It is a privilege to be invited to speak today at the National Hypertension Summit as we gather to advance our shared mission: improving hypertension prevention, diagnosis, management and outcomes for all Australians.
I begin by acknowledging the Kaurna people, the traditional custodians of this land where we are meeting here in Adelaide. I pay my respect to the local Elders past and present recognizing their enduring contribution to the culture and the spirit of this beautiful land. And I extend that respect to all First Nations people joining us here today.
I have been invited to provide a public health and primary care perspective on hypertension in Australia.
Hypertension, as you all know, is one of the most common and preventable causes of cardiovascular disease in Australia. Through effective prevention, early diagnosis, and appropriate management, we can significantly reduce the burden of this condition on individuals and on our nation's healthcare system.
A combination of healthy lifestyle choices, regular blood pressure checks, appropriate use of medication, and more, is critical to managing hypertension.
Three years ago, in December 2022, Australia's Minister for Health, Disability and Ageing, The Honourable Mark Butler MP, launched the National Hypertension Taskforce, established by the Australian Cardiovascular Alliance and Hypertension Australia, with the support of the Australian Government, as a collaborative cross-sector approach to reducing the burden of high blood pressure in Australia. In coming together, you recognized that it was time to do more about one of Australia's major health challenges, high blood pressure. I commend all those involved since that time with the work of the alliance, including my colleagues Professor Alta Schutte from the University of New South Wales, and Professor Markus Schlaich from the University of Western Australia.
The data released at that time in 2022 when the Taskforce launched, showed that one in three Australian adults, equating to 6.8 million people, had hypertension. Of those people, about half, or 3.4 million, didn't know they had high blood pressure, 1.2 million were aware but their high blood pressure was not controlled, and only 2.2 million people, or 32% were being treated effectively and had their high blood pressure under control.
As we all well know, hypertension underlies many of the serious medical conditions encountered every day in clinical practice from heart attack and stroke to pregnancy complications, heart failure, atrial fibrillation and as a contributing risk factor for dementia.
However, with only half of the people with high blood pressure knowing that they had high blood pressure, and only 32% receiving support to bring their high blood pressure under control, hypertension remains one of our nation's most serious health risks.
I want to touch on dementia risk factors. Coronary heart disease and dementia are the two leading causes of death in our country, and hypertension is a factor in both.
The Lancet Commission on Dementia Prevention, Intervention and Care has identified the 14 main contributing, and potentially modifiable, risk factors for dementia, with the estimation that up to 45% of global dementia cases could potentially be prevented or delayed by addressing this et of modifiable risk factors across the life course. The factors are
- Low education in early life
- Hearing impairment (mid-life)
- Mid-life high blood pressure (hypertension)
- Obesity (mid-life)
- High LDL ("bad") cholesterol (mid-life)
- Excessive alcohol consumption (mid-life)
- Traumatic brain injury (head injury) (mid-life)
- Smoking (any time but especially mid-life)
- Physical inactivity (mid-life and later life)
- Diabetes (mid- to later life)
- Depression (later life)
- Social isolation / low social contact (later life)
- Exposure to air pollution (later life)
- Untreated vision loss (later life)
The benefits of shingles prevention, through vaccination, is also being assessed to see if it may also be a modifiable risk factor for dementia.
Globally, the situation is grave. In September this year the United Nations General Assembly held a special meeting on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being. Among the stark statistics presented to world leaders was how there is an estimated 1.6 billion adults living with hypertension worldwide, and how only 1 in 5 have it under control. This, couple with the 1.6 billion people who use tobacco, the 800 million adults living with diabetes, and the 41 million children over 5 years who are overweight or obese, means that globally, our health systems are facing ever increasing burdens of preventable morbidity and early mortality. The United Nations has called for scaling up of the prevention and treatment of cardiovascular diseases, including early diagnosis, access to affordable and effective treatments, and regular follow up for people at risk of, or living with, high blood pressure.
Our shared goal through the Taskforce has been to increase awareness and blood pressure control rates in Australia from 32% of those with hypertension, to 70% by 2030-a target that demands innovation, collaboration, and commitment, and which, if achieved, would still leave more than two million people at risk, and many of those people will be among the hardest for our health care services to reach, usually through absolutely no fault of their own. 70% is great, but closer to 100% would be even better, and we must aim to do even better.
The Taskforce's Roadmap is built on three pillars: prevention, detection, and effective treatment. This work is a testament to the power of multidisciplinary collaboration, and I am delighted that, among the 25 original partner member organisations of the Taskforce, the Royal Australian College of General Practitioners, the organization which oversaw my own postgraduate specialty training, and which I led as national president for four years from 200 to 2006. But I am also pleased to see the multidisciplinary nature of the taskforce bringing together GPs, nurses, pharmacists, allied health professionals, consultant specialists, Aboriginal community-controlled health organisations, peak consumer and community organisations, and health and medical research leaders from across our nation.
