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Addressing the barriers to optimal use of out-of-office blood pressure monitoring

23 Aug 2017
Results from a survey presented at the 2017 Asia Pacific Society of Cardiology Congress indicate that 98% of respondents involved in managing patients with hypertension in Singapore recommend home blood pressure monitoring (HBPM) to patients with hypertension. However, a number of barriers remain to the effective use of out-of-office blood pressure (BP) monitoring.

It is increasingly being recognized that one-off BP recordings performed in the clinic may not provide the most accurate assessment of hypertension, and that out-of-office BP measurements can offer important additional information for effective hypertension diagnosis and management. Despite this, the proper utilization of out-of-office BP monitoring methods such as HBPM and ambulatory blood pressure monitoring (ABPM) has been limited. To better understand current clinical practice in Singapore, a survey was conducted to evaluate the uptake of HBPM and ABPM among physicians managing hypertension.

Co-author of the survey, A/Prof. Tay Jam Chin from Tan Tock Seng Hospital in Singapore commented that “The role of out-of-office blood pressure measurement is becoming more critical in determining the true blood pressure of the patient. Many international guidelines now require an out-of-office blood pressure measurement before diagnosing hypertension, so this study has come at the right time to look at current clinical practice with out-of-office blood pressure measurements.”

The survey highlighted that, although the vast majority of physicians recommend HBPM, most do not have time to explain to patients how, when and why HBPM should be performed. There is also a lack of consensus among Singaporean physicians on how and when to conduct HBPM. Importantly, half of physicians continue to use the office-based BP cut-off for hypertension of 140/90 mmHg when diagnosing hypertension instead of the recommended threshold of 135/85 mmHg for patients performing HBPM.

“We need to have proper local guidelines in place for HBPM so that physicians are aware and follow a standard practice, and will be able to educate patients more informatively and consistently. With the guidelines in place, we can then educate physicians on the HBPM guidelines and implement them nationally. We also need to develop patient education information on out-of-office BP monitoring so that patients themselves can take ownership of BP monitoring and control” added A/Prof. Tay.

While in-clinic BP measurement remains the ‘gold standard’ for the screening, diagnosis and management of hypertension, out-of-office BP measurements play an important, complementary role in hypertension management. Data from HBPM can be used to plan next steps and to close the gap between the clinical trial data used to develop treatment guidelines and real-world clinical practice. Given that approximately 7.8 million people worldwide die from the complications of hypertension every year, and hypertension contributes to at least 45% of deaths due to heart disease and 51% of deaths due to stroke, there is a need for continuing medical education and updated guidelines to help standardize the use of HBPM.

 

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Most Read Articles
Roshini Claire Anthony, 28 Sep 2015

Individuals with chronic ischaemic heart disease (IHD) and a small left ventricle and thick myocardium demonstrated higher levels of cardiac remodelling as opposed to those with a large ventricle and thin myocardium, contrary to the prevailing understanding, according to the DOPPLER-CIP study. 

18 Aug 2016
Chronic kidney disease (CKD), regardless of the stage, appears to have no direct effect on cardiovascular mortality within 180 days and 2 years from digoxin treatment initiation in treatment-naïve patients with non-valvular atrial fibrillation (AF), a Danish cohort study suggests.
2 days ago
The presence of target organ damage (TOD) in hypertension is more likely to result in blood pressure (BP) elevation, independently of the type of measurement (office or ambulatory, central or peripheral), according to a recent study. Central BP, even monitored during 24 hours, is not better correlated with TOD than peripheral BP.
09 Nov 2016
Ischaemic conditioning has no overall effect on the mortality risk in people undergoing invasive procedures, and its possible effects on stroke and acute kidney injury remain unknown given methodological concerns and low event rates, according to a systematic review and meta-analysis.