High Blood Pressure (Hypertension) - Doctor Q&A

In this ‘Ask the Specialist’ Q&A forum, Dr Sun Jingfeng, Family Physician from SingHealth Polyclinics (SHP), a member of the SingHealth group, will answer your questions on high blood pressure (hypertension) such as how to prevent it and manage this common condition.

Due to overwhelming response, we will not be accepting any more questions for this Q&A forum. Thank you for your interest and participation.

Scroll down to see all questions and answers submitted for this forum. Do continue to check back this page from time to time as we will continue to add answered questions.

High blood pressure (hypertension) is on the rise in Singapore!

According to the National Population Health 2020, there is an increase in the prevalence of high blood pressure (hypertension) from 19.8% in 2010 to 35.5% in 2020.

High blood pressure (also known as hypertension) is often referred to as a silent killer as it may not cause any obvious symptoms most of the time, with any signs typically showing only when the condition reaches a dangerous high level.

Don't miss this chance to find out from our Specialist how you can lower your risk of getting it, or if you have it, what you can do to manage it better!

To know what is considered normal blood pressure or high blood pressure, read this article.

About Dr Sun Jingfeng

Dr Sun graduated from Duke-NUS Medical School in 2016 with M.D. degree and obtained MRCP (UK) in 2019. She received her Master of Medicine in Family Medicine in 2022, and is currently practicing as a Family Physician at SingHealth Polyclinics.

Questions and answers on high blood pressure (hypertension)

1. Question by c****

Hi Dr Sun,

I’m a senor female 69 years, no history of cholesterol, diabetes, or high bp. I measure my BP at home almost daily, sometimes when I first measure, readings are above 140, I will wait about 10min and take again and it is 130+. Do I have a problem with BP? Is it necessary to check out with a doctor? At the times when I measure at clinic, it always higher than 145. Please advise. Thanks.

Answer by Dr Sun Jingfeng

Dear C****,

The measurement of your blood pressure would usually depend on your activity prior to measuring it. Blood pressure can fluctuate throughout the day depending on many factors. The difference is likely due to the different environment and settings. When you are anxious, or have walked about for a while, or just smoked or drank coffee, it can cause your blood pressure to rise. When you sit down and relax for 5-10 minutes, your blood pressure may come down. If your blood pressure is always higher in the clinic compared to at home, you’re likely to have “white-coat hypertension”, or a rise in blood pressure only when you come to see your doctor.

If your average home blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension, and should seek a doctor for advice.

2. Question by M*****

Hi Dr,

If my high blood is not high consistently, can I avoid taking the pill for high blood?

If I were to start taking, I will have to take forever, is it correct?

Will exercise help lower my pressure? Which exercise is best?

How about food? What to avoid?

Answer by Dr Sun Jingfeng

Dear M*****,

If you are already on medication for hypertension, please do not stop taking it without checking with your doctor first.

None of the hypertension drugs are addictive. You can stop the drug anytime. If your doctor had recommended you to take drugs for your blood pressure, then it is likely that your blood pressure has been high for some time. If hypertension is not controlled, this can lead to organ damage such as heart attacks, heart failure, stroke and kidney failure. The damage may occur over many years to decades but once set in, is not usually reversible. Thus, prevention is better than cure.

If you have already started on hypertension medication, it is likely that you will need to keep taking it for a long time. However, it is not necessarily for everyone to take it for a lifetime. The need to continue hypertension medications may vary for different individuals and their health conditions. Thus, it is important for you to monitor your blood pressure regularly and consult your doctor to determine the appropriate course of action.

Exercising regularly does help to lower blood pressure. Aim to engage in aerobic exercises, such as brisk walking, jogging, swimming or cycling about 30 minutes 3-5 times a week.

For diet wise, take less salt in the form of sauces, seasoning or gravy, and lesser red meats like beef and mutton. Take more lean white meats like chicken and fish, and more fruits and vegetables. Consume alcohol only in moderation or not at all.

3. Question by T*****

Hello Dr Sun,

May I check what’s the difference between the 2 readings HP vs BP, what it represents and how to bring it down, particularly the BP as my is in a constant high above 90. Thank you.

Answer by Dr Sun Jingfeng

Dear T*****,

I would like to clarify if you mean to ask what is the difference between systolic and diastolic pressure, and are you referring to your diastolic pressure being persistently more than 90 mmHg, or do you mean your pulse rate is constantly more than 90/min?

Systolic pressure is the pressure when the heart contracts, and diastolic is when the heart fully relaxes. Both blood pressure values need to be controlled. There isn’t a different drug for each. All blood pressure medications lower both readings. Likewise, all lifestyle measures will lower both readings.

You can adopt the following lifestyle measures to lower your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

If you are referring to the pulse rate (e.g. > 90/min), then this represents mild resting tachycardia. In most cases it can be normal or due to anxiety, but sometimes it is due to low blood count (anaemia) or high thyroid hormones (hyperthyroidism).

If your diastolic pressure is constantly > 90 mmHg, or your pulse rate is constantly > 90/min, please consult your doctor.

4. Question by D*****

Dear Doctor,

I check my blood pressure twice a day, once when I wake up and once before I go to bed. I usually get normal blood pressure reading (below 130/85) in the morning but in the evening half the time my systolic reading is between 130 and 145 whereas my diastolic reading remains below 85.

The other half the time my readings are normal. Am I considered at risk of hypertension or already am at hypertension?

Answer by Dr Sun Jingfeng

Dear D*****,

In a normal blood pressure pattern, blood pressure typically decreases towards the evening. A person whose blood pressure drops at night is called a "dipper." This represents normal circadian rhythm (e.g. normal biological clock). On the other hand, a "non-dipper" refers to individuals whose blood pressure remains relatively high at night. This represents a disruption of the normal circadian rhythm (e.g. abnormal biological clock). Non-dippers are at risk of developing hypertension and other related problems, such as heart disease and stroke.

You seem to be a “non-dipper”, as your blood pressure is higher in the evening compared to the morning blood pressure, and this does put you at risk of hypertension and related problems. Try to avoid caffeine or alcohol in the evening (if you drink them). Try to lose weight If you are overweight. If you are obese, snores, and feel sleepy in the day time, you may have obstructive sleep apnea (OSA). This may need further evaluation by a sleep specialist.

You can adopt the following lifestyle measures to lower your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

Because blood pressure fluctuates, and doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns for a patient’s blood pressure. If your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension, and should seek a doctor for advice.

5. Question by M******

Hi Dr,

How do I manage low blood pressure? Thanks

Answer by Dr Sun Jingfeng

Dear M******,

Low blood pressure does not require any management at all if you are otherwise well. Ladies, especially if petite ones, can have low blood pressure (e.g. 90/60 mmHg) and that is completely normal if you do not experience any symptoms, such as giddiness, weakness, or blurred vision.

