Hypertension – tailoring the management plan to optimise blood pressure control

Published on 15 Dec 2023

This ACE Clinical Guidance (ACG) highlights the importance of clinical assessment and management of elevated blood pressure to reduce risk of cardiovascular disease. The ACG offers evidence-based recommendations on assessing cardiovascular risk and optimising blood pressure control through pharmacotherapy, with considerations for appropriate selection of first-line antihypertensives in context of associated conditions. Principles of lifestyle intervention, strategies to encourage adherence, considerations for intensification of medications, home blood pressure monitoring, and regular follow-up are also discussed. An additional resource on the updated Singapore-modified Framingham Risk Score supplements the ACG.

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Hypertension – tailoring the management plan to optimise BP control (Dec 2023) [PDF]

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ACG recommendations

1. Include cardiovascular risk assessment to inform management options for patients with elevated BP.

2. Use an ACE inhibitor, ARB, or CCB as first-line antihypertensive medications; consider thiazide/thiazide-like diuretics as alternative first-line if indicated.

3. Avoid initiating beta blockers (BBs) as first-line monotherapy for BP control unless BB use is expected to have favourable effect on patient comorbidities.

4. Consider initiating low dose dual therapy from two different antihypertensive medication classes based on required BP reduction and cardiovascular risk.

5. Intensify antihypertensive medications to optimise BP control if response to initial treatment is not achieved as expected (e.g. within three months).

6. Follow up all patients with hypertension at least every six months, with more frequent review as needed.

ACG references

Hypertension – tailoring the management plan to optimise BP control references (Dec 2023) [PDF]

Healthier SG cardiovascular risk calculator

Click here to access an online calculator to compute SG-FRS-2023 scores for the general population, originally developed as part of Healthier SG Care Protocols resource. The calculator additionally generates target levels for LDL cholesterol (and blood pressure) for patients at various levels of cardiovascular risk.

Additional resource for cardiovascular risk assessment using SG-FRS-2023 [PDF]