An ambitious plan to improve Australia’s blood pressure control involves more frequent testing and drug combinations.
All adult patients who attend a general practice should have their blood pressure measured at least once a year, whether they have red flags or not, says an Australian expert.
Professor Alta Schutte, co-lead of the National Hypertension Taskforce, said measurements should be taken three times and averaged to maximise accuracy.
She also flagged a need to initiate patients on hypertension treatment with two or more medications rather than the monotherapy recommended by Australia’s “outdated” hypertension guidelines.
The recommendations form part of a roadmap released by the taskforce and published in the Medical Journal of Australia today, which aims to improve Australia’s blood pressure control rates from the current 32% to 70% by 2030.
Other key recommendations include a focus towards team-based care, empowering the community to take charge of their health, and supporting equitable and accessible screening and health testing programs, including the implementation of more automated health stations to allow the general public to screen and monitor their blood pressure themselves.
The prevention of blood pressure-related disease would be achieved through system-based strategies that promote target blood pressure levels of less than 130/80 mmHg across the nation (this is an international guideline), according to the authors of the MJA article.
Hypertension is a leading cause of death in Australia, contributing to more than 25,000 deaths each year, according to the taskforce.
It is also the leading risk factor for death from stroke, heart disease, kidney disease, and dementia, yet 68% of Australians with hypertension are uncontrolled, according to the NCD Risk Factor Collaboration report published in The Lancet in 2021.
These results contributed to the establishment of the taskforce in 2022, led by the Australian Cardiovascular Alliance and Hypertension Australia.
Its roadmap is built on three pillars to prevent, detect and effectively treat hypertension.
“Improving blood pressure control rates in Australia is not only critical but possible,” said Professor Schutte, who is also professor and principal theme lead of Cardiac, Vascular and Metabolic Medicine in the Faculty of Medicine and Health at UNSW Sydney.
She also has a joint appointment as professorial fellow at the George Institute for Global Health, and is a board member of Hypertension Australia.
Professor Schutte told The Medical Republic that GPs were in the box seat to play a major role in changing Australia’s blood pressure control rates, and screening was integral to that plan.
She conceded that screening all adult patients would be an added burden on general practitioners, but reiterated a recommendation from the taskforce that other people in the practice such as nurses and other allied health professionals could contribute through team-based care.
Machines could also be set up in waiting rooms with instructions to help patients measure their own blood pressure.
“We know there are time constraints on GPs, and we have actually lots of sympathy for that,” said Professor Schutte.
“We think there’s a real case to be made to try and do blood pressure measurement in the waiting room or in a separate room by a nurse or even by a receptionist, rather than the GP, and save time.
“It’s important to have a quality device which is validated for accuracy, giving you the average of three readings or the last two readings. Accurate readings are something that they [GPs] can then use to make clinical decisions on.”
Once identified, the treatment protocol should include lifestyle coaching plus a linear, stepwise algorithm describing progressively more intensive medication treatment until blood pressure is controlled, the authors wrote in the MJA.
“The protocol should provide evidence-based medicines and doses, ideally single-pill combinations (SPC) of two or more drugs as initial therapy,” they wrote.
“For most patients, successful treatment requires two or more medications. SPCs can be cost-neutral or result in a cost saving and benefits include improved medication adherence, improved blood pressure control over a shorter period of time, with no increase in side effects.
“SPCs also lessen treatment inertia and the impact of infrequent following up of patients after prescribing.”
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Professor Schutte said current practice in Australia was to start treatment with monotherapy, where the dose is often increased at follow-up visits. However, she said these guidelines needed to change.
“In Australia, the hypertension guidelines from 2016 are outdated, and one of the first things we [the taskforce] will do next is to update the Australian hypertension guidelines through Hypertension Australia.
“We are behind because all international guidelines … say that when you start treating a patient with high blood pressure you should start with two drugs.”
However, at present, policy changes were required to allow prescription of SPCs as first-line treatment in Australia, as SPCs are not subsidised by the PBS for initial treatment, said the MJA authors.
The roadmap is the result of consultative workshops held with taskforce members, including key representatives from organisations such as the RACGP, the Heart Foundation, the Stroke Foundation and Kidney Health Australia.
Professor Markus Schlaich, taskforce co-lead and president of Hypertension Australia, said the focus on hypertension management in the community “must include general practitioners, pharmacists, remote health care workers, nurse practitioners and all other healthcare providers”.
Professor Jason Kovacic, president of the Australian Cardiovascular Alliance, described the roadmap as a significant achievement.
“From the outset, our vision has been to unite the sector in addressing the most pressing areas of unmet need and hypertension is clearly one of them,” he said.
“This roadmap marks a significant milestone – a testament to collective efforts. We’re thrilled to be playing a role in this meaningful collaboration. It presents a genuine opportunity to positively impact the health outcomes of everyday Australians.”
