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- Page navigation anchor for Hypertension control, commercial support, and the way forwardHypertension control, commercial support, and the way forward
We thank Dr. Lexchin for his comments. Word and reference limits precluded us from addressing all issues, and industry funding had not been quantitatively reported in prior publications. The effort that was associated with improved hypertension control in Canada was initiated in 2000, by an academic and clinical coalition, with limited industry funding (1). At the time, the hypertension control rate in Canada was 13%, representing half of the control rate seen in the United States. In contrast to the United States’ government funded program, there were no governmental or academic funding sources interested in hypertension control. With great effort over many years, the hypertension control rate in both in Ontario (2006) and nationally (2007-2009) had risen to 66% and these gains were associated with markedly increased prescriptions for antihypertensive drugs, and a corresponding reduction in the rates of death and hospitalizations for cardiovascular disease (1). The hypertension control program had a series of steps to reduce bias from commercial sources including oversight by major national primary care organizations, the Public Health Agency of Canada, and the Heart and Stroke Foundation. Enhanced education was provided through the program, a partnered Heart and Stroke Foundation program, and by pharmaceutical company programs, as well as traditional sources (2). The program worked with pharmaceutical companies and traditional education programs to align with the hyperte...
Show MoreCompeting Interests: Alexander Leung was involved in the development of the Hypertension Canada clinical practice guidelines (2016–2020) and is cochair of Hypertension Canada’s research and evaluation committee. He also reports grants from the Canadian Institutes of Health Research and Hypertension Canada, outside the submitted work. Alan Bell is a member of the board of directors of Hypertension Canada, cochair of the implementation and education committee (2016–present) and coauthor of the clinical practice guidelines (2020). He also reports consulting fees from Amgen, Bristol Myers Squibb, Janssen, AstraZeneca, Novartis, Pfizer, Bayer, Lilly, Boehringer Ingelheim, HLS Therapeutics, Spectrum Therapeutics, Sanofi, Bausch Health. Ross Tsuyuki is the president of Hypertension Canada (2020–present), cochair of the implementation and education committee (2017–present), member of the Implementation Research Task Force (2005–2011) and the Public Recommendations Task Force (2007–2010), and editor-in-chief of the Canadian Pharmacists Journal. He also reports consulting fees from Emergent Biosolutions, Shoppers Drug Mart and HLS Therapeutics, as well as an honorarium from Sanofi Genzyme. Norman Campbell is past president and special advisor to the board of the World Hypertension League, and is vice chair of the Canadian Hypertension Advisory Committee. He reports support from Resolve to Save Lives, World Bank, the Pan American Health Organization and the World Health Organization related to involvement in hypertension control programs. He is also a consultant to the Hearts in the Americas Initiative of the Pan American Health Organization (2012–present), and a reviewer of the World Health Organization Hearts Program (2014–present). He reports personal fees from Resolve to Save Lives (RTSL), and the World Bank outside the submitted work, and is an unpaid consultant on dietary sodium and hypertension control to numerous governmental and non-governmental organizations.References
- 1. Campbell NR, Tobe S. The Canadian effort to prevent and control hypertension: can other countries adopt Canadian strategies? Curr Opin Cardiol. 2010 Jul;25(4):366-72. doi: 10.1097/HCO.0b013e32833a3632.
- 2. Drouin D, Campbell NR, Kaczorowski J. Implementation of recommendations on hypertension: the Canadian Hypertension Education Program. Can J Cardiol. 2006 May 15;22(7):595-8. doi: 10.1016/s0828-282x(06)70281-1.
- 3. Campbell NRC, Ordunez P, Giraldo G, et al. WHO HEARTS: A Global Program to Reduce Cardiovascular Disease Burden: Experience Implementing in the Americas and Opportunities in Canada. Can J Cardiol. 2021 May;37(5):744-755. doi: 10.1016/j.cjca.2020.12.004
- 4. World Health Organization. Improving hypertension control in 3 million people: country experiences of programme development and implementation. Geneva: World Health Organization; 2020.
- 5. Global burden of disease study. Seattle (WA): University of Washington, Institute for Health Metrics and Evaluation; 2017. Available: http://vizhub.healthdata.org/gbd-compare (accessed July 22, 2021).
- Page navigation anchor for RE: Refocusing on hypertension control in CanadaRE: Refocusing on hypertension control in Canada
In the article entitled “Refocusing on hypertension control in Canada” (1), the authors speculate that one of the reasons for the decline in focus on hypertension control is because of the “termination of industry sponsorship for education initiatives” due to the genericization of medications used to treat hypertension. In support of this statement they cite an article in the Canadian Journal of Cardiology (2) which was co-authored by some of the same people. That second article cites one possible cause for the decline in control of hypertension in women as being a “termination of pharmaceutical industry support resulting from widespread genericization of medications” but there is no explicit mention of education initiatives. This second article refers to an article in the Annals of Global Health (3) also with some authors in common from the first two publications. The third article also does not mention anything about education initiatives and just refers to a decline in Canadian investments in hypertension research by pharmaceutical companies and the federal government. The citation for this statement is a 2014 strategic plan from the Institute of Circulatory and Respiratory Health (4). Once again, anything about education initiatives is absent and the only mention of the pharmaceutical industry is with respect to the effectiveness of adequate links between academic research and industry. That statement is unreferenced.
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Show MoreCompeting Interests: In 2017-2020, Joel Lexchin received payments for being on a panel at the American Diabetes Association, for talks at the Toronto Reference Library, for writing a brief in an action for side effects of a drug for Michael F. Smith, Lawyer and a second brief on the role of promotion in generating prescriptions for Goodmans LLP and from the Canadian Institutes of Health Research for presenting at a workshop on conflict-of-interest in clinical practice guidelines. He is currently a member of research groups that are receiving money from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is a member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. He receives royalties from University of Toronto Press and James Lorimer & Co. Ltd. for books he has written.References
- 1. Alexander A. Leung, Alan Bell, Ross T. Tsuyuki, et al. Refocusing on hypertension control in Canada. CMAJ 2021;193:E854-E855.
- 2. Leung A, Williams J, McAlister F, Campbell N, Padwal R, Hypertension Canada’s Research and Evaluation Committee. Worsening hypertension awareness, treatment, and control rates in Canadian women between 2007 and 2017. Canadian Journal of Cardiology. 202
- 3. Schiffrin E, Campbell N, Feldman R, Kaczorowski J, Lewanczuk R, Padwal R, et al. Hypertension in Canada: past, present, and future. Annals of Global Health. 2016;82:288-99.
- 4. ICRH strategic plan for 2013-2016 2014 [updated September 8, 2014. Available from: https://cihr-irsc.gc.ca/e/documents/ICRH_Strategic_Plan_En_v8sept2014.pdf.
- 5. Spithoff S, Leece P, Sullivan F, Persaud N, Belesiotis P, Steiner L. Drivers of the opioid crisis: an appraisal of financial conflicts of interest in clinical practice guideline panels at the peak of opioid prescribing. PLoS ONE. 2020;15:e0227045. 6. v