Hypertension (High Blood Pressure)

Hypertension is a cardiovascular condition where blood pressure against artery walls remains consistently elevated above 140/90 mmHg. This prolonged high pressure can damage blood vessels and organs over time, leading to complications such as heart disease, stroke, kidney problems, and vision changes.Althrough hypertension often develops without noticeable symptoms, it can be managed effectively through lifestyle changes and medical treatment.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG) | MRCP (UK) | MMed (Internal Med) (SG) | FAMS (Cardiology, SG)

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Hypertension

Many people remain unaware of their high blood pressure until a routine check-up or complications arise. However, when blood pressure is significantly elevated, certain symptoms may appear.

Headaches: Persistent or throbbing headaches, especially in the morning and at the back of the head, may be linked to high blood pressure, particularly when severely elevated.
Dizziness: Lightheadedness or unsteadiness can occur, especially with sudden movements like standing up too quickly.
Vision Changes: Blurred or double vision may result from high blood pressure affecting the blood vessels in the eyes. In severe cases, it can contribute to vision loss.
Shortness of Breath: Breathing difficulties, especially during mild exertion or while lying flat, may indicate high blood pressure affecting heart and lung function.
Nosebleeds: Frequent or unexplained nosebleeds may occur in cases of severe hypertension and should be evaluated by a medical professional.

Causes and Risk Factors

Hypertension results from a combination of genetic influences and lifestyle factors that affect blood pressure regulation.

Age

Blood pressure tends to rise with age as arteries lose elasticity, making it harder for blood to flow smoothly.
Family History

A genetic predisposition increases the risk, especially if close relatives have hypertension or related cardiovascular conditions.
Obesity

Excess body weight forces the heart to work harder, increasing pressure on blood vessels and contributing to elevated blood pressure.
Dietary Habits

A high-sodium diet leads to fluid retention, raising blood pressure, while insufficient potassium intake disrupts the balance needed for proper blood vessel function.
Physical Inactivity

Lack of regular exercise weakens the heart and blood vessels, reducing circulation efficiency and increasing the risk of hypertension.
Chronic Conditions

Diabetes, kidney disease, and sleep apnoea can impair the body’s ability to regulate blood pressure, leading to long-term increases.

Types of Hypertension

Primary Hypertension

The most common form, accounting for about 95% of cases (Medscape), it develops gradually over time without a specific cause. Genetics and lifestyle factors, such as diet, stress, and physical activity, contribute to its progression. Regular monitoring helps track blood pressure changes and treatment effectiveness.

Secondary Hypertension

This type results from an underlying medical condition, such as kidney disease, hormonal disorders, or medication side effects. It often appears suddenly and can cause higher blood pressure than primary hypertension. Treating the underlying condition may help restore normal blood pressure levels.

Resistant Hypertension

Blood pressure remains above target levels despite using different types of antihypertensive medications, including a diuretic. It requires further evaluation to identify contributing factors, such as medication interactions, lifestyle influences, or undiagnosed secondary causes.

Diagnostic Methods

Blood Pressure Measurement

Blood pressure is measured using a sphygmomanometer (manual or digital device). Readings are taken on multiple occasions to confirm consistently high levels. A diagnosis of hypertension is made when readings are 140/90 mmHg or higher in a clinic or 135/85 mmHg or higher when measured at home.

Home Blood Pressure Monitoring

Patients may be advised to check their blood pressure at home using a validated monitor. This helps track daily variations and reduces the risk of white coat hypertension (elevated readings due to stress in a medical setting).

Ambulatory Blood Pressure Monitoring (ABPM)

A 24-hour blood pressure monitor automatically records readings at regular intervals throughout the day and night. This provides a more accurate picture of blood pressure trends and helps detect masked hypertension (normal readings in a clinic but high at home).

Treatment Options

Hypertension management typically starts with lifestyle changes, with medication added if necessary to maintain healthy blood pressure levels.

Lifestyle Modifications

Adjustments in diet, exercise, and stress management can help lower blood pressure over time. A balanced diet low in sodium, regular physical activity, and weight management play key roles. Regular blood pressure monitoring helps track progress and guide further treatment as needed.

Diuretics

These medications help the body remove excess sodium and water, reducing blood volume and lowering blood pressure. Regular blood tests monitor potassium levels and kidney function, as diuretics can cause imbalances.

ACE Inhibitors

ACE inhibitors prevent the formation of angiotensin II, a hormone that narrows blood vessels. This helps blood vessels relax, improving circulation and lowering blood pressure. Regular kidney function monitoring is essential to ensure safe and effective use.

Beta Blockers

These medications slow the heart rate and reduce the force of heart contractions, decreasing overall workload and lowering blood pressure. Heart rate monitoring helps determine appropriate dosing and response.

Calcium Channel Blockers

By relaxing blood vessels and, in some cases, slowing heart rate, these drugs improve blood flow and lower blood pressure. They work by blocking calcium entry into heart and vessel cells. Regular assessments ensure effectiveness and adjust treatment as needed.

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Prevention and Management

Managing blood pressure involves a balanced diet low in sodium (less than 6g per day), regular exercise (at least 150 minutes of moderate activity per week), and maintaining a healthy weight. Limiting alcohol, managing stress, and getting sufficient sleep further support blood pressure control. Regular monitoring and adherence to prescribed medication help prevent complications, while keeping a blood pressure diary allows healthcare providers to assess treatment effectiveness and make necessary adjustments.

Frequently Asked Questions (FAQ)

How often should blood pressure be checked?

People with controlled hypertension should check their blood pressure at least weekly. Those with fluctuating readings or recent medication changes may need daily measurements.

Can stress cause permanent hypertension?

Chronic stress contributes to sustained blood pressure elevation through hormonal changes and behavioural patterns. Managing stress through various techniques helps maintain healthy blood pressure levels.

When is the best time to take blood pressure medications?

Blood pressure medications work best when taken at consistent times each day. Some medications prove more effective when taken at bedtime, based on blood pressure patterns and medication properties.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG)|MRCP (UK)|MMed (Internal Med) (SG)|FAMS (Cardiology, SG)

A Senior Consultant Cardiologist specialising in interventional cardiology and serves as the Medical Director at Carrington Cardiology, located at Mount Elizabeth Medical Centre in Singapore.

Dr. Kua obtained his MBBS from the National University of Singapore. He furthered his medical education by earning an MRCP in the UK and an MMed in Internal Medicine from NUS. He completed advanced training in interventional cardiology at Hammersmith Hospital in London.
Dr. Kua’s international training at Hammersmith Hospital provided him with extensive experience in complex coronary interventions and exposure to advanced cardiovascular research. He served as an International Cardiology Fellow and Honorary Consultant during his tenure there.

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