
        • Tu K.
        • Klein-Geltink J.
        • Mitiku T.F.
        • Mihai C.
        • Martin J.
        De-identification of primary care electronic medical records free-text data in Ontario, Canada.
        BMC Med Inform Decis Mak. 2010; 10: 35
        • Godwin M.
        • Williamson T.
        • Khan S.
        • et al.
        Prevalence and management of hypertension in primary care practices with electronic medical records: a report from the Canadian Primary Care Sentinel Surveillance Network.
        CMAJ Open. 2015; 3: E76-82
        • Gupta M.
        • Szmitko P.
        • Singh N.
        • et al.
        Contemporary management and control of uncomplicated hypertension in Canada: insight from the Primary Care Audit of Global Risk Management (PARADIGM) study.
        Can J Cardiol. 2015; 31: 664-670
        • Campbell N.R.
        • Brant R.
        • Johansen H.
        • et al.
        Increases in antihypertensive prescriptions and reductions in cardiovascular events in Canada.
        Hypertension. 2009; 53: 128-134
        • Reaven G.M.
        Relationships among insulin resistance, type 2 diabetes, essential hypertension, and cardiovascular disease: similarities and differences.
        J Clin Hypertens. 2011; 13: 238-243
        • McAlister F.A.
        • Robitaille C.
        • Gillespie C.
        • et al.
        The impact of cardiovascular risk-factor profiles on blood pressure control rates in adults from Canada and the United States.
        Can J Cardiol. 2013; 29: 598-605
        • Tobe S.W.
        • Stone J.A.
        • Walker K.M.
        • et al.
        Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE): 2014 update.
        CMAJ. 2014; 186: 1299-1305
      3. Public Health Agency of Canada. 2009 tracking heart disease and stroke in Canada. Available at: Accessed March 7, 2015.

        • Myers M.G.
        • Godwin M.
        • Dawes M.
        • et al.
        Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial.
        BMJ. 2011; 342: d286
        • Myers M.G.
        • Valdivieso M.
        • Kiss A.
        Use of automated office blood pressure measurement to reduce the white coat response.
        J Hypertens. 2009; 27: 280-286
        • Peng M.
        • Chen G.
        • Lix L.M.
        • et al.
        Refining hypertension surveillance to account for potentially misclassified cases.
        PLoS One. 2015; 10: e0119186