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...

Introduction Elevated blood pressure (BP) is the major contributor to mortality and disease burden worldwide. May Measurement Month (MMM) is a global BP screening campaign, which aims to raise awareness of BP measurement and provide evidence to inform and influence related health policy. Methods This cross-sectional survey included individuals age...

BACKGROUND Patient education is needed to perform home blood pressure measurement (HBPM) according to blood pressure (BP) guidelines. It is not known how BP is measured at home and what education is provided, which was the aim of the study. METHODS Mixed-methods study among Australian adults who perform HBPM (June to December 2023). Participants c...

Blacks are more prone to salt‐sensitive hypertension than Whites. This cross‐sectional analysis of a multi‐ethnic cohort aimed to search for proteins potentially involved in the susceptibility to salt sensitivity, hypertension, and hypertension‐related complications. The study included individuals enrolled in African Prospective Study on the Early...

Objective To quantify the costs of hypertension diagnosis and treatment in Australia, particularly in primary care, including general practices and pharmacies. Study design Economic analysis; analysis of Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data. Setting Australia, 2012–22. Main outcome measure Estimated expe...

Objective This study aimed to describe and compare the nutrient intake of young adults in the African Prospective Study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African–PREDICT) study according to ethnicity and socioeconomic status (SES). Design Cross–sectional analysis of baseline nutrient intakes in t...

BACKGROUND Community-based health check kiosks provide opportunities to improve the detection and long-term monitoring of hypertension. We describe the sociodemographic and cardiovascular characteristics of first-time and repeat users of these kiosks. METHOD This was an observational study. Deidentified data collected from 430 SiSU Health consumer...

Background Globally, oral diseases remain a major public health problem. However, there is limited information about the oral health status and factors associated with oral disease among children in Uganda. The aim of this study was to examine the oral health status and factors associated with oral health of primary school children in urban and rur...

Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. We estimated incidence, prevalence, death, and disability-adjusted life-year (...

Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods: We estimated incidence, prevalence, death, and disabilit...

Hypertension control remains a significant challenge globally.1 Even in Europe, a region that has produced some of the best science on managing hypertension, the control rates of hypertension is poor, ranging between ~20% and 40% for most countries.2 If this was a simple issue to solve, one could ask - what do we need to ensure that the 60% to 80%...

BACKGROUND Hypertensive disorders of pregnancy are associated with high maternal and fetal morbidity and mortality. There are limited global data on the characteristics of women during and after pregnancy hypertension. METHODS May Measurement Month is a global campaign to raise awareness of the importance of blood pressure. Adults (≥18 years) recr...

Background and objective May Measurement Month (MMM) is a global campaign aiming to raise awareness of raised blood pressure (BP). In 2022, concurrent screening for BP and atrial fibrillation (AF) was conducted in ten countries, given that hypertension and AF are both major treatable risk factors for stroke. Here, we evaluate AF prevalence and trea...

Background and Objective Hypertension frequently coexists with other chronic conditions and cardiometabolic risk factors. The identification of comorbidities is key in the management of hypertensive patients. May Measurement Month (MMM) is a global initiative aimed at enhancing the detection and awareness of hypertension. This study analyzes data f...

Background and Objective Within-visit blood pressure variability (BPV) is predictive of cardiovascular events independent of mean blood pressure (BP) levels and may serve as marker of cardiovascular aging. This study aimed to explore changes in BPV by age, and sex in May Measurement Month (MMM) 2019 survey participants. Methods Adults (≥18 years)...

Background and Objective Detection rates of hypertension continues to be suboptimal worldwide. The risk of hypertension increases substantially in older adults aged ≥65 years, a group also at increased risk of atrial fibrillation (AF), cognitive decline and hearing loss—all factors associated with hypertension. This pilot study aimed to 1) implemen...

Background and Objective Physical activity (PA) lowers blood pressure (BP) and improves other cardiovascular risk factors, but many adults fail to achieve recommended PA levels. We aimed to evaluate adherence to the World Health Organisation's (WHO) PA guidelines and associations with BP treatment and control rates amongst adults screened in May Me...

Background and Objective The accuracy of blood pressure (BP) monitors is essential for an accurate diagnosis, yet few devices have been validated using an established protocol. This study assessed the published evidence on validation studies of BP monitors. Methods STRIDE BP (www.stridebp.org) performs periodic systematic PubMed searches to identi...

Background and Objective May Measurement Month (MMM) is a global blood pressure (BP) screening campaign with aims to raise awareness of raised BP. In 2022, MMM incorporated home BP measurements from UK users of the ZOE Health Study app. We compare rates of hypertension prevalence, treatment, and control amongst ZOE app users with other European non...

Background and Objective Validated automated upper-arm cuff blood pressure (BP) measuring devices are currently recommended for BP measurement. However, a validated BP device in the general population may be inaccurate in pregnant women. Thus, separate validation studies are required in pregnant women with normal BP, hypertension, and preeclampsia....

