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In order to describe the changes in the control of arterial hypertension from 2016 to 2021 and the relationship between the progress made and the maturity of implementation of the HEARTS Initiative at the first level of care in Cuba, a prospective implementation study was designed to promote the correct measurement of blood pressure with validated automatic sphygmomanometers, risk-based care, introduction of standardized antihypertensive treatment protocols, secondary prevention, and teamwork. Patient education, active case-finding, and community activities were also encouraged. Data were obtained from implementation logs and were analyzed with SPSS Statistics V21; outcome values and 95% confidence intervals were reported. Population indicators were evaluated: registration coverage, control between treatments, population control, and the HEARTS in the Americas Maturity Index. The number of participating centers increased from a single demonstration center in 2016 to 22 polyclinics in six provinces and seven municipalities in 2021. There was a significant increase in the absolute values for the total population served, number of hypertensive patients registered, controlled patients among those treated, and controlled hypertensive patients among all adults, although with annual variations in percentages of coverage, control between treatments, and population control. The greatest progress occurred in centers with high-performance health teams. Five years after implementation of the HEARTS Initiative in Cuba, the methodology is becoming institutionalized.A fim de descrever as mudanças no controle da hipertensão arterial de 2016 a 2021 e a relação entre o progresso e a maturidade da implementação da Iniciativa HEARTS no primeiro nível de atenção em Cuba, foi elaborado um estudo prospectivo de implementação que promoveu a aferição correta da pressão arterial com esfigmomanômetros automáticos validados, cuidados baseados em risco, a introdução de protocolos padronizados de tratamento anti-hipertensivo, a prevenção secundária e o trabalho em equipe. A educação dos pacientes, a busca ativa de casos e as atividades comunitárias também foram incentivadas. Os dados foram obtidos a partir dos registros de implementação e foram analisados com o programa de estatística SPSS versão 21. São relatadas medidas de desfecho e seus intervalos de confiança de 95%. Foram avaliados os seguintes indicadores populacionais: cobertura de registro, controle entre os pacientes tratados e controle populacional, bem como o índice de maturidade dos processos da Iniciativa HEARTS nas Américas. Comparativamente, entre 2016 e 2021, o número de centros participantes aumentou de um só centro de demonstração para 22 policlínicas em 6 províncias e 7 municípios. Evidenciou-se um aumento significativo nos valores absolutos da população total atendida, do número de pessoas com hipertensão cadastradas, de pacientes controlados entre os tratados e de pessoas com hipertensão controlada entre todos os adultos, embora com variações anuais nos percentuais de cobertura, no controle entre os tratados e no controle populacional. Os maiores avanços ocorreram nos centros que têm equipes de saúde de alto desempenho. Cinco anos após a implementação da Iniciativa HEARTS em Cuba, avança-se rumo à institucionalização da metodologia.

BACKGROUND DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower Blood Pressure in Indigenous and low- and middle-income countries) studied a SMS text messaging–based system for blood pressure measurement and hypertension management in Canadian Aboriginal and Tanzanian communities. The use of SMS text messages is an emerging point of interest in global health care initiatives because of their scalability, customizability, transferability, and cost-effectiveness. OBJECTIVE The study aim was to assess the effect on the difference in blood pressure reduction of active hypertension management messages or passive health behavior messages. The system was designed to be implemented in remote areas with wireless availability. This study described the implementation and evaluation of technical components, including quantitative data from the transmission of blood pressure measurements and qualitative data collected on the operational aspects of the system from participants, health care providers, and community leadership. METHODS The study was implemented in six remote Indigenous Canadian and two rural Tanzanian communities. Blood pressure readings were taken by a community health worker and transmitted to a mobile phone via Bluetooth, then by wireless to a programmed central server. From the server, the readings were sent to the participant’s own phone as well. Participants also received biweekly tailored SMS text messages on their phones. Quantitative data on blood pressure reading transmissions were collected from the study central server. Qualitative data were collected by surveys, focus groups, and key informant interviews of participants, health care providers, and health leadership. RESULTS In Canada, between February 2014 and February 2017, 2818 blood pressure readings from 243 patients were transmitted to the central server. In Tanzania, between October 2014 and August 2015, 1165 readings from 130 patients were transmitted to the central server. The use of Bluetooth technology enabled the secure, reliable transmission of information from participants to their health care provider. The timing and frequency were satisfactory to 137 of 187 (73.2%) of participants, supporting the process of sending weekly messages twice on Mondays and Thursdays at 11 am. A total of 97.0% (164/169) of the participants surveyed said they would recommend participation in the DREAM-GLOBAL program to a friend or relative with hypertension. CONCLUSIONS In remote communities, the DREAM-GLOBAL study helped local health care providers deliver a blood pressure management program that enabled patients and community workers to feel connected. The technical components of the study were implemented as planned, and patients felt supported in their management through the SMS text messaging and mobile health program. Technological issues were solved with troubleshooting. Overall, the technical aspects of this research program enhanced clinical care and study evaluation and were well received by participants, health care workers, and community leadership. CLINICALTRIAL Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226.

