Aletta E Schutte

UNSW Sydney | UNSW · School of Population Health

Elevated blood pressure is the strongest modifiable risk factor for cardiovascular disease worldwide. Despite extensive knowledge about ways to prevent as well as to treat hypertension, the global incidence and prevalence of hypertension and, more importantly, its cardiovascular complications are not reduced—partly because of inadequacies in preven...

Early vascular aging reflects increased arterial stiffness of central blood vessels at young chronological ages and powerfully predicts cardiovascular events and mortality, independent of routine brachial blood pressure and other risk factors. Since ethnic disparities exist in routine blood pressure, in hypertension and cardiovascular outcomes, thi...

In recent decades low-and middle-income countries (LMICs) have been witnessing a significant shift toward raised blood pressure; yet in LMICs, only 1 in 3 are aware of their hypertension status, and ≈8% have their blood pressure controlled. This rising burden widens the inequality gap, contributes to massive economic hardships of patients and carer...

Hypertension is the leading risk factor for cardiovascular disease and premature death among women globally. However, there is a fundamental lack of knowledge regarding the sex-specific pathophysiology of the condition. In addition, risk factors for hypertension and cardiovascular disease unique to women or female sex are insufficiently acknowledge...

Background: Raised blood pressure (BP) remains the single most important modifiable risk factor contributing to cardiovascular and all-cause mortality in Australia and worldwide. May Measurement Month, a global BP measurement and screening campaign initiated by the International Society of Hypertension and carried out in Australia since its incept...

We now know that not only in high-income countries, but also in low- and middle-income countries there is a major challenge in ensuring that BP devices are accurate. When evaluating the global availability of devices online for sale, there was no evidence of validation for 73% of all devices (2486 devices listed on the Medaval database). This globa...

Adverse changes in large arteries and retinal microvascular calibres are predictors for hypertension and stroke. These adverse changes were reported in response to the suppressed night-time dipping as well as in hypertensive individuals with exaggerated morning surge. However, it is unknown whether young healthy individuals with normal morning surg...

Cardiovascular disease (CVD) remains the major contributor to premature death globally, with black populations presenting with a disproportionate burden of CVD and early target organ damage. Renin angiotensin system dysregulation is a key factor involved in hypertension development and organ damage in black populations. Angiotensin converting enzym...

The extent of the alerting reaction on systolic blood pressure (BP) measurements has been shown to be related to age and the magnitude of the first reading, with implications for the monitoring and diagnosis of hypertension. We investigated the effects of age on the direction and magnitude of change in both systolic and diastolic BP from the first...

The 2019 Global Burden of Disease (GBD) findings highlight raised systolic blood pressure (SBP) as the leading cause of death globally. In a high-income country, Australia, it is unclear how SBP ranks among other risk factors regarding the overall and cardiovascular disease (CVD) burden, and whether the situation has changed over time. We analysed...

Globally, it is estimated that 10.4 million people die each year due to raised blood pressure (BP). Unfortunately, at least 40% of those with high BP globally are unaware of their condition. In the most recent UK and Ireland community-based data, 66.5% of people were unaware of their high BP(1). The UK and Ireland have taken part in the global May...

Hypertension is a leading cause of global morbidity and mortality and is a principal risk factor for cardiometabolic multimorbidity. Evidence regarding the prevalence of hypertension, hypertension treatment and blood pressure (BP) control is scarce in people with cardiometabolic long-term conditions (LTCs). May Measurement Month is the largest annu...

Cardiovascular disease (CVD) affects individuals across the lifespan with multiple cardiovascular (CV) risk factors increasingly present in young populations. The underlying mechanisms in early cardiovascular disease development are complex and still poorly understood. We therefore employed urinary proteomics as a novel approach to gain better insi...

The online purchase of automated blood pressure (BP) devices is a multibillion-dollar industry, but most BP devices available for online purchase have not passed adequate clinical validation testing. This study aimed to determine the extent to which BP devices available in best-selling lists of the e-commerce business Amazon were properly validated...

