Dr Kenneth Guo, cardiologist at Mount Elizabeth Novena Hospital, explains how hypertension (high blood pressure) is treated.
As the name suggests, high blood pressure (also known as hypertension) is the force of blood pushing against the walls of your blood vessels. If you have high blood pressure, this force is stronger, which means your heart needs to work extra hard to transport blood around your body.
Doctors measure both systolic pressure (the pressure in the arteries as the heart contracts) and diastolic pressure (the pressure in the arteries as the heart relaxes) to determine an accurate blood pressure reading.
Normal blood pressure is generally considered to be a systolic pressure of less than 120mmHg and a diastolic pressure of less than 80mmHg.
A person has high blood pressure when their blood pressure, which is the force of blood flowing through the blood vessels, is consistently high. There are several categories of high blood pressure:
|Blood pressure category||Systolic mm Hg||Diastolic mm Hg|
|Elevated||120 – 129||and||< 80|
|Hypertension stage 1||130 – 139||or||80 – 89|
|Hypertension stage 2||≥ 140||or||≥ 90|
|Hypertension crisis||> 180||and/or||> 120|
Most patients with high blood pressure have few or no symptoms, so it can be hard for them to recognise they have a problem and know whether treatment is working.
Symptoms like light-headedness, facial flushing or headaches might only set in when systolic blood pressure rises higher than 160 mmHg or above.
High blood pressure does not have any symptoms unless it is very severe. The best way to know if you have high blood pressure is through regular checkups or monitoring at home.
Symptoms of severe high blood pressure may include:
According to the American Heart Association, you should have a high blood pressure screening during every visit to the doctor, or at least every 2 years, from the age of 20. You'll need more regular screenings if your blood pressure is higher than 120/80 mmHg.
High blood pressure increases your risk of heart attack, stroke, heart failure and kidney disease. A 40 year old obese male with a blood pressure of about 141/91 mmHg, for example, will be 6.8 times more likely to have a stroke than a healthy individual.
While these health risks may increase if your high blood pressure worsens, they can generally be improved with treatment. That's why it's so important to go for regular check-ups, and seek treatment early.
Lifestyle changes can be a huge factor when it comes to treating high blood pressure, as is evident by the Ministry of Health's suggestions for a healthier heart:
|Lifestyle measure||Expected decrease in systolic blood pressure (mmHg)|
|Limiting alcohol intake to less than 1 unit/day for females and less than 2 units/day for males||2 – 4|
|Regular walks for 30min, 5 times a week||4 – 9|
|Minimising salt intake||2 – 8|
|Weight management||1 – 2 per kg weight loss|
|Quitting smoking||1 – 5|
Keep checking your blood pressure at home. Most people diagnosed with high blood pressure want to lower their blood pressure to 130/80 mm Hg. However, your doctor is the best person to advise you on your personal target blood pressure. Work with your doctor to develop a plan to lower blood pressure.
Eat lots of fruits, vegetables, whole grains and low-fat dairy, and less of saturated and total fat.
Aim for at least 90 to 150 minutes of exercise per week. They should include:
Limit your alcohol intake to 1 drink a day for women or 2 a day for men.
One standard drink contains 10 grams of alcohol. This equals to 285 ml of full-strength beer, 425 ml of low strength beer, 100 ml of wine and 30 ml of spirits.
When you smoke, your blood pressure increases for many minutes after you finish. Stopping smoking helps your blood pressure return to normal. It also can reduce your risk of heart disease and improve your overall health.
Ideally, try to consume less than 1,500 mg of sodium a day. If your daily consumption is way more than this, aim for at least a 1,000 mg per day reduction.
The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC) released new guidelines in 2014 for the proper management of high blood pressure.
They analysed evidence worldwide to recommend treatment goals for patients living with high blood pressure. For most people, the goal is 140/90mmHg. However, for elderly people, this is usually slightly higher at 150/90mmHg.
Your doctor will help you to set a treatment goal and regularly monitor your progress to help you stay on target.
Various medication combinations can be used to help treat high blood pressure. These may include:
The combination and concentration of these medications depends entirely on your needs and body type. Some examples of treatment plans include:
The JNC recommends combination therapy for patients with a high blood pressure over 160/100 mmHg, or for elderly patients with a high blood pressure over 170/110mmHg. This has been shown to get the patient on board with their treatment quicker, as well as help them to achieve their treatment goals faster.
You've probably heard of beta-blockers – they're the little pills that help to slow your heart rate by blocking the effects of certain hormones in your system.
But nowadays, they're not the first port of call when it comes to high blood pressure. This is partly due to a recent study that compared the effects of ARB and beta-blockers in patients aged between 55 and 80 years old, which found that ARB are 13% more effective at reducing the risk of death or stroke.
In some parts of the world, like England and Canada, beta-blockers are still a popular first-treatment option for patients under 80. They are also useful for treating other conditions, including:
An uncommonly high systolic pressure together with an uncommonly low diastolic pressure might give a blood pressure reading like 150/70mmHg. This is known as isolated systolic hypertension, and it is particularly common in the elderly.
The most common cause is arteries stiffening with age, but it can also be caused by:
A doctor will explore each of the possible causes before treating the condition. They will also be careful to avoid dropping the diastolic pressure too low with medication.
It's worth noting that elderly individuals are especially prone to postural hypotension, ie. low blood pressure that occurs when standing up after sitting or lying down. It normally doesn't last long, but it can make them feel dizzy or even faint. One study found that elderly individuals have a 43% higher risk of hip fracture if they fall within the first 45 days of taking high blood pressure medication. If you are worried an elderly relative may be at risk, speak to your doctor.