“Is my blood pressure too high?”

“How do I manage hypertension without relying only on medication?”

“Can I reverse the effects of high blood pressure?”

These are the common questions many have about hypertension.

Hypertension, or high blood pressure, is often called a "silent killer" because it usually shows no symptoms but the damage still occurs in the body.

In Singapore, hypertension is the major cause of heart disease and stroke. 

According to the Ministry of Health’s National Population Health Survey 2022 and Health Promotion Board’s National Nutrition Survey 2022, hypertension affects 1 in 3 adult Singaporeans, with local prevalence of hypertension having almost doubled over the last decade. 

Most people with hypertension require life-long medications to control their blood pressure. If left untreated, uncontrolled hypertension can lead to life-threatening complications like stroke, heart attack (myocardial infarction), kidney failure, and vision loss.

The good news: early detection and intervention can make a huge difference. 

With a combination of lifestyle changes, monitoring and medical support, hypertension can be effectively managed and even prevented.

Types of hypertension include:

• Primary hypertension: The most common type of hypertension has no identifiable cause, but is linked to risk factors like age, genetics, diet and stress.

• Secondary hypertension: Caused by underlying conditions such as kidney disease, hormonal disorders or certain medications. Adrenal hypertension is also a type of secondary hypertension caused by abnormalities, such as growths, in the adrenal glands.  

Gain deeper insights into hypertension, the treatment options, and personalised management strategies by submitting your question to Dr Saradha in this month's 'Ask the Specialist' Q&A.

Related articles:

Navigating the body’s chemistry: all ‘glands’ on deck!

Changi General Hospital offers advanced mass spectrometry and AI-assisted testing to diagnose salt-sensitive and curable forms of hypertension for enhanced patient outcomes

About Dr Saradha Anantharaman

Dr Saradha Anantharaman is a Consultant with the Department of Renal Medicine at Changi General Hospital. 

A nephrologist – a specialist in the diagnosis, treatment and prevention of kidney diseases – her clinical interests include chronic kidney disease, nutrition and hypertension, with a focus on integrating lifestyle and dietary interventions into kidney care. 

Dr Saradha is committed to holistic, patient-centred care, and is actively involved in initiatives aimed at improving long-term outcomes for patients living with kidney disease.

Questions and answers on hypertension (high blood pressure)

1. Question by James

Hi Doctor Saradha,

There are cases of patients reducing their doses and finally need no medications after taking some chinese medical herbs.

Even if the above may not have scientific proof, can one still reduce medicine dosage for high blood, cholesterol and blood thinning?

What are your comments on the above? Thanks and regards.

Answer by Dr Saradha Anantharaman

Hi James,

Different Chinese medical herbs have different properties, and whether they can replace western medicines for treatment of chronic diseases such as hypertension and hyperlipidemia has not been proven in large clinical research studies.

There are instances where patients may have their dosages of medications reduced for high blood pressure and cholesterol. 

These usually occur in instances where improvements in lifestyle, such as exercise, dietary changes and weight loss have an additional effect and thus aid in lowering the medication dosages. 

However, any reduction in medication dosages should always be done under medical supervision.

If you are taking any herbal supplements or medication, inform your healthcare provider and do not stop or reduce prescribed medications on your own.

2. Question by Jamie

Hi Dr Saradha,

I would like to know what are the possible causes for high diastolic alone. If only diastolic high (around 90Hg) and systolic is okay (120mm Hg).

Family history: low blood pressure at old age. (100/70). Thanks.

Answer by Dr Saradha Anantharaman

Hi Jamie,

Diastolic pressure represents the pressure in the arteries when the heart is relaxed (i.e. In between beats or diastole). A high diastolic blood pressure is when the diastolic blood pressure reading is 90mmHG or higher.

An isolated high diastolic pressure may signal early hypertension and is associated with an increased risk of heart attack, stroke and cardiovascular disease. 

Before confirming the diagnosis of isolated diastolic hypertension, it is important to ensure that blood pressure measurements have been taken accurately by taking an average of at least two readings on two different occasions, with adequate rest, positioning and preparation prior to the measurements. 

Isolated diastolic hypertension is often related to stiff or tight arteries which is caused by atherosclerotic plaques or constriction of the arteries.

