GP Helpline:
Last updated on 21 April 2023
Recommended considerations when taking blood pressure 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 blood pressure (BP) measurements separated by 2 minutes. If the first two readings differ by 5mmHg 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 as the cut-off for hypertension.
Table 1: Initial Screening Blood Pressure (BP) (Average of 2 or More Readings)
Hypertensive emergency:
Diagnose if high blood pressure (often > 180/110 mmHg) 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
1. General:
2. Special conditions:
Table 2. Recommended Care Components
Kidney Assessment
If patient also has 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 events5.
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.
Pharmacological4
Figure 1: Drug Choices
Drug Combinations
Beta-blocker + ACE-I / ARB does not produce synergistic BP reduction
ACE-I + ARB decreases GFR in CKD patients and should be avoided. (Consider monitoring serum creatinine and potassium levels for all patients started on either ACE-I or ARB)
Beta-blocker + diuretic increases risk of developing diabetes mellitus
Beta-blocker + non-dihydropyridine CCB (e.g., diltiazem) increases risk of bradycardia and AV 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.
Blood Pressure
Blood Glucose
Lipid Profile
Weight
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 at capped selling prices. 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 Letter of Appointment. Enrolment Programme Agreement.