Hypertension Treatment and Prevention in Singapore
by: Dr. Paul Chang, General Practitioner, Regis Medical
Hypertension is one of the most common health conditions in Singapore, with almost 1 in 4 Singaporeans aged 30 to 69 years having hypertension. The number rises in the 60 to 69 years-old group, with more than 1 in 2 people having hypertension.
Hypertension in Singapore
According to the Ministry of Health (MOH), hypertension is prevalent in 21.5% of Singaporeans aged 18 to 69 years. Statistics have shown that hypertension is more prevalent in Singaporean males compared to females.
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What is Hypertension?
Hypertension, also known as high blood pressure, is a common chronic disease in Singapore. The risk of developing hypertension increases as you grow older and is most prevalent amongst those aged 60 and above.
Blood pressure refers to the pressure put on the artery walls when blood travels through the body. This rises and falls throughout the day as you go about your daily routine. If untreated, in the long term, this condition can lead to serious health complications, such as heart attack, stroke, and kidney disease.
How is blood pressure measured?
When measuring blood pressure, both systolic and diastolic blood pressure numbers are required. Systolic blood pressure refers to the pressure created by the pushing of blood through the arteries when your heart beats. Diastolic blood pressure refers to the pressure in the arteries when the heart is resting between beats. During this time, the heart is filled with build and gets oxygen.
Symptoms of Hypertension
Hypertension usually does not have any symptoms or warning signs, and many with the condition do not realise they have it. Symptoms only start to show when the condition has become extremely severe. These symptoms include:
- Severe headaches
- Fatigue
- Chest pain
- Breathing difficulties
- Blood in the urine
- Vision problems
If you experience any of these symptoms you should seek a doctor immediately. These could be signs of a hypertensive crisis that could lead to fatal heart attacks or strokes, or signs of other serious health conditions.
It is therefore important that you have your blood checked regularly to ensure the early detection of hypertension. For those aged 40 and above, it is recommended that you have your blood pressure checked at least once a year.
Stages of Hypertension
Hypertension can be categorised into 4 stages.
Elevated (Blood pressure levels between 130-139/80-89 mmHg)
Patients at this stage experience elevated levels of blood pressure that are not high enough to be considered to be hypertension. This can be considered prehypertension and places the patient at a higher risk of developing hypertension in the future.
Hypertension Stage 1 (Blood pressure levels between 140-159/90-99 mmHg)
Patients at this stage are diagnosed with hypertension and will require lifestyle changes and medication depending on their doctor’s advice. Blood pressure medication may be prescribed if the patient has been assessed to have a high risk of developing cardiovascular diseases such as heart attack or stroke.
Hypertension Stage 2 (Blood pressure levels at or above 160/100 mmHg)
Patients at this stage will require lifestyle changes as well as a prescription of medication to control the disease. The risk of developing serious health complications such as kidney disease and cardiovascular diseases is higher so medication and management will be required to lower their risk of developing serious health complications.
Hypertensive Crisis (Blood pressure levels spikes to 180/120 mmHg or greater)
Patients who experience such severe spikes in blood pressure must seek immediate medical assistance, as blood vessels may be damaged, potentially leading to life-threatening complications.
Hypertensive crises can be split into two categories: urgent and emergency.
In an urgent hypertensive crisis, blood pressure levels are extremely high but have not resulted in damage to the organs. It is critical to treat this as soon as possible to prevent it from developing into a hypertensive emergency, which is often life-threatening.
In an emergency hypertensive crisis, blood pressure levels are extremely high and have caused damage to your organs, potentially leading to life-threatening complications such as heart attack and stroke. Immediate medical attention is required due to its severity.
Types of Hypertension
Primary Hypertension
Also known as essential hypertension, primary hypertension refers to hypertension that is not caused by any other medical conditions. This type of hypertension is typically a result of poor lifestyle choices, obesity, and an unhealthy diet. The condition can be reversed via lifestyle changes and medication.
