Blood pressure is measured using two numbers: systolic pressure (when your heart beats) and diastolic pressure (when your heart rests between beats). Normal blood pressure is typically below 120/80 mmHg. High blood pressure, or hypertension, occurs when readings consistently exceed 140/90 mmHg. Risk factors include family history, age, obesity, excessive salt intake, lack of physical activity, smoking, and excessive alcohol consumption. Understanding these factors helps in developing an effective management strategy.
Implementing lifestyle changes is often the first line of defence against high blood pressure. Regular physical activity, maintaining a healthy weight, reducing sodium intake, limiting alcohol consumption, and managing stress can significantly impact blood pressure levels. The DASH (Dietary Approaches to Stop Hypertension) eating plan, which emphasises fruits, vegetables, whole grains, and lean proteins, has proven particularly effective for Australian patients.
Several classes of antihypertensive medications are readily available through Australian pharmacies, each working through different mechanisms to control blood pressure:
Regular monitoring is crucial for successful hypertension management. Home blood pressure monitoring devices are widely available in Australian pharmacies and provide valuable data between medical appointments. Healthcare professionals recommend checking blood pressure at least monthly for those with controlled hypertension and more frequently during medication adjustments. Regular check-ups ensure medication effectiveness and help identify any side effects early.
Many patients require combination therapy to achieve optimal blood pressure control. Fixed-dose combinations available in Australia often pair an ACE inhibitor with a diuretic or combine a calcium channel blocker with an ACE inhibitor. These combinations can improve adherence by reducing pill burden and often provide superior blood pressure control compared to single-agent therapy.
Cholesterol exists in several forms that affect cardiovascular health differently. Low-density lipoprotein (LDL) cholesterol, often called "bad" cholesterol, can build up in artery walls, leading to atherosclerosis. High-density lipoprotein (HDL) cholesterol, known as "good" cholesterol, helps transport cholesterol away from arteries to the liver for disposal. Triglycerides, another type of blood fat, can also contribute to heart disease when elevated. Understanding these different lipid components helps guide appropriate treatment strategies.
Dietary modifications play a fundamental role in managing cholesterol levels. The Mediterranean diet, rich in olive oil, fish, nuts, and fresh produce, has shown excellent results for Australian patients. Reducing saturated fats found in red meat and full-fat dairy products, whilst increasing soluble fibre from oats, beans, and fruits, can significantly impact cholesterol levels. Plant sterols and stanols, available in fortified foods and supplements throughout Australia, can further enhance dietary cholesterol management.
Statin medications remain the gold standard for cholesterol management and are widely prescribed across Australia. These medications work by inhibiting HMG-CoA reductase, the enzyme responsible for cholesterol production in the liver:
For patients who cannot tolerate statins or require additional cholesterol reduction, several alternative medications are available in Australia. Ezetimibe works by blocking cholesterol absorption in the intestine and can be used alone or combined with statins. Fibrates, such as fenofibrate, are particularly effective for lowering triglycerides. PCSK9 inhibitors represent a newer class of injectable medications for patients with familial hypercholesterolaemia or those who cannot achieve targets with traditional therapy.
Regular lipid monitoring ensures treatment effectiveness and guides medication adjustments. Australian guidelines recommend initial lipid screening for all adults over 45 years, or from 35 years for Aboriginal and Torres Strait Islander peoples. For patients on lipid-lowering therapy, testing every 6-12 weeks initially helps establish optimal dosing, followed by annual monitoring once stable. Patients with diabetes or existing cardiovascular disease may require more frequent monitoring as determined by their healthcare provider.
Heart rhythm disorders, or arrhythmias, occur when the electrical signals that coordinate your heartbeats don't work properly. These conditions can cause your heart to beat too fast, too slow, or irregularly. Common types include atrial fibrillation, ventricular tachycardia, bradycardia, and premature ventricular contractions. Symptoms may include palpitations, dizziness, shortness of breath, chest pain, or fainting episodes.
Atrial fibrillation (AF) is the most common type of arrhythmia affecting Australians. Management focuses on controlling heart rate, restoring normal rhythm when possible, and preventing stroke through anticoagulation therapy. Treatment approaches include medication management, electrical cardioversion, and in some cases, catheter ablation procedures. Regular monitoring and lifestyle modifications play crucial roles in successful AF management.
Amiodarone is a powerful antiarrhythmic medication available through the Pharmaceutical Benefits Scheme (PBS) for treating serious ventricular and atrial arrhythmias. It requires careful monitoring due to potential side effects affecting the thyroid, lungs, and liver.
Flecainide is commonly prescribed for paroxysmal atrial fibrillation and other supraventricular arrhythmias in patients without structural heart disease. It's available as tablets and requires regular cardiac monitoring during treatment initiation.
Sotalol combines beta-blocking properties with antiarrhythmic effects, making it suitable for both atrial and ventricular arrhythmias. Regular ECG monitoring is essential due to the risk of proarrhythmic effects.
Anticoagulant therapy is essential for many patients with atrial fibrillation to reduce stroke risk. Options include warfarin, which requires regular INR monitoring, and newer direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and dabigatran. These medications are subsidised under the PBS for eligible patients based on stroke risk assessment scores.
Several lifestyle factors can trigger or worsen arrhythmias. Excessive caffeine consumption, alcohol intake, stress, lack of sleep, and certain medications can all affect heart rhythm. Maintaining a healthy weight, regular exercise within recommended limits, and managing underlying conditions like sleep apnoea and thyroid disorders are important for rhythm control.
