High blood pressure, also known as hypertension, is a common condition that can increase your risk of heart attack, stroke, and other serious health problems.
There are three measures of blood pressure – systolic pressure, diastolic pressure and central aortic pressure. In May 2000, the US National High Blood Pressure Education Programme issued a Clinical Advisory Statement stating that systolic pressure, the highest pressure in the arteries when the heart beats and pumps blood out, should be used as the primary indicator of hypertension in adults.
Systolic blood pressure is also used to reflect the superimposition of increased arterial stiffness in older patients.
In recent years, there has been increased interest in using central aortic pressure – the pressure in the aorta, which is the main blood vessel that carries blood from the heart to the rest of the body – to assess a patient’s blood pressure and his risk of getting cardiovascular disease.
There have also been arguments and studies showing patients with high systolic blood pressure having similar numbers to stage 1 hypertension patients in the measurement of their central aortic pressure. This is likely due to pulse pressure amplification, a condition that is influenced by a number of physiological factors such as age, gender, height, heart rate, and even medication. Hence, a person could be overtreated for hypertension if the numbers of the central aortic pressure is not being considered when being diagnosed for hypertension.
With a subspecialty in hypertension, I often get patients being referred for hypertension. At first glance, some of these patients look relatively healthy and do not show any risk factors for hypertension – on the contrary, they are tall, young, slim and exercise regularly.
If we only look at the systolic value, it would be accurate to diagnose them with hypertension. However, many of them only show higher numbers in the systolic pressure, while the numbers for the diastolic pressure fall within normal range.
Using pulse wave analysis, an non-invasive method to measure the central aortic pressure, we can determine if the higher numbers in the systolic pressure was due to pulse pressure amplification, especially when the measurement is taken at the arm or leg. Due to the progressive narrowing of the arterial diameter, there is resistance to flow increases and downstream pulse pressure, leading to an amplification of the systolic blood pressure.
Therefore, if the patient only shows high systolic pressure, and both diastolic and central aortic pressure are normal, then it could be due to pulse pressure amplification and the patient need not be treated for hypertension.
The right diagnosis also avoid complications with the insurance providers, and ensure patients get the full coverage without any exclusion
About Dr Adrian Mondry
Dr Adrian Mondry is a Hypertension Specialist accredited by the German Hypertension League in Singapore. He was previously a senior consultant in the department of medicine at the National University Hospital and Ng Teng Fong General Hospital (NTFGH), Dr Mondry has more than 30 years of experience in the field of internal medicine.
Dr Adrian Mondry is recognised for his leadership and contributions in establishing the dedicated hypertension clinic within the National University Health System and fast-track deep vein thrombosis service at NTFGH.
Dr Adrian Mondry is fluent in English, German and French.
About Kaizen Medical
Kaizen Medical is located at Mount Elizabeth Novena Specialist Centre, Suite 11-57.
At Kaizen, we provide in depth health care to patients with multi-organs diseases; tackling undifferentiated presentations that cannot be easily assigned to a single organ.