Background and Objective Blood pressure (BP) measurement in public spaces using kiosk devices may be useful in improving hypertension awareness and control. Validation studies of kiosk devices using an established protocol are necessary prior to their use. Methods A PubMed search was performed using the following algorithm: (kiosk OR “public space...

Background and Objective Properly validated automated upper-arm cuff blood pressure (BP) measuring devices are currently recommended for office, home, and ambulatory BP measurement. However, the validation of BP devices in children presents additional challenges, necessitating separate studies. This study assessed the evidence on accurate automated...

Background and Objective Within-visit blood pressure variability (BPV) is a predictor of cardiovascular events, independent of mean blood pressure (BP) levels. This study explored the associations of BPV with hypertension status and comorbidities in May Measurement Month (MMM) 2019 global survey participants. Methods Adults (≥18 years) were survey...

Objective To summarize the current legislative and regulatory framework in Australia and abroad, as well as evidence on the potential impact that dispensed quantity and prescription durations may have on patient outcomes and costs. Methods We searched the PubMed database for peer-reviewed articles using the search terms “prescription duration”[tit...

Importance With the high burden of hypertension in sub-Saharan Africa, there is a need for effective, safe and scalable treatment strategies. Objective To compare, among Black African adults, the effectiveness and safety of a novel low-dose triple-pill protocol compared with a standard-care protocol for blood pressure lowering. Design and Setting...

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hyper...

The exposure to modifiable risk factors at young ages have been linked to premature fatal and non-fatal cardiovascular and kidney outcomes. The use of urinary metabolomics has shown strong predictability of kidney function and cardiovascular disease (CVD). We therefore determined the associations between estimated glomerular filtration rate (eGFR)...

Background and objectives: Previous randomized controlled trials and longitudinal studies have indicated that ongoing antihypertensive use in late life reduces all-cause dementia risk, but the specific impact on Alzheimer dementia (AD) and non-AD risk remains unclear. This study investigates whether previous hypertension or antihypertensive use mo...

Blood pressure (BP) is a key contributor to the lifetime risk of preclinical organ damage and cardiovascular disease. Traditional clinic-based BP readings are typically measured infrequently and under standardized/resting conditions and therefore do not capture BP values during normal everyday activity. Therefore, current hypertension guidelines em...

BACKGROUND The strong relationship between blood pressure (BP) and age is well known. Limited evidence suggests that a steeper age-BP slope may be associated with an increased risk of adverse outcomes. The May Measurement Month campaign enables an investigation of geographic, socioeconomic, and sex differences in age-BP gradients and their associat...

Background and Aims We investigated circulating homocysteine (Hcy), a cardiovascular disease (CVD) risk factor, examining its dietary associations to provide personalized nutrition advice. This study addressed the inadequacy of current dietary interventions to ultimately address the disproportionately high incidence of CVD in Black populations. Met...

We participated in the UK and Republic of Ireland May Measurement Month 2021 (MMM21) campaign to raise awareness about blood pressure (BP) measurement and the dangers posed by elevated BP and hypertension. In addition, the campaign aimed to collect and report levels of BP awareness and control in the community setting. The MMM21 campaign set up opp...

Pulse pressure amplification (PPA) is the brachial-to-aortic pulse pressure ratio and decreases with age and cardiovascular risk factors. This individual-participant meta-analysis of population studies aimed to define an outcome-driven threshold for PPA. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of cardiovascular a...

The proportion of time that blood pressure (BP) readings are at treatment target levels, commonly referred to as time at target or time in therapeutic range (BP-TTR), is emerging as a useful measure for evaluating hypertension management effectiveness and assessing longitudinal BP control. However, method of determination for BP-TTR differs across...

Background Few studies evaluated the contribution of long-term elevated blood pressure (BP) towards dementia and deaths. We examined the association between cumulative BP (cBP) load and dementia, cognitive decline, all-cause and cardiovascular deaths in older Australians. We also explored whether seated versus standing BP were associated with these...

Wearable health monitoring is a multibillion-dollar industry. But the holy grail is probably getting it right for blood pressure monitoring without a cuff, because raised blood pressure is very common and the leading cause of death in the world. Many have tried and failed, but industry is persisting: numerous cuffless wearable blood pressure device...

Centenarians represent a phenomenon of successful aging. This systematic review aimed to understand lifestyles and health practices, focusing on diet and medication use for healthy longevity in community-based adults 95 years or over. Medline, CINAHL, Scopus, and gray literature were searched from 1 January 2000 to 10 December 2022. Study quality w...

Purpose of Review We summarise the physiological changes and risk factors for hypertension in females, potential sex-specific management approaches, and long-term prognosis. Key Findings Pregnancy and menopause are two key phases of the life cycle where females undergo significant biological and physical changes, making them more prone to developi...

The duration of treatment for which a physician may prescribe a medicine, 'prescription duration', is often dispensed at the pharmacy on multiple occasions of shorter time periods, 'dispensing duration'. These durations vary significantly between and within countries. In Australia, the quantity of medication supplied at each dispensing has recently...