We sought to compare the proportion of individuals with hypertension obtained from the large-scale May Measurement Month (MMM) opportunistic screening program with those from the population-based household STEPwise Approach to Non-communicable Risk Factor Surveillance (STEPS) surveys in 14 countries. The MMM program was first implemented in 20117 b...

Hypertension is one of the most important and complex risk factors for cardiovascular diseases. Identifying biomarkers in hypertension may lead to better strategies to understand the development of hypertension. Biomarker discovery through the use of peptidomics may also provide essential information for the prediction and prevention of premature C...

Cuffless wearable blood pressure (BP) monitors have great potential in assessing 24-hour BP without user disturbance for weeks and months. However, it is uncertain whether these devices can accurately track BP changes during usual daily activities and sleep as with standard 24-hour ambulatory BP monitoring (ABPM). We assessed daytime and nighttime...

Hypertension is the single most important cause of premature morbidity and mortality in the world. Over half of all heart disease and stroke are attributable to hypertension, which is associated with approximately 10% of direct medical costs globally. Clinical trial evidence has conclusively demonstrated that pharmacist care, including patient educ...

Although blood pressure measurement is perhaps the most common measurement done in clinical practice, many have started to challenge this procedure and calling for transformation in blood pressure monitoring. This is because blood pressure measurement in primary care has many problems, whether clinic, 24-hour ambulatory or home blood pressures are...

There is a lack of consensus on the optimal mathematical indices for quantifying blood pressure variability (BPV). We sought to compare four established indices of BPV across six age strata among the substantial international population screened during May Measurement Month (MMM) 2019. Within visit BPV of readings taken at 1 minute intervals was ca...

Excessive salt intake is the leading dietary risk factor for cardiovascular disease (CVD). This increased risk may be attributed to alterations in the human metabolome. Salt sensitivity is associated with ethnicity, and ethnic differences in the interaction between sodium intake and the metabolome may play an integral part in CVD development. We th...

People with diabetes mellitus (DM) have a higher prevalence of suboptimal blood pressure (BP) control compared to those without DM. Whether the presence of DM affects the ability of antihypertensive therapies to lower blood pressure (BP) is uncertain. We investigated whether DM affects the efficacy of a low dose triple combination pill or usual car...

The increasing prevalence of people living with multimorbidity is an increasing challenge for health systems. Mean arterial pressure (MAP) serves as the steady component in a patient's arteries during one cardiac cycle while pulse pressure (PP) is recognized as the pulsatile component. Along with systolic blood pressure (BP) and diastolic BP, both...

There is a dearth of comprehensive studies on the burden of hypertensive heart disease (HHD) and high systolic blood pressure (SBP) among the Australian population over time. We aimed to explore the burden of HHD and SBP, and how it changed over time from 1990 to 2019. We analysed the 2019 Global Burden of Disease data with a focus on Australia. We...

In LMICs, the rapid uptake and availability of mobile phones provide excellent opportunities for host of an intervention. However, research on the effectiveness and acceptability of mHealth in these settings remains limited. The main objective of this feasibility study was to assess the effectiveness and acceptability of a mobile phone text messagi...

Wearable cuffless blood pressure (BP) monitoring technology has emerged as a novel approach to continuously measure BP for weeks and months, rather than single snapshot clinic measures that are subject to substantial variability. Given poor patient engagement with home and 24-hour BP monitoring, we explored patient attitudes toward the use of a wri...

[This corrects the article DOI: 10.5334/gh.913.].

Introduction The VALID BP project was initiated to increase the availability of validated blood pressure measuring devices (BPMDs). The goal is to eliminate non validated BPMDs and minimise over- and underdiagnosis of hypertension caused by inaccurate readings. This study was undertaken to assess the potential return on investment in the VALID BP p...

Elevated homocysteine (Hcy) increases cardiovascular disease (CVD) risk. Our objective was to emphasize Hcy’s contribution in hypertension and CVD management by determining H-type hypertension (hypertension with Hcy ≥ 10 µmol/L) and associations between Hcy, blood pressure (BP) and estimates of vascular function among Black South Africans. We inclu...

