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Intensive BP control recommended for Asian patients at high CV risk

12 Jun 2018

Intensive blood pressure (BP) control is recommended for Asian patients with hypertension and increased cardiovascular (CV) risk, such as those with comorbid type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD) or atrial fibrillation (AF), according to a recently published consensus document.

The consensus document on improving hypertension management in Asian patients was developed by experts from China, Japan, South Korea and Taiwan in view of the significant ethnic differences in determinants of hypertension and hypertension-related demographics of CV disease (CVD) between Asian and Western populations. [Hypertension 2018;71:375-382]

“Stroke, especially haemorrhagic stroke, and nonischaemic heart failure are common outcomes of hypertension-related CVD in Asia. The association between BP and CVD is stronger in Asia than in the West. Higher salt sensitivity, even with mild obesity and higher salt intake, is an Asian characteristic of hypertension,” the experts noted.

For Asian hypertensive patients with T2DM, the experts suggested a BP goal of <130/80 mm Hg. For those with CKD, intensive BP control is recommended, along with more intensive out-of-office BP monitoring and comprehensive CV evaluation. In those with AF receiving anticoagulant therapy, a target systolic BP of <130 mm Hg can be considered.

For elderly patients, the experts recommended a BP target of <140/90 mm Hg, to be achieved with calcium channel blockers (CCBs), renin-angiotensin system (RAS) blockers and diuretics.

Highlighting the importance of strict 24-hour BP control in Asian patients, the experts recommended a home BP-guided approach as the first practical step. “The use of a long-acting and potent CCB and RAS inhibitor, with or without a diuretic, is preferable,” they noted.

In addition, out-of-office BP measurement is recommended to detect white-coat hypertension, while accurate detection and management of masked or masked uncontrolled hypertension is also important. “The initial focus should be on morning BP, then nocturnal BP, in Asian populations,” the experts advised.

“Morning BP surge confers CV risk independent of 24-hour ambulatory BP. Morning BP control can and should be improved with the use of long-acting antihypertensives in appropriate, often full, dosages and in proper combinations,” they added.

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Most Read Articles
24 Aug 2016

Roshini Claire Anthony spoke with Adjunct Associate Professor Gamaliel Tan, head and senior orthopaedic consultant at Ng Teng Fong Hospital in Singapore, on how GPs can help diagnose and treat lower back pain.

26 Dec 2017
Supplementation with omega-3 fatty acids in combination with rosuvastatin may yield significant reductions in triglycerides and nonhigh-density lipoprotein (HDL) cholesterol as compared with rosuvastatin monotherapy, according to data from the ROMANTIC (rosuvastatin-omacor in residual hypertriglyceridemia) trial.
Teng Sung Shin, Joyce Lam Ching Mei, 03 Sep 2018
Bleeding disorders in children can be divided into acquired and congenital conditions, with the acquired being far more common than the congenital. Clinical bleeding manifestations can vary in severity. Identifying the root cause early is crucial to control and halt bleeding as well as to prevent the risk of future bleeding in a vulnerable age group. This can be achieved by a thorough and salient history, physical evaluation, and appropriate investigations. This review will describe the common causes of bleeding disorders in children and will suggest an approach to the workup and diagnosis of such disorders.
Rachel Soon, 12 Dec 2018

MIMS Pharmacist presents an overview of superoxide dismutase (SOD) and its role in resisting the effects of oxidative stress and aging.