Prevalence, incidence, awareness and control of hypertension in the province of Quebec: perspective from administrative and survey data.
Blais, Claudia ; Rochette, Louis ; Hamel, Denis 等
La traduction du resume se trouve a la fin de l'article.
Among modifiable risk factors associated with cardiovascular
diseases, systemic hypertension is the leading one in terms of risk for
mortality, responsible for 13% of deaths globally. (1) In 2009, the cost
of antihypertensive treatment to the Quebec government alone was $589
million. (2) The importance of this risk factor for heart, renal and
vascular diseases is well known, which is why population studies are
essential to assess its prevalence over time. It was recently
demonstrated using administrative databases all over Canada, that nearly
6 million Canadians aged [greater than or equal to]20 years were
hypertensive in 2007-2008 (crude prevalence of 23.0%). (3) Moreover,
according to the 2007-2009 Canadian Health Measures Survey (CHMS) and
the 2007-2008 Canadian Community Health Survey (CCHS), the prevalence of
hypertension was 19.5% and 18.2%, respectively, for Canadian adults aged
20 to 79 years, whereas it was 20.3% according to administrative data
(2007/2008). (4,5)
The three sources of data have their strengths and limitations.
Administrative databases contain data for all Quebecers and are
continually updated, however they tend to concentrate on those who are
diagnosed and actively consulting physicians, and they under-report
hypertension in the presence of other diseases. Survey data estimate
either self-reported diagnosed or measured hypertension, the latter
being expensive and limited to a few representative people, especially
with direct physical measures. The aim of this study was to compare the
prevalence of hypertension using both sources of data, in the province
of Quebec. We also concentrated our comparison on people at higher risk,
i.e., the elderly population. The levels of hypertension awareness,
treatment and control were also assessed with the CHMS since it combined
information on direct measurements with self-reported diagnosis and
treatment.
METHODS
Data sources
Administrative Databases
The methodology used to conduct the surveillance of hypertension is
based on the Canadian Chronic Disease Surveillance System, a
collaborative network of provincial and territorial surveillance systems
supported by the Public Health Agency of Canada. (3) The Quebec
Integrated Chronic Disease Surveillance System (QICDSS) of the Institut
national de sante publique du Quebec was used to determine if a person
has a diagnosis of hypertension. It consists of five linked
administrative databases with records dating from January 1, 1996 and
updated annually; two of the databases were used for this study: 1) the
physician billing database from the Regie de 1'assurance maladie du
Quebec (RAMQ), and 2) the hospitalization database. The first database
includes all procedures billed to the RAMQ, while the second is
referring to the principal diagnosis and up to 15 or 25 secondary
diagnoses associated with hospitalization stays, depending on whether
the stay came before or after April 1, 2006. In both databases, the
International Classification of Diseases (ICD) was used; dating from
April 1, 2006, the 10th ICD version was used in the hospitalization
database. Demographics and geographical data such as age, sex, postal
code and date of death as well as information on eligibility for health
insurance were obtained from the register of insured persons (FIPA). In
addition, the death file was used for information on the causes of death
(coded in ICD-10 since January 1, 2000). The denominator for calculating
the rate was determined according to 2006 Canadian census data,
specifically population estimates for 2000 to 2005 and population
projections for 2006 and over.
Canadian Health Measures Survey
The CHMS is a cross-sectional survey from Statistics Canada that
aims to collect important health information through a household
interview followed by direct physical measurements at a mobile
laboratory centre for individuals aged between 6 and 79 years living in
privately occupied dwellings in the 10 provinces and the 3 territories
of Canada. Full-time members of the Canadian Forces, and residents of
Crown lands or Indian reserves, institutions and certain remote regions
were excluded. (6) The collection sites were created using the Labour
Force Survey's area frame, grouped as well with respect to
provincial and census metropolitan-area boundaries and population
density criteria. Sites were then randomly selected using a systematic
sampling method with probability proportional to the size of each
site's population. Four representative sites in Quebec were
interviewed in each cycle (cycle 1: 2007-2009, cycle 2: 2009-2011).
