Elevated Blood Pressure (Hypertension)Total indicators and qualifiers: 39
Elevated blood pressure (also known as 'hypertension') is a common condition affecting nearly a quarter of Australians,1 and is the most frequently managed problem by general practitioners.2 Aside from its prevalence, elevated blood pressure is clinically important because it is major risk factor for complications from cardiovascular disease.3 As such, the direct costs of elevated blood pressure (e.g. anti-hypertensive medication prescription) are estimated as $812 million, with indirect costs totalling approximately $16.3 billion.4 Several countries, such as Canada,5 the United Kingdom,6 and USA7 have produced clinical practice guidelines (CPGs) to help guide the management of elevated blood pressure. Importantly, the Australian guideline has recently been updated.8, 9
Despite the availability of CPGs for the diagnosis and management of elevated blood pressure, a number of Australian studies report that usual care for the condition is often not evidence-based.4, 10, 11 In addition, our recent CareTrack Australia study demonstrated that, on average, people receive evidence-based care for elevated blood pressure 72% of the time – with particularly low compliance for people with severe elevated blood pressure.12 Therefore, the purpose of this wiki-based consultation process is to seek national agreement on what constitutes evidence-based and appropriate care for elevated blood pressure in Australia, and to organise this information within clinical indicators as a standard of care.
- Australian Bureau of Statistics 2016, National Health Survey. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001. Accessed: 9th March 2017.
- Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L, Pan Y, Charles J, Pollack AJ, Wong C, Gordon J. General practice activity in Australia 2015–16. General practice series no. 40. Sydney: Sydney University Press, 2016. Available at <purl.library.usyd.edu.au/sup/9781743325131>
- Bromfield, S. and Muntner, P., 2013. High blood pressure: the leading global burden of disease risk factor and the need for worldwide prevention programs. Current hypertension reports, 15(3), pp.134-136.
- Carrington M, Jain A, Stewart S: Pressure Points in Primary Care: A Study of Blood Pressure in 532,050 Patients in Australia from 2005 to 2010. Melbourne, Australia: Baker IDI Health and Diabetes Institute; 2012.
- Leung, A.A., Nerenberg, K., Daskalopoulou, S.S., McBrien, K., Zarnke, K.B., Dasgupta, K., Cloutier, L., Gelfer, M., Lamarre-Cliche, M., Milot, A. and Bolli, P., 2016. Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Canadian Journal of Cardiology, 32(5), pp.569-588.
- National Institute for Health and Care Excellence, 2011. Hypertension in adults: diagnosis and Management. Available at: https://www.nice.org.uk/guidance/cg127/resources/hypertension-in-adults-diagnosis-and-management-35109454941637. Accessed: 9th March 2017.
- Weber, M.A., Schiffrin, E.L., White, W.B., Mann, S., Lindholm, L.H., Kenerson, J.G., Flack, J.M., Carter, B.L., Materson, B.J., Ram, C.V.S. and Cohen, D.L., 2014. Clinical practice guidelines for the management of hypertension in the community. The journal of clinical hypertension, 16(1), pp.14-26.
- National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults – 2016. Melbourne: National Heart Foundation of Australia, 2016. Available at: https://www.heartfoundation.org.au/images/uploads/publications/PRO-167_Hypertension-guideline-2016_WEB.pdf. Accessed: 9th March 2017.
- Gabb, G.M., Mangoni, A.A., Anderson, C.S., Cowley, D., Dowden, J.S., Golledge, J., Hankey, G.J., Howes, F.S., Leckie, L., Perkovic, V. and Schlaich, M., 2016. Guideline for the diagnosis and management of hypertension in adults—2016. Med J Aust, 205(2), pp.85-89.
- Gallego, B., Runciman, W. B., Perez-Concha O., Liaw, S-T., Day, R. O., Dunn, A. G., Coiera, E., 2013. The management of severe hypertension in Australian general practice. BMC Health Services Research 2013, 13:414.
- Heeley E, Peiris D, Patel A, Cass A, Weekes A, Morgan C, Anderson C, Chalmers J: Cardiovascular risk perception and evidence-practice gaps in Australian general practice (the AusHEART study). MJA 2010, 195(5):254–259.
- Runciman, W.B., Hunt, T.D., Hannaford, N.A., Hibbert, P.D., Westbrook, J.I., Coiera, E.W., Day, R.O., Hindmarsh, D.M., McGlynn, E.A. and Braithwaite, J., 2012. CareTrack: assessing the appropriateness of health care delivery in Australia. Medical Journal of Australia, 197(10), p.549.
Prof Derek Chew
Derek Chew is a clinical and interventional cardiologist, clinical trialist and outcomes researcher in cardiovascular medicine. His training in Interventional Cardiology was at the Cleveland Clinic Foundation, and he as completed a Masters of Public Health at the Harvard School of Public Health. His PhD thesis explored the factors for improving heart attack care in Australia. His is currently Professor of Cardiology Flinders University, and is the Network Director of Cardiology for the Southern Adelaide Local Health Network. He has led the Heart Foundation/CSANZ 2016ACS Guidelines writing group and served on the European Society of Cardiology Guidelines for the management of ACS Writing committee.
