1
|
Schutte AE, Bennett B, Chow CK, Cloud GC, Doyle K, Girdis Z, Golledge J, Goodman A, Hespe CM, Hsu MP, James S, Jennings G, Khan T, Lee A, Murphy L, Nelson MR, Nicholls SJ, Raffoul N, Robson B, Rodgers A, Sanders A, Shang C, Sharman JE, Stocks NP, Usherwood T, Webster R, Yang J, Schlaich M. National Hypertension Taskforce of Australia: a roadmap to achieve 70% blood pressure control in Australia by 2030. Med J Aust 2024. [PMID: 38990122 DOI: 10.5694/mja2.52373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/05/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Aletta E Schutte
- University of New South Wales, Sydney, NSW
- George Institute for Global Health, Sydney, NSW
| | | | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW
| | | | - Kerry Doyle
- Australian Cardiovascular Alliance, Sydney, NSW
| | - Zoe Girdis
- Pharmacy Guild of Australia, Canberra, ACT
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University, Townsville, QLD
| | - Andrew Goodman
- Australian e-Health Research Centre, CSIRO, Brisbane, QLD
| | | | - Meng P Hsu
- Australian Cardiovascular Alliance, Sydney, NSW
| | - Sharon James
- Sexual and Reproductive Health for Women in Primary Care Centre of Research Excellence, Monash University, Melbourne, VIC
| | | | | | - Audrey Lee
- George Institute for Global Health, Sydney, NSW
| | | | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
| | | | | | | | | | | | | | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS
| | | | | | | | - Jun Yang
- Hudson Institute of Medical Research, Melbourne, VIC
| | - Markus Schlaich
- Dobney Hypertension Centre, University of Western Australia, Perth, WA
- Royal Perth Hospital, Perth, WA
| |
Collapse
|
2
|
Lin J, de Oliveira Costa J, Pearson SA, Buckley NA, Brieger D, Schutte AE, Schaffer AL, Falster MO. Impact of coordinated care on adherence to antihypertensive medicines among adults experiencing polypharmacy in Australia. J Hypertens 2024; 42:1248-1255. [PMID: 38704239 PMCID: PMC11139236 DOI: 10.1097/hjh.0000000000003721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Adherence to antihypertensives is key for blood pressure control. Most people with hypertension have several comorbidities and require multiple medicines, leading to complex care pathways. Strategies for coordinating medicine use can improve adherence, but cumulative benefits of multiple strategies are unknown. METHODS Using dispensing claims for a 10% sample of eligible Australians, we identified adult users of antihypertensives during July 2018-June 2019 who experienced polypharmacy (≥5 unique medicines). We measured medicine use reflecting coordinated medicine management in 3 months before and including first observed dispensing, including: use of simple regimens for each cardiovascular medicine; prescriber continuity; and coordination of dispensings at the pharmacy. We measured adherence (proportion of days covered) to antihypertensive medicines in the following 12 months, and used logistic regression to assess independent associations and interactions of adherence with these measures of care. RESULTS We identified 202 708 people, of which two-thirds (66.6%) had simple cardiovascular medicine regimens (one tablet per day for each medicine), two-thirds (63.3%) were prescribed >75% of medicines from the same prescriber, and two-thirds (65.5%) filled >50% of their medicine on the same day. One-third (28.4%) of people experienced all three measures of coordinated care. Although all measures were significantly associated with higher adherence, adherence was greatest among people experiencing all three measures (odds ratio = 1.63; 95% confidence interval: 1.55-1.72). This interaction was driven primarily by effects of prescriber continuity and dispensing coordination. CONCLUSIONS Coordinating both prescribing and dispensing of medicines can improve adherence to antihypertensives, which supports strategies consolidating both prescribing and supply of patients' medicines.