If you experience any symptoms of low blood pressure as mentioned above, check if you get dizzy when getting up from a bed or a chair. If so, ensure you are hydrating well and/or check if you are having menses at that time. If you experience persistent symptoms of low blood pressure, you should see a doctor for advice. If you do not experience any symptoms, no action is required.

6. Question by H****

Hi Dr Sun,

My mother is 86 years old, is diabetic and diagnosed with dementia since 2012. She goes to an elderly dementia day care centre Mon to Fri.

In the last one over month her BP fluctuates constantly. She does not show any symptoms of giddiness or breathlessness except looks tired sometimes.

Both Clinic and Polyclinic doctors advised to closely monitor her BP and she’s on Losartan. Drs also advised to let her rest and elevate her legs whenever her BP is high.

My sister is into natural health supplements and has prescribed several supplements to my mother.

Could you advise what should I do whenever her BP is high? In her case what reading is considered dangerously high?

I look forward to receiving your reply and advice. Thank you.

Answer by Dr Sun Jingfeng

Dear H****,

Blood pressure naturally fluctuates up or down depending on many factors. A person’s blood pressure can rise when feeling anxious, having long walks, or after a cup of coffee. When one sits down and relax for 5-10 minutes, blood pressure may come down.

There is no need to react to every reading that is high if your mother does not experience any symptoms, such as headache, giddiness, blurred vision, chest pain, or breathlessness. The average blood pressure is more important. Doctors often do not rely on any single value to decide on hypertension treatment. Rather they take the average blood pressure over the last 1 month to decide this. Thus, it is important to bring your mother’s blood pressure records each time you see the doctor.

Elevation of the legs does not lower your mother’s blood pressure, but it may help if she has leg swelling. You should also take note of any drop in blood pressure when your mother gets up from a chair/bed as this can sometimes occur if one stands up too quickly.

The normal home blood pressure target for elderly who are 80 years old and above is less than 150/90 mmHg. Blood pressure target is higher in the elderly in view of potential risks associated with more aggressive treatment in this age group. Severe or dangerously high blood pressure is defined as blood pressure greater than or equal to 180/110 mmHg.

If your mother’s blood pressure fluctuates significantly and persistently, she can consider other blood pressure medicine with longer half-life (e.g. telmisartan), but she should consult her doctor first.

7. Question by D*****

Hi Dr,

What is the root cause of hypertension? Is it possible to eliminate it instead of suppress it?

Answer by Dr Sun Jingfeng

Dear D*****,

The root cause of primary hypertension is most likely the result of many factors including genetic and lifestyle factors.

Some examples of risk factors associated with hypertension are:

Obesity
Having family members (parents or siblings) with hypertension
Taking too much salt in your diet
Drinking too much alcohol/beer
Smoking
Lack of exercise
Stress
Insufficient sleep

Unfortunately, hypertension cannot be completely eliminated once it sets in. Hypertension is a chronic condition that requires long term monitoring and regular follow up with the doctor. With appropriate lifestyle changes and appropriate hypertension medications, it is possible to control your blood pressure.

Lifestyle changes that can help to lower your blood pressure include:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all
Avoid smoking
Keep a healthy weight

8. Question by J*****

Hi Dr,

I am 29.6 years old (M) taking Propranolol for a condition unrelated to hypertension (Anxiety).

My question is: Although hypertension is not the main reason why I take this medication (Anxiety), Will it reduce my chances of getting hypertension in the long-term, As is there any proven dual-use benefit for this medication in terms of its co-relation in reducing anxiety and at the same time also reducing the risks of hypertension in the foreseeable future?

Thank you.

Answer by Dr Sun Jingfeng

Dear J*****,

Propranolol is a medication that helps to slow down the heart rate. It can be used to treat both symptoms of anxiety and hypertension. However, Propranolol is used in the treatment of hypertension, rather than reducing the risk of hypertension. Taking propranolol is not a preventive measure for hypertension.

To reduce of the risk of developing hypertension, you can adopt the following lifestyle changes:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

9. Question by J*

Hi Dr,

I am 35, and exercise regularly, doing 3 days of bodyweight training and 3 days of 30-min runs a week. I also try to avoid eating meat as much as possible. While my BMI is low (around 18-20), my diastolic BP has tended to hover at the lower part of the High-Normal BP range (around 81-82), with a normal systolic BP of around 120.

Some doctors have told me that this is normal, and there is nothing to worry about, while others have mentioned that it is in the High-Normal / Pre-Hypertension stage.

Is my BP ok, and how can I reduce it? Thank you!

Answer by Dr Sun Jingfeng

Dear J*,

The systolic blood pressure reading should be less than 130 mmHg and the diastolic blood pressure reading should be less than 85 mmHg if measured at home. Your home blood pressure readings as stated above are in the normal range.

To reduce the risk of developing hypertension and to lower blood pressure, you can adopt the following lifestyle changes:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

Do continue to keep up your good work!

10. Question by J****

Dear Dr,

There is a lot of advice on high blood pressure. How about low blood pressure? When is blood pressure too low for the typically healthy population with no medication?

When do we need to be concern and seek medical attention? What can we do when we find that our blood pressure has been on the low side?

Answer by Dr Sun Jingfeng

Dear J****,

Low blood pressure is typically defined as blood pressure reading of less than 90/60 mmHg. Low blood pressure does not require any management at all if you are otherwise well. Ladies, especially if petite ones, can have low blood pressure (e.g. 90/60 mmHg) and that is completely normal if you do not experience any symptoms, such as giddiness, weakness, blurred vision or breathlessness.

If you experience any symptoms of low blood pressure, check if you get dizzy on getting up from a bed or a chair. If so, ensure you are hydrating well and/or check if you are having menses at that time. If you experience persistent symptoms of low blood pressure, you should see a doctor for advice. If you do not experience any symptoms, no action is required.

11. Question by H****

Dear Dr Sun,

Hypertension (HT) is so prevalent in Singapore and beside taking medicine to manage the problems, what are the other measures are our medical specialist are taking to reduce or mange the problems.

If medicine (eg Diovan) are taken will there be side effects to the body and is there cases whereby a patient is taken off the medicine when the HT improve or go back to normalcy.

Are there natural ways (i.e. without medication) that we can adopt to alleviate the problems. Will medication be a long-term remedy to solve HT. Kindly enlighten.

Answer by Dr Sun Jingfeng

Dear H****,

On top of taking hypertension medications, there are also several lifestyle measures that you can adopt to control and lower your blood pressure.

These lifestyle measures include:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

Diovan (Valsartan) is a medication that helps to lower blood pressure and also protects the kidneys at the same time. It is generally safe to take for long term. As with any medications, Diovan can have side effects, although not everyone experiences them. Possible side effects include high potassium levels in the blood and low blood pressure. If you experience any concerning side effects while taking Diovan, please consult your doctor.

If you have already started on hypertension medication, it is likely that you will need to keep taking it for a long time. However, it is not necessarily for everyone to take it for a lifetime. Some people may be able to stop the medication depending on their health conditions. The need to continue hypertension medications varies for different individuals. Thus, it is important for you to monitor your blood pressure regularly and consult your doctor to determine if you need to continue with your medications.