Secondary Hypertension
Secondary hypertension, unlike primary hypertension, is caused by known diseases or medical conditions. These include:
- Kidney diseases. Damage to the kidneys can result in poor blood supply to the organ, resulting in the increased production of a hormone named renin. Renin causes substances that increase blood pressure to be produced in the body.
- Diabetes complications. Damage to the kidneys can be a complication of diabetes, resulting in high blood pressure. One specific example would be renal artery stenosis, where the blood vessel supplying the kidney is blocked.
- Thyroid problems. When the patient suffers from hyperthyroidism, the overactive thyroid gland produces too much of the thyroid hormone, increasing heart rate and blood pressure. On the other hand, patients with hypothyroidism, where the thyroid gland is underactive, can result in the weakening of the heart and lowered heart rate, stiffening the blood vessel walls. This can lead to hypertension.
- Sleep apnea. Sleep apnea refers to a condition in which the patient’s breathing stops repeatedly in their sleep, resulting in the patient not getting sufficient oxygen. This can damage the blood vessel walls and cause the nervous system to become overactive, releasing chemicals that can increase blood pressure in the body.
- Rarer conditions such as Conn Syndrome and Pheochromocytoma can also cause secondary hypertension.
Malignant Hypertension
Malignant hypertension refers to a rapid increase in blood pressure that causes organ damage, most commonly to the eyes and kidneys, and can be considered a medical emergency. While the condition is extremely rare, it is life-threatening. Malignant hypertension can be the result of:
- Missing doses of blood pressure medication
- Kidney disease
- Abuse of drugs such as cocaine and amphetamine
- Spinal cord injuries
- Collagen vascular disease
Resistant hypertension
Resistant hypertension refers to a condition in which the blood pressure of hypertension patients remains high despite using blood pressure medication, including a diuretic. Resistant hypertension is difficult to treat and suggests underlying medical conditions. These include:
- Sleep apnea
- Obesity
- Alcohol abuse
- Abnormalities in the hormones controlling blood pressure
- Renal artery stenosis, where artery-clogging plagues are accumulated in the kidneys
Hypertension Risk Factors
Understanding the risk factors for hypertension will allow you to take the first step in lowering your risks of developing the disease. Hypertension is generally caused by poor lifestyle choices and habits, or other medical conditions that are left uncontrolled. These include:
- Age. The risk of developing hypertension increases with age, being most prevalent in those aged 60 and above.
- Beans
- Sex. Women are more likely to develop hypertension in comparison to men.
- Fish
- Low-fat or fat-free dairy foods
- Whole grains
- Healthy fats
On the other hand, foods that are bad for your health should be avoided or kept to a minimum as much as possible. These include:
- Processed foods
- Foods high in sodium content
- Foods high in sugar content
- Sugary drinks
- Processed carbohydrates
- Alcohol
- Foods high in saturated fats
- Foods high in trans fats
By keeping to a healthy diet, you can ensure that your body gets sufficient nutrients without putting you at greater risk of cardiovascular disease.
Staying physically active
Regular exercise leads to direct and indirect benefits to your health. It has been shown that exercise can aid in lowering BMI, which helps with lowering blood pressure, improving insulin sensitivity, and improving LDL and HDL levels. It is recommended for adults to engage in moderate to intense aerobic exercises for at least 2 hours and 30 minutes a week, which averages to about 30 minutes a day. Simple exercises such as brisk walking can make a big difference in your journey towards preventing heart diseases. We should also aim to maintain a good level of baseline activity, which can be monitored by the number of steps we take a day.
Quit smoking
Smoking is damaging to your cardiovascular health and puts you at a heightened risk for many health complications. Studies have shown positive results in lowering the risk of developing heart diseases just by quitting smoking. For example, within a year of quitting, the risk of heart attack drops dramatically.
