Last updated on 5 June 2023
Recommended considerations when taking BP measurements for diagnosis:
Allow the patient to sit or lie down for at least 3 minutes before measuring the BP.
Use the correct size BP cuff.
Take an average of 2 seated BP measurements separated by 2 minutes. If the first two readings differ by 5 mmHg or more, further readings should be obtained and averaged.
Repeat BP measurements on at least 2 separate occasions.
Diagnose hypertension if systolic ≥140 mmHg or diastolic ≥90 mmHg. For home blood pressure monitoring, use 135/85 mmHg as the cut-off for hypertension.
Table 1: Initial Screening BP (Average of 2 or More Readings)
Diagnose if high blood pressure (often >180/110 mmHg) is associated with signs or symptoms of acute end organ damage or dysfunction.
History, examination and investigations
Important Note - determine whether there is/are
Blood Pressure Treatment Targets
<140/90 mmHg in patients <80 years old.
<150/90 mmHg in patients ≥80 years old (do not decrease diastolic BP to <60 mmHg).
2. Special conditions:
<140/80 mmHg in patients with diabetes mellitus
<130/80 mmHg in patients with proteinuria (both diabetic and non-diabetic patients)
<150/100 mmHg in pregnant patients without target organ damage (do not decrease diastolic BP to <80 mmHg)
<140/90 mmHg in pregnant patients with target organ damage
Table 2. Recommended Care Components
If patient also has diabetes mellitus (DM), Angiotensin Converting Enzyme (ACE) inhibitor or Angiotensin Receptor Blocker (ARB) are preferred antihypertensives to slow progression of diabetic nephropathy.
Annual screening of:
All patients should be stratified for their risk of developing future coronary events.5
Targets of treatment should be personalised by levels of risk.
Please refer to
Care Protocol for Lipid Disorders.
Where resources are available, consider the roles of other primary care team members – nurse counsellors and primary care coordinator.
*Please refer to BMI Control and Smoking Cessation Care Protocols for lists of programmes.
Care teams may use the relevant Lifestyle Prescription to help patients understand practical steps they can take to manage hypertension. A copy may be printed for the patient's use.
Figure 1: Drug Choices
Beta-blocker + angiotensin-converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB) does not produce synergistic BP reduction
ACE-I + ARB decrease GFR in patients with chronic kidney disease and should be avoided. (Consider monitoring serum creatinine and potassium levels for all patients started on either ACE-I or ARB)
Beta-blocker + diuretic increase risk of developing DM
Beta-blocker + non-dihydropyridine calcium channel blocker (CCB) (e.g. diltiazem) increase risk of bradycardia and atrioventricular block and should be avoided
Considerations for Specialist Referral2
GPs may use the CHAS Medical Referral Form to make subsidised SOC referrals and the GPFirst Referral Form for Emergency Department referrals. These can be found on Healthier SG-compatible GP CMS and on the PCDS web-portal.
The following data fields should be documented in GPs' case notes as part of good clinical practice for all patients enrolled to their practice.
Submission of data fields marked with asterisks* is required for subsidy claims and Healthier SG payments.
CHAS/PG/MG cardholders who are Healthier SG enrolees would be eligible for the Healthier SG Chronic Tier, which provides percentage-based subsidies for a whitelist of drug products sold within the MOH price caps. When making claims, GPs will need to submit the quantities and selling prices for each whitelisted drug product prescribed.
Details on the GP annual service fee for enrolees with hypertension can be found in the Healthier SG Enrolment Programme Agreement.