12. Question by S******

Hello Dr,

What frequency per week and at what time should I measure my blood pressure regularly?

Answer by Dr Sun Jingfeng

Dear S******,

There is no “best time” to measure your blood pressure as blood pressure can fluctuate throughout the day. What is more important is that you have your blood pressure checked regularly (about 2-3 times a week) with a digital blood pressure machine. Blood pressure tends to be highest soon after you wake, and lowest before sleep. You can consider checking your blood pressure at these 2 timings.

13. Question by B********

Dear Dr Sun,

I would like to check whether my condition is considered as high blood pressure. Recently these few years, my BP has been irregular.

E.g. some of the mornings can be a bit high at 166/97, noon dropped a bit to 152/88 and night back to normal at 136/82. Whenever I'm at the GP or doing any health check related, my BP will always around 150/80.

Under such cases, am I considered as high blood pressure? Is medication required or I can continue to monitor? Thank you for your time.

Answer by Dr Sun Jingfeng

Dear B********,

It is normal to have variation in blood pressure, whereby blood pressure at night is lower compared to the morning. A person whose blood pressure drops at night is called a "dipper." This represents normal circadian rhythm (e.g. normal biological clock) and normal blood pressure pattern.

Blood pressure can also fluctuate throughout the day depending on many factors. Your blood pressure can rise when you are anxious, having long walks, just smoked, or after a cup of coffee. When you sit down and relax for 5-10 minutes, your blood pressure may come down. As blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns on a patient’s blood pressure. A normal blood pressure should be less than 135/85 mmHg.

As your blood pressure has been high over the past few years, (e.g. home blood pressure persistently more than 135/85 mm Hg), you may be having high blood pressure and should consult a doctor soon, who may start you on blood pressure medications. It is also important for you to bring your blood pressure records when you visit the doctor.

Some lifestyle measures you can adopt to lower blood pressure are as follows:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

14. Question by A***

Dear Dr,

I would like to know besides control under medication, how about exercise?

Based on BMI it tends to portray an unachievable weight measuring against the height. How else can we prevent hypertension? Thank you.

Answer by Dr Sun Jingfeng

Dear A***,

Hypertension is often due to a multitude of factors. Besides medications, exercising can also help to control high blood pressure.

Here are some tips to prevent/control hypertension:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

If you are already on medication for hypertension, please do not stop taking it without checking with your doctor first.

15. Question by T**

Hi Dr,

I am a moderate social drinker of beer and wine. I noticed that after I have drunk alcohol and after my drinks and when I took my blood pressure readings, my BP was actually lower than without alcohol!

So my question is does alcohol actually brings down the blood pressure, although we know that alcohol is supposedly going to raise BP? Thank you.

Answer by Dr Sun Jingfeng

Dear T**,

Alcohol taken in moderation can have a temporary blood pressure lowering effect. This is because alcohol triggers the release of chemicals in the body which relaxes and widens blood vessels thereby lowering the blood pressure. However this effect is only temporary, as the chemicals do not stick around for long. Blood pressure will eventually rise after some time, especially if a large amount of alcohol was consumed.

People who drink alcohol regularly and heavily are at risk of developing hypertension, heart disease, liver problems, addiction and a series of health problems. The short-term benefit of alcohol in temporarily lowering blood pressure is outweighed by its associated risks. The World Health Organization (WHO) recommends not drinking alcohol for health reasons as even moderate drinking is associated with increased risk of cancers (such as breast cancer, colorectal cancer, liver cancer etc.)

Hence, consume alcohol only in moderation or not at all.

Other lifestyle changes which are more reliable than alcohol in bringing down blood pressure includes:

Exercise regularly. Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Avoid smoking
Keep a healthy weight

16. Question by A****

Hi Doctor,

I recently on hypertension medication due to sudden spike of blood pressure perhaps due to menopausal. Currently on 5mg amlodipine for near to 2 months. Readings been below 120/80. Been good. And is it possible to reduce the dose to 2.5? How do I manage my hypertension from here? Thanks much.

Answer by Dr Sun Jingfeng

Dear A****,

A normal home blood pressure target is usually less than 135/85 mmHg but may be different depending on your medical condition or age.

Your blood pressure readings of below 120/80 mmHg does appear to be well controlled blood pressure and you may be able to reduce the dosage of Amlodipine to 2.5 mg a day. However, please do not reduce the dosage of your blood pressure medication without checking with your doctor first.

Do continue to check your blood pressure regularly if you were to reduce the dosage of your medication. If your blood pressure rises again, you need to remain on Amlodipine 5 mg to control your blood pressure.

Here are some lifestyle changes that can help to control/ maintain your well controlled blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

17. Question by K**

Dear Dr Sun,

My age is 70. What would be a normal blood pressure range?

I have been taking bp readings using Omron over the last few weeks.

My systolic readings range from: 120~143.

My diastolic readings range from: 50~79.

Do they look good?

Answer by Dr Sun Jingfeng

Dear K**,

For patients less than 80 years old, we will recommend having a blood pressure reading of below 135/85 mmHg at home. If you are more than or equal to 80 years old, we should aim for a blood pressure of below 150/90 mmHg.

If your average blood pressure over 4 weeks is less than 135/85 mmHg, your blood pressure is under control. However, if your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension and should seek a doctor for advice. It is important to bring your blood pressure records when you see the doctor.

18. Question by A*****

Hi Dr,

My dad is suffering from high blood pressure and is a diabetic. He needs to monitor his blood pressure every day.

May I know which is a good blood pressure monitor to get? He is currently using Omron brand. Thank you.

Answer by Dr Sun Jingfeng

Dear A*****,

There are no specific brand of blood pressure monitoring devices that is more superior. Omron blood pressure monitor is fine to use. One of the factors you may consider when getting a blood pressure machine is ease of use. Choose a machine that is easy to operate with large display screens and easy-to-read numbers. It is also important to get a blood pressure machine with the right cuff size for your father’s arm, as the wrong size cuff can affect the accuracy of blood pressure reading.

Most blood pressure machines require regular calibration to ensure that the blood pressure readings are accurate. Do follow the manufacturer’s guidelines on the procedure to calibrate and the recommended calibration interval.

19. Question by M*******

Dear Dr Sun,

I've been reading a lot about high blood pressure. I will be 80 years in a few months' time. What should be the ideal readings when in a sitting position and while standing?

Is it possible for a person to be classed as low blood pressure? Are readings below 90/50 considered low?

I would appreciate that you please discuss this issue. Thank you.

Answer by Dr Sun Jingfeng

Dear M*******,

If you are more than or equal to 80 years old, we should aim for a blood pressure of below 150/90 mmHg. It is recommended to take your blood pressure in a seated position, after resting for at least 5 minutes rather than in the standing position.

