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Why sleep deprivation is Singapore’s hidden health concern
What is blood pressure?
Blood pressure refers to the pressure of blood in your blood vessels. Blood pressure is measured in millimetres of mercury (mm Hg) and is recorded as two figures. For example blood pressure may be recorded at 140/90 mm Hg, which is referred to as 140 over 90.
The top (first) number is the systolic pressure, which is the pressure in the arteries when the heart contracts.
The bottom (second) number is the diastolic pressure, which is the pressure in the arteries when the heart rests between each heartbeat.
How do we check blood pressure?
Blood pressure is measured using a machine called a sphygmomanometer, and generally requires an average of two or more blood pressure readings (across multiple visits) to establish a baseline measurement.
Diagnosis of hypertension (high blood pressure)
Hypertension is diagnosed when the average reading is at least 140 mm Hg (systolic) or at least 90 mm Hg (diastolic).
What is ‘white coat hypertension’?
White coat hypertension is a condition where blood pressure readings are significantly higher at a doctor’s office compared to a reading at home or when monitored over 24 hours.
Normal blood pressure values for adults (non-pregnant) are defined as less than 135/85 mm Hg during the day, less than 120/70 mm Hg during the night, and less than 130/80 mm Hg over 24 hours.
How common is hypertension?
According to the Singapore National Health Survey (2010), 23.5% of Singaporeans between the ages of 30 and 69-years-old suffer from hypertension.
Health promotion, screening, early diagnosis and correct management of the condition play a major role in tackling this disease.
Symptoms of hypertension
While hypertension can have no symptoms, they may include:
Headache
Blurred vision
Nausea and vomiting
Dizziness
Chest pain
Shortness of breath
Risk factors of hypertension
Lifestyle risk factors – including smoking, lack of physical activity, obesity, unhealthy diet and excessive consumption of alcohol.
Pre-existing medical conditions – such as high cholesterol, diabetes and kidney diseases that affect kidney function.
A strong family history of hypertension (e.g. immediate family who developed heart disease or a stroke before the age of 55 for men or 65 for women)
Early menopause in women
Age (the older you become, the more likely you are to develop hardening of vessels and fat accumulation)
Possible complications of hypertension
Cardiovascular diseases (such as stroke, heart attack, peripheral artery diseases, irregular heart beat or heart failure)
Kidney diseases
Retinopathy/eye diseases
Management of hypertension
How to deal with hypertension once diagnosed with the disease.
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Weight reduction
Blood pressure can fall by 1-1.5 mm Hg for each excess kilogram which is lost
Aim for reducing weight by 0.5 kg per week when starting off
BMI calculation
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Regular physical activity
Can reduce systolic blood pressure by 2-10 mm Hg
Recommended exercise duration – 150 minutes of moderate intensity exercise per week
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Healthy diet
Possible to reduce blood pressure by 10-12mm Hg
Recommended to follow the DASH diet (Dietary Approaches to Stop Hypertension): rich in fruits and vegetables (eight to 10 servings per day), rich in low-fat dairy products (two to three servings per day) and reduced in saturated fat and cholesterol
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Low salt intake
According to the Health Promotion Board (HPB), as many as eight out of 10 Singaporeans are consuming more than the daily recommended allowance of 2 000 mg of sodium3
1g of sodium reduction can lower your blood pressure reading by 2.5 mm Hg
Consume no more than 5-6g of salt per day
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Restrict caffeine intake
Consume no more than five cups per day
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Cut down on alcohol intake
Men should consume no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days each week.
Women should consume no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days each week.
Reducing consumption to the recommended limits can lower a high systolic blood pressure by up to 10 mm Hg.
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Stop smoking
Smoking is an independent risk factor for cardiovascular heart disease
Methods available include nicotine replacement and oral medications
Treatment for high blood pressure
There are several medicines that can lower blood pressure. The most appropriate medication for you will depend on:
Other medical problems
Current medication
Possible side-effects
Age
Some medicines work well in some people, but may not be appropriate for others. One or two medicines may be tried before the most suitable is found. Two or more different medicines or combination medicines might be needed to reduce blood pressure to a healthy level. Medication is usually needed for life in most cases.
What is the target blood pressure?
For people with high blood pressure, treatment is recommended to achieve a goal blood pressure of <140/90 mm Hg for patients younger than 60-years-old. For those older than 60-years-old, a blood pressure reading of less than 150/90 mm Hg is recommended.
In some people, the target is to get the blood pressure to an even lower level. This generally applies to people who have diseases where very good blood pressure control is important (such as cardiovascular diseases, diabetes and chronic kidney disease).
Prevention is better than cure
Lifestyle changes and screening to ensure you are diagnosed early are very important.
The Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation and Treatment of High Blood Pressure recommends screening every two years if blood pressure is less than 120/80 mmHg or annually if it exceeds 139/89 mm Hg.4
References
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