High blood pressure in veterans

Professor Jenny Firman AM
Chief Health Officer, DVA

Professor Jenny Firman

One of the most common things checked by doctors in routine consultations is blood pressure. In Australia, we know that one third of the adult population has high blood pressure (hypertension) and cardiovascular disease causes about 25% of all deaths each year. Many of these deaths are preventable through early detection and treatment. Reducing high blood pressure can help to prevent stroke, coronary heart disease, chronic kidney disease and the abnormal heart rhythm known as atrial fibrillation.

If you needed another reason to be vaccinated for COVID, recent research in the UK has shown that in a large study looking at more than 16,000 people with the virus, those with high blood pressure had a 22% higher risk of hospitalisation and death than those with normal blood pressure. Those whose blood pressure was well controlled by medication had a similar risk to those without high blood pressure.

Your doctor will check your blood pressure as part of an overall cardiovascular risk check. They will also check your lipids (this includes cholesterol), whether you have diabetes, your smoking history, your family history and your age. Unfortunately, the risk of cardiovascular disease increases with age – a non-modifiable risk factor. 

While there have been improvements in the population in some of these risk factors, the vast majority (about 95%) of Australian adults still have at least one modifiable risk factor, and two-thirds (66%) have three or more risk factors at the same time.

If your doctor finds that your blood pressure is high, they will often want to check this again at the next visit, or ask you to do some measurements at home, or to undergo ambulatory blood pressure measurement. The latter involves wearing a blood pressure monitor for 24 hours that records the pressure at regular intervals while the wearer goes about their usual activities during the day, and at night while asleep. This provides the best information about blood pressure and can be very useful for those people with ‘white coat’ hypertension whose blood pressure goes up whenever they are in a clinical setting, such as visiting their doctor.

If your doctor finds your blood pressure is high, lifestyle interventions can help and are usually the first step, depending on cardiovascular risk. This means not smoking, eating a healthy diet (lots of vegetables, fruit, whole grains, low-fat dairy, fish, nuts, legumes etc.), being physically active (minimum of 2.5 hours of exercise per week), reducing salt, reducing alcohol and maintaining a healthy weight.

If blood pressure is not reduced sufficiently, medication may be needed. In the 1960s and 1970s there were far fewer medication options available, and we are fortunate today that there are three main types of medication available that can control blood pressure in most people.

Commonly, more than one antihypertensive is required to reach your blood pressure goal and there can be differences in how each person may respond to each medication. Research has shown that two medications at a lower dose can be more effective than a single medication at a higher dose, with reduced side effects. Fortunately, combined medications are readily available, so the overall number of pills does not need to increase. For a minority, even three medications may not control their blood pressure sufficiently and they may require specialist advice regarding further medication.

In addition to routine consultations, your doctor can provide you with a Heart Health Check if you are aged 45 and over under Medicare. DVA covers this and also provides the one-off Veteran Health Check that includes checking cardiovascular risk, as does the Annual Veteran Health Check that is available annually for 5 years after transition from the Australian Defence Force (from 1 July 2019).

You may also be eligible for the DVA Heart Health Program. This aims to increase your physical health, fitness and wellbeing by providing practical exercise resources, nutritional advice and healthy lifestyle coaching for 12 months. The program is free and open to all veterans and peacekeepers with operational service and those covered under the Australian Defence Force Firefighter Scheme who have not previously participated in the program.

Everyone should know their blood pressure and check it regularly. If you are prescribed medication, it is important to take it every day. Whether you take your medication in the morning or night, the most important thing is to take it as prescribed. The cardiovascular disease death rate fell by 82% between 1968 and 2015 and that is due to the availability of improved clinical treatment, widespread use of medication to reduce cholesterol levels and more effective blood pressure medications. 

Making sure you address cardiovascular risk factors can help you to enjoy a long and healthy life as you age.