Blood pressure (BP) on the right arm was measured 6 times at one-minute
intervals, in the sitting position, following a 5-minute rest period
according to a protocol created by the CHMS. (7) Measurements were taken
using an oscillometric BP measurement automated electronic device and
the last 5 measurements were used. (4,8) In the household interview,
respondents were asked questions consistent with those in other
Statistics Canada health surveys: "Do you have high BP?"
(diagnosed by a health professional) and "In the past month, have
you taken any medicine for high BP?" Pregnant women and people aged
between 6 and 19 years were excluded from our analysis.
Definitions
Administrative Databases
To be considered hypertensive, an individual aged [greater than or
equal to] 20 years should be eligible for health insurance in Quebec,
and have either [greater than or equal to] 2 diagnoses of hypertension
on the physician billing database within a two-year period, or 1
diagnosis (primary or secondary) of hypertension recorded in the
hospitalization database. (3) The following diagnostic codes were used:
401 to 405 for ICD-9 and I10 to I13 and I15 for ICD-10. In order to
exclude cases of gestational hypertension, all hypertension diagnoses
for women aged 20 to 54 years recorded in a window 120 days before or
180 days after any obstetrical-related hospital admission were not
considered. Diagnostic codes used to identify these events were: 641 to
676 and V27 for ICD-9, and O10-O19, O21-O95, O98, O99 and Z37 for
ICD-10. This case definition has been validated in three Canadian
provinces with sensitivity of 66-72% and specificity of 95-97%. (9,10)
The observation period used runs from January 1, 1996 to March 31,
2010. However, a minimum of four years is necessary to distinguish
incident cases from prevalent cases diagnosed before January 1996. Thus,
measures are presented from 20002001.
Canadian Health Measures Survey
Hypertension was defined as an average measured systolic or
diastolic blood pressure (SBP/DBP) [greater than or equal to] 140/90 mm
Hg or self-reported use of BP-lowering medication in the last month.
Awareness of hypertension was defined as a self-report of either
medically diagnosed hypertension or BP medication use in the past month.
(4) Treatment of hypertension was defined as the self-reported use of
BP-lowering medication within the last month. BP control was reported as
an average currently treated (with medication) SBP/DBP <140/90 mm Hg.
The three latter measures were calculated among all those with
hypertension. (4,11)
Statistical analysis
Prevalence, incidence and mortality using administrative databases
were calculated as in Robitaille et al. (3) Age-adjusted rates are used
to analyze time trend, using the 2001 Quebec population aged [greater
than or equal to] 20 years as the standard population. Relative changes
(%) of prevalence, incidence and mortality over time are obtained by
dividing the difference between the first and final rates by the rate of
the first year multiplied by 100. The relative difference between sexes
is obtained by dividing the difference in rates by the one from men
multiplied by 100. Regarding the CHMS, frequencies and means were
produced to estimate the prevalence of hypertension, distribution of BP,
awareness, treatment, and control by using the combined sampling weights
from both cycles. Bootstrap techniques and Student t distribution (with
6 degrees of freedom for Quebec data) were used to calculate the 95%
confidence intervals of estimates and the statistical t test on
differences between estimates. Statistical analyses were performed with
SAS Enterprise Guide version 5.1 (Cary, NC, USA). P-values <0.05 were
considered significant.
RESULTS
Administrative data
Prevalence
In 2009-2010, the number of Quebecers aged [greater than or equal
to] 20 years with diagnosed hypertension was approximately 1,433,400.
This represents a crude prevalence of 23.6% [95% confidence interval
(CI), 23.5-23.6] and an age-standardized prevalence of 21.0% [95% CI,
21.0-21.1]. Figure 1A shows that the age-standardized prevalence of
diagnosed hypertension increased in both sexes by 32.1% between
2000-2001 and 2009-2010. In people aged [greater than or equal to] 65
years, the prevalence was much higher among women (p<0.05). In fact,
this proportion rose to 69.0% [95% CI, 68.8-69.2] and 61.7% [95% CI,
61.5-61.9] for women and men, respectively, in 2009-2010.
