Australian research changing hypertension management worldwide

The rules are changing around the management of hypertension (high blood pressure) worldwide, with a single lab in Melbourne at the heart of the change.

In Australia, hypertension affects about 6 million people and, thanks to the work of Associate Professor Jun Yang at Hudson Institute of Medical Research, we now know that at least 10 per cent of them have a unique form that can’t be effectively treated by the usual blood pressure-lowering medications.

Globally, an estimated 1.28 billion adults have hypertension, which equates to about 128 million with the condition. However, less than 1% of affected people know they have the condition. 

The cause of their hypertension is primary aldosteronism (PA), a condition caused by an increased production of aldosterone by the adrenal glands, resulting in excess salt and fluid retention and increased blood pressure.  A/Prof Yang is at the forefront of the move to make PA screening a routine part of hypertension management.  

Making headlines in hypertension

Along with and Professor Peter Fuller and the Primary Aldosteronism Centre of Research Excellence (PACE) at Hudson Institute, she has been the driving force behind the adoption of a global standard for assessing non-surgical management of PA.

This is big news in the medical community, as evidenced by the publication of A/Prof Yang’s work establishing these new international assessment criteria in The Lancet Diabetes & Endocrinology.

New hypertension assessment guidelines

It’s not just treatment of PA that is changing – the European Society of Cardiology has recently agreed on a new set of guidelines that for the first time recommend screening for PA in all hypertensive adults. A/Prof Yang says it’s a move that will be followed worldwide. 

“PA affects an estimated 1.2 billion people and 600,000 in Australia alone, but it’s often undiagnosed, and that has a huge impact on cardiovascular health,” she said.

Taken together, these developments highlight the leading role that A/Prof Yang and Hudson Institute are playing in this field worldwide.

“Having a set of criteria for assessing people who are being treated will hopefully help to standardise both clinical practice and research,” she said. “It will unify how people with this condition are managed, using the same set of rules, and it also makes it easier for researchers to report treatment outcomes using a single assessment protocol – so it helps to standardise both clinical practice and research.”

“Once there is a clear guideline for monitoring, it may even make it more appealing for people to test for PA; the more clarity there is around a condition – its diagnosis, treatment and assessment – the more likely it will be that doctors will look for this potentially curable disease.”

Hypertension facts (source: World Health Organization)

• An estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries
• An estimated 46% of adults with hypertension are unaware that they have the condition.
• Less than half of adults (42%) with hypertension are diagnosed and treated.
• Approximately 1 in 5 adults (21%) with hypertension have it under control.
• Hypertension is a major cause of premature death worldwide.
• One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.

PA facts (source: Hudson Institute of Medical Research)

• In primary aldosteronism, the adrenal glands, which sit on top of each kidney, produce too much aldosterone (a hormone that retains salt in the body).
• This can lead to excess salt and fluid retention and increased blood pressure. It also increases the risk of heart arrhythmia, heart attack and stroke more than ordinary forms of hypertension.
• Primary aldosteronism affects five to 10 per cent of those with hypertension but often goes undiagnosed.
• It is treatable with medication and/or surgery, depending on the cause.
• If undiagnosed, PA can lead to higher blood pressure that becomes increasingly difficult to control with medication.
• This can leave those who have it at risk of strokes, heart attacks at a younger age and in some cases heart and kidney failure. Others may end up taking numerous ineffective blood pressure medications while still suffering from high blood pressure.
• If correctly diagnosed, management of PA-based hypertension can often be achieved with appropriate medication or surgery.