Norm R C Campbell

Publications (39)173.18 Total impact

• Article: Outcomes Among 3.5 Million Newly Diagnosed Hypertensive Canadians.

  Hude Quan, Guanmin Chen, Karen Tu, Gillian Bartlett, Debra A Butt, Norm R C Campbell, Brenda R Hemmelgarn, Michael D Hill, Helen Johansen, Nadia Khan, Lisa M Lix, Mark Smith, Larry Svenson, Robin L Walker, Andy Wielgosz, Finlay A McAlister
  [show abstract] [hide abstract]
  ABSTRACT: 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.
  The Canadian journal of cardiology 03/2013; · 3.36 Impact Factor
• Article: High Blood Pressure Selected As the Theme for World Health Day April 7, 2013: Cup Half Full or Half Empty?

  Norm R C Campbell, Ross D Feldman, Janusz Kaczorowski, Pierre Larochelle
  The Canadian journal of cardiology 02/2013; · 3.36 Impact Factor
• Article: Incidence, cardiovascular complications and mortality of hypertension by sex and ethnicity.

  Hude Quan, Guanmin Chen, Robin L Walker, Andy Wielgosz, Sulan Dai, Karen Tu, Norm R C Campbell, Brenda R Hemmelgarn, Michael D Hill, Helen Johansen, Finlay A McAlister, Nadia Khan
  [show abstract] [hide abstract]
  ABSTRACT: OBJECTIVE: To compare ethnic and sex difference in the incidence of newly diagnosed hypertension, and subsequent risk of cardiovascular disease outcomes among South Asian, Chinese and white patients. METHODS: We identified patients with newly diagnosed hypertension aged ≥20 years. Patients were followed for 1-9 years for all-cause mortality and cardiovascular disease with myocardial infarction, heart failure and stroke. Cox proportional hazard models stratified by sex and adjusted for age, median income and co-morbid conditions, were constructed to determine the independent association between ethnicity and the development of the combined cardiovascular endpoint as well as death. RESULTS: There were 39 175 South Asian (49.4% men, 34.4% age ≥65), 49 892 Chinese (48.1% men, 36.7% age ≥65) and 841 277 white (47.9% men, 38.8% age ≥65) patients with newly diagnosed hypertension. Age and sex adjusted incidence of hypertension was highest in South Asian patients and lowest in Chinese patients. Compared with white patients, South Asian and Chinese patients had a lower mortality (adjusted HR (aHR) 0.91 and 0.66) and risk of cardiovascular disease outcomes (aHR 0.94 and 0.49). Compared to men, women had significantly lower mortality (aHR: 0.83 for Chinese, 0.78 for South Asian and 0.77 for white) and cardiovascular disease outcomes (0.72 for Chinese, 0.63 for South Asian and 0.65 for white). CONCLUSIONS: South Asian patients had higher rates of hypertension compared to the other ethnic groups. South Asian and Chinese patients had a lower risk of death and developing cardiovascular outcomes compared to whites. Women with hypertension have a better prognosis than men regardless of ethnicity.
  Heart (British Cardiac Society) 02/2013; · 4.22 Impact Factor
• Article: Efforts to reduce dietary salt in the Americas.

  Norm R C Campbell, Ricardo Correa-Rotter, Barbara Legowski, Branka Legetic
  Revista Panamericana de Salud Pública 10/2012; 32(4):253-257. · 0.85 Impact Factor
• Article: Monitoring and Evaluating Efforts to Control Hypertension in Canada: Why, How, and What It Tells Us Needs to Be Done About Current Care Gaps.