Incidence
Globally, there were approximately 86,900 individuals diagnosed
with hypertension in each of the last 5 years of the study. In
2009-2010, the crude incidence rate was 17.2 per 1000 personyears [95%
CI, 17.1-17.3]. The overall incidence decreased by 27.3% between
2000-2001 and 2009-2010 (Figure 1B). In people aged [greater than or
equal to] 65 years, there is also a higher incidence among women, but in
the final year, the incidence among men reached a comparable level.
Mortality
As shown in Figure 1C, between 2000-2001 and 2009-2010, there was a
reduction of 16.4% of mortality in people with diagnosed hypertension.
The mortality rate was always higher in men vs. women, particularly in
the elderly group with a 14.2% higher mortality rate in men in
2009-2010.
Causes of death
Table 1 shows the 10 leading causes of death in individuals with
diagnosed hypertension who died between January 1, 2000 and December 31,
2007. These causes of death explain 43.2% of all deaths. Of these,
cardiovascular etiologies and cancer were responsible for 20.2% and
14.1% of deaths, respectively. When we consider all causes of death, the
proportion from cardiovascular causes as the main cause (ICD-10: I00 to
I99) decreased from 39.4% to 30.8% between 2000 and 2007. Cardiovascular
etiologies were present (main or secondary causes) in 62.8% and 56.7%
over the same period.
Canadian Health Measures Survey
BP measures were obtained in a sample of 1,706 Quebecers which is
weight-representative of the Quebec population aged 20 to 79 years,
excluding 13 pregnant women. Average SBP/DBP was 113/72 mm Hg [95% CI,
111-116/70-74]. As illustrated in Figure 2, in the younger age group,
both the average SBP and DBP were higher among men (110/72 mm Hg [95%
CI, 107-114/70-74]) than among women (103/68 mm Hg [95% CI,
101-105/66-70]), p[greater than or equal to] 0.0001 and p=0.002 for SBP
and DPB, respectively. However, among people aged 65-79 years, the
average SBP and DBP were similar between women (126/70 mm Hg [95% CI,
123-129/69-74]) and men (123/71 mm Hg [95% CI, 120-127/69-74]), p=0.204
and p=0.338 for SBP and DPB, respectively.
The overall crude prevalence of hypertension was 23.1% [95% CI,
20.7-25.5] for both sexes (22.6% [95% CI, 18.1-27.1] in men and 23.6%
[95% CI, 19.3-27.9] in women, p>0.5). Awareness of hypertension was
84.3%. It was similar between women (87.4%) and men (81.1%); p>0.5.
As the prevalence of hypertension increases with age (60.4% in people
aged 65-79 years), so does the awareness (89.3%). As shown in Table 2,
treatment of hypertension was 83.1% and was similar between women and
men (86.8% vs. 79.4%, p>0.25). Almost 70% had their BP controlled and
this was similar between men and women.
As shown in Figure 3, for both sexes and ages 20-79 years, the
crude prevalence of hypertension based on administrative database (20.2%
[95% CI, 20.1-20.2]) is only 3 points of a percentage lower than one
obtained with the measurement/medication in the CHMS (23.1% [95% CI,
20.725.5], p<0.05). The prevalence of the auto-declared hypertension
was lower (20.9% [95% CI, 18.2-23.6]) but not statistically different
from the measurement/medication. This difference between the
administrative data and measurement/medication prevalence of
hypertension is not driven by the difference observed in sexes
separately.
DISCUSSION
This is the first study comparing hypertension prevalence in the
province of Quebec using different sources of data. For people aged
20-79 years, the prevalence determined via administrative database
(20.2%) is comparable to the one auto-declared (20.9%) while the
measurement/medication was 23.1%. This is also the first study that
estimated trends in hypertension prevalence, incidence and mortality in
Quebec. Using the most recent administrative data, hypertension was
diagnosed in approximately 1,433,400 individuals aged [greater than or
equal to] 20 years in 2009-2010 in the province of Quebec (23.6%).