Low blood pressure is typically defined as blood pressure reading of less than 90/60 mmHg. Having a blood pressure reading of 90/50 mmHg is considered on the low side for you.

Low blood pressure may not require any management at all if you are otherwise well (e.g. no giddiness, weakness, or blurred vision). However, If you experience any symptoms of low blood pressure, check if you get dizzy on getting up from a bed or a chair.

If you experience dizziness when moving from lying to sitting or sitting to standing, you could be suffering from postural hypotension. If so, ensure that you are well hydrated. To check for postural hypotension, You can measure your blood pressure at sitting after resting for 5 minutes, then measure your blood pressure at standing, after standing for 3 minutes. Postural hypotension is a drop in blood pressure of more than 20mmHg systolic and 10mmHg diastolic when changing into an upright position.

If your blood pressure is persistently on the low side, or if you experience persistent symptoms of low blood pressure or postural hypotension, you should consult a doctor for advice.

20. Question by W*****

Hi Dr Sun,

May I know what is the normal range of blood pressure for man around 66 years of age and woman at the age of 65?

Is there any concern when there was once after having 1 bun for supper and around half hour later measure bp n is at 88/58 at night? No symptoms. Pls advise. Thank you.

Answer by Dr Sun Jingfeng

Dear W*****,

The recommended blood pressure range for both men and women less than 80 years old, is below 135/85 mmHg when measured at home. There is no difference in blood pressure target between male and female.

If you experience any symptoms of low blood pressure, check if you get dizzy on getting up from a bed or a chair. If so, ensure that you are hydrating well. If you experience persistent symptoms of low blood pressure, you should see a doctor for advice. If you do not experience any symptoms, no action is required.

21. Question by D******

Dear Dr,

I would be grateful to you if you can throw some light on my following queries.

May I know the difference between portal hypertension and Blood pressure?

Are they related? Is my BP due to Hypertension?

I am talking Proprananol for Hypertension and Iserbertan for BP. Why am I given different types of medications?

Also, would like to know as to how BP is related to Pulse rate? Thank you!

Answer by Dr Sun Jingfeng

Dear D******,

While both portal hypertension and hypertension contain the word ‘hypertension’, they are actually two different medical conditions and are not related to each other.

Portal hypertension refers to increased blood pressure in the blood vessels heading to the liver. Portal hypertension usually occurs due to liver disease or conditions that blocks the blood flow to the liver.

High blood pressure, also known as hypertension, refers to increased blood pressure in the blood vessels throughout the body and is diagnosed based on a persistent high blood pressure of more than 135/85 mmHg measured using a blood pressure machine. Some factors that can increase your risk of hypertension includes obesity, taking too much salt in your diet, lack of exercise, stress, smoking and drinking too much alcohol.

Irbesartan and propranolol are different blood pressure medicines that bring down your pressure in different ways and they both work together. It is not uncommon to take 2 or even more medications for blood pressure to be controlled.

While propranolol can be used to treat high blood pressure, it can also be taken for portal hypertension to decrease the blood pressure in the blood vessels heading towards the liver. Portal hypertension can cause the development of enlarged blood vessels called varices in the stomach and food pipe (e.g. gastric varices and oesophageal varices). Propranolol used in portal hypertension can help to reduce the risk of varices, which can leak blood and cause life-threatening bleeding if it occurs.

Pulse rate and blood pressure are different measurements of your health. Pulse rate measures how many times your heart beats per minute, while blood pressure measures the force in your blood vessels as the heart pumps.

Pulse rate and blood pressure can be related in certain situations. For example, during exercise or when you are stressed, your blood pressure and pulse rate may both increase. When you are dehydrated, your blood pressure may decrease, and your heart rate may increase to make up for it. While there can be a relationship between blood pressure and heart rate, they can also be independent of each other, and may not necessarily rise or fall at the same time.

A normal blood pressure reading is less than 135/85 mmHg. The normal pulse rate is 60 to 90 beats per minute, but it can sometimes be as low as 50 beats a minute. You need not worry about having slightly low heart rate if you are feeling normal, however, if your average heart rate is more than 100, or less than 50 a minute, please consult your doctor.

22. Question by A***

Dear Doctor,

I have High BP and now on medication (HCT exForge),

It has been under control with this medication (125/80 on average) but recently rose to 150/88 even with this medication.

I do not want to keep increasing the dosage. What should I do? Any natural way to reduce my BP? Thank you.

Answer by Dr Sun Jingfeng

Dear A***,

Here are some ways to reduce your blood pressure naturally:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

Exforge HCT contains 3 different blood pressure medications that work together to bring down your pressure in different ways. If your blood pressure is still high despite your current treatment, you may have to consult your doctor, who may recommend you with either taking a higher dose, or to add another hypertension drug. It is the results (that is, your blood pressure) that matters, not the number of drugs you are on.

23. Question by D***

Dear Dr Sun, a few enquiries:

1. I am skinny and my diastolic is always on the high side 90+ to slightly over 100. Systolic is around 14X most of the time. And I do have heart palpitation. I ever had once in my life with my diastolic reading at 70+. What is the reason for diastolic which is always high?

2. I do not prefer to take western medicine, can I normalize my BP through holistic approach

3. I was prescribed with Indapamide. Is this med safe? And must I take this long term?

4. Why is my mum prescribed with Enalapril and not Indapamide? And is it possible for her to stop medication if it has been normalise? Can she also take Indapamide?

Kindly advise. Thank you!

Answer by Dr Sun Jingfeng

Dear D***,

If your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension and should seek a doctor for advice.

If you are experiencing heart palpitations, has hypertension and is skinny, you may need to check if you have high thyroid hormone (hyperthyroidism). Other conditions that can cause both heart palpitations and hypertension include heart conditions and anxiety. You should consult your doctor as soon as you can to determine the cause of your heart palpitation and hypertension.

You can try to reduce your blood pressure holistically through the following ways:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

Indapamide is a medication, which helps to lower blood pressure by getting rid of salt(sodium) and water from the body. It is generally a safe medication to take for most people. As with any medications, Indapamide can have side effects. Possible side effects include low levels of salt (potassium or sodium) in the body, low blood pressure or postural giddiness (e.g. feeling dizzy when getting up from a bed or a chair). However, not everyone will experience them. If you experience any of the symptoms, do seek your doctor for advice.

If you have already started on hypertension medication, It is likely that you will need to keep taking it for a long time. However, it is not necessarily for everyone to take it for a lifetime. The need to continue hypertension medications varies for different individuals and their health conditions. Thus, it is important for you to monitor your blood pressure regularly and consult your doctor to determine if you need to continue your medications.

Enalapril and Indapamide are different blood pressure medicines that bring down blood pressure in different ways. If your mother is already on Enalapril for hypertension, please do not stop taking it without checking with her doctor first, even if her blood pressure has been normal.

Whether your mother can take Indapamide depends on her blood pressure level, kidney function, blood potassium level, and other medications your mother may have. Hence, it is crucial for you to check with her doctor before changing her blood pressure medication.

