Abstract

Background

Hypertension (or high blood pressure) affects almost one in four adults in Canada. Quantifying risk factors associated with hypertension may help to inform prevention efforts.

Data and methods

Data from the first four cycles of the Canadian Health Measures Survey (including 13,407 respondents) were used to identify hypertension status by systolic and diastolic blood pressure levels and the use of antihypertensive medications. Logistic regression analysis was employed to estimate the association between six cardiovascular risk factors (individually and as a composite score) and hypertension.

Results

Engaging in less than 150 minutes per week of moderate-to-vigorous physical activity, eating fruits and vegetables fewer than five times per day, being overweight or obese, having diabetes, and having chronic kidney disease were all independently associated with an increased risk of hypertension. When these factors were combined into a risk score, there was a linear increase in the predicted risk of hypertension with each additional risk factor. The predicted prevalence of hypertension for those with all six risk factors was 55% in women and 44% in men aged 20 to 39 years, and 80% in women and 76% in men aged 70 to 79 years. Being overweight or obese, consuming fruits and vegetables less often, being inactive, and having diabetes contributed to the largest attributable fractions for hypertension in the Canadian population.

Interpretation

Physical activity, diet, body mass index, the presence of diabetes, and the presence of chronic kidney disease were strong risk factors for hypertension. Many of these risk factors are modifiable and highlight targets for future prevention strategies.

Keywords

hypertension, risk, prevalence, survey, cross-sectional, lifestyle, exercise, diet, obesity, diabetes, chronic kidney disease, cholesterol, prevention

Findings

Hypertension (or high blood pressure) is a leading modifiable risk factor for cardiovascular disease and accounts for more than 10% of the population-attributable fraction (PAF) for mortality worldwide. Hypertension affects almost 1 in 4 Canadian adults, and the lifetime incidence of developing high blood pressure is estimated to be 90%. [Full Text]

Authors

Alexander A. Leung (aacleung@ucalgary.ca) is with the Departments of Medicine and Community Health Sciences at the University of Calgary, Calgary, Alberta. Tracey Bushnik, Deirdre Hennessy, and Douglas G. Manuel are with the Health Analysis Division at Statistic Canada, Ottawa, Ontario. Finlay A. McAlister is with the Department of Medicine, University of Alberta, Edmonton, Alberta. Douglas G. Manuel is also with the Ottawa Hospital Research Institute and the Institute of Clinical and Evaluative Sciences, Ottawa, Ontario.

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What is already known on this subject?

  • Despite substantial improvements in hypertension treatment and control, hypertension affects almost one in four Canadian adults.
  • Primary prevention may be an appropriate strategy to reduce the burden of hypertension.

What does this study add?

  • Four cycles of the Canadian Health Measures Survey allow for sex- and age-specific analysis of risk factors associated with hypertension status.
  • A number of factors related to lifestyle and behaviour, including physical activity, diet, and body mass index, were associated with hypertension in women and men.
  • Hypertension was associated with the presence of diabetes and chronic kidney disease in women and with the presence of diabetes in men.
  • The risk score is significantly associated with hypertension risk in both women and men.
  • The largest fraction of attributable risk for hypertension is from being overweight or obese, eating fruits and vegetables fewer than five times per day, being inactive, and having diabetes.

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