High Blood Pressure

Blood pressure is the pressure of blood pushing against the walls of your arteries when your heart pumps. It varies from person to person. Even for the same individual, blood pressure may vary from time to time, for instance, when one gets angry versus when one is relaxed.

When a person’s blood pressure is consistently at 140/90mmHg or higher, he/she is said to have high blood pressure.

According to the National Population Health Survey 2024, over one in three Singaporeans between age 18 to 74 years has hypertension (or persistent high blood pressure), an decrease from 37.0% in 2021-2022 to 33.8% in 2023-2024. The decrease in crude prevalence during 2024 was found in those aged 50 to 59 years (53.7% to 48.1%) and those aged 60 to 69 years (64.3% to 59.2%), among males and all education levels, and for Chinese (37.3% to 34.0%) and Malays (40.5% to 36.8%) compared to 2021-2022.

What is High Blood Pressure?

High blood pressure, also called hypertension, is a condition in which the heart has to pump harder for blood to flow through narrowed blood vessels, leading to persistently raised pressure. Expressed as a fraction of two numbers, blood pressure is measured in millimetres of mercury (mmHg). The first number is the systolic blood pressure, i.e. the pressure in the arteries when the heart contracts and pumps blood to the rest of the body. The second number is the diastolic blood pressure, which is registered as the heart relaxes and its chambers open, filling with blood.

Understanding Blood Pressure Readings

In general, blood pressure is classified as shown below:

Normal: A normal blood pressure reading would be less than 130/85mmHg. At this stage, no treatment is required, but it is recommended to continue monitoring to ensure that we do not develop high blood pressure.

In a young healthy woman, normal blood pressure may vary from 90/60mmHg to 120/80mmHg.

If you have diabetes or kidney disease, you must aim to keep your blood pressure within 120/80mmHg as marginally higher blood pressure can increase your risk of developing complications.

Borderline: Individuals with borderline high blood pressure of 130/85 to 139/89mmHg are considered pre-hypertensive. If your BP is higher than 130/85mmHg most of the time, even at rest, it is a sign to start taking precautions and follow your doctor’s advice to manage your blood pressure. Lifestyle changes are strongly recommended.

High: If your systolic pressure is 140mmHg or more, and/or diastolic pressure is 90mmHg or more when measured on two or more occasions, you may be suffering from high blood pressure.

Note: Your blood pressure reading may vary depending on what you are doing – body position, breathing, emotional state, exercise, and sleep.

Reasons for High Blood Pressure

Common types of high blood pressure include essential (primary) hypertension, secondary hypertension, and gestational hypertension (high blood pressure during pregnancy).

Essential Hypertension

Also known as primary hypertension, it is the most common type of high blood pressure that develops over time. It is usually caused by a combination of hereditary and lifestyle-related risk factors.

Age

As we grow older, our arteries may stiffen and narrow due to the build-up of plaque over the years, causing the heart to beat harder, thus developing high blood pressure.

Family History

Having a family member with high blood pressure before the age of 60 makes it twice as likely for you to develop the condition due to genetics.

Existing Health Conditions

Conditions such as diabetes and high cholesterol can increase our risk of hypertension.

Smoking

Smoking can raise our blood pressure temporarily and its chemicals can damage our artery walls, causing our arteries to narrow and stiffen.

Unhealthy Diet

A diet high in fat, sugar, or sodium can increase our risk of developing hypertension.

Physical Inactivity

Individuals who lead sedentary lifestyles tend to have a higher heart rate than those who are physically active. This means that the heart needs to work harder.

In addition, with little physical activity, there is a high likelihood of the person being overweight.

Obesity/Overweight

The heavier we are, the more blood is required to supply oxygen and nutrients around our body, thus increasing the pressure on our blood vessels.

Alcohol Consumption

Drinking too much alcohol can raise blood pressure to unhealthy levels. Having more than three drinks in one sitting temporarily increase blood pressure, but repeated binge drinking can lead to long-term increased blood pressure.