Chronic diseases including cardiovascular disease and cancer are the leading causes of disability and death in Canada.1,2 The majority of chronic diseases are caused by physical inactivity, tobacco use, excess alcohol consumption and unhealthy diet.3-6 In particular, unhealthy diet is the leading risk factor for death and disability in Canada resulting in an estimated 64,000 deaths and over 1 million years of disability (DALYs) in 2010 alone.7 Worldwide, a staggering 11 million deaths and over 200 million DALYs were attributed to unhealthy eating in 2010.

Questionnaire used by physicians when reviewing medical charts. (DOC 144Â kb)

List of Read codes (Table S1) and antihypertensive drugs (Table S2), Clinical characteristics of study cohort with the age of 60 to 65 (Table S3) and 70 to 75 (Table S4). (DOCX 36 kb)

Canadian Institute for Health Information methodology to identify ACSC hospitalizations for uncomplicated hypertension in the discharge abstract database. (DOC 33Â kb)

BACKGROUND Hypertension, the leading cause of morbidity and mortality, affects more than 1 billion people and is responsible globally for 10 million deaths annually. Hypertension can be controlled on a national level; in Canada, for example, awareness, treatment, and control improved dramatically from only 16% in 1990 to 66% currently. The ongoing development, dissemination, and implementation of Hypertension Canada’s clinical practice guidelines is considered to be responsible, in part, for achieving these high levels of control and the associated improvements in cardiovascular outcomes. A gap still exists between the evidence and the implementation of hypertension guidelines in Indigenous communities in Canada, as well as in low- and middle-income countries (LMICs). The rapid rise in the ownership and use of mobile phones globally and the potential for texting (short message service, SMS) to improve health literacy and to link the health team together with the patient served as a rationale for the Dream-Global study in both Canada and Tanzania. OBJECTIVE The primary objective of the Dream-Global study is to assess the effect of innovative technologies and changes in health services delivery on blood pressure (BP) control of Indigenous people in Canada and rural Tanzanians with hypertension using SMS messages and community BP measurement through task shifting with transfer of the measures electronically to the patient and the health care team members. METHODS This prospective, randomized blinded allocation study enrolls both adults with uncontrolled hypertension (medicated or unmedicated) and those without hypertension but at high risk of developing this condition who participate in a BP screening study. Participants will be followed for at least 12 months. RESULTS The primary efficacy endpoint in this study will be assessed by analysis of variance. Descriptive data will be given with the mean and standard deviation for continuous data and proportions for ordinal data. Exploratory subgroup analyses will include analysis by community, sex, mobile phone ownership at baseline, and age. The knowledge gained from the text messages will be assessed using a questionnaire at study completion, and results will be compared between the groups. CONCLUSIONS This study is expected to provide insights into the implementation of an innovative system of guidelines- and community-based treatment and follow-up for hypertension in Indigenous communities in Canada and in Tanzania, an example of an LMIC. These insights are expected to provide the information needed to plan scalable and sustainable interventions to control BP virtually anywhere in the world. CLINICALTRIAL Clinicaltrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 (Archived by WebCite at http://www.webcitation.org/6v7IdYzZh)

