Australian hypertension control rates still lag

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 due to be finalised later this year.
 
Around 39% of adult Australians were living with hypertension in 2022, the AIHW reported last month, with rates highest in older patients, reaching 85% among those aged 75 and over.
 
It also estimates only four in 10 people overall had their blood pressure under control.  
 
That remains well short of a 70% target set by the National Hypertension Taskforce, which was established in 2022 with a goal of reaching that level by 2030. 
 
Australia is often unfavourably compared to countries such as Canada, where an estimated 70% of people with hypertension reportedly have their blood pressure under control.
 
Professor Mark Nelson, Chair of General Practice at the University of Tasmania, sits on the Taskforce’s steering committee.
 
‘Those of us who are on the group would recognise it’s an ambitious target, but it’s still worth trying for,’ he told newsGP.
 
‘Canada simply started a program like we’re doing now a bit earlier.
 
‘The good thing is I think we’ll learn by both their successes and their failures about the way they went about it. 
 
‘Certainly, we can turn this around through population level interventions and general practice and other specialty interventions.’
 
The Taskforce estimates around 2.2 million Australians have diagnosed and effectively controlled hypertension – defined as less than 140/90 mmHg.
 
Its 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.
 
An updated national guideline on the diagnosis and management of hypertension in adults is due for publication later this year.
 
Professor Charlotte Hespe is Head of General Practice and Primary Care Research at the University of Notre Dame, and co-chairs one of the Taskforce’s working groups.  
 
‘We 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 … have significantly improved their identification and management of blood pressure,’ she told newsGP.
 
Professor Hespe has previously called for changes to the way hypertension is managed, and advocates for a target blood pressure of less than 130/80 mmHg, saying it is ‘imperative’ guidelines are ‘up-to-date and suitable for our community’.
 
She points to discussions around those definitions, as well as trust in blood pressure readings that are prone to a ‘white-coat effect’ when measured by a doctor, as among the complexities of the area.
 
For her, the take-home message is that risks from high blood pressure outweigh those of low-blood pressure.
 
Professor Hespe also wants patients to be empowered to track their blood pressure at home.
 
‘We’re 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’re ever going to achieve with it being a little bit too low,’ she said.
 
‘We have to challenge some of those clinical fears – and that’s going to be a big job.
 
‘And that’s the patient as well – they’ll say, “I don’t want you to” or you give them medication and they start feeling a bit dizzy because their brain is used to a much higher pumping pressure.
 
‘Sometimes it can take two, three months to adjust to a lower pressure because it’s been high for so long, and you’ve got to convince them that they’re alright and give them strategies to make sure they don’t fall over.’ 
 
While the updated clinical advice is yet to be approved, Professor Nelson points to the risk-based approach outlined in the 2023 guideline for assessing and managing cardiovascular disease.
 
Like Professor Hespe, he says older patients are undertreated for hypertension.
 
‘There’s 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,’ he said. 

‘We need to get away from the feeling that if we treat the elderly, we’re going to cause harm.
 
‘You’re treating what is, in the main, an asymptomatic condition.
 
‘Because it’s a preventive activity, your experience as a doctor is that you’ll never be able to identify the heart attacks and strokes you’ve prevented – but there is a confirmation bias that any adverse effects or adverse events you will attribute to the medication you give them.’
 
Professor Nelson welcomed recent changes to the PBS, which the Taskforce had advocated for, allowing dual single pill combinations to be prescribed as an initial treatment for hypertension – but says progress towards the 70% target does not all have to be driven by ‘GPs and the prescription pad’.
 
‘When you have a high prevalence of blood pressure or cholesterol or smoking, there are population level changes that can help as well – reduction in salt in the diet, reduction in alcohol consumption in the general population,’ he said.
 
‘But ultimately, after all of the lifestyle things, we do know that pharmacotherapy is a reliable way of bringing it down significantly.’
 
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