Asian management of hypertension: Current status, home blood pressure, and specific concerns in Taiwan

Abstract

Approximately 25% of the population in Taiwan has hypertension, and the rate has increased over time. Although age‐standardized cardiovascular mortality has decreased over the last 25 years, the annual stroke incidence has increased, and national health insurance reimbursement for cardiovascular disease (CVD) has grown by 22% over the last 10 years. Automatic oscillometric sphygmomanometer devices are increasingly available and affordable in Taiwan, making this the main method of out‐of‐office blood pressure (BP) measurement. Furthermore, home blood pressure monitoring (HBPM), along with shared informed decision making, could be beneficial in driving changes in health behavior and hypertension management. The 2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension recognize that home BP is a stronger predictor of CVD than office BP. Therefore, HBPM is recommended and implementation instructions provided. However, a home BP target that corresponds to the office BP used in the majority of clinical studies has yet to be clearly defined. Care for hypertension in Taiwan takes place more often in the hospital versus primary care setting. Combination therapy, often fixed drug combinations, is needed in 60% of patients to achieve BP control. Calcium channel blockers are the most commonly prescribed agents, followed by angiotensin receptor blockers. Overall, there is still substantial room for improvement in the awareness, treatment, and control rate of hypertension in Taiwan. HBPM has a central diagnostic and prognostic role in the management of hypertension.

Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department

“…A recent study reported that the prevalence of hypertensive crisis per 1000 visits to the emergency department (ED) has tripled from 1.8 to 4.6 in the United States [ 3 ]. In Taiwan, approximately one in every four Taiwanese has hypertension [ 4 ] and it is estimated that 1–2% of patients with hypertension may develop HTN-C [ 5 ]. Therefore, the management of hypertensive crisis and its associated complications are crucial in Taiwan.…”

May Measurement Month 2018: an analysis of blood pressure screening results from Taiwan

“…In Taiwan, cardiovascular diseases were the second leading cause of death in 2018 with a mortality rate of 165.8 per 100 000, consisting of a mortality rate of 48.8, 26.1, and 12.8 per 100 000 for heart diseases, cerebrovascular diseases, and hypertension, respectively. 1 Compared with the 2017 statistics, the 2018 cardiovascular mortality rate increased by 4.5%; but decreased by 2.0% in cerebrovascular diseases, and by 1.6% in hypertension.…”

“…The prevalence of hypertension in Taiwan has reached a plateau of ∼25% in the general population aged 18 years or over according to the reports of the 2013–15 and 2015–19 Nutrition and Health Surveys. 1 Although the prevalence of hypertension is not declining in recent years, hypertension-related mortalities are decreasing. In Taiwan, cardiovascular diseases were the second leading cause of death in 2018 with a mortality rate of 165.8 per 100 000, consisting of a mortality rate of 48.8, 26.1, and 12.8 per 100 000 for heart diseases, cerebrovascular diseases, and hypertension, respectively.…”

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

“…The “perfect 24‐hour BP control” strategy taking Asian characteristics into account is essential for achievement of the “zero” cardiovascular event goal . Considerable work has already been done on the journey to achieving this goal . Practically, a staged approach to the 24‐hour management of hypertension should be considered, first targeting morning hypertension, then nocturnal hypertension, followed by daytime hypertension .…”