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Hormonal Regulation and Hypertension / Blood Pressure and Hypertension Studies · Journal article
Singapore Medical Journal · August 1, 2026
Early or partial results. Treat as a signal, not a conclusion.
This cross-sectional survey of 85 primary care physicians in Singapore documents substantial knowledge gaps in resistant hypertension management: only 74% correctly defined resistant hypertension, and only 27% considered work-up for secondary causes. The study identifies practice–guideline discrepancies but provides no evidence on clinical outcomes or the impact of these knowledge gaps on patient care.
Cross-sectional survey. Primary care physicians in Singapore, both public and private healthcare sectors; specialists were excluded.. n = 85. Singapore.
74% (n = 63) of respondents correctly defined resistant hypertension as uncontrolled BP above 140/90 mmHg despite three or more antihypertensives including a diuretic 53% (n = 45) correctly defined uncontrolled hypertension as home BP exceeding 135/85 mmHg 69% (n = 59) would refer to a specialist after trial of three antihypertensives; 13% (n = 14) chose to continue in primary care
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Clinicians should recognize that knowledge gaps in resistant hypertension definition and secondary cause investigation are widespread among primary care peers in this setting. This survey does not establish whether these gaps translate to adverse patient outcomes, but it highlights targets for continuing education and guideline implementation.
Single-center cross-sectional survey of physician knowledge and practice patterns with no comparator arm or outcome data; identifies practice gaps but cannot establish clinical efficacy or guideline concordance quantitatively.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize that knowledge gaps in resistant hypertension definition and secondary cause investigation are widespread among primary care peers in this setting. This survey does not establish whether these gaps translate to adverse patient outcomes, but it highlights targets for continuing education and guideline implementation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
INTRODUCTION: Resistant hypertension poses significant management challenges in primary care, with varying practices influencing patient outcomes. We evaluated current practices of primary care physicians in Singapore in managing resistant hypertension and examined their concordance with local and international guidelines. METHODS: An anonymised cross-sectional survey was conducted from July 2021 to October 2023, using a 26-item questionnaire distributed to primary care physicians across Singapore. The survey included physicians from both the public and private healthcare sectors, while specialists were excluded. The survey assessed their knowledge of the definitions, diagnostic criteria, treatment preferences and referral patterns for resistant hypertension. RESULTS: A total of 85 respondents participated in the survey. Only 74% (n = 63) of respondents correctly defined resistant hypertension as uncontrolled blood pressure (BP) (above 140/90 mmHg) despite concurrent use of three or more antihypertensives, including a diuretic. In addition, 53% (n = 45) correctly defined uncontrolled hypertension as home BP exceeding 135/85 mmHg. The majority (69%, n = 59) of primary care physicians would consider referral to a specialist after a trial of three antihypertensives, whereas 13% (n = 14) chose to continue management in primary care. Referrals were made mainly to Endocrinology (43%, n = 47) and Cardiology (35%, n = 39). Notably, few primary care physicians (27%, n = 23) considered the necessary work-up for secondary causes such as primary aldosteronism. CONCLUSION: This study identifies discrepancies between clinical practice and guidelines. The findings highlight a need to improve education on accurate definitions and guideline-based diagnosis of resistant hypertension, and develop clear national referral pathways for suspected secondary hypertension in primary care.
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