Ministry of Health Clinical Practice Guidelines: Hypertension

Abstract

The second edition of the MOH clinical practice guidelines on hypertension for Singapore was published in 2005. Since then, more facts about this important condition have emerged, particularly those recommending home blood pressure monitoring (HBPM) and 24-hour ambulatory blood pressure monitoring (ABPM) as key procedures in diagnosing suspected hypertension. Target groupThe main aim of these guidelines is to help physicians make sound clinical decisions about hypertension by presenting up-to-date information about diagnosis, classification, treatment, outcomes and follow-up. These guidelines are developed for all healthcare professionals in Singapore. Guideline developmentThese guidelines have been produced by an MOH-appointed committee of cardiologists, internists, general medicine practitioners, renal physicians, family physicians, and a neurologist. They were developed by adaptation of existing guidelines, critical review of relevant literature and expert clinical consensus taking local practice into consideration. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or his guardian or carer. Review of guidelinesEvidence-based clinical practice guidelines are only as current as the evidence that supports them. Users must keep in mind that new evidence could supersede recommendations in these guidelines. The workgroup advises that these guidelines be scheduled for review five years after publication, or earlier if new evidence appears that requires substantive changes to the recommendations. EXECUTIVE SUMMARY OF RECOMMENDATIONS IntroductionThis is the executive summary of the MOH Clinical Practice Guidelines (CPG) on Hypertension. It is intended to be used with reference to the full version of the CPG, which is freely available on the MOH website at this link: https://www.moh.gov.sg/ content/moh_web/healthprofessionalsportal/doctors/guidelines/ cpg_medical.html.Hypertension is the leading associated risk factor for cardiovascular disease. It is prevalent and increasing in many developing and developed countries. The Singapore National Health Survey (NHS) 2010 showed that the crude prevalence of hypertension (defined as BP of ≥ 140/90 mmHg) among Singapore residents aged 30 to 69 years was 23.5%, compared to 24.9% in 2004 and 27.3% in 1998. However, the age-specific prevalence for hypertension rises markedly from age 40 years onward and, with our ageing population, we continue to face challenges in the prevention and control of hypertension. Target audienceThese guidelines are developed for all healthcare professionals in Singapore as an evidence-based resource to provide up-to date information and guidance on diagnosis, classification, treatment, outcomes and follow-up. CMEArticle Ministry of Health Clinical Practice Guidelines: HypertensionJam Chin Tay, Ashish Anil Sule, Daniel Chew, Jeannie Tey, Titus Lau, Simon Lee, Sze Haur Lee, Choon Kit Leong, Soo Teik L...

Unsolved Problem: (Isolated) Systolic Hypertension with Diastolic Blood Pressure below the Safety Margin

“…The general recommendations for (I)SH treatment mostly agree in various international and national guidelines. They differ in terms of a class of recommendations and level of evidence, but most guidelines recommend thiazide(-like) diuretics and dihydropyridine calciumchannel blockers (CCBs) [47][48][49][50][51]. The Korean Society also recommends angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers as first-line drugs for (I)SH [52].…”

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Singapore

“…Although most clinicians would recommend HBPM, there seems to be a knowledge gap in how to do HBPM and evaluating treatment response; there was also no consensus in home BP targets . This is not unexpected because the Singapore hypertension guidelines mostly emphasize use of HBPM for the diagnosis of hypertension rather than for evaluating BP control and guiding changes in antihypertensive therapy.…”

“…Consistent with HOPE Asia Network guidance, the Singapore hypertension clinical practice guidelines recommend the use of HBPM in hypertension care. These guidelines also state that both the diagnostic and therapeutic thresholds of home BP measurements are 135/85 mm Hg, which are considered equivalent to 140/90 mm Hg in office BP.…”

Contribution of Hypertension to Cerebrovascular Disease in the Asian Population

“…[37] The Singapore National Guidelines for hypertension are consistent with most treatment guidelines, with initiation of treatment with ACE inhibitor or calcium channel blocker, and adding a second agent of either beta-blocker or diuretic to achieve target goals of blood pressure treatment. [38] Physicians should also tailor each patient's antihypertensives appropriately according to their comorbidities, drug tolerance, and threshold of compliance.…”