S-30-2: ASIAN MANAGEMENT OF HYPERTENSION: CURRENT STATUS, HOME BP MONITORING, AND SPECIFIC CONCERNS IN PHILIPPINES

Abstract

Introduction: Cardiovascular disease (CVD) in the Philippines showed hypertension as the highest (38.6%), followed by stroke (30%), coronary artery disease (17.5 %), heart failure (10.4%). Risk factor were: diabetes at 3.9%, dyslipidemia at 72%, smoking at 31%, obesity at 4.9% (BMI). Latest hypertension prevalence is 37%. Aware hypertensives were 19%, unaware was 18%. Treatment rate was 68%, compliance was 86%, blood pressure (BP) control rate was 37%. Mortality from CVD were stroke, mostly infarct (22.6%), MI (6.5%), Heart Failure (6.5%). Drugs used were angiotensin receptor blockers (64%), calcium channel blockers (42%), beta-blockers (6%), ACE inhibitors (4%) and diuretics (1%). Current status of home BP monitoring (HBPM): HBPM is performed by 23% of hypertensive population in the Philippine. Barriers to its use include cost, availability and lack of trust regarding the accuracy of digital BP devices. Currently, physicians encourage patients to monitor BP at home to better assess their treatment to rule out white coat, masked hypertension and other parameters. Philippine sub-analysis of AsiaBP@Home study: Data on HBPM offer solution to problems encountered particularly in Asia. Based on AsiaBP@Home study as a multi-national Asian specialty center performance regarding home and clinic BP control, majority of uncontrolled hypertension simulated by the new lower ACC/AHA guideline threshold gave additional 18% increase in sustained uncontrolled hypertension (SUCH) and to additional 5% increase in white-coat uncontrolled hypertension (WUCH). In a sub-group analysis of the Philippines in this study (Fig.1), using conventional threshold values, well-controlled clinic SBP was only 69% and well controlled morning home SBP was 79%. Using the new threshold levels, the well-controlled clinic SBP decreased to 43% and well controlled morning home SBP was lower at 67%. Comparing the conventional to the new thresholds, controlled hypertension decreased from 62% to 37%, masked morning hypertension decreased from 8% to 6%, Sustained hypertension increased from 13% to 27%, and white-coat hypertension increased from 18% to 31%. Summary: Hypertension still remains a major problem in the Philippines. Office BP measurement remains to be our standard for hypertension assessment and it appears to be insufficient in guiding us in our management approach. With the availability of newer and practical tools such as the HBPM, it will certainly improve hypertension evaluation, patient awareness, physician alertness in achieving better BP control and hence, better outcomes.