Improve your sleep
A lack of sleep, as well as sleep quality can contribute to greater risks of developing cardiovascular diseases. It is recommended that you have at least 7 hours of sleep every night. Keeping a regular sleep schedule can help improve sleep quality. If you have sleep disorders that are affecting your sleep quantity and/or sleep quality, we are here to listen to your concerns and help you get a good night’s rest.
Regular health screenings
High blood pressure and high cholesterol can damage the cardiovascular system, leading to cardiovascular diseases. However, because these conditions do not usually show any symptoms until later stages, many patients remain undiagnosed. Diabetes is a similar common chronic condition that can lead to heart disease. By regularly screening for such conditions, you can ensure early detection and intervention to prevent serious complications from developing.
Cardiovascular Health and Stress Management
Stress can increase your risk of cardiovascular diseases. It is good to relieve stress, but some people choose to deal with stress in unhealthy ways. For example, overeating, excessive drinking, smoking or even substance abuse. All these methods are destructive to your health. Choose alternative ways of managing stress such as exercising or relaxation exercises like yoga, that can be both effective in relieving stress and also keeping your body healthy.
Early Intervention
If you are at a higher risk of developing cardiovascular diseases, early intervention is key in halting the progression of cardiovascular risk factors. Primary prevention programs can be effective in detecting cardiovascular risk factors as well as improving your cardiovascular health, ultimately reducing the risk of cardiovascular diseases in the future. Being educated on the risk factors of cardiovascular health, the importance of good cardiovascular health and finally, how to reduce these risk factors can be vital in safeguarding your health.
Here are some ways in which early intervention can be helpful to you:
Leading a healthy lifestyle
Leading a healthy lifestyle is key in preventing the development of not only cardiovascular diseases but other types of diseases as well, especially chronic illnesses that become more prevalent as we age. It is ideal that these healthy lifestyle habits are instilled since young, but you can adopt these habits at any age. This can include:
- Stay physically active and fit
- Quit smoking
- Stick to a healthy diet (low in sugar, fats and sodium)
Identifying high risk individuals
If you are at a higher risk of developing cardiovascular diseases, it is important that you are identified as such as soon as possible. This can be done through regular health screening. Early detection and treatment of silent diseases can help you prevent possible health complications that can lead to cardiovascular diseases.
How to Improve Cardiovascular Health
Improving your cardiovascular health is long term project and requires determination and discipline. However, it does not require complicated techniques or equipment and you can start today.
Physical exercise
Your cardiovascular health is ultimately tied to your overall physical health and the heart itself is also a muscle that can be strengthened. It is recommended that you get at least 150 minutes of moderate intensity aerobic exercise every week, or 75 minutes of high intensity vigorous exercise. This can also serve the purpose of keeping your weight in check and lowering your overall blood pressure levels, which are risk factors for developing cardiovascular diseases.
Even while not exercising, during your daily routine, you should keep active by moving around once in a while. Avoid staying seated for extended periods of time. Physical inactivity has been linked to greater risks of cardiovascular diseases and moving about frequently while you are seated at work or at home can help you reduce these risks significantly.
Physical Exercises Good for Cardiovascular Health
When it comes to improving your cardiovascular health through exercise, the most important thing is to improve your cardiovascular endurance. If you have any underlying medical issues, it is best to ask for a doctor’s advice on the types of exercises you are suitable for.
Aerobic exercises can help you improve your cardiovascular endurance greatly. The benefits of improving your cardiovascular endurance via aerobic exercises include:
- Your heart pumps more efficiently
- Your lungs become more efficient
- Improved blood circulation and volume
- Lowered resting heart rates
- Your body uses fat as an energy source
- Lowered risk of developing various diseases including cardiovascular diseases
There are many different types of aerobic exercises to get your heart pumping. You should choose something that you enjoy, if possible, as you will need to exercise regularly and make it a long-term lifestyle choice to see the best effects. This can include:
- Brisk walking
- Running
- Jogging
- Swimming
- Cycling
- Playing tennis
- Jumping rope
- Stair climbing
- Hiking
Experiment with the intensity and duration of the exercise to see what suits your body best, while setting attainable goals so you can make gradual progress towards improving your cardiovascular health.
