Update on the Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings-review of evidence on the definition of high blood pressure and goal of therapy

The Hong Kong Reference Framework for Hypertension Care for Adults in Primary Care Settings is updated regularly to ensure it reflects the latest medical development and best practice. In 2017, guidelines from the United States included a major change, adopting the lower blood pressure values of 130/80 mm Hg in defining hypertension, in contrast to the prevailing international consensus of 140/90 mm Hg. After thorough review of the literature and international guidelines, the Advisory Group on Hong Kong Reference Framework for Care of Diabetes and Hypertension in Primary Care Settings (Advisory Group) recommends that the definition of hypertension adopted in the Reference Framework should remain unchanged as a blood pressure of ≥140/90 mm Hg, as there is currently inadequate evidence and lack of general consensus to support such change in Hong Kong. The Advisory Group agrees on individualised treatment goals, and recommends that the initial blood pressure goal for individuals with uncomplicated hypertension should be <140/90 mm Hg; for those who can tolerate it, the goal should be ≤130/80 mm Hg. A lower blood pressure is advisable for young or overweight/obese patients, smokers, and patients with other cardiovascular risk factors.

Comparison of positional therapy versus continuous positive airway pressure in patients with positional obstructive sleep apnea: a meta-analysis of randomized trials

BACKGROUND

Obstructive sleep apnea (OSA), caused by the obstruction of the upper airway, is the most common type of sleep apnea. Continuous positive airway pressure (CPAP) and positional therapy have been shown to be effective to improve positional OSA.

AIM

To compare the effectiveness of positional therapy versus CPAP on positional OSA.

METHODS

Prospective randomized trials were systematically searched from the OVID databases. The trials comparing positional therapy versus CPAP in patients with positional OSA were included. Apnea-hypopnea index (AHI), mean oxygen saturation level, arousal index, sleep efficiency, and sleep time were the outcomes of this meta-analysis.

RESULTS

Three crossover trials were identified from Canada, New Zealand, and United States from 1999 to 2010. A total of 71 patients were randomly assigned to receive CPAP or positional therapy and the mean age of patients was 51 y. Positional therapy showed higher AHI (mean difference, MD: 4.28, 95% CI: 0.72-7.83) and lower oxygen saturation level (MD: -1.04, 95% CI: -1.63 to -0.46) than CPAP. It showed no distinct advantage over CPAP in terms of arousal index, sleep efficiency, and total sleep time, but CPAP reduced sleep time in the supine position.

CONCLUSION

CPAP is superior to positional therapy in reducing the severity of sleep apnea and increasing the oxygen saturation level in patients with positional OSA.