High Blood Pressure (Hypertension)

High blood pressure (hypertension) is a fairly common problem in Singapore.


What is High Blood Pressure (Hypertension)? 

Blood pressure is the force generated as your heart pumps blood and moves it through the blood vessels in your body. It is made up of two numbers called the systolic and diastolic blood pressure.

Systolic blood pressure represents the pressure while the heart is beating. A normal systolic blood pressure is 140mmHg or below. Diastolic blood pressure represents the pressure when the heart is resting between beats. A normal diastolic blood pressure is 90mmHg or below. 

Blood pressure that stays persistently above this level is considered high and the person is said to have high blood pressure or hypertension.

Blood pressure changes during the day. It is at its lowest as you sleep and rises when you get up. It can also rise when you are excited, nervous or active.

A person is considered to have high blood pressure after three to six elevated blood pressure measurements over several months. These definitions apply to adults who are healthy and not using medication for high blood pressure. If the two pressures fall in different categories, the higher one is used to determine the severity of hypertension.
Normal blood pressure — systolic <120mmHg and diastolic <80mmHg
Prehypertension — systolic 120 to 139mmHg or diastolic 80 to 89mmHg. The term “prehypertension” was chosen because patients with blood pressures in this range are at increased risk of progressing to hypertension and developing cardiovascular complications.
Stage 1: systolic 140 to 159mmHg or diastolic 90 to 99mmHg
Stage 2: systolic ≥160mmHg or diastolic ≥100mmHg

According to a survey carried out in 1998, more than a quarter of Singaporeans between the ages of 30 and 69 years suffer from hypertension. It is one of the major risk factors for coronary artery disease and stroke. Untreated hypertension can also cause heart failure and renal failure. Hypertension is the most important risk factor for development of intracerebral bleed.

Most adults with hypertension have essential or primary hypertension, which means that the cause of the high blood pressure is not known. A small subset of adults have secondary hypertension, which means that there is an underlying and potentially correctable cause.

Blood pressure monitoring can be easily learnt and done conveniently at home. There are several home blood-pressure monitoring devices available on the market. These devices are battery-operated and are relatively easy to use. 

High Blood Pressure Symptoms 

High blood pressure does not usually result in any symptoms. It is often called the silent killer as even in severe cases, there may be no symptoms.

High Blood Pressure Causes and Risk Factors 

In 95 percent of cases, the cause of hypertension is unknown. In five percent of cases, it 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.

High Blood Pressure Screening and 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 electrocardiogram (ECG)

High Blood Pressure Treatment 

Hypertension, if untreated, can lead to a variety of complications, including heart disease and stroke. The risk of these conditions increases as blood pressure rises above 110/75mmHg, which is still in the healthy range.

High Blood Pressure Medication

Antihypertensive medication is usually recommended when the blood pressure is consistently at or above 140/90mmHg. Treatment with medication is recommended at a lower blood pressure (usually 130/80mmHg) for people with diabetes or chronic kidney disease.

Benefits of High Blood Pressure Treatment 

In multiple studies of people with hypertension, those who were given blood pressure-lowering medications for four to five years had a significant reduction in the number of coronary events, stroke and death compared to those who did not receive treatment.

Lifestyle Changes

Treatment of hypertension usually begins with lifestyle changes. Making these lifestyle changes involves little or no risk. Recommended changes often include:
A moderate restriction on salt in the diet
Weight loss in those who are overweight or obese 
Avoiding excess alcohol intake

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