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