There are significant population health and economic implications if Australia were to adopt recently revised American guidelines
There are few things more controversial in medicine than when authoritative bodies shift the goalposts for common conditions and redefine normal values. This is particularly the case when the normative values for common chronic disease risk factors in the community, such as blood pressure or cholesterol, are made more stringent. In the stroke of a pen, millions of people have a disease or a risk factor they did not have the day before. Is this “the medicalisation of life” referred to by Illich?1
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Illich I. Medical nemesis: the expropriation of health. New York: Pantheon Books, 1976.
- 2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 13: 24430.
- 3. Maddox TM, Borden WB, Tang F, et al. Implications of the 2013 ACC/AHA cholesterol guidelines for adults in contemporary cardiovascular practice: insights from the NCDR PINNACLE registry. J Am Coll Cardiol 2014; 64: 2183-2192.
- 4. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab 2012; 97: 1153-1158.
- 5. SPRINT Research Group. A randomized trial of intensive versus standard blood- pressure control. N Engl J Med 2015; 373: 2103-2116.
- 6. Muntner P, Carey RM, Gidding S, et al. Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. J Am Coll Cardiol 2018; 71: 109-118.
- 7. Gabb GM, Mangoni AA, Anderson CS, et al. Guideline for the diagnosis and management of hypertension in adults — 2016. Med J Aust 2016; 205: 85-89. <MJA full text>
- 8. Wang JG, Liu L. Global impact of 2017 American College of Cardiology/American Heart Association Hypertension guidelines: a perspective from China. Circulation 2018; 137: 546-548.
- 9. Schiffrin EL. Global impact of the 2017 American College of Cardiology/American Heart Association Hypertension guidelines: a perspective from Canada. Circulation 2018; 137: 883-885.
- 10. Wander GS, Ram CVS. Global impact of the 2017 American College of Cardiology/American Heart Association Hypertension guidelines: a perspective from India. Circulation 2018; 137: 549-550.
- 11. Australian Bureau of Statistics. National Health Survey: first results, 2014–15 (Cat. No. 4364.0.55.001). Canberra: ABS, 2015. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001 (viewed May 2018).
- 12. Hoare E, Kingwell BA, Jennings GLR. Blood pressure Down Under, but down under what? US and Australian hypertension guideline conversation. Hypertension 2018; 71: 972-975.
- 13. Gee ME, Campbell N, Sarrafzadegan N, et al. Standards for the uniform reporting of hypertension in adults using population survey data: recommendations from the World Hypertension League Expert Committee. J Clin Hypertens (Greenwich) 2014; 16: 773-781.
- 14. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey; 2013–2014 data documentation, codebook, and frequencies; blood pressure [website]. Atlanta, GA: CDC, 2015. https://wwwn.cdc.gov/Nchs/Nhanes/2013-2014/BPX_H.htm (viewed Mar 2018).
- 15. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Melbourne: National Stroke Foundation, 2012. https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf (viewed May 2018).
- 16. Karakaya G, Van Tielen R, Umbach I. [OP.6C.02] Risk factors associated with medication non-compliance in arterial hypertension. J Hypertens 2016; 34: e72.
- 17. American Academy of Family Physicians. Guidelines developed by external organizations not endorsed by the AAFP [website]. AAFP, 2017. https://www.aafp.org/patient-care/clinical-recommendations/non-endorsed.html (viewed Mar 2018).
- 18. Hoare E, Stavreski B, Kingwell BA, Jennings GL. Australian adults’ behaviours, knowledge and perceptions of risk factors for heart disease: a cross-sectional study. Prev Med Rep 2017; 8: 204-209.
- 19. Australian Institute of Health and Welfare. Australian burden of disease study: impact and causes of illness and death in Australia 2011. Canberra: AIHW, 2016. https://www.aihw.gov.au/getmedia/d4df9251-c4b6-452f-a877-8370b6124219/19663.pdf.aspx?inline=true (viewed May 2018).
- 20. Rose G. Sick individuals and sick populations. Int J Epidemiol 2001; 30: 427-432.
This work was supported by funding from the Australian National Health and Medical Research Council (NHMRC) (Program Grant #1036352, and Centre for Research Excellence Grant #1000986) and the Victorian Government’s Operational Infrastructure Support Program (Garry Jennings and Bronwyn Kingwell). Erin Hoare was supported by an Australian Rotary Health Postdoctoral Research Fellowship. Bronwyn Kingwell was supported by an NHMRC Senior Principal Research Fellowship (NHMRC #1059454).
Garry Jennings is Chief Medical Advisor of the Heart Foundation.