Collapse
Affiliation(s)
- Jialing Lin
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales
| | - Juliana de Oliveira Costa
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales
| | - Sallie-Anne Pearson
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales
| | | | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital
- Faculty of Medicine and Health, University of Sydney
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales
- The George Institute for Global Health, Sydney, Australia
- Hypertension in Africa Research Team (HART), MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom
- MRC/WITS Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea L. Schaffer
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales
| | - Michael O. Falster
- Medicines Intelligence Research Program, School of Population Health, Faculty of Medicine and Health, University of New South Wales
| |
Collapse
|
3
|
Gnanenthiran SR, Barnhart M, Tan I, Zeng M, O'Hagan E, Gianacas C, Chow C, Schlaich M, Rodgers A, Schutte AE. Shop-to-Stop Hypertension: A multicenter cluster-randomized controlled trial protocol to improve screening and text message follow-up of adults with high blood pressure at health kiosks in hardware retail stores. Contemp Clin Trials 2024; 143:107610. [PMID: 38878995 DOI: 10.1016/j.cct.2024.107610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
High blood pressure (BP) is the leading preventable risk factor for death, but only one in three patients achieve target BP control. A key contributor to this problem is poor population awareness of high BP, as the majority of patients are asymptomatic. The Shop-To-Stop Hypertension study is a multicenter, cluster-randomized controlled trial to identify, refer and follow adults in need of hypertension care, whilst raising population-wide awareness. In participants with high BP measured by SiSU Health Stations located in major hardware chain stores across New South Wales, Australia, we will determine whether text message-based nudges will encourage repeat BP checks and visits to their doctor. Based on pilot data, we anticipate 65,340 participants will be screened over 12 months, of which 18% will have high BP. Thirty hardware stores will be randomized (1:1) to: (i) Intervention: participants detected with high BP (≥140/≥90 mmHg) will receive text message-based nudges to return for a repeat SiSU Health Station BP check and to visit their general practitioner (GP) to check and manage their BP; (ii) Control: participants with high BP will not receive text messages. The primary outcome is the difference in the proportion of participants with high BP having a repeat BP check at hardware Health Stations in the intervention vs. control group at 12 months. This novel setting for screening utilises a novel 'citizen science' approach inviting the general public to perform their own BP screening at health kiosks and foster behavioral change. This will allow screening in a low-stress environment.
Collapse
Affiliation(s)
- Sonali R Gnanenthiran
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia; Concord Repatriation General Hospital, Concord West, Sydney, NSW, Australia
| | - Molly Barnhart
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Isabella Tan
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Mingjuan Zeng
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Dept. of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Christopher Gianacas
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Clara Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Dept. of Cardiology, Westmead Hospital, Westmead, NSW, Australia
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Anthony Rodgers
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia
| | - Aletta E Schutte
- The George Institute for Global Health; University of New South Wales, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Sydney, NSW, Australia.
| |
Collapse
|
4
|
Nolde JM, Streets F, Meyer D, Chen WS, Wei J, Wickramasinghe N, Hannebery P, Lambert GW, Schlaich MP. Trends in blood pressure changes and hypertension prevalence in Australian adults before and during the COVID-19 pandemic. J Clin Hypertens (Greenwich) 2024; 26:145-154. [PMID: 38224191 PMCID: PMC10857471 DOI: 10.1111/jch.14761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
Efforts to limit the impact of the coronavirus disease (COVID-19) pandemic led to the implementation of public health measures and reallocation of health resources. To investigate trends in blood pressure (BP), hypertension and BMI in the Australian population during the COVID-19 pandemic, data from publicly accessible health stations were analyzed. Average BP and BMI measured by the SiSU Health Station network in Australia in over 1.6 million health screenings were compared between the years 2018 and 2021. Additionally, paired trajectories for BP and BMI development before and during the COVID-19 pandemic were calculated. Comparisons between pre-COVID years and post-COVID years of 2018 versus 2020, 2019 versus 2020, 2018 versus 2021, and 2019 versus 2021 showed increases in average adjusted systolic BP of 2.0, 1.7, 2.6, and 2.3 mmHg, respectively. Paired analysis of longitudinal data showed an overall increase in the trajectory of systolic BP of 3.2 mmHg between pre- and post-COVID years. The prevalence of hypertension in users of the health stations increased by approximately 25% in the years 2020-2021. Similar trends were seen for BMI. Data from public Australian health stations indicated a strong trend toward higher BP during the COVID-19 pandemic. At the population level, BP increments have been shown to markedly increase cardiovascular disease risk. Anti-pandemic measures need to be carefully evaluated in terms of secondary public health effects and health support systems extended to effectively target cardiovascular risk.