To manage this condition, it is essential to focuse on lifestyle measures such as adopting a low salt diet, maintaining a healthy BMI, exercising regularly and controlling other cardiovascular risk factors such as hyperlipidaemia. 

Modifying risk factors for heart disease such as smoking cessation will also reduce overall cardiovascular risk. Medications may be necessary if the diastolic pressure is very high or does not improve with lifestyle measures. Please consult a healthcare professional for personalised advice.

3. Question by Saw ZY

Hi Dr,

I have been diagnosed with high blood pressure in May 2023 and has been taking amophine 5mg. Blood pressure was well controlled. Just last year Aug 2024 I visited Cardiologist and they prescribe me Diovarn 40mg to further reduce my blood pressure and protect my kidney but after taking both medicine my blood pressure become low and feel weak. What causes it? 

• No Cholesterol

• Not diabetic

• Kidney Renal function all ok

• BMI in range

Doctor in cardiologist claim that is genetic issue since my mum also has high blood pressure. Thank you for your advice.

Answer by Dr Saradha Anantharaman

Hi Saw ZY,

It is possible to experience low blood pressure symptoms like weakness and dizziness when adjustments are made to your blood pressure medications. 

However, this does not necessarily indicate that something is wrong. It may suggest that the current combination of medications needs review.

Apart from lowering blood pressure, medications prescribed by doctors may at times be intended for other purposes such as protecting the heart or the kidneys in the long term. 

Any symptoms that you are experiencing such as feeling weak and having a low blood pressure should be discussed with your doctor, as they can assess whether medication dosages need to be adjusted.

Blood pressure management is highly individualised. What works well for one person may be too strong for another, depending on your baseline blood pressure, genetics or family history, lifestyle or even how sensitive your body is to medications.

4. Question by CY

Dear Dr,

I have a normal reading on systolic pressure however my diastolic reading tends to be on high side [ range from..85 to 90 over]. Is this normal?

I was told such phenomenon could be due to high calcium intake? Is this true?

I am 62 years of age and is there any measures to prevent this? I am careful with salts and sugar intake… hardly drink soft drinks and regularly walk alot.

Kindly advise. Thank you.

Answer by Dr Saradha Anantharaman

Hi C Y,

Having a normal systolic pressure with higher diastolic pressure may be seen in younger or middle-aged individuals and may indicate increased stiffness or resistance in the small arteries. 

This can be an early sign of hypertension and monitoring these readings over time can help with early detection.

Kudos for watching your salt and sugar intake and staying physically active! 

Some additional tips include maintaining a healthy weight, eating a balanced diet rich in vegetables, fruits and whole grains, avoiding smoking and limit alcohol. 

Since you are 62 years old, it is also a good idea to continue routine blood pressure monitoring and have regular appointments with your doctor.

As for calcium intake, typical dietary calcium intake has not been linked to high diastolic pressure based on current scientific evidence¹. 

In fact, dietary calcium, especially from dairy, leaf grains and tofu are generally associated with neutral or slightly beneficial effects on blood pressure. Calcium supplements at typical doses are not linked with high blood pressure. 

However, excessive calcium intake from supplements may be associated with risks such as arterial stiffness, although the evidence for this is mixed. As such, take high dose calcium supplements only under medical supervision.

[1] Kim MH, Bu SY, Choi MK. Daily calcium intake and its relation to blood pressure, blood lipids, and oxidative stress biomarkers in hypertensive and normotensive subjects. Nutr Res Pract. 2012 Oct;6(5):421-8. doi: 10.4162/nrp.2012.6.5.421. Epub 2012 Oct 31. PMID: 23198021; PMCID: PMC3506873.

5. Question by Kahguan

Hi Dr,

Is drinking copious water daily (2 litres) a key to good renal or kidney heath? Thanks.

Answer by Dr Saradha Anantharaman

Hi Kahguan,

Drinking enough water is important for overall health and does support the kidney function.

However more water is not always better and 2 litres a day is not a “magic number” for everyone.

Hydration needs vary depending on the climate, physical activity, diet and medical conditions.

Staying well hydrated helps the kidneys carry out their usual functions and may prevent kidney stones in those who are prone to them. However, too much water can cause imbalances in electrolyte levels such as low sodium levels and may cause water retention in those with heart, liver or kidney disease where fluid overload is a concern.

