ROADMAP of the National Hypertension Taskforce

Full Roadmap publication

One-page summary of the Roadmap

Goal

To increase blood pressure control* to at least 70% by 2030 in Australia.

*Defined as <140/90 mmHg

The urgency

Raised blood pressure is the #1 cause of preventable deaths in Australia, mainly from heart attacks and strokes leading to >25,000 deaths per year.

The problem

Nearly one in four Australian adults (7.2 million people) have hypertension, but over a third (2.5 million) don’t know they have it. Of those who do have it detected and treated only 40% (or 2.9 million) are treated effectively and have their BP under control. This compares poorly to other high-income countries (e.g. 68% in Canada).

The opportunity

By working together to implement evidence-based strategies, we can (A) prevent, (B) detect and (C) treat hypertension very effectively, whilst saving millions of lives, and AU$91.6 billion in GDP.

The solution

The Taskforce has identified three pillars of work required.

PREVENT

Population-based preventative strategies will benefit people at ALL blood pressure levels across all ages, to prevent and delay hypertension, and reduce risk in people with existing disease.

  • Support the implementation of the National Preventative Health Strategy 2021.
  • Lower sodium (increase potassium) intake, healthy food supply for healthy body weight, increase physical activity and avoid alcohol.
(A)

PREVENT

DETECT

More than 50% of people in Australia with hypertension are not aware of if. If this >3.4 million people remain undetected, they cannot be treated or controlled. With 87% of people in Australia seeing a GP once a year, systematic screening in general practice is most likely to achieve success. Strategies to improve detection include:

  • Systematic screening: perform accurate blood pressure checking in GP for all adults.
  • Implement screening and referral by practice nurses, pharmacists, other health professionals.
  • Ramp up opportunistic screening campaigns.
  • Install health stations or kiosks in shopping malls and workplaces with accurate blood pressure devices.
  • Media campaigns, slogans and improving health literacy in the community on the risks of high blood pressure.
(B)

DETECT

TREAT EFFECTIVELY

The Taskforce adopts the World Health Organization's HEARTS Technical package which applies to primary care:

H - Healthy Lifestyle Counselling: lifestyle modification is first-line treatment for hypertension. Deliver short education modules at diagnosis.

E - Evidence-based treatment protocols: develop a simplifies 1-page treatment protocol with stepwise algorithm for medication, listing specific medication and doses. Ideally start with single pill combination (fixed dose) dual therapy as first-line treatment.

A - Access to essential medicines and blood pressure devices: ensure that low cost single pill combinations are available with long prescription durations of 60 days+. Ensure that validated electronic upper-arm cuff devices are sold and used in the clinic, for 24-hour and home monitoring. Check validation at (stridebp.org).

R - Risk-based cardiovascular disease management: target patients at highest risk based on 2023 Australian CVD Risk Guidelines (www.cvdcheck.orgg.au/calculator). For those with a risk >5% consider blood pressure medications, and for >10% prescribe medication. Through clinical judgment and shared decision making, consider medication prescription with clinic blood pressure >140/90mmmHg.

T - Team-based, patient centred care: collaboration between GPs nurses, pharmacists, exercise physiologists, dietitians would support the high workload of managing millions with hypertension. The Taskforce will enhance consumer involvement in all activities through setting up a large consumer group.

S - Systems for monitoring: an effective hypertension control program requires a robust information system to enable monitoring of BP control at individual patient level. A critical area of development for Australia.

(C)

TREAT EFFECTIVELY
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