  Norm R C Campbell, Finlay A McAlister, Hude Quan
  [show abstract] [hide abstract]
  ABSTRACT: Blood pressure surveillance, monitoring, and evaluation of programs to prevent and control hypertension are critical because increased blood pressure is a leading risk for premature death and disability. Since 2003, the Hypertension Outcomes Research Task Force has existed in Canada, with members who assist in the development and revision of surveys and conduct analyses that help guide hypertension programs. Although the Task Force has tracked a 5-fold increase in the control of hypertension (from 13% in 1985-1992 to 65% in 2007-2009), surveillance data also indicate that many "care gaps" remain. Fifty-four percent of people with diabetes and 34% of those without diabetes have blood pressure readings greater than their target. Treatment rates are high in those who are diagnosed (95%), but 17% of people with hypertension remain undiagnosed. Younger men (more so than women) are too often unaware of having hypertension. Although they are more likely to be aware of their diagnosis, older women are 2 times more likely to have uncontrolled hypertension than men; systolic blood pressure is high in over 80% of those with uncontrolled blood pressure (90% in women); and often people with hypertension are not provided comprehensive advice on healthy behaviours, or assisted in developing plans to control their blood pressure. Many current surveys do not have adequate statistical power to assess vulnerable populations; surveys of Aboriginal populations do not usually assess blood pressure, such that the burden of hypertension in these high risk populations cannot be assessed.
  The Canadian journal of cardiology 07/2012; · 3.36 Impact Factor
• Article: Hypertension revisited.

  Norm R C Campbell, Richard E Gilbert, Lawrence A Leiter, Pierre Larochelle, Sheldon Tobe, Arun Chockalingam, Richard Ward, Dorothy Morris, Ross T Tsuyuki, Stewart Harris
  Canadian family physician Medecin de famille canadien 06/2012; 58(6):634-6. · 1.19 Impact Factor
• Article: Antihypertensive medication use, adherence, stops, and starts in Canadians with hypertension.

  Marianne E Gee, Norm R C Campbell, Femida Gwadry-Sridhar, Robert P Nolan, Janusz Kaczorowski, Asako Bienek, Cynthia Robitaille, Michel Joffres, Sulan Dai, Robin L Walker
  [show abstract] [hide abstract]
  ABSTRACT: Some of the greatest barriers to achieving blood pressure control are perceived to be failure to prescribe antihypertensive medication and lack of adherence to medication prescriptions. Self-reported data from 6017 Canadians with diagnosed hypertension who responded to the 2008 Canadian Community Health Survey and the 2009 Survey on Living with Chronic Diseases in Canada were examined. The majority (82%) of individuals with diagnosed hypertension reported using antihypertensive medications. The main reasons for not taking medications were either that they were not prescribed (42%) or that blood pressure had been controlled without medications (45%). Of those not taking antihypertensive medications in 2008 (n = 963), 18% had started antihypertensive medications by 2009, and of those initially taking medications (n = 5058), 5% had stopped. Of those taking medications in 2009, 89% indicated they took the medication as prescribed, and 10% indicated they occasionally missed a dose. Participants who were recently diagnosed, not measuring blood pressure at home, not having a plan to control blood pressure, or not receiving instructions on how to take medications were less likely to be taking antihypertensive medications; similar factors tended to be associated with stopping antihypertensive medication use. Compatible with high rates of hypertension control, most Canadians diagnosed with hypertension take antihypertensive medications and report adherence. Widespread implementation of self-management strategies for blood pressure control and standardized instructions on antihypertensive medication may further optimize drug treatment.
  The Canadian journal of cardiology 04/2012; 28(3):383-9. · 3.36 Impact Factor
• Article: Factors associated with lack of awareness and uncontrolled high blood pressure among Canadian adults with hypertension.

  Marianne E Gee, Asako Bienek, Finlay A McAlister, Cynthia Robitaille, Michel Joffres, Mark S Tremblay, Helen Johansen, Norm R C Campbell
  [show abstract] [hide abstract]
  ABSTRACT: Approximately 17% of Canadians with high blood pressure were unaware of their condition, and of Canadians aware of having the condition, approximately 1 in 5 have uncontrolled high blood pressure despite high rates of pharmacotherapy. The objectives of the current study are to estimate the prevalence of resistant hypertension and examine factors associated with (1) lack of awareness and (2) uncontrolled hypertension despite pharmacotherapy. Using the 2007-2009 Canadian Health Measures Survey (N = 3473, aged 20-79 years) and logistic regression, we quantified relationships between characteristics and (1) presence of hypertension, (2) lack of awareness (among those with hypertension), and (3) uncontrolled high blood pressure (among those treated for hypertension). Older age, lowest income, and less than high school education were associated with presence of hypertension. Men (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2) and adults < 60 years (OR, 1.7; 95% CI, 1.1-2.6) were more likely than others to be unaware. Among those aged 60+ years, women were more likely than men to have uncontrolled high blood pressure (OR, 2.4; 95% CI, 1.1-5.2) despite treatment. Elevated systolic blood pressure was the issue in over 90% of women and 80% of men with uncontrolled hypertension. Depending on the definition employed, 4.4% (95% CI, 2.4-6.4) to 7.8% (95% CI, 6.0-9.6) of the population with hypertension had resistant hypertension. Messaging or interventions encouraging screening may be helpful for all younger Canadian adults and men; programs encouraging blood pressure control may help older women.
  The Canadian journal of cardiology 03/2012; 28(3):375-82. · 3.36 Impact Factor
• Article: New recommendations for the use of ambulatory blood pressure monitoring in the diagnosis of hypertension.

