Hypertension 101: High Blood Pressure Symptoms, Causes, Prevention, Treatment & Medication

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Hypertension is a common condition for people both young and old. It affects about ¼ of Singaporeans aged 30 to 69 years. Out of those that are aged 60 to 69, at least one out of two suffer from high blood pressure. Many factors can affect your blood pressure as it responds to your physical activity, emotions, age and environment. It is no surprise then that some activities or conditions can actually increase your chances of developing high blood pressure such as smoking, obesity and diabetes.

The prevalence of high blood pressure is alarming, and as such, it is important to not only learn more about hypertension but also understand the importance of having your blood pressure checked regularly.

Hypertension is when pressure against the blood vessel walls is consistently too high.

There normally aren’t any symptoms of high blood pressure. It is known as the ‘silent killer’ as many are not aware of the damage it is causing the body. The only way to find out if you have high blood pressure is to measure.

If you have normal blood pressure, it is recommended that you get your blood pressure checked every 3 years. More frequent readings are suggested if you already have a or are at a high risk of developing high blood pressure or other cardiovascular diseases.

You can have your healthcare provider measure it for you or you can take your own blood pressure measurement. Blood pressure machines are now portable and easy to use in the comfort of your own home.

How do I measure my blood pressure?

Before beginning, empty your bladder and avoid anything that might give a false reading 30 minutes before you take your measurement. This includes coffee, exercise or cigarettes.

As you take your blood pressure, stay seated and remove any clothing covering the location of your cuff placement. Wait at least 5 minutes before reading to make sure you are relaxed. Avoid speaking when taking the test or during the rest period.

Use an average of at least 2 readings taken on separate occasions to estimate your blood pressure level. Check both arms. A difference of 10 mmHg or more between arms may indicate the presence of blocked arteries in the arms.

What do the numbers mean?

In understanding blood pressure readings it is important to take note of both numbers.

The top number is called systolic blood pressure which measures the pressure of the blood vessel walls when your heart beats or contracts.

The bottom number is the diastolic blood pressure. It measures the pressure on your blood vessels between beats when your heart is relaxing.

The normal blood pressure range is under 130/80 mmHg. There are normally two stages of Hypertension.

Stage 1 or Mild Hypertension has a systolic pressure range of 130-139 or diastolic pressure between 80-89 mmHg.

This is the pre-hypertensive and people are this stage are at risk of moving on to develop heart diseases. Medication might not yet be required at this point but an evaluation of lifestyle changes to reduce blood pressure may be recommended.

Stage 2 or Moderate Hypertension has 140/90 mmHg or higher. Medication may be prescribed and lifestyle changes suggested to reduce the risk of stroke or heart disease.

The last stage is called Hypertensive Crisis which has a blood pressure reading of 180/120 mmHg or higher. This is an emergency and requires immediate medical attention.

Primary Hypertension

 Primary Hypertension is also known as essential hypertension. This is the most common type and makes up about 95% of all cases. It develops over the years and has no clear cause. It is thought that a combination of age, genes, race, or unhealthy habits like lack of exercise or drinking too much alcohol can put you at risk to develop high blood pressure.

Secondary Hypertension

Secondary Hypertension takes up 5% to 10% of hypertension cases. This is caused by different medical problems such as narrowing of the arteries that supply blood to your kidneys, adrenal gland disease, thyroid abnormalities or hormonal problems. It can also be caused by medication like birth control pills, diet aids, stimulants and antidepressants.

Subtypes of Hypertension

These subtypes may fall under primary or secondary hypertension.

 Resistant Hypertension

Resistant Hypertension is characterized as a type of high blood pressure that is difficult to manage. Those who have this type may have secondary hypertension where the cause has not yet been identified so multiple drugs are required to keep the blood pressure under control. About 10% of people with high blood pressure have resistant hypertension.

Malignant hypertension

Also known as Hypertensive Crisis, Malignant Hypertension is the type of blood pressure that damages organs with elevated blood pressure at >180 mmHg systolic pressure or >120-130 mm Hg diastolic pressure.

