Our blood pressure is always changing in response to our physical activity, emotions, age, environment and many other factors. Hypertension, or high blood pressure, occurs when our blood is pumped around the body at a higher than normal pressure over a prolonged period. The narrower our arteries and the more blood our heart pumps, the higher our blood pressure.
A complete blood pressure reading is often presented like this: 120/80. This is read as “120 over 80”, and the two numbers represent the systolic and diastolic blood pressure respectively.
Systolic blood pressure refers to the amount of pressure in your arteries when your heart contracts to pump blood around your body, while diastolic blood pressure refers to the blood pressure in our arteries when our heart is between beats.
How do I measure my blood pressure?
Blood pressure machines are portable and easy to use. You can measure your blood pressure level at home too. Here are some things to look out for when taking your blood pressure for an accurate reading:
- Relax for more than 5 minutes before a reading
- Avoid caffeine, exercise and cigarettes for at least 30 minutes before a reading
- Empty your bladder before a reading
- Use an appropriate-sized arm cuff
- Do not speak during the rest period and the measurement
- Sit, instead of standing or lying down
- Remove any clothing covering the location of the cuff placement
- Use an average of at least 2 readings obtained on separate occasions to estimate your blood pressure level
- Check your blood pressure in both arms – a difference of 10 mm Hg or more between arms may indicate the presence of blocked arteries in the arms, diabetes or other health problems
If one or both of the numbers are consistently above the recommended guidelines of 130/80, you should consult a doctor and get checked for hypertension.
Stages of Hypertension
Different countries may classify the stages of hypertension differently. In Singapore, there are 3 stages: Normal, Pre-hypertensive, and Hypertensive.
- Normal: A blood pressure reading lower than 130/80 mm Hg is considered to be within the normal range. At this stage, no treatment is necessary, but it is recommended for us to continue monitoring our blood pressure to ensure it stays within the healthy range.
- Pre-hypertensive: Individuals with a blood pressure reading between 130/80 to 139/89 mm Hg are considered pre-hypertensive and are at risk of moving on to develop heart disease. While medication may not be required at this point, lifestyle measures to reduce blood pressure are recommended.
- Hypertensive: If you have a blood pressure reading of 140/90 mm Hg and above, your doctor may prescribe medication and recommend lifestyle changes to lower your blood pressure and reduce your risk of stroke and heart diseases.
What are the types of hypertension?
There are two types of hypertension: primary and secondary hypertension.
- Primary hypertension, also called essential hypertension, accounts for approximately 95% of all cases and develops gradually over years. There is no clear cause of primary hypertension.
- Secondary hypertension accounts for the remaining 5% and often develops as a result of other conditions, such as sleep apnea, kidney issues, thyroid problems, adrenal gland tumours, congenital defects in blood vessels, and certain drugs and medications.
Symptoms of High Blood Pressure
Commonly known as the silent killer, hypertension often does not give rise to any noticeable symptoms even if blood pressure is dangerously high. Sometimes, individuals with hypertension may experience headaches, shortness of breath or nosebleeds, but they don’t usually occur until blood pressure has reached a severe or life-threatening stage.
Complications of Hypertension
If left untreated, the increased pressure on our artery walls caused by hypertension can damage our blood vessels and organs. The higher the pressure and the longer it goes uncontrolled, the greater the damage.
High blood pressure that’s not well-managed can lead to health complications, including:
Heart Attack or Stroke
A higher pressure means our heart has to work harder to pump blood around our body. This can cause our heart muscles to thicken in a condition known as left ventricular hypertrophy, making it harder for our heart to pump enough blood.
Our blood vessels may weaken and bulge in response to the increased blood pressure, forming an aneurysm, which can be deadly if ruptured.
Hypertension is the second leading cause of kidney failure. Over time, the increase in blood pressure can narrow, weaken or harden the arteries around our kidney and limit blood flow to tissues. This can lead to kidney damage or failure.
Loss of vision
Our vision may be impaired if the blood vessels in the retina are damaged. This condition is known as hypertensive retinopathy and can cause serious damage if not treated promptly.
Trouble with Memory or Understanding
Hypertension can affect our ability to think and learn. If blood vessels supplying oxygen and nutrients to the brain cells responsible for memory are damaged as a result of increased blood pressure, we may experience short-term memory loss.
Vascular dementia is a type of dementia caused by impaired blood flow to the brain. Increased blood pressure can lead to narrowed or blocked arteries that limit blood flow to our brain, resulting in the development of vascular dementia.
Metabolic syndrome is a cluster of conditions that include high blood pressure, high blood sugar, large waist circumference and abnormal cholesterol or triglyceride levels. Having one of these conditions does not mean we have metabolic syndrome. However, if we develop more of these conditions, our risk of complications such as type 2 diabetes and heart disease increases.
What causes high blood pressure?
