Characterizing Hypertension Specialist Care in Canada: A National Survey
Samantha Lui, MD,
Lisa Dubrofsky, MD,
Nadia A. Khan, MD, MSc,
Sheldon W. Tobe, MD,
Jessica Huynh, MD, MHSc,
Laura Kuyper, MD,
Anna Mathew, MD,
Syed Amin, MD,
Ernesto L. Schiffrin, MD, PhD,
Paula Harvey, MD, BMBS, PhD,
Alexander A. Leung, MD, MPH,
Marcel Ruzicka, MD, PhD,
Birinder Mangat, MD, MPH,
David Reid, MD,
John Floras, MD,
Jesse Bittman, MD,
Lauren Garbutt, MD,
Branko Braam, MD,
Rita Suri, MD, MSc,
Fady Hannah-Shmouni, MD,
Ally Prebtani, MD, BScPhm,
Sebastien Savard, MD,
Thomas E. MacMillan, MD, MSc,
Terrence D. Ruddy, MD,
Michel Vallee, MD,
Apoorva Bollu, MD,
Alexander Logan, MD,
Raj Padwal, MD, MSc,
Jennifer Ringrose, MD, MSc
Affiliations
Samantha Lui, MD
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Lisa Dubrofsky, MD
Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada, Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Nadia A. Khan, MD, MSc
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Sheldon W. Tobe, MD
Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto, Toronto and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
Jessica Huynh, MD, MHSc
Department of General Internal Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
Laura Kuyper, MD
Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Anna Mathew, MD
Division of Nephrology, Department of Medicine, St. Joseph Healthcare Hamilton, Hamilton, Ontario, Canada
Syed Amin, MD
Division of Nephrology, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
Ernesto L. Schiffrin, MD, PhD
Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
Paula Harvey, MD, BMBS, PhD
Division of Cardiology, Department of Medicine and Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
Alexander A. Leung, MD, MPH
Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Marcel Ruzicka, MD, PhD
Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
Birinder Mangat, MD, MPH
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
David Reid, MD
Dvision of Nephrology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
John Floras, MD
University Health Network and Sinai Health Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Jesse Bittman, MD
Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Lauren Garbutt, MD
Division of Endocrinology, University of Manitoba, Winnipeg, Manitoba, Canada
Branko Braam, MD
Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
Rita Suri, MD, MSc
Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
Fady Hannah-Shmouni, MD
Division of Endocrinology, University of British Columbia, Vancouver, British Columba, Canada, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
Ally Prebtani, MD, BScPhm
Division of Endocrinology & Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Sebastien Savard, MD
Department of Medicine, Universite Laval, Hotel-Dieu de Quebec, Quebec City, Quebec, Canada
Thomas E. MacMillan, MD, MSc
Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
Terrence D. Ruddy, MD
Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Michel Vallee, MD
Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
Apoorva Bollu, MD
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
Alexander Logan, MD
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Raj Padwal, MD, MSc
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
Jennifer Ringrose, MD, MSc
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Corresponding author: Dr Jennifer Ringrose, General Internal Medicine, Associate Professor of Medicine, University of Alberta, 5-135 Clinical Sciences Building, 11350 - 83rd Ave, Edmonton, Alberta T6G 2G3, Canada. Tel.: +1-780-492-2295; fax : +1-780-492-7277.
Background: The hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertension control strategy. The objective of this study was to characterize hypertension centres and the practice patterns of Canadian hypertension specialists. Methods: Adult hypertension specialists across Canada were surveyed to describe hypertension centres and specialist practice in Canada, including the following: the patient population managed by hypertension specialists; details on how care is provided; practice pattern variations; and differences in access to specialized hypertension resources across the country. Results: The survey response rate was 73.5% from 25 hypertension centres. Most respondents were nephrologists and general internal medicine specialists. Hypertension centres saw between 50 and 2500 patients yearly. A mean of 17% (± 15%) of patients were referred from the emergency department and a mean of 52% (± 24%) were referred from primary care. Most centres had access to specialized testing (adrenal vein sampling, level 1 sleep studies, autonomic testing) and advanced therapies for resistant hypertension (renal denervation). Considerable heterogeneity was present in the target blood pressure in young people with low cardiovascular risk and in the diagnostic algorithms for investigating secondary causes of hypertension. Conclusions: These results summarize the current state of hypertension specialist care and highlight opportunities for further collaboration among hypertension specialists, including standardization of the approach to specialist care for patients with hypertension. Résumé: Contexte: Le spécialiste de l’hypertension reçoit souvent des patients orientés pour une hypertension sévère, d’apparition précoce et difficile à maîtriser, pour une urgence hypertensive ou pour des causes secondaires de l’hypertension. Les soins spécialisés de l’hypertension complètent les soins primaires pour ces cas complexes et font partie d’une stratégie globale de maîtrise de l’hypertension. Cette étude avait pour objectif de caractériser les centres de traitement de l’hypertension et les habitudes de pratique des spécialistes canadiens qui traitent l’hypertension. Méthodologie: Un sondage a été mené auprès de spécialistes de l’hypertension adulte de l’ensemble du Canada afin de décrire les centres de traitement de l’hypertension et la pratique des spécialistes au Canada, notamment les éléments suivants : la population de patients prise en charge par des spécialistes de l’hypertension, les renseignements sur la façon dont les soins sont prodigués, les variations dans les habitudes de pratique ainsi que les différences relatives à l’accès aux ressources spécialisées en hypertension à l’échelle du pays. Résultats: Le taux de réponse au sondage a été de 73,5 % dans 25 centres de l’hypertension. La plupart des répondants étaient des néphrologues et des spécialistes en médecine interne générale. Les centres de l’hypertension recevaient entre 50 et 2500 patients par année. En moyenne, 17 % (± 15 %) des patients provenaient du service des urgences et 52 % (± 24 %) provenaient d’une unité de soins primaires. La plupart des centres avaient accès à des tests spécialisés (prélèvements veineux surrénaliens, études du sommeil de niveau 1, tests autonomes) et à des traitements avancés pour l’hypertension résistante (dénervation rénale). Une hétérogénéité considérable a été constatée en ce qui concerne la pression artérielle cible chez les jeunes présentant un faible risque cardiovasculaire et les algorithmes diagnostiques pour étudier les causes secondaires de l’hypertension. Conclusions: Ces résultats résument la situation actuelle des soins spécialisés de l’hypertension et font ressortir des occasions d’accroître la collaboration entre les spécialistes de l’hypertension, notamment en ce qui concerne une normalisation de l’approche des soins spécialisés pour les patients hypertendus.