Globally, though the prevalence of diagnosed hypertension is increasing
(a rise of 32% in the last decade), both incidence and mortality are
decreasing (27% and 16%, respectively). The difference between men and
women for the year 2009-2010 in the prevalence (+12% for women) and
mortality (-14% for women) of hypertension was most important for
patients aged [greater than or equal to] 65 years. In fact, the
prevalence of hypertension in elderly women was 69.0%, making this a
very high-risk subgroup. Awareness, treatment and control of
hypertension are very high in Quebec.
The relatively lower prevalence of hypertension in the
administrative data compared to the measurement/medication use can be
explained because hypertension is often asymptomatic and a small
proportion of people could have discovered their hypertension at the
mobile laboratory. This is especially true since the prevalence of the
auto-declared hypertension is almost the same as that of the
administrative data. However, a recent study demonstrated that in
Canada, even if the prevalence of hypertension determined through the
CHMS and the administrative data were similar, the one obtained with
administrative data was 20.3% compared to 19.5% for the CHMS in
2007-2009. (5) Nevertheless, both studies found that auto-declared
hypertension was the lowest. Our prevalence was lower than those found
in other developed countries such as England (33%), Denmark (26%), China
(36%) and United States (30%). (11-14) Higher prevalence of hypertension
in elderly women was also reported in China and Spain. (13,15) Of note,
the increase in prevalence of hypertension observed herein is higher
than the one projected by Kearney et al. (16) of 24% for developed
countries between 2000 and 2025.
Awareness of hypertension (84.3%) was higher compared to many
countries, such as China (43%), United States (74%), Finland (68%) and
Denmark (72%). (13,14,17,18) Drug treatment was also higher (83.1%)
compared to China (36%) and Denmark (64%), with the result that control
of hypertension was better (67.9% in Quebec vs. 12% in China, 46% in the
United States, and 57% in Denmark). (11) In fact, these results are
comparable to those obtained in a different survey from our Ontario
neighbours, (19) which reported the highest population rates for drug
treatment and control of hypertension worldwide. These high rates are
compatible with the results of Gee et al. who reported that most
Canadians diagnosed with hypertension are taking antihypertensive
medications and are reporting adherence. (20) Since Canada has been
recognized as a world leader in the prevention, treatment and control of
hypertension, it is interesting to emphasize that Quebec, the
country's second-largest province, is also observing these high
rates. (4,21) Furthermore, when looking at the population-adjusted
number of antihypertensive prescriptions in 2006, Quebec had the
greatest number (42,877 per 10,000 people) and was above the average
Canadian level (26,486). (22) Moreover, most Canadians with diagnosed
hypertension are reporting sustained lifestyle modification to control
their hypertension, such as limiting salt consumption (89%), changing
the types of food they eat (89%), engaging in physical activity (80%),
etc. (23) The greater awareness, treatment and control found in
Quebecers can be seen in light of the introduction, in 1999, of the
Canadian Hypertension Education Program (CHEP), an extensive national
knowledge translation strategy for professionals to improve hypertension
management. (21,24,25) This program has increased the diagnosis and
treatment of hypertension and is viewed as an international model
regarding knowledge translation. (26-28) Moreover, another study
demonstrated that 46% of Canadian adults with hypertension are
monitoring their BP at home, explaining in part these high numbers. (29)
The decrease in cardiovascular deaths between 2000 and 2007 (22%) could
also be seen to be a result of this program. Nonetheless, the majority
of the people with diagnosed hypertension who died did so as a result of
coronary heart disease (CHD: 16.4%), while stroke (3.8%) was the
fifth-leading cause. These results are in agreement with those of Arima
et al., underlying that CHD causes most cardiovascular deaths among
hypertensive Caucasian populations of the "Western world".
