Uncontrolled blood pressure in Australia: a call to action

To the Editor: We congratulate Schutte and colleagues1 for their call to action for improved management of blood pressure in Australia, highlighting that 68% of people have uncontrolled high blood pressure. The burden of high blood pressure is unevenly distributed, with Aboriginal and Torres Strait Islander (hereafter referred to respectfully as Indigenous) people reportedly having a higher rate of high blood pressure than non‐Indigenous Australians in every age group.2 Reducing the prevalence of high blood pressure is one of the most important means of reducing serious circulatory diseases, which are among the leading causes of death for Indigenous Australians.3 Hence, we want to extend the call to action and report on what is happening in primary health care settings with the control of blood pressure for Indigenous people.

During 2012–13, we analysed blood pressure screening and follow‐up for patients diagnosed with hypertension (n = 6523) from 123 primary health care centres across Australia using continuous quality improvement data from audits of adherence to best practice chronic illness care.4 Given there are no recently available data on follow‐up actions after an abnormal blood pressure reading at this geographic scale, and as blood pressure continues to be relatively uncontrolled, these data continue to provide unique insight.

The data, aggregated at primary health care centre level (Box), tells a story of clinical inertia. Regular blood pressure screening was done well — centres on average completed blood pressure screening for about 90% of patients within the past 6 and 12 months. In this cohort, about 65% of patients recorded abnormal blood pressure (n = 4240). Most primary health care centres had documentation of a follow‐up plan for more than 70% of patients, but there was wide variation (range, 0–100%; Box). Dealing with the low levels of medication reviews and adjustments (mean, ~15%; range, 0–100%) is a vital early step in limiting the contribution of uncontrolled blood pressure to adverse health outcomes for Indigenous people.

These data support the need for training on strategies to overcome clinical inertia, which was identified as a top priority by over 200 Indigenous primary health care practitioners, managers and policymakers.5 We add to the call for more attention on prevention of cardiovascular disease and suggest additional investment in evidence‐based interventions appropriate to Indigenous Australian culture and needs. The time for system‐wide action has come.

Box – Boxplots showing a record of scheduled services received by patients with hypertension and follow‐up of abnormal findings within the last 12 months of audit (unless otherwise indicated) at primary health centres during 2012–13

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x = mean value. More information on how to interpret box plots is available in Matthews et al.4