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Int J Gen Med. 2017 Jul 3;10:189-197. doi: 10.2147/IJGM.S138789. eCollection 2017.

Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore.

Author information

1
Chief Medical Office, Medical Affairs, Pfizer Pte Ltd, Singapore.
2
Global Medical Affairs, Asia Pacific Region, Pfizer Australia, West Ryde, New South Wales, Australia.
3
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
4
Department of General Medicine, Tan Tock Seng Hospital, Singapore.

Abstract

PURPOSE:

Out-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore.

MATERIALS AND METHODS:

A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV) awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs.

RESULTS:

Sixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists) were included (77% male, 85% aged 31-60 years, and mean 22-year practice). Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians) and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and only 55% said that they had the ability to provide education on HBPM and BPV. Patient inertia, poor patient compliance, lack of medical consultation time, and poor patient access to a BP machine were the most common challenges for implementing out-of-office BP monitoring.

CONCLUSION:

Although physicians from Singapore do recommend out-of-office BP measurement to patients with hypertension, this survey identified several important gaps in knowledge and clinical practice.

KEYWORDS:

blood pressure monitoring; blood pressure variability; guidelines; hypertension

Conflict of interest statement

Disclosure Dr Sajita Setia and Dr Kannan Subramaniam are employees of Pfizer. Professor Jam Chin Tay has received advisory board and consultant honoraria from Pfizer. The authors report no other conflicts of interest in this work.

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