... which started as a research project and ended up informing a World Health Organization (WHO) policy brief.

Over 1 billion people globally have high blood pressure (hypertension), the leading preventable risk factor for cardiovascular disease, the biggest killer globally. Despite the existence of effective and affordable antihypertensive treatment, high blood pressure is not always well detected, treated, or controlled in high-income countries and even less in low- and middle-income countries.  

Single-pill combination therapy for hypertension incorporates two or more drugs in one pill and is proven to improve the control of blood pressure without increasing side effects. Internationally, single-pill combination therapy is recommended as the first choice of treatment for controlling hypertension, with the WHO adding it to their 2019 essential medicines list to encourage uptake in response to the global burden of high blood pressure.

The review showed that despite there being strong international policy alignment, and countries having antihypertensive medicines available, many LMICs are not policy ready to encourage uptake, highlighting the need for countries to update guidelines and local essential medicines lists to reflect international recommendations. 

The review informed a background paper for the WHO ahead of an upcoming policy dialogue on how best to implement combination drugs as part of a broader focus on improving management of cardiovascular disease. As part of the project, Eleanor and Long worked closely with Resolve to Save Lives, a major global public health initiative, and the World Health Organization, and together they are joint first authors on a publication which has been submitted to a peer-reviewed journal for publication. 

The students also explored the health system readiness of using single-pill combination therapy in managing high blood pressure in a high-income country such as Australia, where the condition also remains poorly detected and controlled. They found local guideline constraints, Pharmaceutical Benefit Scheme restrictions, and clinical perceptions of the role of combination therapy may be limiting uptake of the treatment.  

Reflecting on the project, Eleanor said: “This work has given me the opportunity to learn from experienced researchers and has shown me that so many factors can influence health at the population level and that collaboration and cooperation across sectors is essential to achieve the most meaningful outcomes.”

“The most rewarding aspect has been meeting with the WHO and Resolve to Save Lives representatives to discuss the issue of hypertension from a global perspective,” she said. “I hope the findings from this project become a helpful contribution to public health research.” 

Adding to this, Long said: “The biggest thrill for me was when we received interest in our review from the WHO, which lead to us working with Resolve to Save Lives who supported us on data collection,” he said. “It was incredibly exciting to witness the immediate application of our research into the real world - I always dreamt of working for the WHO but did not expect this with my course."

“I have seen first-hand that any health challenge of international scale is enormous to tackle and can't be solved by one person or a small group alone - the experience has made me feel a lot more equipped and confident in initiating my own research into other public or global health challenges in the future,” he said. 

Eleanor and Long hope this work will lead to tangible changes in hypertension care globally. 

They conducted the research as a project for their Master of Public Health under supervision of Professor Alta Schutte from UNSW School of Population Health and The George Institute for Global Health, and Adjunct Associate Professor Ruth Webster from UNSW School of Population Health. 

“Having Eleanor and Long directly involved in research that is responding to a policy need for a major global health challenge is an example of the impact-driven focus of population health courses delivered by UNSW,” said Professor Schutte. 

“This work will help inform global action that has the potential to prevent many millions of heart attacks, strokes and other life-threatening conditions associated with hypertension,” she added. 

Associate Professor Webster said: “Single-pill combination hypertension treatment is low-hanging fruit for governments, whether in low or high-income countries, to effectively and sustainably reduce the crippling burden of cardiovascular disease.” 

“This research shows that although international guidelines are clear that we need to make single-pill combination treatment widely available to patients – health system roadblocks in LMICS and high-income countries, such as out-of-date guidelines, impede uptake,” she said. 

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UNSW School of Population Health