Diet
Generally, you will want to cut down on foods high in sugar, sodium, saturated and trans-fats. You do not need to completely cut out these types of foods from your diet, but instead, consume them in moderation or try to replace them with foods that are healthier. Fad diets are not encouraged, but rather a sustainable approach to a healthy diet is preferred.
Food Good for Cardiovascular Health
There are a few types of foods that you can adopt into your regular diet that are healthy for your heart. These include:
- Foods high in omega-3 fatty acids (Salmon, mackerels, cod liver oil, etc.)
- Avocados, which are nutrient-dense and high in dietary fiber, minerals, and healthy fats.
- Foods high in antioxidants (Broccoli, spinach, carrots, etc.)
- Low fat dairy products
If you are looking for a healthy diet plan, you can try out the Mediterranean Diet. This refers to a generic term based on the traditional eating habits of countries near the Mediterranean Sea. While eating styles amongst these countries vary, they share similar factors that make the Mediterranean Diet suitable for those who wish to keep their hearts healthy.
A Mediterranean diet usually focuses on:
- Olive oil as the primary fat source
- Large amounts of fruits, vegetables, bread and other grains, potatoes, beans, nuts and seeds
- Low to moderate amounts of dairy products, eggs, fish and poultry
Meat is less common in this diet and is replaced by fish and poultry. The Mediterranean diet can be healthy for your heart because it:
- Reduces the amount of sugar, sodium, highly processed foods, refined carbohydrates, saturated fats, and fatty or processed meats consumed
- Olive oil can help the body remove excess cholesterol
- Emphasis on vegetables, fruits, whole grains, beans and legumes that are high in fiber can reduce blood pressure and inflammation. These foods also tend to be nutrient-dense which is good for our bodies overall.
Screening for Cardiovascular Diseases
Many types of tests are used to screen for cardiovascular diseases. A physical examination alongside a review of your medical history will help your doctor recommend tests that are suitable for you.
These tests include:
- Blood tests. Your blood is tested for substances such as creatinine, kinase and troponin that are released into the bloodstream during a heart attack. These tests will allow your doctor to confirm a heart attack, estimate the time of an attack and detect damage to the heart muscle.
- Chest X-ray. An X-ray of the chest can show the size and shape of your heart, blood vessels and lungs.
- Electrocardiogram (ECG). An ECG provides information of your heart rhythm, heart rate, electrical abnormalities, and thickening of the heart muscle. It can also reveal previous or ongoing heart attacks as well as poor blood supply to the heart.
- Holter Monitoring. This test requires the patient to wear an ambulatory ECG for 24 to 48 hours. This allows abnormal heart rhythms or abnormalities to be recorded over a prolonged period.
- Exercise stress test. This test requires you to run on a treadmill while wearing the ECG electrodes. Speed and elevation gradually increase during the test and will continue until you reach your target exercise heart rate or are unable to continue or experience chest pains.
- Echocardiography. Echocardiography is an ultrasound of the heart that creates a detailed imaging of the heart. This allows for heart conditions to be spotted via assessing the internal structure, movement, chambers, and valves of your heart.
- Computed Tomography (CT) scan. A CT scan creates detailed images of the body, including the heart and surrounding blood vessels. This helps to screen for cardiac tumors, aortic disease, and pericardial disease
- CT Coronary Angiogram. This type of CT scan includes the use of a dye injection. This test helps to screen for narrowed or blocked arteries in the heart and other heart diseases.
- Magnetic Resonance Imaging (MRI). A MRI helps to create detailed three-dimensional images for your internal organs with the use of a magnetic field. This helps with a closer look at the heart muscle structure.
- Cardiac Nuclear Imaging. This test makes use of a very small amount of radioactive material (tracers) combined with the use of a gamma camera to create detailed images of the blood flow through your cardiovascular system. This can sometimes be combined with an exercise stress test.
