Although Canada historically has been a leader in hypertension treatment and control, rates have declined in the past decade, particularly among women and vulnerable groups.

With the aim of improving hypertension control rates and reducing hypertension-attributable healthcare costs by $20 billion nationwide, Hypertension Canada issued new guidelines to change health policies, boost public health education, and promote preventive health measures.

Notably, the blood pressure threshold for defining hypertension has been shifted to 130/80 mm Hg, reflecting similar recommendations accepted in recent years by the American Heart Association, American College of Cardiology, European Society of Cardiology, and World Health Organization.

“This [shift] will lead to sweeping changes in the epidemiology of hypertension in Canada. We will need to pay close attention to how this changes hypertension awareness, treatment, and control in Canadian adults in the next few years,” guideline coauthor Alexander Leung, MD, associate professor of medicine and community health sciences at the University of Calgary, Calgary, told Medscape Medical News.

Leung has written about refocusing on hypertension control in Canada in recent years, particularly after noting the worsening treatment and control rates among women between 2007 and 2017.

“Many people suffer from uncontrolled hypertension,” Leung said. “The most effective strategy is likely to be one that is personalized for each patient.”

Negative Global Trends

Globally, hypertension is the most common modifiable risk factor for cardiovascular disease and mortality. Its prevalence is 32% worldwide and has surpassed 50% in countries across Europe, Asia, and Latin America. Although Canada typically has one of the lowest prevalence rates and some of the highest treatment and control rates, those trends began to move backward about a decade ago, reflecting global trends.

For instance, 82% of Canadians with hypertension were treated and 69% were controlled between 2007 and 2009, Leung and colleagues found. These rates dropped to 72% and 58%, respectively, by 2017. Rates were worse for women, at 65% and 49%, respectively. Similar declines were found in the US and other countries during the same period.

Since 2020, Canadian experts have called for renewed collaboration to address the increase in hypertension risks. Although treatment and control rates have ticked up since then, Hypertension Canada has pushed for additional change.

“The decline in hypertension treatment and control is likely multifactorial, and it is worth noting that this decline preceded the COVID-19 pandemic,” Gregory Hundemer, MD, MPH, senior author of the 2025 Hypertension Canada guidelines, nephrologist at the Ottawa Hospital, and assistant professor of medicine at the University of Ottawa, Ottawa, told Medscape Medical News.

“We believe some of the potential reasons are overly complex guideline recommendations, which are difficult to implement in everyday practice, as well as inadequate implementation strategies and a lack of engagement with primary care, where the vast majority of hypertension is managed,” Hundemer said. “Hypertension Canada has modified its guideline and implementation strategies to try and better address these issues.”

The major next step includes implementation, he said, with a task force that will work with healthcare systems, primary care clinics, community centers, and patients across Canada.

“We have an ever-expanding armamentarium of treatments that are effective in controlling blood pressure,” Hundemer said. “Improving hypertension control rates will require a multidisciplinary, team-based approach, including physicians, nurses, nurse practitioners, physician assistants, dieticians, pharmacists, social workers, and community health workers.”

A Multipronged Approach

Importantly, the 2025 Hypertension Canada guidelines emphasize treatment that targets a systolic blood pressure lower than 130 mm Hg, incorporates healthy lifestyle changes, and provides stepwise guidance for medication choices.

“Hypertension is a complex issue, and there’s no single solution. What we’ve seen in the data is that people without other medical conditions are often less likely to even know they have high blood pressure, while those with multiple health problems face greater challenges in keeping it under control,” said Mohsen Agharazii, MD, vice president of Hypertension Canada, professor of medicine at Université Laval, and director of the endocrinology-nephrology research axis at the Centre Hospitalier Universitaire de Québec, Quebec City.

“We need a multipronged approach: teaching healthy lifestyle habits in schools, making home blood pressure monitors as common as thermometers, giving primary care providers clear and practical guidelines, and ensuring that the right specialized infrastructure is in place for people with more complex hypertension,” he said.

For instance, Agharazii, Hundemer, and Leung have researched avenues that lead to high blood pressure, including aldosterone excess, which contributes to salt retention. This excess has been associated with obesity, increased waist circumference, and other cardiovascular risk factors among men and women.

“There are many possible reasons for high blood pressure, including medication nonadherence, use of suboptimal treatment regimens, inaccurate blood pressure measurement, and unrecognized causes of secondary hypertension,” Leung said. “Related to the latter, it is now estimated that at least 10%-30% of people with hypertension around the world have hormonal abnormalities that cause high blood pressure. My work is focused on finding ways to improve the efficiency of diagnosis for patients with hormonal causes and helping them receive good and effective treatment.”

Treatment and control rates are beginning to improve among women again, he noted, which could be linked to awareness and treatment tactics among physicians and patients alike. Lifestyle changes, such as implementing a healthy diet, reduced sodium intake, and weight loss, could help cardiovascular and cognitive health.

“Whatever the reason, the disparity between women and men has narrowed again,” Leung said. “Ongoing surveillance is needed to confirm that this trend is sustained.”

Leung, Hundemer, and Agharazii reported disclosures outside of the context of this report, including the receipt of grants, honoraria, and consulting fees from the Canadian Institute of Health Research, Kidney Foundation of Canada, their academic institutions, and other Canadian agencies.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.