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Hypertension management practices in Singapore: How can physicians improve patient outcomes?

21 Dec 2017
Hypertension is a significant risk factor for coronary heart disease and stroke that affects approximately 1 in 4 residents of Singapore. Physicians’ practice patterns in managing hypertension, and their awareness of blood pressure variability, were reported in a recent study published in Vascular Health and Risk Management. We discussed some of the clinical practice gaps identified by this study with one of the authors, A/Prof. Teo Boon Wee, during the 13th Asian-Pacific Congress of Hypertension.

Managing hypertension is not straightforward for many patients. A/Prof. Teo noted that physicians need to consider whether blood pressure measured in the clinic is a true reflection of a patient’s actual blood pressure and whether there is any element of variability. For example, blood pressure readings can be affected by factors such as the setting where a measurement is taken, the time of day, recent alcohol consumption and even the patient’s body temperature.

“Increased blood pressure variability is associated with adverse events and outcomes, such as coronary heart disease, stroke and mortality.”

The study looked at whether physicians were aware of, and considered, blood pressure variability in their patients with hypertension. The majority of physicians surveyed indicated that they considered the possibility that a patient’s blood pressure could be elevated due to the clinical setting or the time of measurement (eg, blood pressure may be higher in the morning). However, when it came to diagnosing hypertension, almost half of all physicians surveyed did not follow international guidelines. They also did not follow recommended treatment targets when managing hypertension.

A/Prof. Teo commented on this trend, noting that “although physicians want to adhere to guideline recommendations, sometimes achieving recommended blood pressure targets is not always possible for every patient.” In this study, physicians who advocated home blood pressure monitoring (HBPM) were still likely to not follow guideline-recommended blood pressure targets. A/Prof. Teo suggested that this could be a result of physicians not accepting guideline recommendations, as well as HBPM placing a greater responsibility on the patient to monitor their condition. Setting a universally accepted blood pressure target is important for guiding physicians to manage hypertension, but A/Prof. Teo acknowledged that more research and guidance on how blood pressure variability should be considered is necessary before such a target is widely accepted.

“The issue with the current definition of blood pressure variability is its lack of standardization among the various guidelines.”

A standardized approach to measuring blood pressure and setting targets will enable physicians to reduce the risk of poor outcomes for patients with hypertension. Physicians will need to consider effective methods of monitoring blood pressure, including the use of HBPM. Physician education and modified clinical practice patterns may help them consider blood pressure variability when diagnosing and managing hypertension.

Click here to access the full article: Setia S, et al. Vasc Health Risk Manag 2017;13:275–185

Click here to view the interview video with one of the authors –
A/Prof. Teo Boon Wee
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Most Read Articles
4 days ago
Patients with coronary artery disease (CAD) treated in a poor Southeast Asian setting appear to have far too high short-term and medium-term mortality rates, according to a study.
08 Jun 2017

Multipoint pacing (MMP) in cardiac resynchronization therapy (CRT) provides significant improvements in left ventricular mechanics and fluid dynamics as compared with biventricular pacing (BiV).

02 Aug 2018
Intravenous vasodilator therapy confers survival benefits and superior diuretic response in patients with acute heart failure (AHF), provided that systolic (SBP) reduction is <25 percent, according to a posthoc analysis.
06 Aug 2018
In patients with uncontrolled blood pressure and severe hypertension, microvascular dysfunction is more pronounced and serum C-reactive protein (CRP) and endothelin levels are elevated, a recent study has found.