Epidemiologic Implications of the 2025 Hypertension Canada Guideline on Hypertension Prevalence, Treatment and Control: A Population-based Cohort Study

BACKGROUND: In 2025, Hypertension Canada published a new guideline for the management of hypertension in primary care. Key changes included the adoption of lower blood pressure (BP) thresholds for hypertension diagnosis, treatment initiation, and treatment target. This study sought to evaluate the potential epidemiological impacts of the 2025 Hypertension Canada guideline and its implications for Canadian adults. METHODS: Using data from the population-based CARTaGENE cohort, we compared how transitioning from the 2020 to the 2025 Hypertension Canada guideline recommendations could impact hypertension prevalence, indications for antihypertensive treatment, and BP control rates. RESULTS: 16,825 participants were included in the study. Implementation of the 2025 Hypertension Canada guideline increased the number of individuals with hypertension from 7,005 (41.6%) to 8,564 (50.9%, 95% CI, 50.2 to 51.6%), primarily affecting younger participants and those at low-to-moderate cardiovascular risk. For these individuals, initial non-pharmacological management focused on lifestyle optimization would be recommended. The need for antihypertensive treatment initiation increased by only 1.3% (95% CI 0.3 to 2.4%) and predominantly concerned individuals at high cardiovascular risk. Among treated participants, BP control rates decreased by 8.7% in the low-to-moderate risk group and increased by 9.9% in the high-risk group. CONCLUSION: Adoption of the 2025 Hypertension Canada guideline will substantially increase the prevalence of hypertension among 40-69 year-old Canadians. Non-pharmacological interventions are recommended for all individuals; however, new antihypertensive pharmacotherapy would be recommended for only a small subset, largely limited to those at high cardiovascular risk.