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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Registered doctors and pharmacists may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A for reading each ACG.
| 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.
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| 5. |
Intensify antihypertensive medications to optimise BP control if response to initial treatment is not achieved as expected (e.g. within three months).
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| 6. |
Follow up all patients with hypertension at least every six months, with more frequent review as needed.
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Hypertension – tailoring the management plan to optimise BP control (Dec 2023)
Hypertension – tailoring the management plan to optimise BP control references (Dec 2023)
Additional resource for cardiovascular risk assessment using SG-FRS-2023
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