Blood Pressure Down Under, but Down Under What?
US and Australian Hypertension Guideline Conversation
See related article, pp e13–e115
Australia shares similar blood pressure (BP) profiles within the community as the United States, Europe, and many other countries.1 Hypertension is common, many people are not aware they have it and treatment often falls short of targets. Improvement in smoking rates and other cardiovascular risk factors is being countered by increased obesity and diabetes mellitus. Hypertension is seen more often in disadvantaged people, in rural communities, and particularly indigenous Australians.2 This is a familiar story around the world and it will not surprise that Australian hypertension guidelines have generally been fairly similar to recommendations in the major European and US guidelines.
The American College of Cardiology/American Heart Association (ACC/AHA) recently revised guidelines for the diagnosis, treatment, and management of hypertension.3 Among a host revisions, which have been referred to as radical,4 there are; lower cut offs for the diagnosis of hypertension (BP ≥130/80 mm Hg, previously set at ≥140/90 mm Hg), similarly lower BP criteria for initiating antihypertensive medications, and revised BP targets for individuals already undergoing treatment. US population implications of these changes include an additional 31 million US individuals considered hypertensive just because of the change in threshold, 4.2 million of these newly diagnosed are now eligible for antihypertensive medication.5 Additionally, over half (53%) of those currently medicated (55 million individuals) are in need of improved antihypertensive control to meet newly defined targets.
The process for developing these ACC/AHA guidelines was gold standard with extensive review of the evidence, broad consultation, and rigorous attention to conflict of interest. In this context, it will not surprise if other countries follow the same line and draw similar conclusions. After all the evidence is the evidence! There will always be some divergence as local factors and local evidence comes into play …