Hypertension

Hypertension, also known as high blood pressure (BP), is a condition where the blood is pumped around the body at too high a pressure. The European Society of Cardiology (ESC) guidelines recommend reductions of BP below 140/90 mmHg for all patients, with further reductions for young fit patients to 120-130/80 mmHg if possible and if tolerated. Some patients, particularly the elderly, are unlikely to be able to tolerate the side effects of overtly aggressive BP lowering therapy, hence it is important to tailor treatment to suit the individual.

In Singapore, hypertension is a common problem. About 1 in 4 Singaporeans aged 30 to 69 years old has hypertension. As one ages, he/she is more likely to develop hypertension. In the 60 to 69 years old age group, about 1 in 2 Singaporeans has hypertension.

Symptoms of Hypertension

Hypertension is difficult to spot because most patients do not have any symptoms. Currently, patients with newly diagnosed hypertension are discovered through one of several ways:

  1. During routine health screening
  2. Incidental finding during an outpatient or inpatient doctor’s visit for an unrelated (e.g consulting for upper respiratory tract infection) or related complaint (e.g. headache or giddiness due to very high BP, breathlessness or chest pain due to very high BP).
  3. Self detection due to home BP monitoring by patient using automated blood pressure machine purchased off the counter

The diagnosis of majority of hypertension is via the accurate measurement of peripheral blood pressure. The accuracy of BP reading can be affected by many factors, examples (but not limited to) include: location where BP measurement is taken, adequately sized BP cuff, emotional and physical state of the patient when its taken, time of day reading is taken etc.

Treatment methods for Hypertension

Treatment of hypertension requires a multi-prong approach, including:

  1. Medications (see your Doctor to individualise your treatment)
  2. Lifestyle modifications, including dietary restrictions (low salt diet), increased physical activity, weight loss (if overweight), smoking cessation (if currently smoking).
  3. Sustained behavior modification, including taking charge of your own health and monitoring your BP trend on a regular basis (see your Doctor to individualize your treatment and to find out how to monitor your home BP accurately and reliably).

Individuals may have different response to hypertension: some may develop heart failure while some may remain well without symptoms despite sharing similar BP profiles.

Left untreated, hypertension can cause cardiovascular complications such as heart attack, heart failure, coronary artery disease and thickening of heart muscles. Thickening of heart muscles is initially adaptive, but as time goes on, the heart chambers can weaken (decompensate) and this can result in heart failure.


AUTHOR: Dr. Ang Teck Kee, Consultant & Interventional Cardiologist, Livingstone Cardiology

References
1. Whelton PK, et al. J Am Coll Cardiol 2018; 71: e127-e248
2. Williams B, et al. Eur Heart J 2018; 39: 3021-3104
3. SPRINT Research Group. NEJM 2015; 373: 2103-2116
4. Ference BA, et al. JAMA 2019. Doi/10.1001 jama2019.14120
5. www.who.int/news-room/fact-sheets/detail/salt-reduction