(30)
Limitations
The prevalence of hypertension might have been underestimated
because of the elderly population not surveyed or those living in
nursing homes or other institutions not captured in either
administrative or survey data. Provincial representativeness of the
collection sites in Quebec produced with the CHMS may not be optimal
since the sample design was nationally done. People who achieved BP
control by non-pharmacological means, such as dietary and lifestyle
modification, are not included, resulting in an underestimation of the
"real" hypertension prevalence and control in the survey. Even
when BP was measured 6 times following a standard protocol, this was
performed during only a single visit. Self-reported information,
particularly on the use of BP medications, might be subject to
misunderstanding and/or recall bias. Information on neither dosage nor
compliance are available in the survey. Statistical power is another
limitation of the CHMS, especially when comparing sexes and age
subgroup. Administrative data are only capturing people in contact with
the health care system, and in the case of multiple associated
comorbidities, such as diabetes, hypertension would not be the first
diagnosis in the physician billing database. As 75% of patients with
diabetes also have hypertension, this can be a frequent situation. (31)
Finally, the time comparison of hypertension prevalence between
administrative and survey data was not exactly the same.
Although the prevalence of diagnosed hypertension has increased in
the province of Quebec, this could be attributable in part to a decrease
in mortality and not to an increased incidence since the latter is
decreasing. It is noteworthy to underline that the highest prevalence of
hypertension, i.e., in elderly women, is increasing dramatically over
time, while their mortality is lower compared to men. The level of
awareness, treatment and control of hypertension in Quebec is one of the
highest in the world. More importantly, the prevalence of hypertension
obtained with administrative data is comparable to that obtained with
the measurement/medication from a survey and should be used, especially
to examine the burden of cardiovascular diseases in Quebec, where it is
accessible, continually updated and this at a low cost and for all
people, whatever their age or socio-economic status. Moreover, these
linked databases allow the determination of incidence, mortality and
drug consumption. Even with the strong agreement between administrative
and survey data, future directions should include linking the CHMS with
the QICDSS using the personal health insurance number. This linkage will
allow comparison of cases identified in the CHMS with those identified
using administrative data. These results on prevalence, awareness and
control of hypertension are important for clinical care, health care and
public health planning, and underline the need to reduce the burden of
this silent killer, especially among elderly people.
Received: July 3, 2013 Accepted: January 24, 2014
Funding Sources: This research was partly funded by the Public
Health Agency of Canada. Dr. Paul Poirier is a senior clinical
researcher of the Fonds de recherche en sante du Quebec.
Conflict of Interest: None to declare.
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Claudia Blais, PhD, [1,2] Louis Rochette, MSc, (1) Denis Hamel,
MSc, (1) Paul Poirier, MD, PhD (2,3)
Author Affiliations
[1.] Institut national de sante publique du Quebec, Quebec, QC
[2.] Faculte de pharmacie, Universite Laval, Quebec, QC
[3.] Institut universitaire de cardiologie et de pneumologie de
Quebec, Quebec, QC
Correspondence: Claudia Blais, Institut national de sante publique
du Quebec, Quebec, QC, 945, avenue Wolfe, Quebec (Quebec) G1V 5B3, Tel:
418-650-5115, ext. 5708, Fax: 418-643-5099, E-mail:
claudia.blais@inspq.qc.ca
Table 1. The 10 leading causes of death in people aged 20 years
and older in Quebec with diagnosed hypertension,
January 1, 2000 to December 31, 2007
Rank ICD-10 code Description Proportion of
death (%)
1 I21.9 Acute myocardial 9.54
infarction, unspecified
2 C34.9 Malignant neoplasm of bronchus 8.16
or lung, unspecified
3 I25.1 Atherosclerotic heart disease 6.89
4 J44.9 Chronic obstructive pulmonary 4.14
disease, unspecified
5 I64 Stroke, not specified as 3.80
haemorrhage or infarction
6 F03 Unspecified dementia 2.56
7 C18.9 Malignant neoplasm of colon, 2.31
unspecified
8 G30.9 Alzheimer's disease, unspecified 2.19
9 C50.9 Malignant neoplasm of breast, 2.00
unspecified
10 C25.9 Malignant neoplasm of pancreas, 1.60
unspecified
Source: Quebec Integrated Chronic Disease Surveillance System
(QICDSS) of the Institut national de sante publique du Quebec.
