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Hypertension (High Blood Pressure)

Hypertension, or high blood pressure, is a condition where the force of blood against the walls of arteries remains consistently elevated. Over time, this increased pressure can lead to damage in the blood vessels, heart, kidneys, brain, and eyes. Often referred to as a “silent condition”, hypertension frequently develops without symptoms, making early detection difficult. Effective management of hypertension reduces the risk of complications such as heart attacks, strokes, and kidney failure.

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Dr Adrian Mondry
Physician (FRG) | MD (HHU Düsseldorf) | MRCP (London) | IM Specialist (ÄKNo) | Hypertensiologist (DHL)
Symptoms Causes Types Diagnosis Treatment FAQ
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Symptoms
Causes
Types
Diagnosis
Treatment
FAQ

Symptoms of Hypertension

Hypertension may not cause noticeable symptoms in its early stages. However, certain signs can develop as the condition progresses or complications arise.

  • Shortness of Breath

    Difficulty breathing, especially during physical activity or while lying down, can indicate cardiovascular strain caused by high blood pressure.

  • Headaches

    Persistent or severe headaches, particularly in the morning, are sometimes associated with uncontrolled hypertension.

  • Chest Discomfort or Pain

    A sensation of tightness or pressure in the chest may be a warning sign of hypertension-related heart issues.

  • Vision Problems

    Blurred or impaired vision may result from hypertensive damage to blood vessels in the eyes.

  • Frequent Nosebleeds

    Recurring nosebleeds are rare but may occur in cases of severely elevated blood pressure, particularly during hypertensive crises.

Causes and Risk Factors

Hypertension can develop due to multiple interacting factors, including genetics, lifestyle, and underlying health conditions. Common risk factors include:

  • Ageing

    Arteries lose elasticity over time, increasing the likelihood of elevated blood pressure, particularly after age 40.

  • Family History

    Individuals with a genetic predisposition to hypertension are more likely to develop the condition, especially if close relatives are affected.

  • Dietary and Lifestyle Factors

    A diet high in salt, processed foods, and saturated fats, combined with physical inactivity and excessive alcohol consumption, can elevate blood pressure levels.

  • Chronic Conditions

    Health issues such as diabetes, kidney disease, sleep apnea, and thyroid dysfunction often contribute to elevated blood pressure levels.

  • Stress and Poor Sleep Patterns

    Chronic stress and insufficient or poor-quality sleep can contribute to hypertension by causing temporary or sustained increases in blood pressure.

Types of Hypertension

Hypertension is broadly classified into two main categories, each with distinct causes and treatment approaches.

Primary (Essential) Hypertension

This type develops gradually over years and does not have a specific identifiable cause. Factors like genetics, diet, and overall lifestyle influence its development. Primary hypertension is the most common form and requires ongoing management through medication and lifestyle adjustments.

Secondary Hypertension

Secondary hypertension arises due to an identifiable underlying condition, such as kidney disease, hormonal disorders, obstructive sleep apnea or the use of certain medications. It often develops suddenly and can lead to higher blood pressure readings than primary hypertension. Treating the root cause is necessary for controlling this type effectively.

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Diagnostic Methods

Blood Pressure Measurement

A cuff and device measure systolic (pressure during a heartbeat) and diastolic (pressure between heartbeats) blood pressure. Consistently elevated readings above 140/90 mmHg on multiple occasions suggest hypertension.

Ambulatory Blood Pressure Monitoring (ABPM)

This test involves wearing a portable device that measures blood pressure at regular intervals over 24 hours. This method identifies patterns, such as elevated readings at specific times of the day, and helps confirm the diagnosis.

Blood Tests and Urine Analysis

These tests evaluate kidney function, blood sugar levels, cholesterol, and other markers to identify conditions contributing to or resulting from hypertension.

Imaging and Cardiac Tests

Echocardiography, ultrasounds, and other imaging techniques evaluate structural changes or damage to the heart and blood vessels caused by prolonged hypertension.

Treatment Options

Hypertension is managed through a combination of lifestyle modifications and medication. Treatment plans are tailored based on the individual’s condition and contributing factors.

  • Lifestyle Adjustments
    Adopting a balanced diet with reduced salt and fat intake, engaging in regular physical activity, maintaining a healthy weight, and limiting alcohol consumption can improve blood pressure control. Stress reduction techniques, such as mindfulness, yoga, or relaxation exercises, support better cardiovascular health.
  • Medications

    Common medications used to manage hypertension include diuretics, ACE inhibitors, beta-blockers, calcium channel blockers, and angiotensin receptor blockers (ARBs). These medications work through different mechanisms to lower blood pressure and may be used in combination for optimal effectiveness.

Prevention and Management

Preventing hypertension involves maintaining a healthy lifestyle. Regular physical activity, a balanced diet low in sodium and processed foods, and adequate sleep contribute to reducing the risk of developing high blood pressure. For individuals with hypertension, consistent adherence to treatment plans and regular monitoring help maintain control and reduce the risk of complications. Tools such as home blood pressure monitors or ABPM can provide valuable insights into daily patterns and treatment effectiveness.

Frequently Asked Questions (FAQ)

Is hypertension always permanent?

While primary hypertension is typically a chronic condition requiring long-term management, secondary hypertension may be resolved by treating the underlying cause.

Can hypertension affect younger adults?

Yes, while more common in older adults, younger individuals can develop hypertension, particularly if they have risk factors such as obesity, family history, or poor lifestyle habits.

What is “white-coat hypertension”?

White-coat hypertension occurs when blood pressure readings are elevated in a clinical setting due to anxiety but normal in other settings. It may require further testing, such as ABPM, to confirm a diagnosis.

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Dr Adrian Mondry

Physician (FRG)|MD (HHU Düsseldorf)|Specialist for Internal Medicine (ÄKNo)|Hypertensiologist (DHL)|MRCP (London)

Dr. Mondry has over 30 years of experience as an internal medicine & hypertension specialist.

  • Previously a Senior Consultant in the Department of Medicine at the National University Hospital and Ng Teng Fong General Hospital, where he is currently a visiting consultant.

  • Hypertension Specialist accredited by the German Hypertension League (DHL)

  • Contributed to the latest Singapore ACE Clinical Guidance on “Hypertension – Tailoring the Management Plan to Optimise Blood Pressure Control” as a committee member.

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