Management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: The SingHypertension cluster randomized trial.


Journal Article

BACKGROUND:Hypertension is a serious public health problem in Singapore and is associated with significant morbidity and mortality from cardiovascular disease (CVD) with considerable implications for health-care resources. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering blood pressure (BP) among adults with uncontrolled hypertension in Singapore primary-care clinics. METHODS/DESIGN:The study is a cluster randomized trial in eight polyclinics in Singapore: four deliver a structured MCI and four deliver usual care. The components of the MCI are: (1) an algorithm-driven antihypertensive treatment for all hypertensive individuals using single-pill combination (SPC) and lipid-lowering medication for high-risk hypertensive individuals, (2) a motivational conversation for high-risk hypertensive individuals, (3) telephone-based follow-ups of all hypertensive individuals by polyclinic nurses, and (4) discounts on SPC antihypertensive medications. The trial will be conducted with 1000 individuals aged ≥ 40 years with uncontrolled hypertension (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg, based on the mean of the last two of three measurements) in eight polyclinics in Singapore. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability adjusted life years (DALY) averted and quality adjusted life years (QALY) saved will be computed. DISCUSSION:The demonstration of an effective and cost-effective hypertension control program that is implementable in busy polyclinics would provide compelling evidence for upscaling the program across all primary-care centers in Singapore, and possibly other regional countries with a similar health-care structure. TRIAL, NCT02972619 . Registered on 23 November 2016.

Full Text

Duke Authors

Cited Authors

  • Jafar, TH; Tan, NC; Allen, JC; Finkelstein, EA; Goh, P; Moey, P; Quah, JHM; Hwang, SW; Bahadin, J; Thiagarajah, AG; Chan, J; Kang, G; Koong, A

Published Date

  • March 14, 2018

Published In

Volume / Issue

  • 19 / 1

Start / End Page

  • 180 -

PubMed ID

  • 29540213

Pubmed Central ID

  • 29540213

Electronic International Standard Serial Number (EISSN)

  • 1745-6215

International Standard Serial Number (ISSN)

  • 1745-6215

Digital Object Identifier (DOI)

  • 10.1186/s13063-018-2559-x


  • eng