Hypertension rarely has any symptoms in the early stage, which is why many people who have hypertension are unaware of it. Some find out they have the condition during complications like stroke or heart attack. Don't let this be you! There are ways you can find out about hypertension early and prevent its serious consequences.
In this article, we discuss the essentials you need to know about chronic high blood pressure, including risk factors, causes and diagnoses. Read on to learn when you need to visit a doctor for hypertension, and how you can effectively manage it at home.
Table of Contents
1. What is Hypertension? How is Hypertension Diagnosed?
Hypertension, or high blood pressure, is a chronic condition in which the blood pressure against the blood vessel is consistently high.
Generally, your blood pressure (BP in short) is indicated as Systolic Blood Pressure / Diastolic Blood Pressure, and measured in units of millimetres of mercury (mmHg). Systolic BP measures pressure when your heart beats to pump blood into the blood vessels while Diastolic BP measures pressure in between beats when the heart is relaxed. Both measurements are important, but systolic BP is sometimes more indicative of cardiovascular disease risk in adults aged 50 and above.
For example, a reading of 120/80 means blood pressure when the heart beat is 120mmHg and blood pressure between beats when the heart relaxes is 80 mmHg, and is considered in the normal range.
If your reading is consistently 140/90 or higher over time, you have hypertension. The key word here is “consistent”, as a variety of factors such as exercise, stress, lack of sleep, coffee, alcohol or certain medications can cause blood pressure to elevate temporarily. Doctors will need to take several readings to confirm a hypertension diagnosis.
Hypertension can be diagnosed as:
- Prehypertension (borderline): BP of 121-139 / 80-89
- Stage 1 hypertension: BP of 140-159 / 90-99
- Stage 2 hypertension: BP of 160 and above /100 and above
Blood pressure of 180/120 and above is considered a hypertensive crisis and requires medical attention. Treat it as an emergency if such high BP is accompanied by other symptoms like difficulty breathing, chest pain, dizziness and vomiting, blurred vision, or fainting. Learn more about how to handle abnormally high BP at home in our article on managing acute symptoms at home here.
2. What are the Signs and Symptoms of Hypertension?
High blood pressure has rare noticeable symptoms even in serious cases. In Singapore, almost half of those suffering from hypertension are unaware of it. The condition may be discovered during a health screening. In some cases, it is found out only when a serious complication like a stroke or heart attack occurs.
Severe cases may, but not always, show symptoms such as dizziness, difficulty in breathing, and headache (known as hypertension headache). Among people with symptoms, there can still be difficulty in diagnosis because these symptoms are present in many other diseases and not hypertension specific.
So how do you know whether you have hypertension? The best way is to be aware of your hypertension risk and to go for screening. We list common risk factors of high blood pressure and how to get hypertension screening in the later part of this article. It is not recommended for you to self-diagnose or self-treat hypertension.
If you have a blood pressure monitor at home, it is a good idea to check your blood pressure to know what range it is, and whether you need to seek the opinion of a healthcare professional. Here are some guidance for you to measure and read your blood pressure (BP) accurately.
3. Why is Hypertension Dangerous among Seniors?
In Singapore hypertension is a prevalent problem. One study reported that up to 74.1% of those aged 60 and above in Singapore have high blood pressure. Hypertension is dangerous among elderly individuals because research has also shown that the risk of high blood pressure increases with age.
The older you get, the stiffer your arteries are likely to become, requiring the heart to beat harder to supply blood to your body. This results in high blood pressure. Senior adults are also at higher risk of hypertension complications and have more challenges recovering from them, due to their age and other existing condition.
For everyone, high blood pressure can result in long-term health issues if left undetected and untreated. Complications include heart diseases such heart attack, heart failure, stroke and kidney disease. For this reason, hypertension is often referred to as the ‘silent killer’. We wrote about common heart diseases affecting seniors in Singapore here, and how hypertension can cause kidney failure here. You should also familiarise yourself with the signs and symptoms of stroke and how to be F.A.S.T to act - you can save someone from debilitating complications and even lives!
4. What are the Causes and Risk Factors of Hypertension?
There are 2 types of hypertension. In most cases, the cause of high blood pressure is unknown. This type of hypertension is called essential hypertension or primary hypertension. In other cases, high blood pressure is caused by hormonal imbalance, narrowing of blood vessels, kidney diseases, or the use of certain drugs; this type is called secondary hypertension.
Though we might not know the exact causes of all hypertension cases, researchers have found several risk factors that are directly linked to hypertension, including your lifestyle, family history, and your health conditions as well as genetics, and age. Certain medical conditions such as diabetes, obesity can increase the chances of high blood pressure. Here are a number of common risk factors for high blood pressure.
- Obesity
Research has confirmed a strong linkage between obesity and hypertension. Simply understood, obesity means excess body fat, and having excess weight means that your heart needs to work harder to pump blood into your body. That can add stress on your blood vessels and heart.