  Norm R C Campbell, Brenda R Hemmelgarn
  Canadian Medical Association Journal 02/2012; 184(6):633-4. · 8.22 Impact Factor
• Article: Hypertension in people with type 2 diabetes: Update on pharmacologic management.

  Norm R C Campbell, Richard E Gilbert, Lawrence A Leiter, Pierre Larochelle, Sheldon Tobe, Arun Chockalingam, Richard Ward, Dorothy Morris, Ross T Tsuyuki, Stewart B Harris
  [show abstract] [hide abstract]
  ABSTRACT: To summarize the evidence for the need to improve pharmacologic management of hypertension in people with type 2 diabetes and to provide expert advice on how blood pressure (BP) treatment can be improved in primary care. Studies were obtained by performing a systematic review of the literature on hypertension and diabetes, from which management recommendations were developed, reviewed, and voted on by a group of experts selected by the Canadian Hypertension Education Program and the Canadian Diabetes Association; authors' expert opinions on optimal pharmacologic management were also considered during this process. The pathogenesis of hypertension in patients with diabetes is complex, involving a range of biological and environmental factors and genetic predisposition; as a result, hypertension in people with diabetes incurs higher associated risks and adverse events. Mortality and morbidity are heightened in diabetes patients who do not achieve BP control (ie, a target value of less than 130/80 mm Hg). Large randomized controlled trials and meta-analyses of randomized controlled trials have shown that reducing BP pharmacologically is single-handedly the most effective way to reduce rates of death and disability in patients with diabetes, particularly associated cardiovascular risks. Often, combinations of 2 or more drugs (diuretics, angiotensin-converting enzyme inhibitors, β-blockers, angiotensin receptor blockers, calcium channel blockers, spironolactone, etc) are required for pharmacotherapy to be effective, particularly for patients in whom BP is difficult to control. However, the health care costs associated with extensively lowering BP are substantially less than the costs associated with treating the complications that can be prevented by lowering BP. Detecting and managing hypertension in people with diabetes is one of the most effective measures to prevent adverse events, and pharmacotherapy is one of the most effective ways to maintain target BP levels in primary care.
  Canadian family physician Medecin de famille canadien 09/2011; 57(9):997-1002, e347-53. · 1.19 Impact Factor
• Source

  Available from: Mary L'abbe

  Article: Canadian initiatives to prevent hypertension by reducing dietary sodium.

  Norm R C Campbell, Kevin J Willis, Mary L'Abbe, Robert Strang, Eric Young
  [show abstract] [hide abstract]
  ABSTRACT: Hypertension is the leading risk for premature death in the world. High dietary sodium is an important contributor to increased blood pressure and is strongly associated with other important diseases (e.g., gastric cancer, calcium containing kidney stones, osteoporosis, asthma and obesity). The average dietary sodium intake in Canada is approximately 3400 mg/day. It is estimated that 30% of hypertension, more than 10% of cardiovascular events and 1.4 billion dollars/year in health care expenses are caused by this high level of intake in Canada. Since 2006, Canada has had a focused and evolving effort to reduce dietary sodium based on actions from Non Governmental Organizations (NGO), and Federal and Provincial/Territorial Government actions. NGOs initiated Canadian sodium reduction programs by developing a policy statement outlining the health issue and calling for governmental, NGO and industry action, developing and disseminating an extensive health care professional education program including resources for patient education, developing a public awareness campaign through extensive media releases and publications in the lay press. The Federal Government responded by striking a Intersectoral Sodium Work Group to develop recommendations on how to implement Canada's dietary reference intake values for dietary sodium and by developing timelines and targets for foods to be reduced in sodium, assessing key research gaps with funding for targeted dietary sodium based research, developing plans for public education and for conducting evaluation of the program to reduce dietary sodium. While food regulation is a Federal Government responsibility Provincial and Territorial governments indicated reducing dietary sodium needed to be a priority. Federal and Provincial Ministers of Health have endorsed a target to reduce the average consumption of sodium to 2300 mg/day by 2016 and the Deputy Ministers of Health have tasked a joint committee to review the recommendations of the Sodium Work Group and report back to them.
  Nutrients 08/2011; 3(8):756-64. · 0.68 Impact Factor
• Article: Health behaviour advice from health professionals to Canadian adults with hypertension: results from a national survey.

