1st June 2005
Singapore Ministry of Health
Summary,

Source: National Guidelines Clearinghouse

GUIDELINE OBJECTIVE(S)

To assist physicians in clinical decision-making by providing well-balanced information on the management of patients with hypertension, without restricting the physician's individual judgment

TARGET POPULATION

Adults aged 18 years and over with hypertension

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis and Evaluation

1. Blood pressure measurement using mercury sphygmomanometer or other noninvasive measuring devices
2. Home or ambulatory blood pressure monitoring in defined situations
3. Grading of hypertension according to systolic and diastolic blood pressure
4. Clinical evaluation, including clinical and family history; physical examination; laboratory investigations such as urinalysis for blood, protein, glucose, and microscopy; blood chemistry for electrolytes, creatinine, urea, fasting glucose and lipids; and electrocardiography; additional investigations (as indicated); limited echocardiography
5. Assessment of risk factors, target organ damage, and concomitant diseases (e.g., diabetes, cardiovascular or renal disease)

Management

1. Assessment of overall risk profile as guide to management
2. Life style modifications and non-pharmacological therapy, such as smoking cessation, weight reduction, moderation of alcohol consumption, restriction of salt intake, reduction of intake of cholesterol and saturated fats, maintenance of adequate intake of dietary potassium and increased physical activity
3. Patient education on blood pressure and hypertension, risks involved and prognosis, target blood pressure level, expected benefits as well as the risks and side effects of treatment, and lifestyle modification
4. Antihypertensive drugs (monotherapy or combination therapy), such as diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers, and angiotensin II receptor antagonists (alpha-blockers, hydralazine, and methyldopa are also considered but are uncommonly used)
5. Follow-up to monitor blood pressure and other risk factors
6. Cholesterol lowering and antiplatelet therapy (aspirin, ticlopidine, clopidogrel) in patients with concomitant risk factors and increased cardiovascular risk
7. Special considerations for treatment of hypertension in patients with type 2 diabetes, pregnant women, and the elderly

MAJOR OUTCOMES CONSIDERED

• Morbidity and mortality due to hypertension
• Achievement of target blood pressure levels
• Incidence of major fatal or non-fatal cardiovascular events (e.g., myocardial infarction and stroke)
• Cost-effectiveness of therapy
• Side effects of therapy