24. Question by A***

Dear Dr,

I recently I went to a clinic which checked my blood pressure to be relatively high. I would like to know if stress will cause high blood pressure?

Answer by Dr Sun Jingfeng

Dear A***,

Stress can certainly contribute to higher blood pressure, but by itself, does not often cause hypertension. Hypertension is often due to a multitude of factors, including taking too much salt in your food, not taking enough fruits and vegetables, drinking too much alcohol/ beer, smoking, and/or a lack of exercise.

Nonetheless, it is important to manage your stress. Some ways you can cope with stress is to exercise, listening to music, practise meditation, and seeking support from family and friends.

Blood pressure is not a single value, but constantly fluctuates up or down depending on many factors. When you are anxious, taking a walk for a while, or just smoked or drank coffee, can cause your blood pressure to rise. When you sit down and relax for 5-10 minutes, your blood pressure may come down. If your blood pressure is always higher in the clinic compared to at home, you’re likely to have "white-coat hypertension", or a rise in blood pressure only when you come to see your doctor.

Try to measure your home blood pressure regularly over 4 weeks. If it is less than 135/85 mmHg, your blood pressure is under control, but if your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension and should seek a doctor for advice. It is important to bring your blood pressure records when you see the doctor.

25. Question by M****

Hi Dr. Sun,

I am a 37y.o. female, married with 3 kids who do not smoke or drink. I have high blood since 5 years ago due to environmental factors (work stress and overweight).

I was told by my physician to go on medication (Amcad 5mg) since 1.5 years ago. My blood pressure after medication is stable at approximately 128/90 – 130/90+

I have recently left my stressful job and started exercising since a month ago and also much happier! I noticed that my blood pressure without taking medication has been normal 127/90 range.

Question is, if my blood pressure has become ‘normal’ and if I continue this lifestyle, can I discontinue taking the blood pressure medication? I am aware that would be long term side effects to the kidneys from taking the medication.

Appreciate your expert advice on this. Thank you.

Answer by Dr Sun Jingfeng

Dear M****, well done in adopting a healthier lifestyle!

Although your systolic pressure of 127 mmHg is normal, your diastolic pressure of 90mmHg is high. Systolic pressure is when your heart is squeezing to pump the blood through your blood vessels. This value should be less than 130 mmHg if measured at home. The second reading is the diastolic blood pressure. This is when your heart relaxes to allow blood to fill up in your heart. This value should be less than 85 mmHg if measured at home.

It is important to monitor both the systolic and diastolic blood pressure. As your diastolic blood pressure is persistently higher than 85 mmHg, your blood pressure is not ‘normal’. You should in fact consult your doctor to see if you need to increase or add medication.

Blood pressure medicines do not damage any organs, including the liver and kidneys. Not controlling your blood pressure actually causes this damage. Controlling the blood pressure actually protects your organs. It is important to ensure your blood pressure is controlled by checking your blood pressure regularly. The average blood pressure over 4 weeks should be less than 135/85 mmHg.

26. Question by Y*

Hi Dr,

I am on medication, but still blood pressure remains high. Less oil and salt already the norm in all my diet. I am nearly 70, blood pressure is around 150/70. How can I reduce it further?

Answer by Dr Sun Jingfeng

Dear Y*,

If you are less than 80 years old, we will try to treat a blood pressure to below 135/85 mmHg at home. If you are more than or equal to 80 years old, we will aim for a blood pressure of below 150/90 mmHg.

You can adopt the following lifestyle changes to lower your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy, less red meats like beef and mutton. Take more lean white meats like chicken and fish, and more fruits and vegetables.
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

If your blood pressure is consistently around 150/70 mmHg (e.g. higher than 135/85 mmHg), you should consult your doctor to see if you need to increase or add medication.

27. Question by D****

Hi Doctor,

I have Hypertension for a decade plus and did a coronary angiogram on 26/112020

Currently taking medication for HB, cholesterol and blood thinner medicine.

As I am currently 31, my concern is that will my condition lead to stroke or any major illness? If yes, how can I prevent it? Thanks.

Answer by Dr Sun Jingfeng

Dear D****,

If you have a history of coronary artery disease (narrowing or blockage of the blood vessels supplying the heart) and hypertension, you are at risk of stroke, heart attack and kidney problem.

You can adopt the following lifestyle changes to better control your blood pressure and reduce the risk of stroke, and heart attack:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy, less red meats like beef and mutton. Take more lean white meats like chicken and fish, and more fruits and vegetables. Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

Measure your blood pressure regularly and aim to keep it less than 130/80 mmHg. Take your current medications (e.g. hypertension medication, cholesterol medication and blood thinner medication) regularly as prescribed by your doctor. These medications help to reduce the risk of stroke and heart attack as well. Do continue your regular follow-ups with your doctor and bring your blood pressure record when you visit your doctor.

28. Question by Y*

Hi Dr Sun,

My question is "Why does my blood pressure fluctuates irregularly? Some days, the readings are good (eg 110/70) but on other days the readings suddenly goes bad (e.g. 145/90) for no reason".

This cycle goes on like that for months. I am controlling my diet carefully and my weight has come down over the last 12 months, from 75kg to now 71 kg (my height is 1.64m).

For context, I am 62 years old and still energetic and fit enough to engage in strenuous contact sports regularly. I practice Muay Thai, about four times (sessions) a week with at least 2 hours per session.

On my medical history, about a year back, I experienced slight heart pain and my doctor prescribed me to take Cardiprin (Aspirin), one 100 mg tab daily. I have also a history of high cholesterol problem and am on 1 tablet of Rosuvastin 10 mg daily. While I never have any history of high blood pressure, my doctor still prescribed me with 1 tablet of Amlodipine Besilate, 5 mg daily. Thank you.

Answer by Dr Sun Jingfeng

Dear Y*, keep up the good work in adopting a healthier lifestyle!

As blood pressure fluctuates, doctors often do not rely on any single value to decide on your treatment. Rather they take the average blood pressure over the last 1 month to decide this. Thus, it is important to bring your blood pressure records each time you see the doctor.

If your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension.

Amlodipine is a blood pressure medication, and you should clarify with your doctor to check if you are being treated for high blood pressure.

29. Question by O**

Dear Dr,

1. What is normal BP? Does hp increase with age? Why bp goes up at the clinic? Which readings are more accurate- at home when you are calmer; or at clinic when you are more worked up?

2. Can medication be stopped; if so when? If stopped what will happen to the hp? What are the side effects of medication? Does meditation cause kidney problems? Does meditation cause indigestion? Does meditation cause giddy spells? Does meditation affect quality of sleep? Is it proven that meditation is for lifelong? Does meditation shorten one’s lifespan?

3. Does diet help to control bp? What kind of diet?

4. Does exercise help?

5. Can exercise replaces medication?

6. How does sleep affect bp?

7. Does diabetes cause bp?

8. What are your best advice to manage bp?

Answer by Dr Sun Jingfeng

Dear O**,

A normal blood pressure is usually less than 135 / 85 mmHg if you are less than 80-year-old, but may be different depending on your medical condition. It will be good to consult your doctor on what is the ideal blood pressure for you.