While the exact cause of most hypertension cases is unknown, there are a number of factors associated with an increased risk of developing hypertension.
Non-Modifiable Risk Factors
As we get older, our arteries may stiffen and narrow due to the buildup of plaque over the years. This can cause our blood pressure to increase and lead to hypertension.
Family History of Hypertension
Having a family member with hypertension before the age of 60 makes it twice as likely for you to develop the condition due to genetics. In fact, the more family members you have with high blood pressure before the age of 60, the higher your chance of developing hypertension.
Existing Health Conditions
Conditions such as diabetes, high blood cholesterol, chronic kidney disease, adrenal and thyroid disorders and sleep apnea can increase our risk of hypertension. For example, kidney disease reduces our body’s ability to filter out excess fluid, leading to high volume of blood and subsequently high blood pressure.
Modifiable Risk Factors
Smoking has a direct impact on our blood pressure and immediately raises our blood pressure temporarily. However, the chemicals in tobacco also damages our artery walls, causing our arteries to narrow and stiffen, increasing blood pressure over the long term.
A diet high in fat, sugar or sodium can increase our risk of developing hypertension. Many with hypertension are also “salt-sensitive”, meaning that if they consume more than the minimally required amount of salt, their blood pressure increases.
Individuals who lead sedentary lifestyles tend to have a higher heart rate than those who are physically active. This means that the heart has to work harder with each contraction and the force on our arteries are higher as well. A lack of physical activity also increases the likelihood of us being overweight.
The heavier we are, the more blood is required to supply oxygen and nutrients around our body. With the increased volume of blood, the pressure on our blood vessels increases as well.
You may have read that drinking red wine benefits our heart. While it does contain antioxidants, the evidence backing the claim that red wine is good for our heart is pretty weak. In fact, having more than one alcoholic drink a day for women or two for men can raise our risk of hypertension and other health conditions.
High levels of stress can increase our blood pressure and may also encourage lifestyle habits that further contribute to the development of the condition, such as drinking, smoking, physical inactivity and poor diet.
Whether you are trying to keep your hypertension in check or prevent its development, there are lifestyle habits you can adopt to lower your blood pressure.
Watch Your Diet
A balanced diet that’s low in sodium, fat and sugar, and rich in potassium, whole grains, fruits, vegetables and low-fat dairy products can lower your blood pressure. In fact, this is a diet developed and recommended for those with hypertension and is called the Dietary Approaches to Stop Hypertension (DASH) diet. Read our dietary guide for individuals with hypertension to learn more about what food you should eat more of and what to avoid.
Exercising has many health benefits, including keeping our arteries flexible and preventing the tightening of blood vessels by reducing activity in our sympathetic nervous system. If you have hypertension, regular physical activity can help to reduce our blood pressure readings significantly. However, it is important to be consistent, as our blood pressure may rise again if we revert back to a sedentary lifestyle.
The Health Promotion Board recommends that everyone aim for 150 minutes of physical activity per week. If you are unsure whether you should be doing physical activities due to health conditions, check in with your doctor before devising a suitable exercise plan that’s within your abilities and limits.
Besides hypertension, smoking is widely known to increase our risk of many other health conditions such as cancer. If you don’t smoke, don’t start. If you do smoke, quit smoking today. Here are some resources you can use to get started on your journey to a smoke-free life.
Reduce Stress Levels
If you are constantly feeling stressed out, take some time to understand what is causing you to feel that way and try to eliminate as many stressors as possible.
However, it is usually not possible to remove all your stressors, hence it’s important to know how to manage your stress well. Find healthy ways to cope instead of drinking, smoking or eating unhealthy food. Make time to do the things you enjoy, practise gratitude and manage your expectations.
Manage Your Weight
Being overweight forces our heart to pump harder. We should always aim for our weight to be within the acceptable range to prevent health complications. If you are overweight, come up with a suitable exercise plan and make changes to your diet. Losing weight has the biggest effect on those who are overweight and have hypertension. Even shedding just a couple of kilos can have a significant impact on our blood pressure.
Reduce Alcohol Consumption
When it comes to alcohol, moderation is key. Having a single alcoholic drink can cause a temporary spike in our blood pressure, but this tends to resolve itself within 2 hours. However, regular heavy drinking can result in a sustained rise in blood pressure and may eventually lead to chronic hypertension.
Take Your Medication
To help keep hypertension under control, your doctor may prescribe certain medication. You may need to take blood pressure medication for the rest of your life, but there is a chance that you may be able to reduce or stop treatment if your blood pressure remains under control for several years.
It is important to follow your doctor’s advice and take medication as directed to ensure its effectiveness. If you experience any side effects, inform your doctor immediately.
Living with Hypertension
Hypertension is a chronic condition. This means that it stays with us for life. While it may not be deadly if well-managed, receiving a hypertension diagnosis can still be a depressing experience.