For most healthy adults, 1.5-2 litres of water a day is reasonable. 

However, the best guide is to listen to your body. If your urine is pale yellow and you are rarely thirsty, you are likely well hydrated.

6. Question by Teng KH

Hi Dr, I am 62 years old.

On days that I do not exercise my blood pressure can be 150/110. However, if I do exercises in the morning like 5 km run or walk-a-jog, my blood pressure measured after 1 hour of exercise is usually 120/80.

Is this normal? Should I continue to do my morning exercises or should I take medication?

Answer by Dr Saradha Anantharaman

Hi Teng K H,

It is great that you are exercising regularly and seeing a positive effect on your blood pressure. 

This acute, temporary fall in blood pressure minutes or hours after exercise is known as post-exercise hypotension and can be seen in people with hypertension. It is a physiological response that usually lasts about two to four hours.

You should continue to exercise if you are managing it well. However, if your blood pressure remains high at rest, outside the window of post-exercise effect, it still increases your risk for heart, blood vessel and kidney complications.

The decision to start taking medications for your blood pressure is also dependent on your average resting blood pressure over several days or weeks not just after exercise, in addition to your overall cardiovascular risk and the presence of other comorbidities.

It is best to discuss this blood pressure pattern with your doctor to determine if medication may help, in addition to your current lifestyle measures.

7. Question by George

Dear Dr Saradha, kindly assist with these questions:

a) Whenever we take our 3 BP readings, which reading should we based on? The third reading or the lowest among the 3 readings? Sometimes the third reading turns out to be higher than the other two.

b) Are there any scientifically proven health supplements or foods that help to lower hypertension?

Thank you for your advice.

Answer by Dr Saradha Anantharaman

Dear George,

a) It is recommended to discard the first reading and take the average of the second and third readings to reduce the effect of random errors or fluctuations. 

The first reading is often higher than subsequent readings due to initial anxiety and incomplete rest before the first reading. If the third reading is higher than the others, this could be due to restlessness, movement or cuff placement. Try to be as consistent as possible when taking all three readings.

b) The DASH (Dietary Approaches to Stop Hypertension) diet is a scientifically proven diet that helps to reduce hypertension. 

This approach focuses on taking whole grains such as whole wheat bread, brown rice, oatmeal, and quinoa, fresh fruits, vegetables like leafy greens and mushrooms, low-fat dairy, legumes, nuts and seeds such as unsalted roasted nuts, cooked beans or peas, lean meats, poultry and fish. 

In addition, limit sweets, added sugars, salts, unhealthy fats, red meat and processed meats.

Foods higher in potassium such as bananas and spinach have been shown in studies to have reduce blood pressure slightly in those with hypertension².

Supplements such as omega-3 fatty acids in fish oil may be associated with the reduction in blood pressure in patients with hypertension³.

[2] Aburto, N. J., Hanson, S., Gutierrez, H., Hooper, L., Elliott, P., & Cappuccio, F. P. (2013). Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ (Clinical research ed.), 346, f1378.

[3] Zhang X, Ritonja JA, Zhou N, Chen BE, Li X. Omega-3 Polyunsaturated Fatty Acids Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc. 2022;11(11):e025071.

8. Question by Leena

Dear Dr Sharadha,

I am 53 years old, having undergone Total Hysterectomy 6 years ago. Have a family history of Hypertension. My Mom being treated for High Blood Pressure and lost my Dad due to MI when I was 12 years old.

My BP has been by and large been stable (average 120/85),  but shoots up only when I am under severe stress. Settles when I calm down.

I regularly exercise and eat the right food. Catch about 5.5 hours of sleep in the night. Working on this to better my sleep schedule. I would like to know the following:

a) When should one consider taking BP medication as a preventative care?

b) What precautions can I take being menopausal due to hysterectomy?

Please let me know, thank you.

Answer by Dr Saradha Anantharaman

Dear Leena,

You have already taken proactive measures with exercise, diet and monitoring your blood pressure to take care of your own health – great job!

a) Blood pressure medications are not prescribed solely for preventive care unless the blood pressure level is consistently elevated, or if there are other risk factors present such as kidney disease, diabetes or cardiovascular disease. 