I would like to clarify, do you mean to ask, ‘does BP increase with age’?

Blood pressure does increase with age. If you are more than or equal to 80 years old, we should aim for a blood pressure of below 150 / 90 mmHg.

If your blood pressure is always higher in the clinic compared to at home, you’re likely to have "white-coat hypertension", or a rise in blood pressure only when you come to see your doctor. We would treat the average readings of the blood pressure measured at home when you are calmer. The readings measured at home when you are calmer tends to be more accurate than the readings in clinic when you are more worked up. Your average home blood pressure should be below 135/85 mmHg.

If you have started on hypertension medication, it is likely that you will need to keep taking it for a long time. However, it is not necessarily for everyone to take it for a lifetime. The need to continue hypertension medications may vary for different individuals and their health conditions. Thus, it is important for you to monitor your blood pressure and consult your doctor regularly.

Please do not stop taking your medication without checking with your doctor first. If you choose to stop your medicine, you should continue to check your blood pressure. If it rises again, this means that you need the drug to control your blood pressure.

As with any medications, blood pressure medications can have side effects. However, not everyone will experience them and the side effects are different depending on the type of blood pressure medication. If you are concerned about side effects of your blood pressure medication, please consult your doctor.

Blood pressure medicines do not damage any organs, including the liver and kidneys. They also generally do not cause indigestion, affect quality of sleep or shorten one’s lifespan. Not controlling your blood pressure actually causes damage to organs, which may shorten one’s lifespan. If hypertension is not controlled, it can lead to organ damage, such as heart attacks, stroke and kidney failure. The damage may occur over many years but once set in, is not usually reversible.

Blood pressure medication may cause giddiness if your blood pressure becomes too low. If you experience any symptoms of giddiness, weakness or blurred vision, check if you get dizzy on getting up from a bed or a chair (postural hypotension). If so, ensure that you are well hydrated. If you experience persistent mentioned of symptoms, you should see a doctor for advice.

Giddy spells can also have many other causes and may not be due to blood pressure medication alone. Some possible causes of giddiness include low blood count (anemia), inner ear problems, dehydration, abnormal heart rhythms and even stroke. If you experience persistent giddy spells, you should consult a doctor to find out the underlying cause.

You can adopt the following lifestyle to control and lower your blood pressure:

Exercise and stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

While exercise can help to lower blood pressure, it alone cannot replace medication. To manage hypertension, you can adopt a healthy lifestyle, take your blood pressure medication prescribed by your doctor regularly, and measure your blood pressure consistently. Try to keep your blood pressure below 135/85 mmHg.

Insufficient sleep can certainly contribute to a higher blood pressure, but by itself, does not cause hypertension. Hypertension is often due to a multitude of factors, including taking too much salt in your food, not taking enough fruits and vegetables, drinking too much alcohol/ beer, smoking, and/or a lack of exercise.

Diabetes itself does not cause high blood pressure. However, someone who has diabetes has an increased chance of developing hypertension, as these two conditions share common risk factors, such as lack of exercise, obesity, and not taking enough fruits and vegetables. Hence, it is important for you to adopt a healthy lifestyle to control your blood sugar and blood pressure.

30. Question by A****

Hi Doc,

I’m on Candesartan 16 mg n Amlodipine 5mg
N Simvastatin 10mg for many years but recently I read over Google that one should not take Amlodipine n simsvastin together as it will damage the liver. Is this true?

Answer by Dr Sun Jingfeng

Dear A****,

Amlodipine and Simvastatin can be taken together. However, Amlodipine can interact with Simvastatin and increase the concentration of Simvastatin in the blood. This increase in concentration can increase the risk of side effects from Simvastatin. The side effects include liver damage and rarely muscle breakdown. The maximum recommended dose of Simvastatin is 20mg a day if you are taking it together with Amlodipine.

If you have been taking Amlodipine and Simvastatin for many years with no side effects and well controlled blood pressure and cholesterol, you can most likely continue to take these medications.

If you are worried about the possible drug interaction of Amlodipine and Simvastatin and side effects, do consult your doctor for advice.

31. Question by M*****

Dear Dr,

May I know what is the ideal BP for teenager age 17/18, male at 1.72cm at 82 Kg? Is it normal for teenager to have high BP for this portfolio and can it be reverted if the BP is out of the normal range at this age? Thank you.

Answer by Dr Sun Jingfeng

Dear M*****,

For a teenager who is turning 18-year-old, he can follow the same blood pressure target as an adult, which is less than 135/85 mmHg.

With height of 1.72 cm and weight of 82 kg, his BMI is 27.7 kg/m2, this means that he is obese and should lose weight.

The measurement of a person’s blood pressure would usually depend on his activity prior to measuring it. Blood pressure can fluctuate throughout the day depending on many factors. As blood pressure fluctuates, doctors often do not rely on any single value to decide on a person’s treatment. Rather they take the average blood pressure over the last 1 month to decide this.

If his average blood pressure over 1 month is persistently more than 135/85 mmHg, he may have hypertension. Do bring him to consult a doctor if you have not done so.

He can adopt the following ways to control or bring down his blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch the diet. Take less salt in the form of sauces, seasoning or gravy. Take less red meats like beef and mutton, more lean white meats like chicken and fish, and more fruits and vegetables.
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

32. Question by J*********

Good evening doctor,

Previously my pressure is high.

Now I am taking Amlodipine5mg 1 tablet every day for the past 4months.

How long need to be take this medicine? Can I stop it? Looking forward to your reply.

Answer by Dr Sun Jingfeng

Dear J********,

If you have started on hypertension medication, it is likely that you will need to keep taking it for a long time. The need to continue hypertension medications varies for different people and depends on their general health conditions and their blood pressure levels. Thus, it is important for you to monitor your blood pressure regularly and consult your doctor for advice.

Please do not stop taking your medication without checking with your doctor first.

If you were to stop your medicine, you should continue to check your blood pressure. If it rises again, you need the drug to control your blood pressure.

33. Question by J****

Hi Dr,

I would like to seek clarification on what is the correct reading to ensure that hypertension is under control.

Different doctors give different advice. Some insist that the reading must be 120/80 or below. Others said 140/90.

Appreciate some guidance on this matter. Thank you.

Answer by Dr Sun Jingfeng

Dear J****,

A normal blood pressure reading at home is usually less than 135/85 mmHg, but may be different depending on your medical condition or age. If you are less than 80 years old, we will try to treat a blood pressure of below 135/85 mmHg at home. If you are more than or equal to 80 years old, we should aim for a blood pressure of below 150 / 90 mmHg.

