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\n A significantly lower proportion of patients with hypertension in Australia have their blood pressure under control compared to some other countries.
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\n News<\/p>\n
\n New figures show persistently low rates of control. With an updated clinical guideline on the way, two GPs on the National Hypertension Taskforce discuss the way forward.
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\n A significantly lower proportion of patients with hypertension in Australia have their blood pressure under control compared to some other countries.
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\u2018We need to get away from the feeling that if we treat the elderly, we\u2019re going to cause harm.
newsGP weekly poll
\n New Australian Institute of Health and Welfare (AIHW) figures show persistently high prevalence of hypertension along with low control rates and awareness, with work on an updated clinical guideline<\/a> due to be finalised later this year.
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\nAround 39% of adult Australians were living with hypertension in 2022, the AIHW reported last month<\/a>, with rates highest in older patients, reaching 85% among those aged 75 and over.
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\nIt also estimates only four in 10 people overall had their blood pressure under control. \u00a0
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\nThat remains well short of a 70% target<\/a> set by the National Hypertension Taskforce, which was established in 2022 with a goal of reaching that level by 2030.\u00a0
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\nAustralia is often unfavourably compared to countries such as Canada, where an estimated 70% of people with hypertension reportedly have their blood pressure under control.
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\nProfessor Mark Nelson, Chair of General Practice at the University of Tasmania, sits on the Taskforce\u2019s steering committee<\/a>.
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\n\u2018Those of us who are on the group would recognise it\u2019s an ambitious target, but it\u2019s still worth trying for,\u2019 he told newsGP.
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\n\u2018Canada simply started a program like\u00a0we\u2019re\u00a0doing now a bit earlier.
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\n\u2018The good thing is I think\u00a0we\u2019ll\u00a0learn by both their successes and their failures about the way they went about it.\u00a0
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\n\u2018Certainly, we can turn this around through population level interventions and general practice and other specialty interventions.\u2019
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\nThe Taskforce estimates<\/a> around 2.2 million Australians have diagnosed and effectively controlled hypertension \u2013 defined as less than 140\/90\u2009mmHg.
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\nIts figures also suggest around 1.2 million people are aware they have hypertension without it being under control, while a further 3.4 million people could be unaware they have the condition.
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\nAn updated national guideline on the diagnosis and management of hypertension in adults is due for publication later this year.
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\nProfessor Charlotte Hespe is Head of General Practice and Primary Care Research at the University of Notre Dame, and co-chairs one of the Taskforce\u2019s working groups<\/a>. \u00a0
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\n\u2018We have not updated our guidelines since 2016 and that means that we are sadly quite out of line internationally with what other guidelines are recommending and certainly some other countries that \u2026 have significantly improved their identification and management of blood pressure,\u2019 she told newsGP.
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\nProfessor Hespe has previously called for changes<\/a> to the way hypertension is managed, and advocates for a target blood pressure of less than 130\/80\u2009mmHg, saying it is \u2018imperative\u2019 guidelines are \u2018up-to-date and suitable for our community\u2019.
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\nShe points to discussions around those definitions, as well as trust in blood pressure readings that are prone to a \u2018white-coat effect\u2019 when measured by a doctor, as among the complexities of the area.
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\nFor her, the take-home message is that risks from high blood pressure outweigh those of low-blood pressure.
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\nProfessor Hespe also wants patients to be empowered to track their blood pressure at home.
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\n\u2018We\u2019re all afraid of [blood pressure] being a little bit too low, even though in fact the evidence shows that there is far more damage done with it being a little bit too high than you\u2019re ever going to achieve with it being a little bit too low,\u2019 she said.
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\n\u2018We have to challenge some of those clinical fears \u2013 and that\u2019s going to be a big job.
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\n\u2018And that\u2019s the patient as well \u2013 they\u2019ll say, \u201cI don\u2019t want you to\u201d or you give them medication and they start feeling a bit dizzy because their brain is used to a much higher pumping pressure.
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\n\u2018Sometimes it can take two, three months to adjust to a lower pressure because\u00a0it\u2019s\u00a0been high for so\u00a0long,\u00a0and\u00a0you\u2019ve\u00a0got to convince them that\u00a0they\u2019re\u00a0alright\u00a0and give them strategies to make sure they\u00a0don\u2019t\u00a0fall over.\u2019\u00a0
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\nWhile the updated clinical advice is yet to be approved, Professor Nelson points to the risk-based approach outlined in the 2023 guideline<\/a> for assessing and managing cardiovascular disease.
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\nLike Professor Hespe, he says older patients are undertreated for hypertension.
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\n\u2018There\u2019s a generalised fear of causing harm by lowering blood pressure, but whenever you look at the clinical trials, including those done on our own patients in primary care, the individuals who get blood-pressure-lowering medication actually have lower serious adverse events as well as lower cardiovascular disease events,\u2019 he said.\u00a0<\/p>\n
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\n\u2018You\u2019re\u00a0treating what is, in the main,\u00a0an asymptomatic\u00a0condition.
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\n\u2018Because it\u2019s a preventive activity, your experience as a doctor is that you\u2019ll never be able to identify the heart attacks and strokes you\u2019ve prevented \u2013 but there is a confirmation bias that any adverse effects or adverse events you will attribute to the medication you give them.\u2019
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\nProfessor Nelson welcomed recent changes to the PBS, which the Taskforce had advocated for<\/a>, allowing dual single pill combinations to be prescribed as an initial treatment for hypertension \u2013 but says progress towards the 70% target does not all have to be driven by \u2018GPs and the prescription pad\u2019.
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\n\u2018When you have a high prevalence of blood\u00a0pressure or cholesterol\u00a0or smoking, there are population level changes that can help as well \u2013 reduction in salt in the diet, reduction in alcohol consumption in the general population,\u2019 he said.
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\n\u2018But ultimately, after all of the lifestyle things, we do know that pharmacotherapy is a reliable way of bringing it down significantly.\u2019
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\n high blood pressure<\/a> hypertension<\/a> National Hypertension Taskforce<\/a>
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