In the 42 years since the position of Australia's Chief Medical Officer as the lead health advisor to the Australian Government was first established, I am the first general practitioner to serve in this role.
I see my role as CMO as being an advocate and supporting investments in effective, evidence-based prevention and wellness, not just reactive care, which includes support for lifestyle-based interventions and early detection of serious conditions like hypertension. It is important that our nation's Chief Medical Officer is aligned with the national imperative to improve the prevention, detection and effective control of high blood pressure in all Australians, and I thank you for this opportunity.
As CMO I want to be a champion for the important work of this taskforce. We know the importance of a healthy diet, regular physical activity, weight management, limiting alcohol and salt intake, stress management, and tobacco cessation. We must continue to work together towards creating a healthier environment for all Australians, with policies that include support for healthy eating, increased physical activity, and improved access to healthcare for all.
As a general practitioner for over 40 years, I have seen first-hand the challenges and the opportunities presented through Australian general practice in hypertension prevention and management. As a researcher I first became involved in the work of the Australian National Blood Pressure Study over 30 years ago, working alongside peers like Professor Mark Nelson. The work of the Taskforce is a call to action for all of us in primary care.
We all know the importance of regular blood pressure checks. As a GP, I know that every encounter that a patient has with a health professional, no matter the setting, is an opportunity for prevention. If, as a clinician, you diagnose hypertension in a patient who is in a hospital bed for another reason ,or in someone who has presented to an accident and emergency department, or an urgent care clinic for management of a different condition, do you act to do something about it, or discharge them with the hope of follow up care by somebody else? What is the ethical, moral, and socially responsible action in this situation?
It was drilled into me as a medical student, and as a young GP registrar, that every adult should have their blood pressure measured at every clinical encounter. Given that Australia's GPs conduct 160 million consultations each year, and that, on average, each Australian visits a GP five times a year, with over 85% of the population visiting a GP in any 12 month period, general practice offers the ideal setting to detect, diagnose and manage hypertension, and I commend our nation's hard working general practitioners, primary care nurses, community pharmacists, Aboriginal and Torres Strait Islander health workers and other primary care health professionals for their continuing role in blood pressure management.
Taking a person's blood pressure during a clinical encounter is not just beneficial in diagnosing undetected hypertension or picking up poorly controlled hypertension in those who have already been diagnosed. It also enables touch in the consultation. Another lesson drilled into me as a student and registrar was the importance of touch as a way of building rapport and empathy with patients. The simple act of taking someone's blood pressure can be an important part of the therapeutic relationship between a person and their chosen trusted health care providers.
Part of the challenge is those people who don't engage with primary care, especially young men, but also those people who may be disenfranchised from our health care system or who may not know about how our health care system works. This can include some people with disability, and especially intellectual disability, new arrivals to Australia, especially those who do not speak English and who are unaware of how primary care works in this country, people with mental health concerns, and especially those with chronic mental health conditions who bear a high burden of preventable chronic health concerns, those who are homeless, and many more.
We need to be especially vigilant and opportunistic when we encounter these folk to ensure those with undiagnosed hypertension don't fall between the cracks and miss out on life saving care. Indeed, our greatest challenge in hypertension management, as in all aspects of health care, is reducing health inequities. The social determinants of health, including inequitable access to health care, education and socioeconomic factors, contribute to the higher rates of hypertension seen in many disadvantaged populations.
One of the key challenges once people have been diagnosed and initiated on treatment is adherence, as the clinicians in the audience will all know. Adherence to therapy is crucial for controlling blood pressure and preventing severe outcomes like heart attacks and strokes, but it can be a major challenge for many people, with rates of adherence often low, leading to uncontrolled blood pressure and increased risk of complications for the individual, and higher health care costs for the community. Key barriers to adherence include side effects, the cost of treatments, forgetting doses, and lack of understanding, especially that this is a treatment that may not make you feel any different. Other factors like social support, better education, simpler regimens, and good patient-provider communication can support improved adherence.
In 2022, I led the development of Australia's new National Medicines Strategy. The new strategy aims to ensure that all Australians have fair, timely, reliable, and affordable access to high-quality medicines and medicine services. The strategy emphasizes the safe and correct use of medicines, informed choices, and support for world-class innovation and research.
The strategy underpins many of our efforts to improve hypertension management, ensuring that effective therapies, including the option of single pill combinations, are accessible and affordable for all.