Early detection of cardiovascular diseases through screening can be vital to saving your health or even your life as it allows you to make the necessary changes to your lifestyle or get proper medication and treatment before the diseases worsen.
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“10 Small Steps for Better Heart Health.” Harvard Health, Harvard Health Publishing, 16 Dec. 2019, https://www.health.harvard.edu/healthbeat/10-small-steps-for-better-heart-health.
“12 Foods That Are Very High in Omega-3.” Healthline, Healthline Media, 17 May 2022, https://www.healthline.com/nutrition/12-omega-3-rich-foods.
“3 Kinds of Exercise That Boost Heart Health.” Johns Hopkins Medicine, Johns Hopkins Medicine, 3 Nov. 2021, https://www.hopkinsmedicine.org/health/wellness-and-prevention/3-kinds-of-exercise-that-boost-heart-health.
“30 Ways to Improve Your Heart Health Quickly and Naturally.” Healthline, Healthline Media, 18 Apr. 2022, https://www.healthline.com/health/heart-health/how-to-improve-heart-health-quickly#good-habits.
Amin, Amrin. “News Highlights.” Ministry of Health, Ministry of Health, 29 Sept. 2019, https://www.moh.gov.sg/news-highlights/details/speech-by-mr-amrin-amin-senior-parliamentary-secretary-ministry-of-home-affairs-ministry-of-health-at-the-launch-of-national-heart-week-world-heart-day-2019-29-september-2019-at-kampung-admiralty.
“Arteriosclerosis / Atherosclerosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 1 July 2022, https://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/symptoms-causes/syc-20350569.
Beckerman, James. “Heart Disease and Cardiomyopathy.” Enlarged Heart (Cardiomyopathy) Symptoms, Causes, Treatments, WebMD, 4 June 2022, https://www.webmd.com/heart-disease/guide/muscle-cardiomyopathy.
Beckerman, James. “Heart Disease: Types, Causes, and Symptoms”, WebMD, WebMD. 14 June 2021, https://www.webmd.com/heart-disease/heart-disease-types-causes-symptoms.
Brennan, Dan. “What Is Cardiovascular Endurance?” Cardiovascular Endurance: What It Is, and How to Improve It, WebMD, 27 Nov. 2021, https://www.webmd.com/fitness-exercise/what-is-cardiovascular-endurance#:~:text=Cardiovascular%20endurance%20is%20a%20measure,carry%20out%20your%20daily%20tasks.
“Childhood Intervention Key to Lifelong Heart Health.” American College of Cardiology, American College of Cardiology, 6 Dec. 2018, https://www.acc.org/latest-in-cardiology/articles/2018/12/06/13/33/childhood-intervention-key-to-lifelong-heart-health.
“Coronary Artery Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 25 May 2022, https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613#:~:text=Coronary%20artery%20disease%2C%20also%20called,are%20almost%20always%20to%20blame.
“Diagnosis and Treatment.” Singapore Heart Foundation, Singapore Heart Foundation, https://www.myheart.org.sg/health/diagnosis-and-treatment/.
William S. Weintraub, et al. “Early Intervention for Primary Prevention for Cardiovascular Disease.” PACE, Physicians' Academy for Cardiovascular Education, 2011, https://pace-cme.org/2011/09/05/early-intervention-for-primary-prevention-for-cardiovascular-disease/.
“Everything You Need to Know About Heart Disease.” Heart Disease: Risk Factors, Prevention, and More, Healthline Media, 30 Mar. 2018, https://www.healthline.com/health/heart-disease#symptoms-of-heart-disease.
“Everything You Want to Know about Arrhythmia.” Arrhythmia, Healthline Media, 28 Mar. 2022, https://www.healthline.com/health/arrhythmia#types.
“Acupuncture Alleviates Coronary Artery Disease.” HealthCMi, Healthcare Medicine Institute, 22 Mar. 2019, https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1944-acupuncture-alleviates-coronary-artery-disease.
