Endocrine Abstracts

Introduction: About 12% of patients present to the GPs with hypertension or related symptoms. The current practice of managing resistant hypertension in primary care is inconsistent and general practitioners (GP’s) do not have a criteria for referral to tertiary care.

Methods: Quantitative anonymized online survey of 26 questions on the current prescribing practices and thresholds for referral of resistant hypertension cases amongst GPs in Singapore. Specialists and consultants from various clinical disciplines were excluded from the survey. The survey was conducted over 3 months and sent out twice to encourage maximum participation. The questionnaire included 26 questions and data was compiled and analyzed using SPSS v2022; chi-square test was used where appropriate.

Results: Of the 58 responses, 38/58 (66%) GPs had nearly 10 years of clinical practice and on the average managed up to 50 cases of hypertension per week. 34 of 58 (59%) respondents found it difficult to diagnose resistant HT and 14 of 34 (41%) felt there was no clear definition of resistant HT. The choice of antihypertensives was calcium channel blockers in 25/58 (43%), alpha blockers in 17/58 (29%) and the rest ACE inhibitors. Once resistant HT was suspected, most GPs referred the patients to endocrinology (29/58; 50%), and cardiology (26/58; 45%). Majority (53/58; 91%) referred when patients were on 3 or more antihypertensive agents, usually after a period of 3 months of refractoriness. 85 percent of respondents felt that there was a need for a separate guideline to manage resistant HT. Response rate of the survey was 97%.

Conclusion: Heterogeneity exists in primary care in the management of resistant HT and most felt the need for a separate guideline to help them manage and refer the patients for appropriate treatment.