Hypertension

Hypertension or high blood pressure refers to the condition in which the blood is pumped around the body at too high a pressure.

Blood Pressure (BP) is described by two numbers, for example, if your BP is 120/80, the systolic BP is 120 mmHg and the diastolic BP is 80 mmHg.

You have hypertension if your systolic BP is persistently 140 mmHg or more, or your diastolic BP is 90 mmHg or more, or both (mmHg = millimetres of mercury, a measure of pressure). There are certain things to take note of when measuring your blood pressure, be it at the Doctors’ office or at home with an automatic BP machine:

• Sit down and relax for 5-10 minutes before measurement
• Ensure the BP cuff is of the right size
• Avoid smoking and caffeine during the 30 minutes before measurement
• Avoid talking during BP measurement
• A full bladder can elevate BP readings

Causes & risk factors 
In 95% of cases, the cause of hypertension is unknown. In 5% of cases, hypertension may be due to causes such as kidney disease, narrowing of certain blood vessels or hormonal imbalance. Certain risk factors increase the chance of developing hypertension. These include obesity and diabetes.

Signs & symptoms 
Hypertension is often called the silent killer. This is because, even when severe, it may not give rise to any symptoms.

Occasionally, you may have headaches or giddiness when the hypertension is severe. However, these symptoms are not specific to hypertension; they are also present in other diseases.

Sometimes, hypertension is only discovered when complications set in, for example, a stroke or heart attack.

Complications 
Hypertension increases the risk of developing atherosclerosis (hardening and narrowing of the arteries). If untreated or inadequately treated, hypertension can cause the following problems:

• Coronary heart disease
• Heart failure
• Stroke
• Peripheral artery disease (narrowing of the blood vessels of the limbs)
• Kidney failure

The risk of suffering from the complications of hypertension is increased if you:

• Are a smoker
• Suffer from diabetes
• Have high blood cholesterol
• Are overweight (BMI of 23kg/m2 or higher).

Screening & diagnosis 
If you are diagnosed with hypertension, your doctor will:

• Take a medical history
• Examine you
• Check for signs of complications e.g. heart failure
• Do relevant blood and urine tests
• Do a chest X-ray
• Do an ECG (electrocardiogram).

Treatment 

Monitor your blood pressure 

Checking your blood pressure at home helps you keep a closer watch on your blood pressure and manage your hypertension better. There are many different types of home blood pressure monitors available. Your doctor will help you choose one that is best for you and advise you on how to use it.

Go for regular check-ups

Take your antihypertensive medication as prescribed by your doctor The most commonly used drugs belong to these 5 main groups:

• Diuretics
• Beta-blockers
• Calcium channel blockers
• Angiotensin converting enzyme inhibitors
• Angiotensin II receptor blockers.

Your doctor will decide which drug is most suitable for you. More than one drug may be prescribed to keep your BP at an acceptable level. Single drugs which combine medications from 2 of these groups are also available.

If you are on antihypertensive drugs, note the following:

• Treatment is generally life long (i.e. you have to continue with the medication), so do discuss the cost of anti-hypertensive medications with your doctor.
• Do not stop or change the dose of your medication without consulting your doctor.
• For effective BP control, make sure you see your doctor regularly to monitor your BP. You can also monitor your BP more frequently at home with an electronic BP monitor. Recording your home BP readings in a notebook or spreadsheet will also aid your doctor in managing your hypertension.

Remember, long term effective control of blood pressure is crucial in reducing the risks of serious complications of hypertension.

Self-care 

Lead a Healthy Lifestyle 

Control your weight to keep your BMI less than 23kg/m2 but not below 18.5kg/m2. Reducing your excess weight will help to lower your BP levels.

• Healthy diet
  • Limit your intake of all types of fats. Try to replace saturated with unsaturated fats.
  • Limit your cholesterol intake. Major sources include organ meats (e.g. liver, brains, kidney, intestines and heart), egg yolk, squid, fish roe, shellfish, prawns, crabs and animal fats.
  • Increase fibre intake. Fibre is found in oats, oat bran, barley, fruit, vegetables, legumes and whole grains can speed up the removal of cholesterol from your blood.
• Exercise for 150 minutes per week, for at least 20 minutes each time. Lack of exercise is associated with a low HDL – cholesterol level (the ‘good’ cholesterol’).
• Limit alcohol intake to no more than 2 standard drinks per day.
  • 2/3 small can of beer (220 ml)
  • 1 glass of wine (100ml)
  • 1 nip of spirit (30ml)
• Don’t smoke.

(Text adapted from Singapore Health Promotion Board)