A new national BP management roadmap states that Australia should take a leaf out of the cancer prevention playbook and implement screening for hypertension which contributes to 25,000 deaths per year from stroke, heart disease, kidney disease, heart failure, atrial fibrillation and dementia.

According to the National Hypertension Taskforce of Australia, the goal is to increase the proportion of people with blood pressure <140/90 mmHg from the current 32% to at least 70% by 2030.

In a Perspectives article in The MJA [link here], the Taskforce sets out three pillars of prevention, detection and effective treatment of BP as the basis for the roadmap.

A key priority is greater use of preventive services to identify hypertension, the authors say.

“This is well established in preventing cancer in Australia, but much greater gains are possible through cardiovascular preventive services.”

“Compared with colonoscopy, mammography and flu vaccinations, modelling in the United States indicates that the treatment of hypertension would prevent the greatest number of deaths,” they noted.

The Taskforce said 6.8 million Australians have hypertension but only about 50% were aware of their risk and only 32% had their blood pressure controlled with treatment.

They recommended annual screening in primary care along with opportunistic screening.

“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.”

This could be supported by other health professionals including medical specialists, pharmacists, and allied health.

The authors, led by Professor Aletta Schutte from UNSW Sydney and the George Institute for Global Health, said other initiatives could include:

• Expanding community screening e.g. the annual May Measure Month and Australia’s Biggest Blood Pressure Check
• Use of automated health stations for blood pressure checks
• Media campaigns to increase awareness of hypertension
• Improved health literacy e.g. #KnowYourNumbers or #RollUpYourSleeves.

They acknowledged that secondary hypertension such as primary aldosteronism was an important reason for the suboptimal blood pressure control rates.

“Specific recommendations for identifying secondary causes should be integrated into routine clinical practice.”

Regarding management of hypertension, the Taskforce said single‐pill combinations (SPC) of two or more drugs had practical benefits over the current practice of monotherapy for initial therapy.

“It is safer and more effective to add another blood pressure lowering drug than to double the dose, which is another benefit for SPCs as first‐line treatment,” it said.

“However, at present, policy changes are required to allow prescription of SPCs as first‐line treatment in Australia, as SPCs are not subsidised by the Pharmaceutical Benefits Scheme for initial treatment.”

🚨 Breaking: #HypertensionTaskforce has released a Roadmap to improve Australia’s blood pressure control rates from 32% to 70% by 2030. Achieving this target will make Australia a global leader in blood pressure management. https://t.co/ZCPS0r8BN6@alta_schutte @MarkusSchlaich pic.twitter.com/O86d2qwJ2A

— Hypertension Australia (@HypertensionAus) July 11, 2024