Collapse
Affiliation(s)
- Janis M. Nolde
- Dobney Hypertension CentreMedical School ‐ Royal Perth Hospital Unit / Medical Research FoundationUniversity of Western AustraliaPerthAustralia
| | | | - Denny Meyer
- Department of Health Science and BiostatisticsSchool of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | - Won Sun Chen
- Department of Health Science and BiostatisticsSchool of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | | | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | | | - Gavin W. Lambert
- Iverson Health Innovation Research Institute and School of Health SciencesSwinburne University of TechnologyMelbourneAustralia
| | - Markus P. Schlaich
- Dobney Hypertension CentreMedical School ‐ Royal Perth Hospital Unit / Medical Research FoundationUniversity of Western AustraliaPerthAustralia
- Department of Cardiology and NephrologyRoyal Perth HospitalPerthAustralia
- Neurovascular Hypertension & Kidney Disease LaboratoryBaker Heart and Diabetes InstituteMelbourneAustralia
| |
Collapse
|
5
|
Gnanenthiran SR, Tan I, Atkins ER, Avolio A, Bennett B, Chapman N, Chow CK, Freed R, Gnjidic D, Hespe C, Kaur B, Liu HM, Patel A, Peiris D, Reid CM, Schlaich M, Sharman JE, Stergiou GS, Usherwood T, Gianacas C, Rodgers A, Schutte AE. Transforming blood pressure control in primary care through a novel remote decision support strategy based on wearable blood pressure monitoring: The NEXTGEN-BP randomized trial protocol. Am Heart J 2023; 265:50-58. [PMID: 37479162 DOI: 10.1016/j.ahj.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2023] [Accepted: 07/16/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Despite high blood pressure being the leading preventable risk factor for death, only 1 in 3 patients achieve target blood pressure control. Key contributors to this problem are clinical inertia and uncertainties in relying on clinic blood pressure measurements to make treatment decisions. METHODS The NEXTGEN-BP open-label, multicenter, randomized controlled trial will investigate the efficacy, safety, acceptability and cost-effectiveness of a wearable blood pressure monitor-based care strategy for the treatment of hypertension, compared to usual care, in lowering clinic blood pressure over 12 months. NEXTGEN-BP will enroll 600 adults with high blood pressure, treated with 0 to 2 antihypertensive medications. Participants attending primary care practices in Australia will be randomized 1:1 to the intervention of a wearable-based remote care strategy or to usual care. Participants in the intervention arm will undergo continuous blood pressure monitoring using a wrist-wearable cuffless device (Aktiia, Switzerland) and participate in 2 telehealth consultations with their primary care practitioner (general practitioner [GP]) at months 1 and 2. Antihypertensive medication will be up-titrated by the primary care practitioner at the time of telehealth consults should the percentage of daytime blood pressure at target over the past week be <90%, if clinically tolerated. Participants in the usual care arm will have primary care consultations according to usual practice. The primary outcome is the difference between intervention and control in change in clinic systolic blood pressure from baseline to 12 months. Secondary outcomes will be assessed at month 3 and month 12, and include acceptability to patients and practitioners, cost-effectiveness, safety, medication adherence and patient engagement. CONCLUSIONS NEXTGEN-BP will provide evidence for the effectiveness and safety of a new paradigm of wearable cuffless monitoring in the management of high blood pressure in primary care. TRIAL REGISTRATION ACTRN12622001583730.
Collapse
Affiliation(s)
- Sonali R Gnanenthiran
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Cardiology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Isabella Tan
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Emily R Atkins
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Alberto Avolio
- Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Belinda Bennett
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Niamh Chapman
- University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Ruth Freed
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Charlotte Hespe
- The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Baldeep Kaur
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Huei Ming Liu
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia
| | - Anushka Patel
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - David Peiris
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Markus Schlaich
- Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - James E Sharman
- University of Tasmania, Menzies Institute for Medical Research, Hobart, Australia
| | - George S Stergiou
- Third Department of Medicine, Hypertension Center STRIDE-7, School of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tim Usherwood
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Christopher Gianacas
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Anthony Rodgers
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Aletta E Schutte
- Cardiovascular Division, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia.