- Diabetes
According to these statistics, 6 out of 10 persons who have diabetes also have high blood pressure. Diabetes results in an increased risk of heart disease due to the chronically high levels of sugar in the blood causing damage to the blood vessels.
- Smoking
Smoking can increase your blood pressure and can damage your blood vessels and heart. Smokers are also more likely to develop more severe forms of hypertension.
- Excessive alcohol consumption
Excess drinking of alcohol can result in a sustained elevation of blood pressure, leading to essential hypertension. Alcohol is also linked to diabetes and obstructive sleep apnea, which can cause secondary hypertension.
- Physical inactivity
Regular physical activity helps your blood vessels and heart to stay healthy and strong. Lack of physical inactivity increases the risk of obesity, which in turn increases your risk for high blood pressure.
And some other risk factors include:
- Genetics: hypertension tends to run in the family. If your parents have hypertension, you are recommended to keep an eye on your blood pressure.
- Age: age increases your hypertension risk.
- Race: statistics show that Malays have higher incidents of high blood pressure than Chinese and Indians.
5. What is the Treatment for Hypertension?
As a chronic disease, hypertension treatment is usually lifelong and best to be combined with lifestyle modification to manage the risk factors. Doctors may prescribe you with pharmaceutical drugs to keep blood pressure in check, as well as to reduce the side effects that come with high blood pressure such as the risk for heart attack or stroke. You will also be advised to measure and take note of blood pressure regularly at home.
Lifestyle Modification
Lifestyle changes are crucial in managing high blood pressure. Here are some best modifications that will help in addressing the risk factors and lowering your high blood pressure:
- Quitting smoking.
- Limiting the use of alcohol to two drinks per day or less for men, and one per day for women.
- Eating a healthy diet that includes more vegetables and fruits and less saturated fat, low dairy fat, etc.
- Losing weight if you are obese.
- Taking regular aerobic exercise such as walking, cycling or swimming for a minimum of 30 minutes per day.
- Limiting the sodium amount to 1500 milligrams per day in your diet. In the case of healthy adults, this amount shouldn't cross the limit of 2300 milligrams.
Measuring Blood Pressure Correctly
It's important to take accurate blood pressure readings so that your doctor can provide the optimal treatment to manage your hypertension and its risks. Blood pressure readings can be affected by a few factors, so bear the following in mind for measurements:
6. What are the Complications of Untreated Hypertension?
High blood pressure increases the risks of narrowing and hardening of arteries that is also known as atherosclerosis. You can face the following health problems if you are having improper or no treatment for hypertension.
- Stroke
- Coronary heart disease
- Kidney failure
- Peripheral artery disease (narrowing of blood vessels in the limbs)
These complications and their related risk will also increase if you
- Have a high level of cholesterol
- Are diabetic
- Are overweight
- Are a smoker
7. How to Detect Hypertension Early?
Detecting hypertension early provides us with the opportunity to make lifestyle changes and other interventions to limit the damages to the heart and the arteries. As the condition has no obvious symptoms, the best way to detect hypertension early is to go for screening. Blood pressure reading is a part of all regular health checkups. If your blood pressure is normal during the health screening and you do not have risk factors, you do not have to worry about hypertension for now. However, if the reading indicates a high BP level, you may want to monitor your blood pressure level at home regularly in addition to having it checked periodically by a doctor.
Singaporeans aged 40 years and above with CHAS cards can enjoy subsidised screenings for hypertension (and other common chronic conditions) at all CHAS clinics, under the national screening program Screen for Life. If you are unsure what general health screenings and screenings under Screen for Life is suitable for your age, check out our article on this topic here.
8. Managing Hypertension Successfully at Home
Increasing awareness and understanding of hypertension can help empower you to take control of your health. Through screening, early detection and commitment to treatment program and lifestyle changes, you can effectively manage the condition and prevent its complications. However, you don't have to wait until high blood pressure is diagnosed to start a healthier lifestyle. Make healthier choices today, such as starting a more balanced diet, regular physical activity, and engage in stress reduction techniques. It can help to prevent not only hypertension but also other health conditions.
This article is contributed by Dr Kenneth Koh, Medical Director and Co-founder of OneCare Medical Group. An accredited Family Physician with the College of Family Physicians, Singapore with intensive training and experience in the UK and Singapore, he has overseen the growth of OneCare Medical to a large network of clinics providing primary healthcare services island wide. In December 2020, OneCare Medical and Ninkatec joined hands to launch care services for patients at home. The partnership combines Ninkatec’s advantage in medical technology with OneCare’s strength in providing preventive, accessible and professional healthcare, allowing quality service with flexibility of choice for patients as the end-user. Chat with us below to learn more about our home care services!
