HYPERTENSION AWARENESS, TREATMENT, AND CONTROL IN AUSTRALIA. A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective: Research from the NCD Risk Factor Collaboration indicated that the hypertension control rates in Australia are lagging behind other high-income countries, and a call to action to improve blood pressure (BP) control has been published. To understand the size of the problem, we will systematically examine contemporary evidence of hypertension awareness, treatment and control rates in Australia. Design and method: We performed a systematic literature search of reports of hypertension awareness, treatment and control rates in Australia. We undertook an individual participant data meta-analysis (IPDMA) shared by the NCD Risk Factor Collaboration. Where possible, data were pooled for meta-analysis by random effects meta-analysis. Results: In our meta-analysis based on aggregated data from 23 studies, the pooled proportion of hypertension awareness, treatment and control rates in Australia was 61% (95% confidence interval: 47%–74%), 58% (53%-63%), 40% (33%-47%), respectively. The National Health Survey data (n = 61799) shows a higher proportion of hypertension among males than females was observed until the 7th decade of life, and among those with lower socioeconomic status in Australia. The proportion of hypertensive subjects who were on 1, 2, and 3 or more types of antihypertensives was 44.4%(43.5%-45.2%), 18.4% (17.7%-19.0%), 7.7%(7.3%-8.2%), respectively. Our IPDMA was of 12598 (26.3%, n = 57104) hypertensive subjects, among whom 7227 (57.4%) were on antihypertensives and 58.6% had uncontrolled hypertension (SBP equal to or greater than 140 mmHg or DBP equal to or greater than 90 mmHg, n = 4238). The proportion of uncontrolled hypertension was higher among males (62.7%) than females (55.5%, p<0.0001). Conclusions: The hypertension burden in Australia is substantial, with a significant proportion of people with high BP who were unaware, untreated and uncontrolled. There is a lack of high-quality studies to identify barriers and enablers for hypertension treatment and control in Australia. These results will be key to informing the actions of the National Hypertension Taskforce that the Federal Minister of Health newly established.