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

• hypertension
• blood pressure monitoring
• blood pressure variability
• guidelines

Acknowledgments

The authors would like to thank the management and staff of Kantar Health, Singapore, for their efforts in screening the respondents and carrying out interviews with the eligible respondents. Editorial and medical writing support was provided by Nicola Ryan, independent medical writer, funded by Pfizer.

Pfizer, Singapore funded this survey. Pfizer did not fund any medicines or devices for the conduct of this survey.

Author contributions

Dr Sajita Setia and Dr Kannan Subramaniam were involved in conception, design, analysis, and the interpretation of data. Dr Boon Wee Teo and Professor Jam Chin Tay were involved in the analysis and interpretation of data. All authors were involved in the preparation of the manuscript, the revision of it for important intellectual content, and its final approval before submission for publication.

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.