Abstract
BackgroundHypertension is the most common chronic disease and is the leading cause of morbidity and mortality. Its screening, diagnosis, and management depend heavily on accurate blood pressure (BP) measurement. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). When office BP is used, automated office BP (AOBP) measurement method, which automatically provides an average of 3–5 BP readings, should be preferred. This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients.MethodsIn this cross-sectional survey, all doctors registered in the Hong Kong “Primary Care Directory” were mailed a questionnaire, asking their preferred BP-measuring methods to screen, diagnose, and manage hypertensive patients. Furthermore, we also elicited information on the usual number of office BP or HBPM readings obtained, to diagnose or manage hypertension.ResultsOf the 1738 doctors included from the directory, 445 responded. Manual measurement using a mercury or aneroid device was found to be the commonest method to screen (63.1%), diagnose (56.4%), and manage (72.4%) hypertension. There was a significant underutilisation of ABPM, with only 1.6% doctors using this method to diagnose hypertension. HBPM was used by 22.2% and 56.8% of the respondents to diagnose and manage hypertension, respectively. A quarter (26.7%) of the respondents reported using only one in-office BP reading, while around 40% participants reported using ≥12 HBPM readings. Doctors with specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain the recommended number of office BP readings for diagnosis and management of hypertension.ConclusionPrimary Care doctors in Hong Kong prefer to use manual office BP values, measured using mercury or aneroid devices, to screen, diagnose, and manage hypertension, highlighting a marked underutilisation of AOBP and out-of-office BP measuring techniques, especially that of ABPM. Further studies are indicated to understand the underlying reasons and to minimise the gap between real-life clinical practice and those recommended, based on scientific advances.Trial registrationClinicaltrial.gov; ref. no.: NCT03926897.
Highlights
Hypertension is the most common chronic disease and is the leading cause of morbidity and mortality
Out-of-office blood pressure (BP) is considered the preferred method to diagnose HT according to the National Institute for Health and Clinical Excellence (NICE) guidelines, the American College of Cardiology/ American Heart Association Task Force guidelines, and the Hypertension Canada guidelines [3, 10, 11]
The current study found a great discrepancy between BP measuring methods recommended by international guidelines and those used in routine clinical practice by general practitioners in Hong Kong (HK), who treat most people with hypertension
Summary
Hypertension is the most common chronic disease and is the leading cause of morbidity and mortality. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients. Studies have found ABPM to be the most cost-effective method of diagnosing HT, due to its specificity in identifying truly hypertensive patients who need appropriate management [8, 9]. These findings have led to changes in recommendations made by international guidelines. Out-of-office BP measurement is accepted as an alternative to in-office BP assessment for diagnosis of HT as per the European Society of Hypertension and European Society of Cardiology guidelines [12]
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