Coronary artery disease, stroke and chronic kidney disease are conditions that can come with poorly controlled hypertension. Its role as a disease multiplier makes hypertension management “one of the most valuable interventions in modern clinical medicine”.
“Definitive diagnosis and analysis will allow patients to better reduce the risks associated with poorly controlled hypertension… Very good management will save lives and help patients have a (longer) lifespan,” said Associate Professor Jimmy Teo, head of the nephrology division at National University of Singapore Yong Loo Lin School of Medicine.
Home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) are important tools.
HBPM refers to taking measurements at home, usually with blood pressure monitors that can be bought at retail outlets.
The measurement is usually taken twice a day and recorded for the doctor to assess and fine-tune the medication regimen.
ABPM refers to 24-hour blood pressure monitoring using an electronic device attached to the patient’s arm.
By looking at when patients take medicine, doctors can decide whether to adjust the dose and timing. ABPM also allows doctors to diagnose hypertension conditions such as masked hypertension – high out-of-office blood pressure but normal clinic blood pressure.
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Clinic blood pressure is seen as the gold standard, said Associate Professor Tay Jam Chin, general medicine department head at Tan Tock Seng Hospital.
But there is rising recognition that out-of-office blood pressure measurements such as ABPM and HBPM provide important information that can be useful for decisions in detecting and managing hypertension.
While doctors do recommend HBPM for patients, there is still some confusion on the ways to do it and how to interpret the data, said Prof Tay.
The point is made in a study recently published in the International Journal of General Medicine, which he co-authored with researchers including Prof Teo.
It found that although physicians here do recommend out-of-office blood pressure measurement for patients with hypertension, there are important gaps in knowledge and clinical practice.
HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements and timing.
Only 55 per cent of the physicians surveyed had the ability to provide education on HBPM and blood pressure variability.
Patient inertia, poor patient compliance, lack of medical consultation time and poor patient access to a blood pressure machine were identified by the study as the most common challenges for implementing out-of-office blood pressure monitoring.
Said Prof Tay: “We need to encourage the population to do their HBPM and educate GPs on it. We need to standardise HBPM so patients and general practitioners will know how and when to do HBPM.”
He said HBPM or ABPM will become the standard in the future in diagnosing and managing hypertension.
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