Prevention is better than a cure – lowering your risk of hypertension

Blood pressure refers to the pressure of blood in your blood vessels. Blood pressure is measured in millimetres of mercury (mm Hg) and is recorded as two figures. For example blood pressure may be recorded at 140/90 mm Hg, which is referred to as 140 over 90.

• The top (first) number is the systolic pressure, which is the pressure in the arteries when the heart contracts.
• The bottom (second) number is the diastolic pressure, which is the pressure in the arteries when the heart rests between each heartbeat.

Blood pressure is measured using a machine called a sphygmomanometer, and generally requires an average of two or more blood pressure readings (across multiple visits) to establish a baseline measurement.

Hypertension is diagnosed when the average reading is at least 140 mm Hg (systolic) or at least 90 mm Hg (diastolic).

White coat hypertension is a condition where blood pressure readings are significantly higher at a doctor’s office compared to a reading at home or when monitored over 24 hours.

Normal blood pressure values for adults (non-pregnant) are defined as less than 135/85 mm Hg during the day, less than 120/70 mm Hg during the night, and less than 130/80 mm Hg over 24 hours.

According to the Singapore National Health Survey (2010), 23.5% of Singaporeans between the ages of 30 and 69-years-old suffer from hypertension.

Health promotion, screening, early diagnosis and correct management of the condition play a major role in tackling this disease.

While hypertension can have no symptoms, they may include:

• Headache
• Blurred vision
• Nausea and vomiting
• Dizziness
• Chest pain
• Shortness of breath

• Lifestyle risk factors – including smoking, lack of physical activity, obesity, unhealthy diet and excessive consumption of alcohol.
• Pre-existing medical conditions – such as high cholesterol, diabetes and kidney diseases that affect kidney function.
• A strong family history of hypertension (e.g. immediate family who developed heart disease or a stroke before the age of 55 for men or 65 for women)
• Early menopause in women
• Age (the older you become, the more likely you are to develop hardening of vessels and fat accumulation)

• Cardiovascular diseases (such as stroke, heart attack, peripheral artery diseases, irregular heart beat or heart failure)
• Kidney diseases
• Retinopathy/eye diseases

How to deal with hypertension once diagnosed with the disease

Weight reduction

• Blood pressure can fall by 1-1.5 mm Hg for each excess kilogram which is lost
• Aim for reducing weight by 0.5 kg per week when starting off
• BMI calculation

Regular physical activity

• Can reduce systolic blood pressure by 2-10 mm Hg
• Recommended exercise duration – 150 minutes of moderate intensity exercise per week

Healthy diet

• Possible to reduce blood pressure by 10-12mm Hg
• Recommended to follow the DASH diet (Dietary Approaches to Stop Hypertension): rich in fruits and vegetables (eight to 10 servings per day), rich in low-fat dairy products (two to three servings per day) and reduced in saturated fat and cholesterol

Low salt intake

• According to the Health Promotion Board (HPB), as many as eight out of 10 Singaporeans are consuming more than the daily recommended allowance of 2 000 mg of sodium³
• 1g of sodium reduction can lower your blood pressure reading by 2.5 mm Hg
• Consume no more than 5-6g of salt per day

Restrict caffeine intake

• Consume no more than five cups per day

Cut down on alcohol intake

• Men should consume no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days each week.
• Women should consume no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days each week.
• Reducing consumption to the recommended limits can lower a high systolic blood pressure by up to 10 mm Hg.

Stop smoking

• Smoking is an independent risk factor for cardiovascular heart disease
• Methods available include nicotine replacement and oral medications

There are several medicines that can lower blood pressure. The most appropriate medication for you will depend on:

• Other medical problems
• Current medication
• Possible side-effects
• Age

Some medicines work well in some people, but may not be appropriate for others. One or two medicines may be tried before the most suitable is found. Two or more different medicines or combination medicines might be needed to reduce blood pressure to a healthy level. Medication is usually needed for life in most cases.

• For people with high blood pressure, treatment is recommended to achieve a goal blood pressure of <140/90 mm Hg for patients younger than 60-years-old. For those older than 60-years-old, a blood pressure reading of less than 150/90 mm Hg is recommended.
• In some people, the target is to get the blood pressure to an even lower level. This generally applies to people who have diseases where very good blood pressure control is important (such as cardiovascular diseases, diabetes and chronic kidney disease).

Lifestyle changes and screening to ensure you are diagnosed early are very important.

The Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation and Treatment of High Blood Pressure recommends screening every two years if blood pressure is less than 120/80 mmHg or annually if it exceeds 139/89 mm Hg.⁴