| |
Collapse
|
6
|
Woode ME, Wong K, Reid CM, Stowasser M, Russell G, Gwini S, Young MJ, Fuller PJ, Yang J, Chen G. Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: a Markov modelling analysis. J Hypertens 2023; 41:1615-1625. [PMID: 37466447 DOI: 10.1097/hjh.0000000000003513] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Primary aldosteronism affects 3-14% of hypertensive patients in the primary care setting and up to 30% in the hypertensive referral units. Although primary aldosteronism screening is recommended in patients with treatment-resistant hypertension, diagnosis at an earlier stage of disease may prevent end-organ damage and optimize patient outcomes. METHODS A Markov model was used to estimate the cost-effectiveness of screening for primary aldosteronism in treatment and disease (cardiovascular disease and stroke) naive hypertensive patients. Within the model, a 40-year-old patient with hypertension went through either the screened or the unscreened arm of the model. They were followed until age 80 or death. In the screening arm, the patient underwent standard diagnostic testing for primary aldosteronism if the screening test, aldosterone-to-renin ratio, was elevated above 70 pmol/l : mU/l. Diagnostic accuracies, transition probabilities and costs were derived from published literature and expert advice. The main outcome of interest was the incremental cost effectiveness ratio (ICER). RESULTS Screening hypertensive patients for primary aldosteronism compared with not screening attained an ICER of AU$35 950.44 per quality-adjusted life year (QALY) gained. The results were robust to different sensitivity analyses. Probabilistic sensitivity analysis demonstrated that in 73% of the cases, it was cost-effective to screen at the commonly adopted willingness-to-pay (WTP) threshold of AU$50 000. CONCLUSION The results from this study demonstrated that screening all hypertensive patients for primary aldosteronism from age 40 is cost-effective. The findings argue in favour of screening for primary aldosteronism before the development of severe hypertension in the Australian healthcare setting.
Collapse
Affiliation(s)
- Maame Esi Woode
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East
- Victorian Heart Institute, Monash University
| | - Kristina Wong
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
- Department of Medicine, Monash University, Clayton, Victoria
| | - Christopher M Reid
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Queensland
| | - Grant Russell
- Department of General Practice, Monash University, Clayton
| | - StellaMay Gwini
- Department of Epidemiology, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria
- University Hospital Geelong, Barwon Health, Geelong
| | - Morag J Young
- Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter J Fuller
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
| | - Jun Yang
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research
- Department of Medicine, Monash University, Clayton, Victoria
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East
| |
Collapse
|
7
|
Roseleur J, Gonzalez-Chica DA, Harvey G, Stocks NP, Karnon J. The Cost of Uncontrolled Blood Pressure in Australian General Practice: A Modelling Study Using Electronic Health Records (MedicineInsight). PHARMACOECONOMICS 2023; 41:573-587. [PMID: 36870035 PMCID: PMC9985098 DOI: 10.1007/s40273-023-01251-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Hypertension is the most common condition seen in Australian general practice. Despite hypertension being amenable to lifestyle modifications and pharmacological treatment, only around half of these patients have controlled blood pressure levels (< 140/90 mmHg), placing them at an increased risk of cardiovascular disease. OBJECTIVE We aimed to estimate the health and acute hospitalisation costs of uncontrolled hypertension among patients attending general practice. METHODS We used population data and electronic health records from 634,000 patients aged 45-74 years who regularly attended an Australian general practice between 2016 and 2018 (MedicineInsight database). An existing worksheet-based costing model was adapted to calculate the potential cost savings for acute hospitalisation of primary cardiovascular disease events by reducing the risk of a cardiovascular event over the next 5 years through improved systolic blood pressure control. The model estimated the number of expected cardiovascular disease events and associated acute hospital costs under current levels of systolic blood pressure and compared this estimate with the expected number of cardiovascular disease events and costs under different levels of systolic blood pressure control. RESULTS The model estimated that across all Australians aged 45-74 years who visit their general practitioner (n = 8.67 million), 261,858 cardiovascular disease events can be expected over the next 5 years at current systolic blood pressure levels (mean 137.8 mmHg, standard deviation = 12.3 mmHg), with a cost of AUD$1813 million (in 2019-20). By reducing the systolic blood pressure of all patients with a systolic blood pressure greater than 139 mmHg to 139 mmHg, 25,845 cardiovascular disease events could be avoided with an associated reduction in acute hospital costs of AUD$179 million. If systolic blood pressure is lowered further to 129 mmHg for all those with systolic blood pressure greater than 129 mmHg, 56,169 cardiovascular disease events could be avoided with potential cost savings of AUD$389 million. Sensitivity analyses indicate that potential cost savings range from AUD$46 million to AUD$1406 million and AUD$117 million to AUD$2009 million for the two scenarios, respectively. Cost savings by practice range from AUD$16,479 for small practices to AUD$82,493 for large practices. CONCLUSIONS The aggregate cost effects of poor blood pressure control in primary care are high, but cost implications at the individual practice level are modest. The potential cost savings improve the potential to design cost-effective interventions, but such interventions may be best targeted at a population level rather than at individual practices.