Thankfully, our blood pressure can be managed with simple lifestyle changes and medication. Having supportive friends and family who encourage you to lead a healthy lifestyle can help you too, both physically and emotionally. If you need more support, consider joining a support group such as Pulmonary Hypertension Singapore, where you can connect with individuals with similar conditions, provide emotional support to one another and share practical tips on coping with hypertension.
- Atherosclerosis. National Heart, Lung, and Blood Institute (NHLBI). Retrieved 2 July 2020, from https://www.nhlbi.nih.gov/health-topics/atherosclerosis.
- Choi, H. Y., Park, H. C., & Ha, S. K. (2015). Salt Sensitivity and Hypertension: A Paradigm Shift from Kidney Malfunction to Vascular Endothelial Dysfunction. Electrolyte & blood pressure : E & BP, 13(1), 7–16. https://doi.org/10.5049/EBP.2015.13.1.7
- Corliss, J. (2020). Is red wine actually good for your heart?. Harvard Health Publishing. Retrieved 2 July 2020, from https://www.health.harvard.edu/blog/is-red-wine-good-actually-for-your-heart-2018021913285.
- DASH Eating Plan. National Heart, Lung, and Blood Institute (NHLBI). Retrieved 2 July 2020, from https://www.nhlbi.nih.gov/health-topics/dash-eating-plan.
- E. Kim, J. (2020). Hypertensive retinopathy. EyeWiki. Retrieved 2 July 2020, from https://eyewiki.aao.org/Hypertensive_retinopathy.
- Family History and High Blood Pressure. (2020). [Ebook]. Retrieved 2 July 2020, from https://www.cdc.gov/pcd/issues/2005/apr/pdf/04_0134_01.pdf.
- HEALTH PROMOTION BOARD LAUNCHES NATIONAL PHYSICAL ACTIVITY GUIDELINES. Health Promotion Board. (2011). Retrieved 2 July 2020, from https://www.hpb.gov.sg/article/health-promotion-board-launches-national-physical-activity-guidelines#:~:text=Singapore%2C%2021%20August%202011%3A%20Aiming,more%20is%20better%20than%20some.
- Hecht, M. (2019). Types and Stages of Hypertension. Healthline. Retrieved 2 July 2020, from https://www.healthline.com/health/types-and-stages-of-hypertension#primary-vs-secondary.
- High blood pressure (hypertension). Mayo Clinic. (2018). Retrieved 2 July 2020, from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410.
- How High Blood Pressure Can Lead to Kidney Damage or Failure. American Heart Association. (2016). Retrieved 2 July 2020, from https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/what-is-left-ventricular-hypertrophy-lvh.
- Know Your Risk for High Blood Pressure. Centers for Disease Control and Prevention. (2020). Retrieved 2 July 2020, from https://www.cdc.gov/bloodpressure/risk_factors.htm.
- Maheswaran, Ravi; Jaswinder, Singh Gill; Davies, Paul; David Gareth, Beevers. (2019). High Blood Pressure Due to Alcohol A Rapidly Reversible Effect. Hypertension, 17(6), 787-792.
- Metabolic syndrome. Mayo Clinic. (2019). Retrieved 2 July 2020, from https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916#:~:text=Metabolic%20syndrome%20is%20a%20cluster,abnormal%20cholesterol%20or%20triglyceride%20levels.
- National Health Survey 2010 Singapore. (2010). [Ebook]. Retrieved 2 July 2020, from https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/nhs2010—low-res.pdf.
- Smoking, High Blood Pressure and Your Health. American Heart Association. (2016). Retrieved 2 July 2020, from https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/smoking-high-blood-pressure-and-your-health.
- Teo, J. (2017). 5 things you need to know about hypertension. The Straits Times. Retrieved 2 July 2020, from https://www.straitstimes.com/singapore/5-things-you-need-to-know-about-hypertension#:~:text=Measure%20your%20blood%20pressure%20at,time%20you%20take%20the%20reading.
- Virdis, A., Giannarelli, C., Neves, M. F., Taddei, S., & Ghiadoni, L. (2010). Cigarette smoking and hypertension. Current pharmaceutical design, 16(23), 2518–2525. https://doi.org/10.2174/138161210792062920
- What is Left Ventricular Hypertrophy (LVH)?. American Heart Association. (2020). Retrieved 2 July 2020, from https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/what-is-left-ventricular-hypertrophy-lvh#:~:text=Left%20ventricular%20hypertrophy%2C%20or%20LVH,pressure%20overwork%20the%20heart%20muscle.
- Your Guide to Lowering Blood Pressure. (2003). [Ebook]. Retrieved 2 July 2020, from https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf?cid=GMB#:~:text=Being%20overweight%20or%20obese%20increases,overweight%20and%20already%20have%20hypertension.