Hypertension, also known as high blood pressure, is one of the commonest chronic conditions with a prevalence as high as 25% in adults over 18 years old. More often than not, hypertension does not cause any symptom. If left untreated, it can lead to complications such as stroke, heart failure, other cardiovascular diseases, and kidney failure.

Diagnosing Hypertension

The conventional method for diagnosing hypertension is through blood pressure (BP) measurement in the clinic. Our blood pressure fluctuates with the time of the day, emotions, and physical activity. Therefore for accuracy, patients should be rested in a quiet room for at least 5 minutes before BP is taken. Taking the average of more than 2 readings will also help to improve the accuracy of BP readings.

What is a normal reading?

In Singapore, the Ministry of Health maintains a BP threshold of ≥140/90 mm Hg for hypertension diagnosis.

• Normal: BP reading lower than 130/80 mm Hg
• High-Normal: BP reading between 130/80 to 139/89 mm Hg
• Hypertensive: BP 140/90 mm Hg and above

So you are said to have hypertension if your systolic blood pressure (BP) is 140mmHg or more, or if your diastolic BP is 90mmHg or more, or both.

Almost 1 in 4 adults is diagnosed with hypertension and this prevalence increases with age over 40 years. More than half of the elderly aged above 60 years have hypertension.

Is it important to control your blood pressure?  

Yes of course, it is important to control your blood pressure!

Did you know- the higher your blood pressure is in the long term, the higher your risk of having a stroke?

Therefore stroke prevention alone is a good reason to control your blood pressure.

Next to that, higher blood pressure also leads to hypertensive heart disease. One danger of hypertensive heart disease is an increased risk of heart attack and in the long term, it may lead to heart failure.

High blood pressure can also damage the cells of the inner lining of the arteries that may lead to further narrowing of the vessels in the heart. In some cases, it may cause narrowing even in the lower limbs arteries, limiting blood flow throughout your body.

Thus managing and keeping good control of BP can help to reduce the incidence of coronary artery disease and stroke in the long term.

Treatment of Hypertension

Most patients with hypertension can achieve satisfactory BP control with medications and simple lifestyle changes.

Medication and therapy to control blood pressure

To simplify, there are 4 first line drugs that are often used to treat blood pressure, and most patients will need 2 of them. Some patients will need all 4 classes of drugs and even more, depending on their conditions.

In recent years, a therapy called renal denervation (where a special catheter is inserted into the arteries in the kidney to burn off some of the nerves in the kidney) has been shown to reduce blood pressure. However, this therapy is only suitable for a selected group of patients whose BP cannot be controlled with medications.

For most patients, blood pressure can be controlled with a combination of drug therapy and lifestyle changes.

Lifestyle changes to control blood pressure

We often forget that it is not just a matter of taking medicine, but the entire lifestyle that we need to look at. There are simple lifestyle changes we can adopt to control blood pressure.

• Cut down on your salt intake- Salt contains sodium and scientific studies have provided evidence that lowering sodium intake is beneficial to reducing BP.
• Limit alcohol consumption- Regular heavy drinking can result in a sustained rise in blood pressure that may eventually lead to chronic hypertension.
• Lose weight if needed
• Exercise regularly
• Manage your stress
• Quit smoking

What should you do if you are worried about your high blood pressure?

It is always best to consult your doctor if you are concerned about high blood pressure, or if you have a family history of the disease. If you experience any symptoms of chest discomfort or shortness of breath, it is important to see a cardiologist for a cardiovascular risk assessment.

References:

https://pubmed.ncbi.nlm.nih.gov/29376186/

https://specialty.mims.com/topic/managing-hypertension-in-primary-care

https://www.gleneagles.com.sg/healthplus/article/blood-pressure-control-and-heart-health