Collapse
Affiliation(s)
- Jacqueline Roseleur
- School of Public Health, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
- Flinders Health and Medical Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
| | - David A Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Nigel P Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Institute, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| |
Collapse
|
8
|
Carnagarin R, Nolde JM, Yang J, Marques FZ, Picone DS, Lambert GW, Beaney T, Poulter NR, Schutte AE, Reid CM, Brockman D, Schlaich MP. Stagnating rates of blood pressure control in Australia: insights from opportunistic screening of 10 046 participants of the May Measurement Month campaigns. J Hypertens 2023; 41:632-637. [PMID: 36723455 DOI: 10.1097/hjh.0000000000003379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Raised blood pressure (BP) remains the single most important modifiable risk factor contributing to cardiovascular and all-cause mortality in Australia and worldwide. May Measurement Month , a global BP measurement and screening campaign initiated by the International Society of Hypertension and carried out in Australia since its inception in 2017, aimed at obtaining standardized BP measurements from members of the community to increase awareness of high BP and its associated risks. METHOD Adults participants (≥18 years) were recruited through opportunistic sampling across Australia during the month of May in 2017, 2018 and 2019. Trained volunteers recorded BP readings in a standardized manner and collected data on demographic, lifestyle factors and comorbidities. Hypertension was defined as SBP of at least 140 mmHg, or DBP of at least 90 mmHg, or taking antihypertensive medication. Data were collated centrally and analysis was carried out using regression models to evaluate the associations between BP and participant characteristics. RESULTS A total of 10 046 participants were screened, of whom 3097 (31.0%) had hypertension, only 48.5% were aware of their condition and 44.4% were taking antihypertensive medication. Of those taking antihypertensive medication, 53.2% were controlled to less than 140/90 mmHg, whereas the remaining 46.8% of participants had BP of at least 140/90 mmHg suggestive of inadequately treated hypertension. CONCLUSION Consecutive data obtained over a 3-year period in Australia demonstrated stagnating awareness, treatment and control rates with the latter two being substantially lower than global rates and those in other high-income countries. Concerted efforts from all stakeholders will be required to help overcome the unacceptably poor rates of BP treatment and control in Australia.
Collapse
Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit/Royal Perth Hospital Research Foundation, University of Western Australia, Perth, Western Australia
| | - Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit/Royal Perth Hospital Research Foundation, University of Western Australia, Perth, Western Australia
| | - Jun Yang
- Department of Medicine, Endocrine Hypertension Group, Hudson Institute of Medical Research
| | - Francine Z Marques
- Hypertension Research Laboratory, School of Biological Sciences, Monash University
- Heart Failure Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria
| | - Dean S Picone
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Gavin W Lambert
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Thomas Beaney
- Department of Primary Care and Public Health
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, New South Wales
| | - Christopher M Reid
- School of Population Health, Centre of Clinical Research and Education, Curtin University, Bentley
| | - Derrin Brockman
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit/Royal Perth Hospital Research Foundation, University of Western Australia, Perth, Western Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit/Royal Perth Hospital Research Foundation, University of Western Australia, Perth, Western Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
9
|
Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
Collapse
Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
10
|
Schutte AE, Jennings G, Schlaich M. Uncontrolled blood pressure in Australia: a call to action. Med J Aust 2022; 216:488. [DOI: 10.5694/mja2.51498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Markus Schlaich
- Dobney Hypertension Centre University of Western Australia Perth WA
| |
Collapse
|
11
|
Bailie J, Matthews V, Bailie RS. Uncontrolled blood pressure in Australia: a call to action. Med J Aust 2022; 216:487-488. [DOI: 10.5694/mja2.51503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Jodie Bailie
- University Centre for Rural Health University of Sydney Lismore NSW
- University of Sydney Sydney NSW
| | | | - Ross S Bailie
- University Centre for Rural Health University of Sydney Lismore NSW
| |
Collapse
|