Taking charge of hypertension
There are ways to treat hypertension despite it being chronic and often with no identifiable cause
Hypertension is a chronic condition where the blood pressure in the arteries is higher than it should be, and it is a fairly common problem in Singapore.
Slightly less than one in four Singapore residents aged 30 to 69 have hypertension, said cardiologist Rohit Khurana from The Harley Street Heart and Cancer Centre.
The prevalence goes up among those aged 60 to 69, with more than half suffering from hypertension.
Globally, nearly one billion people are afflicted with hypertension, making it the most important healthcare burden, Dr Khurana said.
Declared by the World Health Organisation as the No. 1 killer, hypertension is expected to hit 1.5 billion people by 2025.
The consequences, if left untreated, can be severe - an increased risk of heart attack, stroke, and eye and kidney damage, said Dr Khurana.
"I have been treating blood pressure in patients for many years. Witnessing the severe consequences of high blood pressure, such as a disabling stroke or life-threatening heart failure, all too often, is what compels me to continue educating my patients," he said.
How is blood pressure measured?
Blood pressure is represented as two numbers: the pressure when the heart is pumping (systolic) and when the heart is relaxing (diastolic).
Keeping the blood pressure at normal levels - lower than 130/80 mmHg - is important for long-term good health.
What are the causes of hypertension?
For the vast majority of hypertensive patients, there is no identifiable cause.
Some have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly.
Various conditions and medications can lead to secondary hypertension, including:
- obstructive sleep apnea
- kidney problems
- chronic alcohol use
- adrenal gland tumours
- thyroid problems
- certain congenital blood vessel defects, and
- certain drugs, such as birth control pills and over-the-counter pain relievers.
What medicines work against hypertension?
The treatment of hypertension should be individualised depending on the blood pressure measurements and other medical problems.
To reduce the number of daily medication doses, a combination of low-dose medications - rather than a large dose of a single drug - is often used.
Finding the most effective medication or combination of drugs may take some refinement. The most common medications I use to treat hypertension are:
- Angiotensin-converting enzyme inhibitors or Angiotensin II receptor blockers such as Olmetec (olmesartan) which help to relax blood vessels by blocking the formation of a hormone that narrows blood vessels
- Thiazide diuretics that act on your kidneys to help the body eliminate sodium and water, reducing blood volume
- Beta blockers that reduce the workload on your heart, and
- Calcium channel blockers, such as Norvasc (amlodipine), that help relax the muscles of your blood vessels. Some slow your heart rate.
Additional medications sometimes used to treat poorly controlled hypertension include:
- Alpha blockers that reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels
- Central-acting agents that prevent your brain from sending signals to your nervous system to increase your heart rate and narrow your blood vessels
- Vasodilators that work directly on the muscles in the artery walls, preventing the muscles from tightening and your arteries from narrowing, and
- Aldosterone antagonists that block the effect of a natural hormone that can lead to salt and fluid retention, which can contribute to high blood pressure.