Background The aim of this study was to evaluate the association between obesity and risk of incident left ventricular hypertrophy (LVH) in community‐dwelling populations with hypertension and investigate whether this association would be attenuated by a lower achieved systolic blood pressure (SBP). Methods and Results We used the EMINCA (Echocard...

Introduction: Non-adherence to blood pressure (BP)-lowering medication is a strong predictor of poor BP control. Sub-Saharan Africa (SSA) has extremely low BP control rates (~10%), but it is unclear what the burden of medication non-adherence among Africans with hypertension is. This systematic review estimated the prevalence and determinants of no...

Summary Background Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injur...

Background Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensiv...

Summary Background Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injur...

Objective Increased blood pressure variability (BPV) is associated with negative health outcomes, but its determinants, and how best to measure it, remain unclear. We aimed to explore differences in four commonly used measures of BPV by clinical factors in the May Measurement Month (MMM) 2019 global survey. Design and method We performed an observ...

Objective This study aimed to explore change in four commonly used measures of blood pressure variability (BPV) by mean blood pressure (BP), age, and sex in May Measurement Month (MMM) 2019 global survey participants. Design and method We performed an observational analysis of BP readings from MMM 2019 participants. Adults (18 years and older) wer...

Objective The amount of time blood pressure (BP) is at target levels, commonly referred to as time at target (TTR), has been shown to be a useful measure for evaluating hypertension management effectiveness and assessing longitudinal BP control. This scoping review was conducted to identify and describe measurement methodologies used for determinin...

Objective Age-related BP trajectories may vary substantially across different populations and associated with differential CV risk and outcomes. The dataset of the May Measurement Month (MMM) campaigns enables a investigation of regional, socio-economic and sex differences in age-BP trajectories and their association with major public-health outcom...

Objective Many contemporary hypertension guidelines recommend controlling blood pressure (BP) to less than 130/80 mmHg in most people, but it is unclear how control rates compare globally to the hitherto ubiquitous control target of 140/90 mmHg. In this analysis, we compare global and regional BP control rates based on targets of 140/90 mmHg versus...

Objective To evaluate adult (>18 years) hypertension awareness, treatment, control, and comorbidities using three years of May Measurement Month (MMM) data (2017-2019). Design and method Up to three sitting blood pressure (BP) readings as well as lifestyle and comorbidity data (self-reported diabetes, myocardial infarction, stroke and overweight/o...

Aims We investigated circulating homocysteine (Hcy), a cardiovascular disease (CVD) risk factor, examining its dietary associations to provide personalized nutrition advice. This study addressed the inadequacy of current dietary interventions to ultimately address the disproportionately high incidence of CVD in Black populations. Methods and Result...

According to several international, regional, and national guidelines on hypertension, lifestyle interventions are the first-line treatment to lower blood pressure (BP). Although diet is one of the major lifestyle modifications described in hypertension guidelines, dietary fiber is not specified. Suboptimal intake of foods high in fiber, such as in...

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important follow...

Background Adherence to antihypertensives is key for blood pressure control. Most people with hypertension have several comorbidities and require multiple medicines, leading to complex care pathways. Strategies for coordinating medicine use can improve adherence, but cumulative benefits of multiple strategies are unknown. Methods Using dispensing...

BACKGROUND Gray matter (GM) and white matter (WM) impairments are both associated with raised blood pressure (BP), although whether elevated BP is differentially associated with the GM and WM aging process remains inadequately examined. METHODS We included 37 327 participants with diffusion-weighted imaging (DWI) and 39 630 participants with T1-we...

Summary Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data...

Aims In a high-income country, Australia, it is unclear how raised systolic blood pressure (SBP) ranks among other risk factors regarding the overall and cardiovascular disease (CVD) burden, and whether the situation has changed over time. Methods We analysed the 2019 Global Burden of Disease (GBD) data, with focus on Australia. We assessed ten le...

Two recent large trials showed the potential of single pill combinations (SPCs) with ≥3 low-dose components among people with hypertension who were untreated or receiving monotherapy. In both trials, these ‘hypertension polypills’ were superior to usual care, achieving >80% BP control without increasing withdrawal due to side effects. However, ther...

The relationship between beverage consumption and risk of cardiovascular disease has been extensively examined in cross-sectional studies. However, limited studies have investigated beverage consumption as a longer-term habitual behavior, which is important owing to potential cumulative harmful or beneficial cardiovascular effects. We examined the...

Excess dietary sodium intake and insufficient dietary potassium intake are both well-established risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving dietary intake have largely failed because the changes required are mostly too hard to implement. Consistent recent data from randomized con...

https://pubmed.ncbi.nlm.nih.gov/38092509/#full-view-affiliation-41

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is a multinational collaborative research study with >10,000 collaborators around the world. GBD generates a time series of summary measures of health, including prevalence, cause-specific mortality (CSMR), years of life lost (YLLs), years lived with disability (YLDs), and disabi...

Background The health benefits of fruits are well established, but fruit juice has been more controversial. Fruit and juice are often ingested with other foods, which prompted our investigation to determine whether fruit consumed as juice may negate the beneficial effects of consuming whole fruit in people with cardiovascular disease. Methods and...