Table 2. Percentage of Quebecers aged 20-79 years with hypertension *
according to their treatment and their blood pressure control
Treated
Both Women Men p-value
sexes (%) (%) (%)
83.1 86.8 79.4 >0.25
Untreated
Both Women Men p-value
sexes (%) (%) (%)
16.9 13.2 20.6 >0.25
Controlled
Both Women Men p-value
sexes (%) (%) (%)
67.9 72.5 63.2 >0.4
Uncontrolled
Both Women Men p-value
sexes (%) (%) (%)
15.2 14.3 16.2 >0.80
* SBP/DBP [greater than or equal to] 140/90 mm Hg or self-reported
current use of antihypertensive medication in the last month.
Source: Canadian Health Measures Survey Cycle 1 (2007-2009)
and Cycle 2 (2009-2011).
Figure 1A. Age-standardized * prevalence of diagnosed
hypertension in men and women aged 20 years
and older in Quebec, by age group, 2000-2001 to
2009-2010
2000- 2001- 2002- 2003- 2004-
2001 2002 2003 2004 2005
Overall 15.9 17.0 18.0 18.9 19.6
Women, 20-44 years 2.4 2.6 2.8 2.9 3.0
Men, 20-44 years 2.7 2.9 3.2 3.4 3.5
Women, 45-64 years 20.0 21.3 22.4 23.2 23.8
Men, 45-64 years 17.7 19.3 20.7 21.9 23.0
Women, [greater than or 52.7 56.3 59.4 62.2 64.4
equal to] 65 years
Men, [greater than or 41.8 45.6 48.8 51.8 54.4
equal to] 65 years
2005- 2006- 2007- 2008- 2009-
2006 2007 2008 2009 2010
Overall 20.1 20.5 20.8 20.9 21.0
Women, 20-44 years 3.1 3.1 3.1 3.1 3.0
Men, 20-44 years 3.7 3.8 3.8 3.8 3.9
Women, 45-64 years 24.1 24.3 24.4 24.3 24.2
Men, 45-64 years 23.9 24.6 25.1 25.5 25.8
Women, [greater than or 66.2 67.5 68.2 68.7 69.0
equal to] 65 years
Men, [greater than or 56.4 58.0 59.4 60.7 61.7
equal to] 65 years
* Age-standardized to the 2001 Quebec population.
Source: Quebec Integrated Chronic Disease Surveillance System
(QICDSS) of the Institut national de sante publique du Quebec.
Figure 1B. Age-standardized * incidence of diagnosed
hypertension in men and women aged 20 years
and older in Quebec, by age group, 2000-2001 to
2009-2010
2000- 2001- 2002- 2003- 2004-
2001 2002 2003 2004 2005
Overall 31.5 30.6 29.5 29.4 27.9
Women, 20-44 years 5.4 5.1 5.1 5.2 4.8
Men, 20-44 years 6.2 6.0 6.1 6.3 6.0
Women, 45-64 years 36.7 34.1 32.8 31.6 28.7
Men, 45-64 years 34.1 33.3 33.0 32.7 31.1
Women, [greater than or 100.4 97.5 91.4 91.2 87.2
equal to] 65 years
Men, [greater than or 84.1 84.0 81.7 81.9 79.5
equal to] 65 years
2005- 2006- 2007- 2008- 2009-
2006 2007 2008 2009 2010
Overall 26.8 25.0 24.2 23.2 22.9
Women, 20-44 years 4.7 4.4 4.2 4.0 3.7
Men, 20-44 years 5.9 5.7 5.5 5.2 5.1
Women, 45-64 years 26.7 24.5 23.3 21.7 20.8
Men, 45-64 years 30.7 29.3 28.1 26.4 26.0
Women, [greater than or 82.2 75.1 72.3 69.2 67.7
equal to] 65 years
Men, [greater than or 76.8 71.2 69.9 67.8 67.8
equal to] 65 years
* Age-standardized to the 2001 Quebec population.
