Pattern of blood pressure in Australian adults: Results from a National Blood Pressure Screening Day of 13,825 adults

https://doi.org/10.1016/j.ijcard.2009.06.003Get rights and content

Abstract

Background

Recent national data of cardiovascular disease (CVD) risk factors in Australia are limited. Therefore this study sought to gain a contemporary snapshot of the blood pressure (BP) profile of Australian adults.

Methods

We established 100 metropolitan and regional screening sites. Using a standardized protocol and the same automated, validated BP monitor, Registered Nurses recorded the BP and other risk factors for CVD of self-selected volunteers on a single day.

Results

A total of 13,825 subjects (55% female, aged 48 ± 16 years) were assessed. Mean systolic and diastolic BP was 131 ± 18 and 79 ± 12 mm Hg. Overall, 34% had an elevated BP while 10% being treated for hypertension (HT) were normotensive (combined total 44%). Elevated BP was more common in older individuals, men (42% versus 27% of women), regional dwelling residents (40% versus 32% of metropolitan) and people from lower socio-economic backgrounds (39% versus 30% of higher). Overall, 50% of subjects with a history of HT had elevated BP compared to 30% without a history of HT. Adjusting for age and sex, elevated BP was independently associated with obesity (OR: 1.77, 95% CI 1.52–2.06), regional location (OR: 1.32, 95% CI 1.19–1.45) and modifiable risk factors (OR: 1.28, 95% CI 1.21–1.35); those being treated for CVD or diabetes are less likely to have high BP.

Conclusions

In the largest study of its kind in Australia, the findings highlight the need for continued vigilance to detect, monitor and prevent elevated BP within an ageing population in whom metabolic disorders are becoming more frequent.

Introduction

As a key contributor to the global increase in cardiovascular disease (CVD), high blood pressure (BP) is a readily detectable and modifiable condition that represents a major target for primary and secondary prevention programs. In 2001, high BP or hypertension (HT) was estimated to contribute to 7.6 million deaths (13.5% of total deaths) and 92 million disability-adjusted life years globally [1]. In Australia, it was the largest contributor to CVD in 2003 and explained 42% of CVD burden (7.6% of total disease burden) [2]. It is also the most commonly managed cardiovascular risk factor by primary care physicians in Australia, accounting for nine in every 100 encounters (three times that of lipid disorder management) [3].

Elevated BP seems to have re-emerged with an even greater effect on premature mortality and disability [3] and despite the availability of effective pharmacological treatments [4]. During the 1980s, the prevalence of high BP in Australia reportedly declined from 38% to 26% but steadily rose again in the 1990s and early 21st Century [5], [6], [7], [8]. The population is ageing and rates of obesity and metabolic disorders are rising [9] which may contribute to increasing rates of HT. Australia has also experienced significant socio-demographic changes, including the overall ageing of the post-war “baby boomer” generation and widening differentials in the socio-economic status of the population, particularly metropolitan versus regional/rural communities. In Australia, regional and remote populations comprise around 32% of the 15 million adult population aged over 18 years [10].

We undertook a National Blood Pressure Screening Day to gain a contemporary “snapshot” of the BP profile of adult Australians. A key objective was to explore differences according to age, sex, geographic location, treatment for those known to have HT and socio-economic status. A secondary aim was to project the prevalence of elevated BP and obesity in adult Australians.

Section snippets

Participants

A total of 13,825 participants were recruited. This equates to one in every 1000 adult Australians (see Fig. 1 for a profile of the Australian population). People were offered a free BP check if they walked by any of the 100 screening stations distributed throughout Australia on a single day (Saturday 30th June 2007). A weekend day was chosen to allow for a broader mix of age groups and to include members of the workforce as well as non-working adults. On this day, invitation to participate was

Results

A total of 13,825 completed profiles were verified from 99 screening stations. Table 1 summarises the socio-demographic and clinical profile according to gender and locality. Overall, 7666 (55%) were women with an average age of 48.7 ± 15.8 years and 48.0 ± 16.2 years for men. Participants were predominantly Caucasian/European (86%) and one in ten was Asian. Based on the median household income for their residential postcode, the majority of participants were from middle socio-economic backgrounds

Discussion

In the largest study of its kind in Australia, in a single day using a standardized protocol and equipment [13], we examined BP in close to 14,000 adults in 100 locations from every state and territory. Overall, we found that one in three (34%) participants recorded an elevated BP. This figure rose to 44% if individuals with a history of HT, but normotensive at the time, were included. There were key differentials in BP levels; older individuals, men (42% versus 27% of women), regional (40%)

Acknowledgement

We gratefully acknowledge Mr. Neil Covey for co-ordinating the National Blood Pressure Screening Day. We thank the nurses for carrying out the survey and Traffik Marketing for organising the screening booths, their distribution across Australia and the return of the study data. MJC and SS are supported by the National Health and Medical Research Council of Australia (NHMRC).