The diagnosis of hypertension is fundamental to the practice of medicine. Increased blood pressure (BP) is the second leading global risk factor for death and disability (behind unhealthy diets), accounting for 18% of global deaths (>9 million deaths per year).1 Contemporary guidelines recommend assessing BP at every care visit; thus, BP measurement is probably the most commonly performed diagnostic maneuver in medicine.2 Importantly, evolving technology is making the diagnosis of hypertension more accurate, reliable, and rapid.

The diagnosis of hypertension is fundamental to the practice of medicine. Increased blood pressure (BP) is the second leading global risk factor for death and disability (behind unhealthy diets), accounting for 18% of global deaths (>9 million deaths per year).1 Contemporary guidelines recommend assessing BP at every care visit; thus, BP measurement is probably the most commonly performed diagnostic maneuver in medicine.2 Importantly, evolving technology is making the diagnosis of hypertension more accurate, reliable, and rapid.

Each year, World Health Day celebrates the formation of the World Health Organization. In 2013, the theme is hypertension, and on April 4 there will be a media release from the World Health Organization (http://www.who.int/ world-healthday/en/). The WHO intends to focus attention on “the causes and consequences of hypertension, the need for people to have healthy behaviours to prevent hypertension, the need for regular blood pressure checks, and the need for governments to create healthy environments that would assist in preventing hypertension.” Increased blood pressure is recognized by the WHO as the leading risk for death and disability worldwide. An estimated 9.4 million deaths annually and 7% of all disability are caused by increased blood pressure. The World Hypertension League supports the efforts of the WHO to bring attention to hypertension and requests national hypertension organizations and experts utilize the World Health Day to advocate for actions to prevent and control hypertension. In addition, the World Hypertension League through its national member leagues and societies promote public awareness of hypertension through World Hypertension Day, annually, on May 17th. The World Hypertension League reminds all that

Directly measured blood pressure (BP) data have not been collected in Canada since the Canadian Heart Health Surveys, conducted between 1985 and 1992. Because hypertension is often asymptomatic, a large proportion of those with the condition are unaware of it.These analyses use BP and heart rate (HR) data from cycle 1 of the 2007-2009 Canadian Health Measures Survey (CHMS) for respondents aged 6 to 79 years. Methods and quality assurance and control procedures are explained. Logistical and feasibility issues that arose during data collection are discussed. The reasons for repeating a series of measures are given. Between- and within- series variations and inter-tester variability are assessed.The BP and HR of almost all respondents who attended the examination centre were measured. Only one series of measurements was taken for 88% of respondents. The series was repeated for around 5% with variability in their BP or HR measurements. About 3% had HR or BP values above the screening cut-offs for the fitness tests. Almost 35% of respondents with HR or BP values above the screening cut-offs after their first series had values below the cut-points after the second series; a further 3% had values below after the third series. Within a series of six measurements, BP decreased until about the fourth measure, after which it remained stable. Mean BP and HR values indicated no inter-tester variability.The protocol for measuring BP and HR by oscillometry in the CHMS appears to have produced reliable estimates. No benefit to repeating the series of six measurements a third time for screening purposes is evident. Four measurements may be sufficient to provide reliable BP and HR data. Oscillometry appears to eliminate inter-tester variability.

Chronic diseases including cardiovascular disease and cancer are the leading causes of disability and death in Canada.1,2 The majority of chronic diseases are caused by physical inactivity, tobacco use, excess alcohol consumption and unhealthy diet.3-6 In particular, unhealthy diet is the leading risk factor for death and disability in Canada resulting in an estimated 64,000 deaths and over 1 million years of disability (DALYs) in 2010 alone.7 Worldwide, a staggering 11 million deaths and over 200 million DALYs were attributed to unhealthy eating in 2010.