Singapore, 10 October 2023 – Changi General Hospital (CGH), through the Shimadzu-CGH Clinomics Centre (SC3), has successfully started performing clinical tests in Singapore for patients to identify those with primary aldosteronism, a common but lesser-known, curable form of hypertension. Harnessing the technology of liquid chromatography coupled with tandem mass spectrometry and powered by artificial intelligence, new clinical tests which accurately measure for the hormones aldosterone and renin were launched in February 2023 to enhance patient outcomes locally and in the region.
In 2021, the SC3 was established, bringing together the clinical and research expertise of CGH with Shimadzu’s diagnostic and analytical capabilities to contribute to enhanced medical care and treatment of hypertension in Singapore. Through a blood test of individuals with hypertension conducted at the SC3, the precise measurements for the hormones aldosterone and renin enables the identification of individuals with salt-sensitive hypertension and those with the curable form of hypertension, primary aldosteronism. To date, CGH has conducted over 1,000 clinical tests in patients with hypertension.
In Singapore, hypertension is the major cause of heart disease and stroke. According to findings from the Ministry of Health’s National Population Health Survey 2022 and Health Promotion Board’s National Nutrition Survey 2022, high blood pressure, or hypertension, affects one in three adult Singaporeans, with local prevalence of hypertension having almost doubled over the last decade. In addition, nine in ten Singaporeans are consuming more salt in their diets than recommended. High salt intake is an important contributor to the development of hypertension, and it is even more harmful in individuals who are salt-sensitive. It is therefore important to identify salt-sensitive individuals who have a higher chance of developing hypertension compared to others when they over-consume salt.
For patients diagnosed with salt-sensitive hypertension, treatment plans include restrictions on their dietary salt intake and using certain types of antihypertensive medications such as calcium channel blockers and diuretics, the latter of which removes salt from the body. Hence, the testing by the SC3 offers a way to prescribe precise medication for patients.
For patients diagnosed with primary aldosteronism through testing at the SC3, the underlying cause of their high blood pressure is an abnormal growth in one or both of their adrenal glands. Adrenal glands are small, triangular-shaped glands located above the kidneys, and are responsible for producing hormones that help to regulate blood pressure. Fortunately, treatment of patients with primary aldosteronism in Singapore has been shown to not only improve blood pressure, but also improve heart function and patients’ quality of life. Through a laparoscopic, or keyhole, surgery to remove the growth in the adrenal gland, a patient with primary aldosteronism may significantly improve or be totally cured of their hypertension.
In Singapore, about 5% of all patients with hypertension have this curable form of primary aldosteronism hypertension. These patients are also at a higher risk of developing heart disease, stroke, and kidney failure. However, despite the higher prevalence, many patients with primary aldosteronism are not screened and treated.
Prior to the establishment of the SC3, hypertensive patients’ blood specimens had to be sent to overseas laboratories for testing, which often took several weeks for results to be ready. With the SC3, specimens can now be processed locally, allowing for shorter turnaround times of three to five days, thus better enabling more patients to be successfully tested, diagnosed by doctors, and treated with precise care.
Clinical Assistant Professor Troy Puar, Senior Consultant, Department of Endocrinology, CGH, and Principal Investigator at the SC3, said, “Some of my patients have lived with hypertension for many years before eventually undergoing aldosterone and renin testing and being diagnosed with primary aldosteronism. With access to these clinical tests at the SC3 in Singapore, doctors can now obtain accurate and prompt test results for our patients. Hopefully, this will result in more patients being screened and treated for this curable form of hypertension. Furthermore, patients diagnosed early are more likely to be cured of hypertension after surgery. Patients who do not opt for surgery can also be treated with certain types of hypertension medication that target the underlying condition, which has great benefit in controlling blood pressure and reducing the risk of complications.”
With the shorter turnaround time for tests processed locally, patients have also benefitted from reduced waiting times for test results and quicker diagnoses. The enhanced patient journey from testing to treatment and recovery has transformed the lives of patients such as Mr Khoo Keow Pin.
The 66-year-old sought specialist medical advice for his condition as he had been living with hypertension for more than 15 years and was not aware that he had the primary aldosteronism type nor of the condition’s curable nature. He first consulted Clin Asst Prof Puar in CGH in June 2023 and received his diagnosis of primary aldosteronism following testing at the SC3. In September 2023, he underwent an adrenalectomy surgery at CGH to remove his affected adrenal gland. As soon as two weeks after his surgery, Mr Khoo’s hypertension condition has improved, and he requires less medications than before. His blood pressure reached normal levels and stabilised for the first time in several years.
Mr Khoo said, “I believe in the importance of testing, especially for long-term hypertension patients like myself. With the quick and detailed investigations done at SC3, the doctors were able to arrive at the accurate diagnosis of my type of hypertension – primary aldosteronism – enabling me to seek treatment at CGH and improve my condition.”
Leveraging advanced smart solutions for Singapore and beyond
A partnership between CGH and Shimadzu, the SC3 diagnoses hypertension through a combination of liquid chromatography and mass spectrometry (LC-MS/MS) technology, a method which is rapidly gaining recognition in clinical laboratories for analysing clinical samples, as it offers higher analytical specificity and sensitivity. Through such testing with the capability to measure precise hormone levels in a patient’s blood sample, doctors can identify and diagnose the type of hypertension a patient may have. The two tests have been rigorously validated based on CLSI (Clinical & Laboratory Standards Institute) guidelines.
Mr. Prem Anand, Managing Director of Shimadzu (Asia Pacific) and Corporate Officer of Shimadzu Corporation said, “Through this collaborative achievement with CGH, Shimadzu reaffirms its steadfast commitment to cultivating strategic partnerships that drive pioneering innovations. As a leader in both Analytical and Medical domains, Shimadzu is dedicated to fostering true synergy and leveraging the potential of AI to develop new and unique solutions for Advanced Healthcare – a vision that has consistently been a core focus for Shimadzu. With these relentless efforts, we want to impact people’s lives towards a healthier and more promising future.”
Dr Daryl Hee, Senior Manager, CGH who is in charge of the SC3 said, “As a smart hospital and leader in leveraging advanced technology, CGH has come a long way to provide crucial diagnostics for patients in Singapore. Through our collaborative efforts with Shimadzu and the building of a multidisciplinary team at the SC3, we are proud that the clinical service by CGH will expand its reach to more patients through upcoming partnerships with both local public and private hospitals in Singapore.”
Serving as a regional reference centre, the SC3 is also developing unique mass spectrometry solutions, including catering to various clinical diagnostics and clinical applications for other chronic conditions, to countries in the Asia Pacific region.
Clin Asst Prof Troy Puar (left) in consultation with patient Mr Khoo Keow Pin at CGH.
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