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People in rural Australia are more likely to have hypertension, and less likely to be treated for it, than their city counterparts.
Hypertension is a silent condition someone who has high blood pressure often doesn't know about it. But it's a major risk factor for coronary heart disease, stroke and kidney failure.
It's the biggest single contributor to poor health in Australia, and nowhere more so than in Australia's rural community, where studies suggest it's not only more common, but less successfully treated than in the cities.
In fact, researchers at Charles Sturt University in New South Wales put the prevalence of hypertension in one rural community at a whopping 58 per cent of 50 to 75-year-olds, based on a study recently published in the journal Clinical and Experimental Hypertension.
The researchers studied a group of 674 people from in and around Albury, a large town in New South Wales, who answered an advertisement offering a free blood pressure check. Researchers quizzed them about their past medical history and treatment, and took their blood pressure.
Thirty-seven per cent had been diagnosed with hypertension in the past and 21 per cent were found to have undiagnosed hypertension.
This high prevalence of hypertension, at 58 per cent, is considerably higher than the average for Australian adults, which other studies have put at 28 to 42 per cent, but which is probably closer to around 30 per cent, the researchers say.
Of the Albury participants who were known to have hypertension, only about 43 per cent were actually being treated with blood pressure lowering medication. And of these, fewer than half had a normal blood pressure defined as 140 mm Hg (systolic) and 80 mm Hg (diastolic) or lower. In other words, less than half were getting optimal treatment.
Now, there was some study bias in this group. The average age was in the early sixties (an age group more likely to have hypertension), and the participants were 'self-selecting' that is, they volunteered to take part, possibly because they thought their blood pressure would be high.
And some in the study may simply have had high blood pressure on the day, but not at other times. So the figure of 58 per cent is probably artificially high.
But other studies have also revealed a country/city difference, says Dr Herbert Jellink from the School of Community Health at Charles Sturt University, one of the study's authors.
He says one 2002 study of adults in New South Wales found the prevalence of hypertension in rural residents was three per cent higher than in urban residents (22.2 per cent compared to 19.3 per cent).
And earlier this year, researchers from Flinders University in Adelaide and Deakin University in Melbourne studied three rural communities in south-east Australia and found one-third of 3320 adults aged 25 to 74 years had hypertension.
Like the Albury study, this study also showed a high percentage of people with hypertension weren't being treated. Among the group with hypertension, two-thirds were aware of it, but only half were receiving treatment, and only half of these had got their blood pressure down to normal levels. Cases of untreated or poorly treated hypertension are considerably more common in rural areas than in the cities, says Jellink.
Why is there more hypertension in the bush? It may be related to higher levels of stress in rural communities from drought and economic hardship. It may also be because there is less awareness in rural communities of the role that exercise, diet and other lifestyle measures play in preventing hypertension. Public health campaigns don't spread the word as effectively in the bush as in the cities, says Jellink.
People are less likely to get their blood pressure checked, even if they think of it. Access to GPs is harder there are fewer GPs, with longer waiting times. It's harder to get in to see a GP for something considered to be non-urgent, like a blood pressure check.
Studies bear this out. One study of GPs in Western Australia found that where city doctors tended to check on their hypertensive patients every one to three months, country GPs followed them up every three to six months.
Country people, especially men, are less likely to want to see a doctor when they fall ill, let alone for a preventive check when they're not actually suffering symptoms.
And when they are diagnosed and treated they're less likely to keep the treatment going, as the message to keep taking the medications doesn't tend to be reinforced.
Jellink says there needs to be a more concerted effort from state and Commonwealth health departments and divisions of general practice to encourage people to be screened and treated for hypertension.
Access to screening could be broadened to include pharmacies, universities, TAFE colleges, and Aboriginal health services to take pressure off GPs, he argues. In Albury, for example, some pharmacists are offering simple screening tests like blood sugar and blood pressure checks, so people don't have to wait for a GP's appointment.
The message for rural communities is clear. Doctors need to be on the lookout for hypertension, and patients need to get themselves checked and then followed up to make sure the treatment is working.