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Draft of 5th Malaysian Hypertension CPG ready for MOH assessment

Dr Joslyn Ngu
19 Feb 2018

The 5th Malaysian Hypertension Clinical Practice Guidelines (CPG) has been drafted and will be submitted to the Ministry of Health and the CPG Council later this year, says an expert.

Speaking at the Malaysian Society of Hypertension’s (MSH) 15th Annual Scientific Meeting, Professor Abdul Rashid Abdul Rahman said one of the new recommendations in the CPG will be a preference for validated electronic blood pressure (BP) sets over mercury sphygmomanometers, even in pregnant women. Additionally, a complementary guideline on both home and ambulatory BP monitoring will be published before the end of 2018, he added.

Another point that is addressed by the draft CPG is the category of patients with systolic BP of 130 to 139 mm Hg or diastolic of 80 to 89 mm Hg. The American College of Cardiology (ACC) and the American Heart Association (AHA) released a guideline late last year noting that those levels of BP are parked under the category of stage 1 hypertension. The drafted Malaysian CPG categorizes patients with that BP range as ’at risk‘ instead, said Abdul Rashid.

Besides that, a new risk category of ’intermediate‘ is introduced for risk stratification for major cardiovascular event in 10 years. Abdul Rashid explained that patients with a risk of 7.5 percent will fall under this new category and the reason for this is the finding from the Heart Outcomes Prevention Evaluation (HOPE)-3 trial. Patients in this category do not require pharmacotherapy, he added. The definitions of the other risk categories—low, medium, high and very high—remains the same as the previous CPG.

The treatment algorithm for hypertensive patients is similar to the one in the previous CPG, said Abdul Rashid. One of the slight changes is the change from ’combination therapy is preferred‘ to ’consider combination therapy‘ in patients with medium, high or very high risk for major cardiovascular event in 10 years. The reasons for this change is to reduce the likelihood of elderly patients being started on combination therapy up front and to take into consideration the healthcare costs incurred by combination therapy vs monotherapy, he explained.

All combination therapy helps to achieve target blood pressure but not all reduces cardiovascular risk, he noted. With that in mind, the new CPG added a few more combination therapies to the list published in the previous edition. Among them are the combination of a calcium channel blocker (CCB) and angiotensin receptor blocker, and a CCB plus beta blocker.

Another new addition to the CPG is a section on suggested areas for research. Included in that list are epidemiology, risk factors, drug treatment, monitoring, complications and pregnancy.

There are many more updates that can be expected from the new CPG, said Abdul Rashid. Hopefully, the CPG will be approved by MOH and released by June.

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