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. ? 2019 Wiley Periodicals, Inc.