Outcomes Among 3.5 Million Newly Diagnosed Hypertensive Canadians

Background: This population-based study assessed rates of all-cause mortality, myocardial infarction, heart failure, and stroke for up to 12 years of follow-up in 3.5 million Canadian adults newly diagnosed with hypertension. Methods: Hypertension cohort, outcomes, and covariates were defined using validated case definitions applied to inpatient and outpatient administrative health databases. Factors associated with each outcome were identified using Cox proportional hazards models. Results: Of 3,531,089 adults newly diagnosed with hypertension and without a previous history of cardiovascular disease, 29.4% were younger than 50 years of age; 48.2% were male, and 17.2% resided in a rural area. Over a median follow-up length of 6.1 years, the crude all-cause mortality rate was 22.4 per 1000 person-years. The incidence of hospitalized myocardial infarction (8.4 per 1000 person-years) and hospitalized heart failure (8.5 per 1000 person-years) was higher than stroke (6.9 per 1000 person-years). The incidence rate for any cardiovascular hospitalization was 19.3 per 1000 person-years. Older age, male sex, lower income, rural residence, and a higher number of Charlson comorbidities were each independently associated with a higher risk of mortality and incident cardiovascular disease hospitalizations. Conclusions: In a nationally-representative incident cohort of hypertensive adults we have demonstrated higher mortality rates and poorer outcomes for the elderly, males, and those living in rural or low income locations. Innovative approaches to the provision of care for these high-risk individuals will lead to improved patient outcomes.