Stress

High levels of stress can increase our blood pressure and may encourage unhealthy lifestyle habits that further contribute to the development of the condition, such as too much alcohol, smoking, physical inactivity, and a poor diet containing too much salt, sugar, and fats.

Secondary Hypertension

This condition is only found in 5 to 10% of hypertensive patients and is more prevalent in those with an underlying condition. This type of high blood pressure usually occurs suddenly and can cause higher readings as compared to essential hypertension. It is usually caused by underlying health problems like:

• Kidney disease
• Adrenal gland disease
• Side effects of some medications, e.g. birth control pills, diet aids, etc.
• Obstructive sleep apnea
• Hormone abnormalities
• Thyroid abnormalities
• Constriction of the aorta

Symptoms of High Blood Pressure

High blood pressure is often called the silent killer because it usually has no symptoms until significant damage has been done to the heart and arteries, and many people go undiagnosed.

However, if symptoms do occur, they can include:

Blurred Vision	Nosebleeds	Shortness of breath
Chest pain	Dizziness	Headache

Checking for High Blood Pressure

The only way to get high blood pressure diagnosed is to either have a health professional check your blood pressure or monitor it using a home blood pressure monitor.

Singapore Heart Foundation advocates for people to start checking their blood pressure from 18 years old. Those above 40 years old should have their blood pressure measured regularly.

If your blood pressure is in the normal range, you should measure it at least once every 2 years.  If your blood pressure is between 130-139/85-89 mmHg, you should have an annual check.

If you are diagnosed with high blood pressure, heart disease, cerebrovascular disease,  diabetes or kidney disease, you need to measure your blood pressure at least once a week to keep it in check.

If you have a family history of heart disease or have risk factors for developing the condition, it is also recommended to have your blood pressure checked twice a year. This can help detect the condition early and treat it before it becomes a problem.

Measuring my Blood Pressure at Home

Before measurement

• Avoid caffeine, alcohol, or smoking 30 minutes before the blood pressure measurement
• Go to the bathroom – a full bladder may cause your blood pressure readings to be inaccurate
• Remove or change out of any constrictive, tight-fitting, or thick clothing (i.e. sweater)
• Sit quietly and relax

During measurement

Wrap the arm cuff around your left upper arm. Ensure that the tube is straight, without any bends that may obstruct the airflow. The arrow below the tube should be pointing downwards, towards the middle of your left palm. Place the cuff 1 to 2 fingers above your elbow crease.	Ensure that the cuff is fitted snugly, with 1 finger spacing between the arm and cuff.
In a seated position with your back supported and both feet flat on the floor, rest your left arm on a table at the level of your heart, with your palm facing up. Do not cross your legs.	Press the “Start” button on the machine*. Once completed, you should see three static numbers on the display. The first two numbers represent the systolic and diastolic readings. The last number is your pulse recorded per minute during the measurement. *Refrain from talking and moving during measurement.

After measurement

• For a more accurate reading, take two blood pressure readings at least 2 minutes apart.
• Record your blood pressure numbers and bring them to your next medical check-up.

Complications of High Blood Pressure

High blood pressure increases one’s risk of cardiovascular disease as the blood vessel walls become irritated by the increased pressure exerted by the blood flowing through. As more and more damage is done to the vessel walls, plaque tends to form, in turn increasing the likelihood of atherosclerosis and coronary heart disease.

Damage Blood Vessels

High Blood Pressure Damages Your Blood Vessels The excessive pressure exerted on your blood vessels may result in tears on its lining.

Plaque begins to build-up Particles of the plaque (fat, cholesterol, and other substances) begin to accumulate in your blood vessel’s walls. As the plaque builds up, your blood vessels will slowly narrow and harden.

High Blood Pressure Speeds Up the Process of Hardening of Your Blood Vessels Your blood vessels will harden and become less elastic over time as you age. However, uncontrolled high blood pressure speeds up the hardening process.