The switch to single pill combination therapy is one of the most promising advances in this area, yet it is not new. The evidence is clear that single pill combination therapies can improve medication adherence by reducing pill burden and simplifying treatment regimens for our patients. Our recent cost analysis found that single pill combinations result in significant savings for both patients and government-these savings should be factored into prescribing decisions for those starting treatment and those already on multiple pills. Importantly, we are working to change drug labels through the Pharmaceutical Benefits Advisory Committee so single pill combinations can be prescribed as first-line therapy.
Another key initiative has been the implementation by the Australian Government of 60-day dispensing for antihypertensives. Over the past 20 months, script volume for 60-day prescriptions has increased dramatically, accounting for 21% of all antihypertensive dispensing by April 2025. This policy has delivered up to $65 million in savings for patients and $87 million for government, with community pharmacies also receiving benefits because of this initiative. However, uptake is not as fast as anticipated. If we can increase 60-day dispensing to 50% of eligible treatments, annual savings could reach $165 million for patients. Work is continuing to overcome any barriers and maximize these benefits.
But management of hypertension is not just about pharmacological treatment. It is about personalized care, with the need for treatment plans that are tailored to the individual, considering individual factors such as age, comorbidities, and the severity of the hypertension. It is about patient education and support to assist people to remain on track with their treatment plans. It is about managing any underlying conditions leading to secondary hypertension, and it is about reducing overall cardiovascular risk through lifestyle interventions.
Effective hypertension management for many people will be most beneficial when based in multidisciplinary, team-based care, especially in primary care. Through the Australian Government's Strengthening Medicare reforms, the government is investing in our nation's Primary Health Networks and the Workforce Incentive Program to support greater integrated care to further harness the strengths of our diverse primary care workforce of GPs, nurses, allied health professionals, and more, to deliver new models of high-quality, patient-centered health care.
The Royal Australian College of General Practitioners produces its Red Book, the Guidelines for Preventive Activities in General Practice, a document which has followed me, and supported me, throughout my career. First published in 1987, this is a compact guide for Australian GPs on screening, early detection, and prevention, evolving significantly from its initial small size to the comprehensive resource it is today, now in its 10th edition. It is a key evidence-based tool, famously known for its red cover and apple logo, guiding preventive care across the lifespan of each patient seen in a general practice setting. I thank and commend my many colleagues who have led this initiative over the past decades, one of the most effective tools we have to reduce preventable morbidity and mortality among our population.
The current edition of the Red Book recommends that GPs systematically screen all adults, from age 18 years, for hypertension. Opportunistic screening during routine visits, as I have mentioned, is important, but systematic annual screening protocols are also essential to detect and treat the millions of Australians with undiagnosed high blood pressure. The Red Book emphasises evidence-based preventive activities, shared decision-making, and the importance of actively engaging our patients in their own health care, including discussing potential harms and benefits.
Education of our nation's health workforce is also critical. We need to support the implementation of robust educational support initiatives programs for GPs and primary care nurses and community pharmacists on single pill combinations and the new Hypertension Guidelines, being developed by the Heart Foundation, Stroke Foundation, and Hypertension Australia. Education provides the opportunity to drive meaningful change together.
For those people in our community with raised blood pressure, we need to look at how we might overhaul our awareness and detection programs. Unlike other conditions, hypertension lacks a formal registry or screening program, despite being the leading risk factor for death in Australia, as well as bring a significant contributor to the burden of heart attack, stroke, dementia, and kidney disease.
Dr. Tom Frieden is a former Director of the Centres for Disease Control in the United States, known well, I am sure, to many of you, and a prominent global health advocate focused on preventing deaths from heart disease by working with countries on scalable and achievable strategies and policies. Tom has said, "Hypertension is the deadliest but most neglected and widespread pandemic of our time." He advises that improving hypertension care "can save millions of lives each year-more than any other adult health-care intervention." He goes on to urges us all to close the gap between knowledge and action, implement effective prevention and control strategies, and align financial incentives to prioritize key patient health outcomes.
The work we are doing is not occurring in isolation, and we need to be cognisant of the many external factors which are impacting the work we all do as individual clinicians.
As we move forward with the important work of the Taskforce, I understand that we won't all necessarily agree on the way to achieve our shared goals. I want to remind you the words of Gandhi, "Honest differences are often a healthy sign of progress." The diversity of our perspectives, across clinical disciplines, health sectors, and the diverse communities we serve, is also our strength. By embracing open dialogue and respectful debate, we can learn from each other, share our viewpoints on priorities and actions, and work together to achieve lasting improvements in hypertension prevention, diagnosis and effective treatment, for all Australians.
Thank you all for the great work you do, and thank you for inviting me to join with you today.