34. Question by S*******

Hi, Dr Sun:

Currently, I took 4 types of medication (Amolodipine-5mg, clopidogrel, simvastatin-20mg and ezetimibe) to control my blood pressure. My diastolic is normalized around 70-75mmHg, but my systolic reading may still go up to 150-160mmHg. Is there any underlying concern and what should I do to cope with this situation? Thanks in advance.

Answer by Dr Sun Jingfeng

Dear S*******,

Among the medications that you are currently taking, Amlodipine helps to lower blood pressure, while Clopidogrel is a blood thinner, Simvastatin and Ezetimibe are medications to lower cholesterol.

Blood pressure can naturally fluctuate throughout the day depending on many factors. When you are anxious, or have walked about for a while, or drank coffee, it can cause your blood pressure to rise. When you sit down and relax for 5-10 minutes, your blood pressure may come down. Because blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns on a patient’s blood pressure. A normal blood pressure should be less than 135/85 mmHg.

If your average blood pressure is consistently high, (i.e. home blood pressure persistently more than 135/85 mm Hg), your blood pressure may be suboptimal and you should consult a doctor soon, who may adjust your blood pressure medications. It is also important for you to bring your blood pressure records when you visit the doctor.

Some lifestyle measures you can adopt to lower blood pressure are as follows:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy, less red meats like beef and mutton. Take more lean white meats like chicken and fish, and more fruits and vegetables.
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

35. Question by N*********

Dear Dr Sun,

I've this problem for many years, every now and then, I would feel uncomfortable as I need to breathe harder and my chest feels tight. I could feel my blood pressure rising, as I felt a sense of discomfort and warmth. At times, this discomfort feeling kept me awake. This trend is quite frequent, especially at night. My blood pressure readings fluctuate from 135+ to 150+ / 75+ to 90+.

I've tried checking in with the doctors at the polyclinic a few times before. Each time, I was told it was normal for my age (I'm 57 years old), but the staff at the hospital would warn me that it's abnormal and advise that I should go for a medical check-up at the polyclinic. This is so contradicting, as the polyclinic doctors would keep brushing me away.

I would try to do some exercises at home whenever I could. That help me to feel slightly better. But it didn't resolve the problem coming back again and again. To make matters worse, from the start of this year, I was too busy with my work again. I felt extremely uncomfortable again at night. I have to resort to taking Omega oil and garlic pill at night to ease the discomfort. I remembered there was once, during a blood extraction, the nurse complained that my blood was too thick and difficult to extract.

Kindly advise.

Answer by Dr Sun Jingfeng

Dear N*********,

There are several possible reasons why you may experience tightness in your chest with the need to breathe harder. Possible causes include heart conditions, lung conditions or emotional stress. It is important for you to consult your doctor to find out the underlying cause. Since exercising makes you feel better, it is less likely due to a heart condition. Hot flashes may occur during the years after menopause. Keeping yourself well hydrated and cool (e.g. with a wet towel), and avoid caffeine and alcohol, may help to reduce that discomfort.

Blood pressure can fluctuate throughout the day depending on many factors. The difference is likely due to the different environment and settings. When you are anxious, or have walked about for a while, or just smoked or drank coffee, it can cause your blood pressure to rise. When you sit down and relax for 5-10 minutes, your blood pressure may come down. As blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns on a patient’s blood pressure. A normal blood pressure should be less than 135/85 mmHg.

The blood pressure you had reported seems high (i.e. > 135/85 mmHg), but you should also check your blood pressure when you feel well, to get a sense of your true average blood pressure. If this is also high, then you’ll likely need to be on some blood pressure medication.

Some lifestyle measures you can adopt to lower blood pressure are as follows:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy, less red meats like beef and mutton. Take more lean white meats like chicken and fish, and more fruits and vegetables.
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

There are a few reasons why it may have been difficult to extract your blood during blood taking. Some factors include the size of the needle, the quality of your veins, or the time it takes to draw the blood. Generally, this does not represent any health concerns.

36. Question by S******

Dear Dr,

I'm a Parkinson patient and on madopar & Entacapone (comtan) medication. I’m on high blood pressure, Amlodipine, and lenothyroxine medication due to removal of thyroid 5 years ago.

My BP measurements used to keep to 120+/80+ as and heartbeat rate at around 70 to 80. But ever since I took Parkinson medicine, my heart beat rate increase to above 95 to 105. ECG has been performed and is normal.

Does the Parkinson medication have impact on my measurements of BP?

Answer by Dr Sun Jingfeng

Dear S******,

Madopar and Entacapone are medications used for the treatment of Parkinson’s disease. Both of these medications may affect blood pressure by causing postural hypotension (e.g. blood pressure drops when you go from lying to sitting position, or from sitting to standing position). When postural hypotension occurs, your heart beat may increase to compensate for the drop in blood pressure in order to maintain blood circulation to your organs.

Symptom of postural hypotension includes dizziness when moving from lying to sitting or sitting to standing. If this occurs, ensure that you are well hydrated.

To check for postural hypotension, you can measure your blood pressure at sitting after resting for 5 minutes, then measure your blood pressure at standing, after standing for 3 minutes. Postural hypotension is a drop in blood pressure of more than 20mmHg systolic and 10mmHg diastolic when changing into an upright position. If the drop is small, or you feel well, then it is not likely that you have this condition.

Besides medications, Parkinson’s disease itself can cause a condition called autonomic dysfunction, whereby the nervous system controlling functions, such as the heart rate and blood pressure does not work properly. Patients with Parkinson’s disease may experience postural hypotension, and also abnormally fast heartbeat due to their underlying autonomic dysfunction.

Sometimes an excess of thyroxine (your thyroid hormone) can also cause your heart rate to rise. Check with your doctor the results of your last thyroid blood test.

A normal blood pressure is usually less than 135 / 85 mmHg if you are less than 80 year old. If you are more than or equal to 80 years old, we should aim for a blood pressure of below 150 / 90 mmHg. Low blood pressure is typically defined as blood pressure reading of less than 90/60 mmHg.

The normal heart rate is 60 to 90 beats per minute, but it can sometimes be as low as 50 beats a minute. If you are feeling normal and well, you probably need not worry about having slightly lower heart rate.

However, if you experience persistent high heart rate of more than 100 beats per minutes, or if you have low blood pressure, postural giddiness or postural hypotension, you should consult your doctor for advice.

37. Question by L**

Hi Dr Sun,

I am 69 years old, I have started taking Telmisartin 40g since 2005. Most of the time, my blood pressure, with the help of daily medication, averaging 130 85.

However, on some days, after working on computer for about 5-8 hours, and with room temperature normally between 19-22c, my blood pressure would go above 140 100 and I feel tightness on my head. This happens especially when my feet is cold after sitting long hours in such temperature.

At times, my blood pressure would reach 180 110 with headache, and I have to drop everything, turn on heater, sit back and just relax. Blood pressure will normally go down after resting for about an hour.

I suspect temperature plays a part but I have no control of the ambient temperature. In fact, I occasionally also have blood pressure surge when I am out and ambient temperature is high like above 34°c.