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the

References (25)

  • D.W. Dunstan et al.

    The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)—methods and response rates

    Diabetes Res Clin Pract

    (2002)
  • CoatsAJ

    Ethical authorship and publishing

    Int J Cardiol

    (2009)
  • A.D. Lopez et al.

    Measuring the global burden of disease and risk factors, 1990–2001

  • Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003:...
  • Australian Institute of Health and Welfare. Australia's health 2006. Canberra, ACT, Australia: AIHW cat. no. AUS 73;...
  • National Heart Foundation of Australia (National Blood Pressure and Vascular Disease Advisory Committee)

    Guide to management of hypertension

    (2008)
  • Australian Bureau of Statistics. National Nutrition Survey 1995: nutrient intakes and physical measurements. Canberra,...
  • E.L.M. Barr et al.

    AusDiab 2005: the Australian Diabetes, Obesity and Lifestyle Study

    (2006)
  • S.A. Bennett et al.

    Trends in cardiovascular risk factors in Australia. Results from the National Heart Foundation's Risk Factor Prevalence Study, 1980–1989

    Med J Aust

    (1994)
  • E.M. Briganti et al.

    Untreated hypertension among Australian adults: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

    Med J Aust

    (2003)
  • Australian Bureau of Statistics. National Health Survey: summary of results. Canberra, ACT, Australia: ABS cat. no....
  • Australian Bureau of Statistics. 2006 Census Data Pack: data and geographic boundaries from the 2006 census of...
  • Cited by (35)

    • Undiagnosing to prevent overprescribing

      2019, Maturitas
      Citation Excerpt :

      It is suggested that re-assessment of variable airflow limitations can assist health professionals to identify people who have sustained periods of clinical remission [48]. A similar issue is hypothesised for blood pressure where the patterns can alter within individuals over time [49,50]. Lifestyle-related conditions can ameliorate with non-pharmacological interventions such as weight loss, diet and exercise.

    • A metabolic syndrome severity score: A tool to quantify cardio-metabolic risk factors

      2016, Preventive Medicine
      Citation Excerpt :

      These estimates are similar to the US where recent data show that over 1 in 5 adults meet the criteria for the MetS (Beltrán-Sánchez et al., 2013). Not all adults have equal risk for the MetS and there are disparities in the global burden of health in general (Carrington et al., 2010; Roux et al., 2001). For example, lower socioeconomic status (Chichlowska et al., 2008) and older age (Ford et al., 2002) are associated with greater risk of cardio-metabolic disease.

    • A systematic review and meta-analysis of primary prevention programmes to improve cardio-metabolic risk in non-urban communities

      2016, Preventive Medicine
      Citation Excerpt :

      Non-urban residing individuals are renowned for having higher levels of antecedent risk for CVD and this observation is paralleled around the globe from Africa (Strasser, 2003) and Europe (World Health Assembly, 2009), to USA (Singh and Siahpush, 2014) and Australia (Trickett et al., 1998). In particular in Australia, a higher proportion of non-urban individuals had high blood pressure (BP, 40%) (Carrington et al., 2010) and were overweight or obese (70%) (Carrington et al., 2010) compared to urban residents, where 32% had high blood pressure (Carrington et al., 2010) and 64% are overweight or obese (Carrington et al., 2010). Non-urban populations are geographically more distant from specialist health care (Carrington et al., 2012) and locally, have limited availability to primary care services per capita (Clark et al., 2007), few or no walking paths or bike tracks and may pay more for fresh produce and meat (Burns et al., 2004).

    • Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia

      2013, Kidney International
      Citation Excerpt :

      Socioeconomic disadvantage is likely to pose a range of barriers to receiving a living-donor kidney. Donors and recipients must be medically suitable and the burden of morbidity is greater and harmful health-related behaviors more common among people who live in disadvantaged areas.11−15 Although higher levels of comorbidity (or underreporting and thus underadjustment for comorbidities within models) within potential recipients may be important, this is not likely to be a factor, given the absence of a SES-related trend for deceased-donor transplants.

    View all citing articles on Scopus

    Sources of support: The National Blood Pressure Screening Day was independently designed and analysed by Baker IDI Heart and Diabetes Institute and generously supported by Schering Plough Pty. Limited. Simon Stewart and Melinda Carrington are supported by the National Health and Medical Research Council of Australia.

    View full text