Seek immediate medical attention if you experience chest pain, severe shortness of breath, loss of consciousness, or persistent rapid heart rate above 150 beats per minute. In Australia, call 000 for emergency services or visit your nearest emergency department if you have concerning symptoms that don't resolve quickly.
Heart failure occurs when the heart cannot pump blood effectively to meet the body's needs. It's classified into four stages from A to D, ranging from high risk without symptoms to advanced structural disease. Common symptoms include shortness of breath, fatigue, fluid retention causing swelling in legs and ankles, and reduced exercise tolerance. Early recognition and treatment can significantly improve outcomes and quality of life.
ACE Inhibitors and ARBs are cornerstone medications that help relax blood vessels and reduce the workload on the heart. Common examples include enalapril, ramipril, and candesartan. These medications are PBS-listed for heart failure management and have proven benefits in reducing hospitalisation and mortality.
Beta-blockers for Heart Failure specifically include carvedilol, metoprolol succinate, and bisoprolol. These medications slow the heart rate and reduce blood pressure, allowing the heart to work more efficiently. They're introduced gradually under medical supervision to optimise dosing.
Diuretics for Fluid Management help remove excess fluid from the body, reducing swelling and breathlessness. Loop diuretics like furosemide are commonly prescribed, along with thiazide-type diuretics for additional blood pressure control.
Aldosterone Antagonists such as spironolactone and eplerenone provide additional benefits in moderate to severe heart failure by blocking hormones that can worsen heart function and cause fluid retention.
Daily weight monitoring is crucial for heart failure management. Patients should weigh themselves at the same time each day and report weight gains of 2kg or more over 2-3 days to their healthcare provider. Fluid restriction may be recommended, typically limiting intake to 1.5-2 litres per day, including all beverages and foods with high water content.
Cardiac rehabilitation programs are available across Australia and provide supervised exercise training, education, and support for people with heart failure. These programs help improve exercise capacity, reduce symptoms, and enhance quality of life. Your GP or cardiologist can refer you to local programs, many of which are covered by Medicare.
Reducing sodium intake is essential for managing fluid retention in heart failure. Australian guidelines recommend limiting sodium to less than 2-3 grams per day. Key strategies include:
Blood clots can develop in veins or arteries throughout the body and may lead to serious conditions such as deep vein thrombosis (DVT), pulmonary embolism, or stroke. Understanding your risk factors and taking appropriate preventive measures is crucial for maintaining cardiovascular health.
Several factors can increase your likelihood of developing blood clots, including:
Preventive measures focus on reducing modifiable risks through lifestyle changes. Remain active and mobile whenever possible, maintain proper hydration, achieve and maintain a healthy weight, and cease smoking. Compression stockings and regular leg exercises are often recommended for people at increased risk during long-distance travel or recovery from surgery.
Several anticoagulant medicines are commonly prescribed in Australia. Warfarin requires regular blood testing to monitor the International Normalised Ratio (INR) and frequent dose adjustments based on results. Direct oral anticoagulants such as rivaroxaban and apixaban typically require less routine monitoring, making them convenient options for many patients. Dabigatran is another direct oral anticoagulant available for specific indications.
Antiplatelet agents like low-dose aspirin or clopidogrel are used to reduce arterial clot risk following certain heart or vascular events. All patients must receive proper counselling about potential drug interactions, the importance of medication adherence, and recognising signs of bleeding complications.
Those prescribed warfarin require ongoing INR monitoring through regular blood tests, whilst people taking direct oral anticoagulants usually need periodic kidney function assessments. It's essential to seek urgent medical care if you experience sudden leg swelling, chest pain, shortness of breath, or any neurological symptoms, as these may indicate serious complications.
Peripheral vascular disease, most commonly peripheral artery disease (PAD), occurs when arteries supplying blood to the legs become narrowed due to atherosclerosis, resulting in reduced blood flow to the lower extremities. This condition affects many Australians and requires comprehensive management to prevent progression and complications.
Typical symptoms of peripheral vascular disease include exertional leg pain or cramping known as intermittent claudication, which characteristically improves with rest. Other signs include slower-healing wounds on the feet or legs, noticeable coldness or paleness in the lower limbs, and in advanced cases, rest pain or tissue loss may occur.
Diagnosis relies on comprehensive clinical history and physical examination, ankle-brachial index measurement to assess blood flow, and duplex ultrasound imaging. When necessary, CT or MR angiography may be performed to define arterial anatomy and plan appropriate treatment strategies.
Management begins with essential lifestyle modifications including complete smoking cessation, which is crucial for preventing disease progression. Supervised exercise programmes or structured walking regimens can significantly improve walking distance and overall symptoms. Weight management and optimal control of diabetes, blood pressure, and cholesterol levels are fundamental components of treatment.
Several medications can help improve symptoms and circulation. Cilostazol is prescribed for intermittent claudication to enhance walking capacity, whilst pentoxifylline may be used as an adjunct for blood flow improvement. Antiplatelet therapy is typically prescribed for cardiovascular risk reduction and overall protection.
Proper foot care and wound management are essential, particularly for people with diabetes or existing ulcers. This includes appropriate wound dressings and coordinated multidisciplinary care. Compression therapy may be indicated for concurrent venous disease but should be used cautiously when arterial insufficiency is present.
Referral to vascular specialists is recommended for patients experiencing progressive symptoms, non-healing wounds, or when revascularisation procedures are being considered to restore adequate blood flow to affected areas.