It is the most severe type and is an emergency condition and requires immediate medical treatment.  Symptoms include chest pain, headache, shortness of breath, dizziness and visual changes. At most only a 3% chance of people with hypertension can get hypertensive emergency in their lifetime and it is mostly caused by taking drugs that stimulate the nervous system.

Isolated hypertension

Isolated Hypertension is the most common type of hypertension in older adults, where 15% of people 60 years and over have isolated systolic hypertension. This is caused by the stiffening of arteries with age. However, it can also occur in young people where it is a common form of hypertension in young people ages 17-27. Isolated Hypertension is when the blood pressure reading reflects the systolic pressure as 130 mm Hg and higher while the diastolic pressure is below 80 mm Hg.

The risk of suffering from the complications of hypertension increases due to factors such as smoking, diabetes, high blood cholesterol levels or obesity. Uncontrolled high blood pressure could lead to serious health problems such as the following.

Heart Attack

A heart attack is a medical emergency where heart muscle begins to fail. This is usually caused by limited blood flow due to blocked arteries.


Increased blood pressure can weaken blood vessels and can cause them to bulge. It can be life-threatening when it ruptures.

Kidney Disease

Hypertension can lead to kidney disease which leads to kidney failure. Dialysis is needed or a kidney transplant.

Loss of vision

High blood pressure can damage the tiny blood vessels that supply blood to your eyes that may damage the retina which leads to bleeding and blurred vision and vision loss.

Difficulty with memory or understanding

High blood pressure when uncontrolled can affect your ability to think, remember and learn and so it is common for people with high blood pressure to have trouble with memory and understanding concepts

Vascular dementia

Hypertension when not managed can damage blood vessels or induce a stroke. when these occur, blood flow to the brain is interrupted leading to a type of dementia known as vascular dementia.

Metabolic syndrome

Metabolic syndrome is a cluster of conditions such as high blood pressure, high blood sugar, abnormal cholesterol or triglyceride levels along with excess body fat around the waist that increases the risk of heart diseases, stroke and type 2 diabetes.

The good news is that in many cases of hypertension, the following lifestyle changes can help manage and even reverse the diagnosis.

Watch your diet

Eat healthy food that is low in salt, fat and calories. Eat fresh vegetables, fruits, whole grain rice and pasta, and avoid food that is high in fat such as whole milk dairy products, fried/processed or fast foods. The optimal recommendation for salt is a teaspoon a day. Try replacing salt with spices and herbs to add flavour to your food. Ask your health care provider for a more detailed list of food you can eat.


Engage in physical activity and try to stay active. It can lower blood pressure and help maintain a healthy weight. Some activities such as meditation and deep breathing even help manage and reduce stress which helps in lowering blood pressure.

Cut down on Smoking and Alcohol Consumption

Quit smoking or using tobacco products and limit alcohol to one drink. (1 drink is equal to 1 ounce of alcohol, 5 ounces of wine or 12 ounces of beer). Consuming too much alcohol can raise blood pressure.

Not all cases of hypertension require medication. But for those cases that do, the following are the common medications prescribed to manage high blood pressure. Your physician will inform you of the side effects and possible problems that might occur when taking your blood pressure medications.

1.      Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs)

Blocks production of angiotensin II hormone which the body uses to control blood pressure. When blocked, the blood vessels don’t narrow.

2.      Calcium Channel Blockers- prevents calcium from entering the muscle cells of the heart and blood vessels allowing them to relax.

3.      Diuretics – Water or fluid pills flushes out excess sodium from the body, reducing the amount of fluid in the blood.

4.      Alpha-2 agonists – Relaxes blood vessels by changing nerve impulses. This reduces blood pressure.

5.      Beta-blockers – Slows down the heartbeat and lessens the amount of blood pumped through arteries with each beat and lowers blood pressure.


Hypertension is a common condition that if left untreated could lead to serious health problems. A healthy diet with fruits and vegetables along with regular physical activity and limiting alcohol can decrease blood pressure and reduce the risks of suffering from complications.

As such it is important that those who suffer from hypertension, especially the elderly, take the necessary steps to manage their blood pressure. It might also be a good idea to call in certified and trusted care providers who are trained in elderly care to ensure that they get the assistance they need.

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