Prof Debra Rowett
Prof Mark Nelson
• Qualifications. MBBS(Hons), MFM, FRACGP, FAFPHM, PhD • Current employer / role(s). Professor and Chair, Discipline of General Practice, and Senior Professorial Fellow, Menzies Institute for Medical Research, University of Tasmania and an Adjunct Professor, Department of Epidemiology and Preventive Medicine, Monash University. • Clinical expertise and/or interests. General practice, public health. • Research expertise and/or interests. Large-scale clinical trials in CVD prevention in primary care. • Awards, special projects and/or accomplishments. National Health and Medical Research Council Australian Clinical Research Fellowship, RACGP Friends of the College award, Distinguished paper General Practice and Primary Health Care Research Conference, Hobart, AAPC Bridges-Webb Medal, Heart Foundation Tasmania Diamond Service Award. • Professional and/or community service. High Blood Pressure Research Council of Australia executive, Tasmania Health Practitioner Tribunal, Heart Foundation (Tasmania Chapter) Health Advisory Committee, Cardiovascular Disease Expert Advisory Group (CVDEAG), and National Vascular Disease Monitoring Advisory Group (NVDMAG), National Centre for Monitoring Vascular Diseases (NCMVD) at the Australian Institute of Health and Welfare, World Hypertension League Australian regional office executive member, Australian Atherosclerosis Society member, Australian Cardiovascular Alliance Board of Directors, Australia New Zealand Alliance of Cardiovascular Trials.
Prof Clara Chow
Professor Clara Chow is a clinician-scientist (Cardiologist), Professor of Medicine at the University of Sydney and in Academic Director of the Westmead Applied Research Centre (WARC). She holds honorary posts as the Program Director of Community Based Cardiac Services at Westmead Hospital, Academic co-Director of the Charles Perkins Centre Westmead (2016), co-lead of the Cardiovascular stream of Sydney Health Partners and Honorary Professorial Fellow at The George Institute. In the community, she is a member of PBAC and is on the Board and Honorary Secretary of the Cardiac Society of Australia and New Zealand. Prof. Chow has extensive experience in the design, development, management, analysis, interpretation and reporting of large-scale epidemiology and clinical trial studies. Her work in cardiovascular disease prevention is recognised both nationally and internationally. She has a PhD in cardiovascular epidemiology and international public health from the University of Sydney, and a Postdoc in Cardiac Imaging and Clinical trials and Epidemiology from McMaster University, Canada. She has been supported by the NHMRC through consecutive fellowships since her PhD and now holds a NHMRC CDF (Level 2) and National Heart Foundation Future Leader Fellowship (2016-20). In a relatively short career, Prof. Chow has a strong record of published work including >150 publications including 2 in NEJM, 3 in Lancet and 6 in JAMA. http://sydney.edu.au/medicine/people/academics/profiles/clara.chow.php
Prof Arduino Mangoni
Professor Arduino A Mangoni trained in Cardiology, Clinical Pharmacology and General Medicine in Milan, Boston and London. He was awarded a PhD in Pharmacology at King’s College, University of London, in 2003. He was appointed Senior Lecturer (2003-2007) and Associate Professor (2007-2009) in Clinical Pharmacology at Flinders University before taking up the Chair in Medicine of Old Age at the University of Aberdeen, UK (2010-2012). In 2013 he was appointed Strategic Professor of Clinical Pharmacology and Head of Department at Flinders University. Between 2015-2016 he was Associate Dean and Head, Flinders Medical Science and Technology. Professor Mangoni plays a key role in the regular review of the Australian Hypertension guidelines and has contributed to the development of the SIGN guidelines on the Management of Chronic Pain, released in December 2013. His research interests include arginine metabolomics and ageing, drug discovery and geriatric clinical pharmacology. Professor Mangoni has published over 180 refereed publications. http://www.flinders.edu.au/people/arduino.mangoni
Ms Allison Willis
I have worked as a private health policy and education consultant since 2007 to current. As a private health education and policy consultant I have worked with clients in both government and non-government and across health, community services, the education sector, disability and aged care. Some of my clients have included Asthma Australia, Department of Education and Child Development, Eldercare, ShineSA, Sacred Heat College, Repatriation General Hospital. I undertake discrete project briefs, which might include: • development of units of competency and education curriculum • developing workforce/professional practice standards and policy • training health practitioners in regulation, professional practice, law and ethics • reviewing and developing new models of care I am currently employed by Health Consumer Alliance of South Australia to undertake a project for the Northern Adelaide Local Health Network (NALHN) to develop a Consumer Engagement Strategy NALHN wide.