A large body of evidence exist on diet and cardiovascular mortality, but limited studies have investigated the long-term intake of food groups, which may have cumulative effects on cardiovascular health in the long term. This review therefore evaluated the relationship between long-term consumption of ten food groups and cardiovascular mortality. W...

Cardiovascular disease (CVD) affects individuals across the lifespan, with multiple cardiovascular (CV) risk factors increasingly present in young populations. The underlying mechanisms in early cardiovascular disease development are complex and still poorly understood. We therefore employed urinary proteomics as a novel approach to gain better ins...

In Black populations excessive salt intake may exacerbate the genetic predisposition to hypertension and promote the early onset of cardiovascular disease. Ethnic differences in the interaction between sodium intake and the metabolome may play a part in hypertension and cardiovascular disease development. We determined (1) urinary amino acid and ac...

We investigated whether diabetes mellitus (DM) affects the efficacy of a low-dose triple combination pill and usual care among people with mild-moderate hypertension. TRIUMPH (TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension) was a randomised controlled open-label trial of patients requiring initiation or escalat...

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high-and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, presen...

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high-and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, presen...

We have been using cuff-based methods to measure blood pressure for more than a century. In fact, blood pressure measurement is the most common procedure performed today in clinical practice. But patients, industry, and forward-thinkers have called for transformation in blood pressure monitoring.¹ This is because blood pressure measurement in prima...

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce systolic blood pressure (SBP), but whether they affect SBP variability is unknown. There also remains uncertainty about the prognostic value of SBP variability for clinical outcomes. Methods: We conducted a post-hoc analysis of the CANVAS Program and CREDENCE trial in individuals...

Introduction: Cuffless blood pressure (BP) monitoring offers great potential in assessing 24-hour BP without user disturbance. Despite the myriad of commercially available cuffless BP devices, it is uncertain whether these devices can accurately track BP changes during usual daily activities and sleep as with standard 24-hour ambulatory BP monitori...

Background Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with COVID‐19. Methods and Results MEDLINE, EMBASE, Cli...

Exogenous estrogens and progestins may affect the components of the renin–angiotensin–aldosterone system (RAAS). Changes in ventricular blood volume are associated with increased secretion of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP), which may also be affected by hormonal contraceptives. In this study, we aimed to compare compo...

Background Blood pressure control has a pivotal role in reducing the incidence and recurrence of stroke. May Measurement Month (MMM), which was initiated in 2017 by the International Society of Hypertension, is the largest global blood pressure screening campaign. We aim to compare MMM participants with and without a previous history of stroke and...

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis,...

Supplementary data

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air p...

Aim: Risk factors contributes to a dysregulated metabolism and may ultimately increase the predisposition for cardiovascular disease (CVD) development. To increase our understanding of mechanistic pathways associated with CVD risk, we profiled the urinary metabolome according to individual and clusters of CVD risk factors in comparison with a cont...

Background: Risk factors for oral disease can potentially be ameliorated by school-based interventions. This review evaluates the effectiveness of primary school-based interventions in improving oral health among children in low-and middle-income countries (LMICs). Methods: Our systematic review was conducted in accordance with the Joanna Briggs...

Background: Many cuffless blood pressure (BP) measuring devices are currently on the market claiming that they provide accurate BP measurements. These technologies have considerable potential to improve the awareness, treatment, and management of hypertension. However, recent guidelines by the European Society of Hypertension do not recommend cuff...

Background High dietary sodium intake is a leading cause of hypertension. A major source of dietary sodium is salt added to processed food products available in retail food environments. The fast-growing online grocery shopping setting provides new opportunities for salt reduction interventions that support consumers in choosing healthier options....

Background Dental caries remains the most prevalent non-communicable disease globally affecting 60–90% of children. The World Health Organisation’s (WHO) health-promoting school program offers a framework for dental intervention in low- and middle-income countries (LMICs). This study explored teacher contributions to children’s oral health in relat...

