New roadmap for improving blood pressure control in Australia

Hypertension is the leading risk factor for preventable deaths in Australia, contributing to over 25 000 deaths every year through stroke, heart disease, kidney disease and dementia.

One in three Australian adults has hypertension, but only half of these people have been diagnosed and are receiving appropriate treatment.

Of those who are receiving treatment, only 32% are being treated effectively.

To address the stagnating rates of hypertension control, the National Hypertension Taskforce of Australia was launched in 2022, hosted by the Australian Cardiovascular Alliance and Hypertension Australia.

In a perspective published in the Medical Journal of Australia, co-chair of the Taskforce Professor Aletta E Schutte and colleagues have outlined their roadmap for achieving 70% blood pressure control in Australia by 2030.

“This roadmap paves the way for success,” the authors wrote.

“We have all the tools to achieve our goal. With strong drive, commitment and collaboration, Australia is poised to become the global exemplar of blood pressure control.”

The three pillars of hypertension control

The key priorities for action identified by the Taskforce are divided into three pillars; prevent, detect and treat effectively.

Prevention strategies include developing economic tools to ensure healthy choices are the most affordable ones, targeting sodium reduction and increased potassium intake, and promoting healthy bodyweight, increased physical activity and reduced alcohol intake.

“Population-based strategies that shift the whole distribution of risk factors would produce substantial reductions in cardiovascular disease (CVD) burden, and will benefit children, older people, people living in rural and remote areas, culturally and linguistically diverse populations and First Nations peoples, as well as those not accessing primary care services,” the authors wrote.

Strategies for detection include systematic screening programs through general practice to increase detection of hypertension.

“With 87% of people in Australia seeing a general practitioner once in any given year, implementation of primary care incentives for routine blood pressure and heart health checks is likely to achieve most success in the detection, diagnosis and treatment of high blood pressure,” the authors wrote.

In terms of effective treatment, the Taskforce outlines the need for up-to date and easy to use blood pressure management tools for health care providers, a blood pressure target of less than 130/80 mmHg, and an emphasis on managing hypertension in older populations.

The Taskforce also calls for value-based care instead of current fee-for-service models, which prioritise financial drivers over optimising health outcomes and team-based care.

“A shift towards value-based care (paying for delivering care that improves patient health outcomes) would ensure optimal use of funding across multiple providers to achieve better health outcomes,” the authors wrote.

The HEART of primary care

The Taskforce has adopted the World Health Organization HEARTS technical package for cardiovascular disease management in primary health care, and tailored it to the needs of Australian health care.

The package is broken down into the following modules, which provide a strategic approach to improving cardiovascular health:

• Healthy lifestyle counselling: providing lifestyle modification education as the first line of treatment;
• Evidence-based treatment protocols: providing a 1-page simplified treatment protocol to help overcome inertia at the beginning of treatment;
• Access to essential medicines and blood pressure devices: ensuring medications are available at a low cost with long prescriptions, and that upper-arm cuff devices are readily available in clinics and for home monitoring;
• Risk-based cardiovascular disease management; targeting patients at the highest risk of CVD when it comes to screening for hypertension;
• Team-based, patient-centred care: coordinating care across general practitioners, pharmacists and nurses to improve continuity of care;
• Systems for monitoring: establishing a national blood pressure database to monitor blood pressure control at a patient, primary care and health system level.

“The Taskforce is cognisant of the substantial barriers in implementing the roadmap at the community, patient, provider and system level,” the authors wrote.

“For each aspect of implementation, we will encourage and expand ongoing research, and liaise widely to design and implement actions that are feasible, acceptable, cost-effective, scalable and tailored for the Australian setting.”

“With timely implementation of the actions in this roadmap, we will be able to achieve a 70% blood pressure control rate in Australian adults by 2030, thereby achieving the best control rate in the world,” the authors concluded.

Read the perspective in the Medical Journal of Australia.