  Robin L Walker, Marianne E Gee, Christina Bancej, Robert P Nolan, Janusz Kaczorowski, Michel Joffres, Asako Bienek, Femida Gwadry-Sridhar, Norman R C Campbell
  [show abstract] [hide abstract]
  ABSTRACT: Health professionals play an important role in providing health information to patients. The objectives of this study were to examine the type of advice that Canadians with hypertension recall receiving from health professionals to manage their condition, and to assess if there is an association between health behaviour advice provided by health professionals and self-reported engagement in health behaviour modification. Respondents of the 2009 Survey on Living with Chronic Diseases in Canada (N = 6142) were asked about sociodemographic characteristics, health care utilization, and health behaviour modification to control hypertension. Association between receipt of advice from health professional and ever engaging, continuing to engage, and not engaging in health behaviour modification was quantified by prevalence rate ratios. Most participants (90.9%; 95% confidence interval [CI], 89.6-92.2) reported that the health professional most responsible for treating their high blood pressure was their general practitioner. Approximately 9% reported that they had not received or do not recall receiving any advice for blood pressure control. The most commonly reported advice received from a health professional was to participate in physical activity or exercise (70.0%). Respondents who had received advice on health behaviour change to manage their high blood pressure were more likely to report engaging in the behaviour compared with those who did not receive such advice. Many Canadians with hypertension receive health behaviour change advice from their health professionals. Receiving this advice was associated with a greater likelihood of attempting health behaviour change and attempting to sustain that change.
  The Canadian journal of cardiology 06/2011; 27(4):446-54. · 3.36 Impact Factor
• Article: Hypertension: prevention is the next great challenge and reducing dietary sodium is the starting point.

  Norman R C Campbell, Robert Strang, Eric Young
  The Canadian journal of cardiology 06/2011; 27(4):434-6. · 3.36 Impact Factor
• Article: Mobilising the Americas for dietary salt reduction.

  Norm R C Campbell, Barbara Legowski, Branka Legetic
  The Lancet 03/2011; 377(9768):793-5. · 38.28 Impact Factor
• Article: Cardiovascular outcomes in framingham participants with diabetes: the importance of blood pressure.

  Guanmin Chen, Finlay A McAlister, Robin L Walker, Brenda R Hemmelgarn, Norm R C Campbell
  [show abstract] [hide abstract]
  ABSTRACT: We designed this study to explore to what extent the excess risk of cardiovascular events in diabetic individuals is attributable to hypertension. We retrospectively analyzed prospectively collected data from the Framingham original and offspring cohorts. Of the 1145 Framingham subjects newly diagnosed with diabetes mellitus who did not have a previous history of cardiovascular events, 663 (58%) had hypertension at the time that diabetes mellitus was diagnosed. During 4154 person-years of follow-up, 125 died, and 204 experienced a cardiovascular event. Framingham participants with hypertension at the time of diabetes mellitus diagnosis exhibited higher rates of all-cause mortality (32 versus 20 per 1000 person-years; P<0.001) and cardiovascular events (52 versus 31 per 1000 person-years; P<0.001) compared with normotensive subjects with diabetes mellitus. After adjustment for demographic and clinical covariates, hypertension was associated with a 72% increase in the risk of all-cause death and a 57% increase in the risk of any cardiovascular event in individuals with diabetes mellitus. The population-attributable risk from hypertension in individuals with diabetes mellitus was 30% for all-cause death and 25% for any cardiovascular event (increasing to 44% and 41%, respectively, if the 110 normotensive subjects who developed hypertension during follow-up were excluded from the analysis). In comparison, after adjustment for concurrent hypertension, the population-attributable risk from diabetes mellitus in Framingham subjects was 7% for all-cause mortality and 9% for any cardiovascular disease event. Although diabetes mellitus is associated with increased risks of death and cardiovascular events in Framingham subjects, much of this excess risk is attributable to coexistent hypertension.
  Hypertension 03/2011; 57(5):891-7. · 6.21 Impact Factor
• Source

  Available from: PubMed Central

  Article: Do recommendations for the management of hypertension improve cardiovascular outcome? The canadian experience.