“Health Effects of Cigarette Smoking.” Smoking & Tobacco Use, Centers for Disease Control and Prevention, 29 Oct. 2021, https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm#:~:text=Top%20of%20Page-,Smoking%20and%20Increased%20Health%20Risks,%2C%20stroke%2C%20and%20lung%20cancer.&text=Estimates%20show%20smoking%20increases%20the,by%202%20to%204%20times&text=For%20stroke%20by%202%20to%204%20times.
“Heart Disease Statistics.” Singapore Heart Foundation, Singapore Heart Foundation, https://www.myheart.org.sg/health/heart-disease-statistics/#:~:text=In%20Singapore%2C%2021%20people%20die,to%20heart%20diseases%20or%20stroke.
“Heart Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Feb. 2021, https://www.mayoclinic.org/diseases-conditions/heart-disease/diagnosis-treatment/drc-20353124#:~:text=In%20general%2C%20treatment%20for%20heart,Medications.
“Heart Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Feb. 2021, https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118.
“Heart Failure.” NHS Choices, NHS, 19 May 2022, https://www.nhs.uk/conditions/heart-failure/#:~:text=Heart%20failure%20means%20that%20the,your%20heart%20has%20stopped%20working.
“Heart Valve Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Sept. 2021, https://www.mayoclinic.org/diseases-conditions/heart-valve-disease/symptoms-causes/syc-20353727#:~:text=In%20heart%20valve%20disease%2C%20one,your%20body%20to%20be%20disrupted.
Meng Khoo, Chin, and E Shyong Tai. “Trends in the incidence and mortality of coronary heart disease in asian pacific region: the Singapore experience.” Journal of atherosclerosis and thrombosis vol. 21 Suppl 1 (2014): S2-8. doi:10.5551/jat.21_sup.1-s2
Ni, Yu-Ming & Frishman, William. “Acupuncture and Cardiovascular Disease: Focus on Heart Failure.” Cardiology in Review. 26. 93-98. (2018). 10.1097/CRD.0000000000000179.
“Preventive Cardiology Programme.” Our Services, National University Heart Centre, Singapore, 29 Jan. 2022, https://www.nuhcs.com.sg/Our-Services/Specialties/Pages/Preventive-Cardiology-Programme.aspx.
“Principal Causes of Death.” HealthHub, Ministry of Health, 12 Apr. 2022, https://www.healthhub.sg/a-z/health-statistics/4/principal-causes-of-death.
Shannon, Heather. “7 Powerful Ways You Can Strengthen Your Heart.” UCI Health, UCI Health, 9 Feb. 2017, https://www.ucihealth.org/blog/2017/02/how-to-strengthen-heart.
Sorrentino, Matthew J. “Early intervention strategies to lower cardiovascular risk in early nephropathy: focus on dyslipidemia.” Cardiology clinics vol. 28,3 (2010): 529-39. doi:10.1016/j.ccl.2010.04.009
“Strategies to Prevent Heart Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Jan. 2022, https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502.
Welch, Ashley. “Treatment and Prevention of Heart Disease”, EverydayHealth, EverydayHealth, 21 May 2018, https://www.everydayhealth.com/heart-disease/treatment-prevention/.
“What Are Congenital Heart Defects?” Congenital Heart Defects (CDHs), Centers for Disease Control and Prevention, 24 Jan. 2022, https://www.cdc.gov/ncbddd/heartdefects/facts.html.
“What Is the Mediterranean Diet?” Www.heart.org, American Heart Association, 21 July 2022, https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet#:~:text=A%20Mediterranean%2Dstyle%20diet%20can,vegetable%20oils%20and%20nuts%3B%20and.
Yee, Tee Joo. “Prevention Programme for Heart Disease.” Heart Health, National University Heart Centre, Singapore, 25 July 2019, https://www.nuhcs.com.sg/Heart-Health/Articles/Pages/Prevention-Programme-for-Heart-Disease-.aspx.