Source: Quebec Integrated Chronic Disease Surveillance System
(QICDSS) of the Institut national de sante publique du Quebec.
Figure 1C. Age-standardized * all-cause mortality rate of men
and women aged 20 years and older with
diagnosed hypertension in Quebec, by age group,
2000-2001 to 2009-2010
2000- 2001- 2002- 2003- 2004-
2001 2002 2003 2004 2005
Overall 11.6 11.3 11.2 11.1 10.7
Women, 20-44 years 2.5 2.6 2.7 2.4 1.8
Men, 20-44 years 3.7 2.6 3.4 2.7 2.8
Women, 45-64 years 6.5 6.0 6.2 6.6 6.0
Men, 45-64 years 10.4 10.3 10.3 10.1 9.8
Women, [greater than or 42.4 44.1 43.7 45.7 44.8
equal to] 65 years
Men, [greater than or 59.3 59.1 57.3 57.7 56.7
equal to] 65 years
2005- 2006- 2007- 2008- 2009-
2006 2007 2008 2009 2010
Overall 10.5 10.1 9.9 9.9 9.7
Women, 20-44 years 2.5 2.1 2.0 2.5 2.2
Men, 20-44 years 3.1 2.6 2.4 2.6 2.6
Women, 45-64 years 6.2 6.0 6.2 6.1 6.3
Men, 45-64 years 9.5 9.2 8.8 8.8 8.7
Women, [greater than or 41.9 43.3 42.3 43.2 42.9
equal to] 65 years
Men, [greater than or 51.8 52.2 51.2 50.9 50.0
equal to] 65 years
* Age-standardized to the 2001 Quebec population.
Source: Quebec Integrated Chronic Disease Surveillance System
(QICDSS) of the Institut national de sante publique du Quebec.
Figure 2. Mean measured systolic blood pressure (SBP) and
diastolic blood pressure (DBP), by sex and age
group (20 to 79 years) in Quebec, 2007-2011
20-44 years 45-64 years 65-79 years
Women SBP 103 115 126
Men SBP 110 119 123
Women DBP 68 71 70
Men DBP 72 78 71
* Statistically significantly different between men
and women, in the same age group, p<0.05.
Source: Canadian Health Measures Survey Cycle 1
(2007-2009) and Cycle 2 (2009-2011).
Figure 3. Prevalence of hypertension based on administrative
database, blood pressure measurement/medication
use ([dagger]) and auto-declared ([double dagger]),
by sex and age group in Quebec, 2007-2011
20-79 20-44 45-64 65-79 20-79
years years years years years
Women
Administrative 20.8 3.1 24.3 62.3 19.6
data
Autodeclared 23.6 4.6 29.3 59.4 22.6
Age group 21.9 5.4 26.9 52.5 19.8
20-79
20-44 45-64 65-79 years
years years years Both
Men sexes
Administrative 3.8 25.5 57.4 20.2
data
Autodeclared 3.8 30.4 61.4 23.1
Age group 2.4 26.4 57.8 20.9
* Statistically significantly different from hypertension
prevalence with measurement/medication, p<0.05.
([dagger]) SBP/DBP [greater than or equal to] 140/90 mm Hg or
self-reported current use of antihypertensive medication in
the last month.
([double dagger]) Questions asked: "Do you have high blood
pressure?" or "In the past month, have you taken any medicine
for high blood pressure?"
Source: Quebec Integrated Chronic Disease Surveillance
System (QICDSS) of the Institut national de sante publique
du Quebec (administrative data, year 2008-2009) and Canadian
Health Measures Survey Cycle 1 (2007-2009) and
Cycle 2 (2009-2011).