  Peter Bolli, Norm R C Campbell
  [show abstract] [hide abstract]
  ABSTRACT: The Canadian Hypertension Education Program (CHEP) was established in 1999 as a response to the result of a national survey that showed that a high percentage of Canadians were unaware of having hypertension with only 13% of those treated for hypertension having their blood pressure controlled. The CHEP formulates yearly recommendations based on published evidence. A repeat survey in 2006 showed that the percentage of treated hypertensive patients with the blood pressure controlled had risen to 65.7%. Over the first decade of the existence of the CHEP, the number of prescriptions for antihypertensive medications had increased by 84.4% associated with a significant greater decline in the yearly mortality from stroke, heart failure and myocardial infarction and a significant decrease in the hospitalization for stroke and heart failure. Therefore, the introduction of the CHEP and the yearly issue of updated recommendations resulted in a significant increase in the awareness, diagnosis and treatment of hypertension and in a significant reduction in stroke and cardiovascular morbidity and mortality. The CHEP model could serve as a template for its adoption to other regions or countries.
  International journal of hypertension. 01/2011; 2011:410754.
• Article: The Canadian effort to prevent and control hypertension: can other countries adopt Canadian strategies?

  Norm R C Campbell, Tobe Sheldon
  [show abstract] [hide abstract]
  ABSTRACT: To indicate the key elements of current Canadian programs to treat and control hypertension. In the early 1990s Canada had a hypertension treatment and control rate of 13%. A Canadian strategy to prevent and control hypertension was developed and a coalition of national organizations and volunteers formed to develop increasingly extensive programs. The Canadian effort was largely based on annually updated hypertension management recommendations, an integrated and extensive hypertension knowledge translation program and an increasingly comprehensive outcomes assessment program. After the start of the annual process in 1999, there were very large increases in diagnosis and hypertension treatment coupled with dropping rates of cardiovascular disease. More recent initiatives include an extensive education program for the public and people with hypertension, a program to reduce dietary salt and a funded leadership position. The treatment and control rate increased to 66% when last assessed (2007-2009). The study describes important aspects of the Canadian hypertension management programs to aid those wishing to develop similar programs. Many of the programs could be fully or partially implemented by other countries.
  Current opinion in cardiology 07/2010; 25(4):366-72. · 2.66 Impact Factor
• Article: Hypertension: are you and your patients up to date?

  Selina Omar Allu, Jocelyne Bellerive, Robin L Walker, Norm R C Campbell
  [show abstract] [hide abstract]
  ABSTRACT: While there have been substantive efforts to improve treatment and control of hypertension in Canada, many individuals with hypertension remain unaware of their condition and many health care professionals are unaware of key hypertension management recommendations. The present article reviews the new Canadian strategic direction for increased knowledge translation and dissemination of information to patients and health care professionals by providing new, innovative and easily accessible resources for hypertension education in Canada. A multitude of resources that address the diverse learning needs of health care professionals and the general public are highlighted.
  The Canadian journal of cardiology 05/2010; 26(5):261-4. · 3.36 Impact Factor
• Article: Confirming the critical importance of blood pressure control in people with diabetes.

  Norm R C Campbell, Lawrence A Leiter, Pierre Larochelle, Sheldon Tobe, Arun Chockalingam, Richard Ward, Dorothy Morris, Ross Tysuyuki
  The Canadian journal of cardiology 10/2009; 25(10):594-5. · 3.36 Impact Factor
• Source

  Available from: ecmaj.ca

  Article: Effective population-wide public health interventions to promote sodium reduction.

  Sailesh Mohan, Norm R C Campbell, Kevin Willis
  Canadian Medical Association Journal 09/2009; 181(9):605-9. · 8.22 Impact Factor