Background: The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction beyond that based on traditional osteoporotic risk...

Background Influential guidelines currently define hypertension at different thresholds of blood pressure (BP). The global May Measurement Month initiative provides a unique opportunity to estimate the potential consequences of universal lowering of BP thresholds on the prevalence of hypertension based on a large, real-world, patient-level data set...

The relationship between negative events, neighbourhood characteristics, and systolic blood pressure in developing countries is not well-documented, particularly using longitudinal data. To explore this relationship, we analysed panel data from the first three waves of the South African National Income Dynamics Study using a correlated random effec...

This study aims to compare soluble (pro)renin receptor [s(P)RR] levels between black and white adults and to explore the associations of left ventricular (LV) structure and function with s(P)RR in the total and ethnicity-stratified groups. The study sample included 1172 apparently healthy black (n = 587) and white (n = 585) participants of the Afri...

Importance: Cumulative exposure to high blood pressure (BP) is an adverse prognostic marker. Assessments of BP control over time, such as time at target, have been developed but assessments of the effects of BP-lowering interventions on such measures are lacking. Objective: To evaluate whether low-dose triple combination antihypertensive therapy...

Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. Howev...

Current hypertension guidelines recommend using the average values of several blood pressure (BP) readings obtained both in and out of the office for the diagnosis and management of hypertension. In-office BP measurement using an upper-arm cuff constitutes the evidence-based reference method for current BP classification and treatment targets. Howe...

A recent study found that only 23.8% of blood pressure (BP) devices available for purchase from Australian pharmacies were validated for accuracy. The extent to which pharmacists are aware of this, and other issues related to the accuracy of BP devices, is not known and gathering this information was the aim of this study. An online survey of Austr...

Objectives To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors. Design Systematic analysis. Setting Participants were aged ≥70 from 204 countries and terri...

Background: Uncontrolled blood pressure (BP) is the leading cause of preventable deaths in low- and middle-income countries. mHealth interventions, such as mobile phone text messaging, are a promising tool to improve BP control, but research on feasibility and effectiveness in resource-limited settings remains limited. Objective: This feasibilit...

Open in new tabDownload slide Sodium hidden in medication warrants warning labels by drug companies.

Aims: Patients with type 2 diabetes mellitus (T2D) and PAD have a markedly elevated risk of macrovascular events and death. The sodium glucose co-transporter 2 (SGLT2) inhibitor canagliflozin has well-established cardiorenal benefits but net effects in patients with PAD remain uncertain. We sought to define the proportional and absolute benefits o...

This study uses data from the publicly available Medaval database to determine the number of upper arm cuff and wrist cuff blood pressure measuring devices sold globally as well as the percentages of those devices that have been clinically validated for accuracy.

Most studies disregard long-term dairy consumption behaviour and how it relates to mortality. We examined four different types of long-term milk consumption, namely whole milk, reduced fat milk, skim milk and soy milk, in relation to mortality among adults diagnosed with cardiovascular disease (CVD). A retrospective population-based study was condu...

Objective Single-pill combination (SPC) therapy is recommended as first-line therapy for most patients in global hypertension guidelines due to benefits of improved adherence and blood pressure (BP) control. We aimed to understand factors affecting SPC use in the management of raised BP in Australia. Design A mixed-method study comprising of quali...

South Africa was among the first countries to adopt mandatory regulation in 2016 to lower the salt content in processed foods, aiming to reduce population salt intake to <5 g/day. To assess the effectiveness of this regulation in 20-30 year-old adults, we determined the change in salt intake over a mean follow-up time of 4.56-years spanning the imp...

Objective: The World Health Organization (WHO) included single-pill combination (SPC) antihypertensive medications on their 2019 essential medicines list (EML) to encourage uptake and improved hypertension control. We documented key national-level facilitators (SPCs on national EMLs, recommendation for SPCs in national hypertension guidelines and...