Damaged Blood Vessels can lead to: Blood Clots When the plaque ruptures, blood clots may form. These clots will obstruct blood flow to the vessels in supplying oxygen-rich blood to your organs and other parts of your body. Damaged Organs Your organs require oxygen and nutrients from a full supply of blood. However, damaged blood vessels cannot deliver adequate blood flow and can result in significant damage to your organs.

Other complications of hypertension can also include:

Vision Loss High blood pressure can strain and damage blood vessels in the retina.	Stroke Reduced blood supply to the brain, can lead to rapid loss of brain function or stroke.	Heart Failure The heart has to pump harder and over time, the heart muscle will enlarge and fail to pump enough blood to meet the body’s needs.
Heart Attack High blood pressure can damage and block the arteries, preventing oxygen-rich blood from reaching a section of the heart. The heart muscle will start to die when there is no oxygen and nutrients.	Kidney Failure Found in about 5% of hypertensive patients, narrowed, weakened, and hardened blood vessels around the kidneys will cause the organs to lose their ability to filter blood.	Sexual Dysfunction Occurs as a result of reduced blood flow throughout the body. Lower blood flow to the pelvis can affect the sex lives of both men and women.

Manage High Blood Pressure

Early diagnosis and treatment reduce your risk of developing severe hypertension-related diseases.

A decreased BP of 10/5mmHg (either by medication or a lifestyle change) can reduce the risk of:

• heart failure by 50%
• stroke by 38%
• heart attack by 15%
• death by 10%

Lifestyle changes and medication can aid in lowering blood pressure and decrease the risk of associated health complications. Here are some ways to help lower blood pressure:

Do not smoke or stop smoking

Limit Alcohol Consumption

• Do not consume more than 1 standard drink for women and 2 standard drinks for men per day [One standard drink: ⅔ can of beer (200ml), a small glass of wine (100ml), or a glass of spirit (30ml)]

Reduce your weight

• Maintain a healthy BMI of 18.5 to 22.9kg/m²

A heart-healthy diet

• More fruit and vegetables (1/2 plate), whole-grains (1/4 plate), lean proteins (1/4 plate), and good fats
• Less refined grains, added sugar, fatty, processed meats and bad fats
• Adopt the Dietary Approaches to Stop Hypertension (DASH) diet

Reduce salt intake

• Use herbs and spices to flavour your food instead of salt and sauces.
• When eating out, consume less gravy, sauces and soup.

Regular physical activity

• 7 – 18 years old: At least 60 minutes of moderate to vigorous-intensity physical activity every day
• Adults: 150 – 300 minutes of moderate-intensity aerobics physical activity every week

Manage stress

• Adopt activities like meditation, deep breathing, or massage
• Get adequate sleep

Go for regular check-ups

Monitor your blood pressure regularly

• Keep a log and take it to your doctor’s appointments
• For people with diabetes, chronic kidney disease, or a prior heart attack or stroke, BP must be maintained below 130/85mmHg as even marginally higher pressure will increase your risk of developing complications. Patients should consult their doctor on their specific goals.

Take medication as prescribed

Medication may be necessary for patients who do not respond to lifestyle changes. Examples of blood pressure medications used to control high blood pressure are:

• ACE inhibitors
• Angiotensin receptor blockers (ARBs)
• Calcium-channel blockers
• Diuretics
• Alpha-blockers (Doxazocin)
• Beta-blockers

Disclaimer: This listing is for information only and is not meant to substitute direct medical advice from your doctor or clinician.

Conclusion

High blood pressure is a chronic condition that will stay for life and lead to serious health problems. However, it is not deadly if it is well-managed and discovered early.

Avoid a hypertensive crisis by making simple lifestyle changes in your diet and adopting an exercise regime. It is never too late to manage high blood pressure. So gather your friends and family now and take the first step to make a heart difference in your lifestyle.