Why high blood pressure deserves your attention
High blood pressure, or hypertension, is common, silent, and serious. Most people feel perfectly well even when their readings are high, yet over time raised blood pressure quietly increases the risk of heart attack, stroke, heart failure, kidney damage and even problems with vision and memory. In Singapore, surveys now suggest that roughly one in three adults has hypertension, and a substantial number either do not know they have it or are not well controlled. The encouraging news is that even small improvements make a difference: large studies show that lowering the upper number (systolic blood pressure) by just about 5 mmHg can reduce the risk of major cardiovascular events by around 10%. That is a significant benefit from a relatively modest change.
How high is “high”? Understanding your numbers
Blood pressure is usually written as two numbers, for example 138/82. The top number (systolic) reflects the pressure when your heart squeezes; the lower number (diastolic) reflects the pressure when your heart relaxes between beats. In the clinic, we start to worry when repeated readings are 140/90 mmHg or higher. We do not diagnose hypertension based on a single rushed measurement; blood pressure varies with stress, pain, activity and even conversation. We prefer to measure it carefully on more than one occasion, with proper technique, and increasingly we use home blood pressure monitoring as part of the confirmation. At home, when readings are taken correctly over several days, an average of 135/85 mmHg or higher generally corresponds to hypertension.
Getting the basics right: lifestyle still comes first
When someone is first told their blood pressure is high, the instinctive question is whether they can “fix it naturally”. Lifestyle measures are always the foundation, and for some people with milder elevations and no other risk factors, they may be enough. Eating in a way that is kinder to your blood vessels—more fruits and vegetables, whole grains, lean protein, and less salt, processed food and sugary drinks—can lower blood pressure and improve cholesterol and blood sugar at the same time. Cutting down on high-salt soups, sauces and snacks, which are common in local diets, often makes a noticeable difference. Regular physical activity such as brisk walking, cycling or swimming for at least 150 minutes a week helps too, as does maintaining a healthy weight, sleeping well, managing stress, limiting alcohol and avoiding smoking.
We do not expect anyone to overhaul their lifestyle overnight. In practice, we usually agree on one or two realistic changes to start with—perhaps replacing a few high-sodium dishes each week, or building a daily walking habit—and then build on that. In people with high-normal blood pressure or mild hypertension and otherwise low cardiovascular risk, it is reasonable to try focused lifestyle adjustments for a few months, with proper monitoring, before deciding on medication.
When it is safer to start medication earlier
There are, however, situations where relying on lifestyle alone is not advisable. If blood pressure is clearly high at the outset—say 160/100 mmHg or more on repeated, accurate readings—or if there are other important conditions such as diabetes, chronic kidney disease, prior heart attack or stroke, or evidence of organ damage from long-standing hypertension, the risk of doing nothing is too great. In these cases, we usually recommend starting medication alongside lifestyle changes from the beginning. The aim is not to “medicalise” you, but to protect your heart, brain and kidneys from further damage.
What does “good control” actually mean?
Treatment targets depend on your overall risk profile. For many adults with hypertension but no major complications, controlling blood pressure to below 140/90 mmHg in the clinic is a sensible and achievable goal. For people at higher cardiovascular risk—those with diabetes, established heart or kidney disease, or clear hypertension-related organ damage—we often aim for readings closer to 130/80 mmHg, provided this is tolerated without dizziness or other side effects. In older adults, especially those who are frail, unsteady, or prone to falls, we are more cautious. For them, keeping blood pressure comfortably below about 150/90 mmHg may be safer than pushing too low, and we focus on how they feel day to day rather than chasing a single number at all costs.
Making sense of blood pressure tablets
Many patients are understandably anxious about starting blood pressure tablets. There is no single “best” pill; instead, we choose from several main families of medication. Some help the kidneys get rid of extra salt and water, some relax the blood vessels, and others reduce the heart’s workload. Often we start with one medicine at a low dose and adjust over time. If blood pressure remains above target, we may add a second drug or use a combination tablet. This stepwise approach, supported by large clinical trials, usually provides steadier control with fewer side effects than forcing one drug to very high doses.
Why taking medicine regularly really matters
It is natural to ask whether you will need medication for life. For many people, hypertension is a chronic condition and tablets are indeed a long-term partner. However, the dose and combination are not fixed forever. If your lifestyle improves significantly—if you lose weight, become more active, sleep better, and keep to a lower-salt diet—we may be able to reduce the amount of medication over time. The important point is that any change should be planned together, with proper monitoring, rather than stopping abruptly on your own because you feel well or see a few good readings.
Because high blood pressure rarely causes symptoms, taking medication regularly can be challenging. It is tempting to skip doses when you feel fine, or to stop once your readings improve. Unfortunately, this is exactly when silent damage can creep back in. Good control depends on consistency: taking your tablets at about the same time each day, not missing doses, and not stopping suddenly without a discussion. If you experience side effects—such as ankle swelling, a persistent cough, frequent urination or feeling light-headed—it is important to tell your doctor. There are usually alternatives or adjustments we can make; you should not have to “put up with” unpleasant symptoms in silence.
The role of home blood pressure monitoring
Home blood pressure monitoring can be a powerful tool in this partnership. Using a validated upper-arm device with proper technique, you can track your own readings at home and see how they respond to lifestyle changes and medication. When you bring these readings back to the clinic, we can look at the overall pattern rather than a single snapshot and adjust treatment more confidently. Home monitoring also helps us identify white-coat hypertension (high readings only in the clinic) and masked hypertension (normal in clinic but high at home), both of which have different implications for risk and treatment.
Working together over the long term
Ultimately, managing high blood pressure is not a one-off project; it is a long-term relationship between you, your body and your healthcare team. Over time, your life circumstances may change—new stresses, new responsibilities, perhaps new health conditions—and your blood pressure management plan needs to adapt with you. My role as a family physician is to measure your blood pressure accurately, interpret it in the context of your overall risk, help you choose lifestyle changes that are realistic for your situation, select and adjust medication when needed, and keep an eye on your heart, kidneys and other organs along the way.
Taking the next step
If you have been told your blood pressure is high, if you are unsure whether lifestyle changes are enough, or if you are already on medication but not certain whether your numbers are where they should be, it may be helpful to sit down for a structured review. At Kenneth Tan Medical Clinic, we can confirm your blood pressure with proper technique, guide you on home monitoring if appropriate, assess your overall cardiovascular risk, and work with you on a plan that combines realistic lifestyle changes with sensible use of medication.
If you would like to discuss your blood pressure management or review your current treatment, we would be glad to see you.
Book Your Appointment Online or call us at 6920 1952.