If your blood pressure remains under 130/85, lifestyle changes like improving your diet and exercise are usually sufficient. It is also important to get adequate sleep and be able to manage stress.

However, if your blood pressure readings exceed 130/85 consistently and you have other risk factors like a family history of heart disease or menopause, your doctor may consider prescribing low-dosage blood pressure medication.

b) Having a hysterectomy and entering menopause early can affect hormonal levels. Menopause reduces oestrogen levels and this has a few effects including an increased risk of cardiovascular disease, osteoporosis and menopausal symptoms being some of them. 

You can take the following steps to reduce these complications:

• Go for annual check-ups to track your blood pressure, cholesterol levels and blood sugar levels

• Consider monitoring your blood pressure at home

• Aim to have a normal Body Mass Index (BMI) of between 18-23

• Eat healthily and follow the DASH diet – rich in whole grains, fresh fruits, vegetables, low-fat dairy, legumes, nuts, seeds and lean meats.

• Check your calcium and vitamin D levels and ensure adequate intake through diet or supplements

• Regular exercise including weight bearing and resistance exercises to preserve muscle strength
  

• Ensure you get adequate of sleep (at least seven hours) at night. Consider relaxation techniques and mindfulness to help you achieve this.

9. Question by Ann

Dear Dr,

How does one know if hypertension is primary or secondary hypertension?

Answer by Dr Saradha Anantharaman

Dear Ann,

Primary hypertension is the most common cause of hypertension which gradually develops over the years. It can be influenced by genetics, age, diet, lifestyle and even stress.

Secondary hypertension is usually due to an underlying condition such as kidney disease, hormonal imbalances or obstructive sleep apnoea. 

It usually results in higher blood pressure readings, requiring multiple anti-hypertensive medications. It may occur at a younger age, or show unusual patterns such as fluctuating blood pressure readings. 

Secondary hypertension may be associated with other symptoms such as palpitations, sweating, muscle weakness, snoring, puffy face, weight gain or abnormalities in lab test results such as low potassium without a clear reason.

Blood tests, urine tests and specialised imaging or sleep studies may be used to diagnose the different causes of secondary hypertension.

10. Question by Mdm Kaur

Hi Dr,

What foods should I avoid or eat to bring my blood pressure down without the need for medicine? Additionally, which exercises will help? Thanks.

Answer by Dr Saradha Anantharaman

Dear Mdm Kaur,

To lower blood pressure, a diet low in sodium, sugary foods and drinks, saturated or trans fats and processed foods such as chips and instant noodles is recommended. 

Follow the DASH diet which has scientifically proven to help reduce hypertension.

For exercises, it is important to stay active. Consider doing cardio exercises like brisk walking, light jogging, cycling and swimming, for thirty minutes a day, five days a week. 

It is recommended to couple this with strength and resistance exercises and activities like yoga and tai chi for flexibility and stress relief.

11. Question by Eileen

Hi Doctor,

Which is the more important factor indicating cardiovascular risk or stroke risk? Is it the systolic or the diastolic reading? Or are both readings important? Thank you.

Answer by Dr Saradha Anantharaman

Hi Eileen.

Both systolic and diastolic readings are important, as elevated readings are associated with increased cardiovascular risk. 

However, the systolic blood pressure reading is associated more strongly with risk of heart attacks, stroke, kidney disease and death, particularly in seniors.

12. Question by Ms Y

Dear Dr,

I started the hypertension medication more than a year now. I discovered the condition through many years annual health screening but refused to take med.

Until last year, I only decide to take med when I turned 60 years old by visited polyclinic. It give me good result and continue to be on medicine.

I would like to know can I stop medication? And if not working I will go back to take medication. Thank you and regards.

Answer by Dr Saradha Anantharaman

Dear Ms Y,

It is great to know that you are experiencing good results with anti-hypertensive medication.

There are instances where medication dosages are reduced for high blood pressure and cholesterol, usually when lifestyle changes like exercise, improved diet and weight loss help lower blood pressure.

However, any changes to medication dosages should always be done with a doctor’s advice and medical supervision. 

This is because not everyone can stop anti-hypertensive treatment, in view of other conditions, for example, if they have had a heart attack or stroke in the past; have diabetes or chronic kidney disease; or had high blood pressure before starting treatment. 

Ref: G25