Please advise if I should consider increasing the strength of my medication, carry out specific tests or checks, and if there are ways to prevent sudden surge in Blood Pressure.

Also, I would like to have your advice on how best to react when experiencing a blood pressure surge to prevent heart problem or stroke. I travel and work in temperate country,

Thank you and look forward to hearing from you.

Ps. I am taking 100mg aspirin in the morning and Lipitor 20g in the evening too. I have recently carried out dobutamine-atropine stress test with echocardiography and 24-hour MAPA blood pressure monitoring test, both negative.

Answer by Dr Sun Jingfeng

Dear L**,

Blood pressure naturally fluctuates up or down depending on many factors and it may be hard to prevent sudden surge in blood pressure. When a person is stressed (e.g. after working for long hours or feeling cold/hot, or having pain), have a long walk for a while, or drank coffee, can cause one’s blood pressure to rise. When one sits down and relax (take a break from work) for 5-10 minutes, blood pressure may come down. You can also take some paracetamol for your headaches, which can reduce the stress from the pain.

There is no need to react to every reading that is high if you do not experience any symptoms. (i.e. no headache, giddiness, blurred vision, chest pain, or breathlessness). The average blood pressure is more important. Doctors often do not rely on any single value to decide on hypertension treatment. Rather they take the average blood pressure over the last 1 month to decide this. Thus, it is important to bring your pressure records each time you see the doctor.

A normal blood pressure should be less than 135 / 85 mmHg (average) as you are less than 80 year old. If your average blood pressure over 1 month is persistently more than 135/85 mmHg, you may need to consult a doctor to adjust your blood pressure medication.

Exposure to cold temperature may cause a temporary increase in blood pressure. This is because the cold temperature causes the blood vessels in the body to narrow as the body tries to retain heat. As such, the heart works harder to pump blood to the organs resulting in an increase in blood pressure. However, the temperature you’re experiencing (19-22C) is mild, hence is unlikely the cause of your increased in blood pressure.

If you are feeling cold, try to keep yourself warm by wearing layered clothing (e.g. jacket) with gloves and scarves. You can also consider wearing thick socks to keep your legs warm when working in a cooler temperature. When it is hot, dress lightly, and consider an umbrella or cap to get shade from the sun.

Severe or dangerously high blood pressure is defined as blood pressure ³ 180/110 mmHg. When you experience high blood pressure surge, try to stop what you are doing, sit down and relax for 5 to 10 minutes, then check your blood pressure again. If your blood pressure is persistently high, ³ 180/110 mmHg and does not come down, or if you experience persistent headache, giddiness, chest pain or breathlessness with a high blood pressure, you should consult a doctor immediately.

It is also important for you to take your medications Aspirin, Lipitor and Telmisartan regularly to prevent heart problems and stroke.

You can also adopt the following lifestyle measures to lower and control your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy, less red meats like beef and mutton. Take more lean white meats like chicken and fish, and more fruits and vegetables.
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

38. Question by P******

Dear Hi Dr,

How can we determine that our pressure is normal or high if the daily reading fluctuates? Sometimes is like 140/80 or 145/85, 135/85. How to manage to bring the blood pressure to a normal level? Pls advise.

Answer by Dr Sun Jingfeng

Dear P******,

Blood pressure naturally fluctuates up or down depending on many factors. When you are anxious, taking a walk for a while, or just smoked or drank coffee, can cause your blood pressure to rise. When you sit down and relax for 5-10 minutes, your blood pressure may come down. As blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns on a patient’s blood pressure. A normal blood pressure should be less than 135/85 mmHg.

If your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension and should seek a doctor for advice. It is important to bring your blood pressure records when you see the doctor.

You can adopt the following lifestyle measures to lower/control your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

39. Question by G****

Dear Dr Sun Jingfeng,

First and foremost, thanks SHP and yourself for having this Q&A session about hypertension.

My background - Male hypertension patient, 36y/o, taking amlodipine besylate 2.5mg & losartan potassium 50mg for about 6 years, non-smoker, non-drinker, mother side has hypertension history.

I would like to ask few questions:

a) Is there any way to know whether my condition is due to genetic cause or otherwise? Any test can I do to ascertain?

b) Last month, I have started what people call "meals substitute", which I only take supplement (called Old Recipe) for about 21 days - during this period, I only consume water and Old Recipe. My blood pressure normalized during the process (around 110/70) and I stopped the medication which I have taken for years. My weight loss from 87kg to 75kg. However, after the course ended and resumed meals, my blood pressure has risen and I thus have to continue my medication.

Based on above scenario, any conclusion for my high blood pressure situation? Foods induced? Genetic?

c) What should I do if I wish to maintain healthy blood pressure level without taking medicine

d) Any long-term effect for taking hypertension medicine?

Thank you.

Answer by Dr Sun Jingfeng

Dear G****,

a) The root cause of hypertension is most likely the result of many factors including genetic and lifestyle factors. Some examples of risk factors associated with hypertension are:

Obesity or being overweight
Having family members (parents or siblings) with hypertension
Taking too much salt in your diet
Drinking too much alcohol/ beer
Smoking
Lack of exercise.
Stress
Insufficient sleep

As you developed high blood pressure at a relatively young age of 30 years old, you can consult your doctor who may order further investigations to find out why you are having hypertension if this has not already been done. Your doctor may order further investigations, such as thyroid hormone test, ultrasound of the kidney or other tests depending on the examination findings.

b) The most likely cause of your hypertension is the result of many factors including genetic and lifestyle factors and not solely due to a single factor. Based on the above scenario, it does appear that your blood pressure responds to changes in lifestyle and weight loss.

Meal substitute or meal replacements should be used in tandem with a professional guidance from a dietician or doctor. While meal substitute is formulated to replace a complete meal at a lower calorie content, it should not replace all your meals totally. When incorporated as part of a healthy eating plan, meal substitutes can be a healthy weight loss tool. However, when meal replacements are used to replace all your meals, this may not provide enough calories or essential nutrients, and may put you at risk of nutritional deficiencies and other health problems.

While the use of meal substitute may result in short term weight loss and lower blood pressure, it is still important to have a long-term healthy eating habit, and exercise routine to maintain a healthy weight and blood pressure.

In addition, losing 12 kg (from 87 kg to 75 kg) over 1 month may be too fast, where you may be putting yourself at risk of nutritional deficiencies. Fast weight loss also slows down your metabolism, and you may gain back the weight quickly. If you are overweight (e.g. BMI>23 kg/m2), try to aim for a gradual and steady weight loss of around 0.5 kg to 1 kg per week which is more likely to keep the weight off. Do consult a dietitian about your meal plan and weight.

c) You can adopt the following lifestyle measures to lower your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

If you are already on medications for hypertension, please do not stop them without checking with your doctor first.

d) As with any medications, blood pressure medications can have side effects. However, not everyone will experience them and the side effects are different depending on the type of blood pressure medication.

The damage may occur over many years but once set in, is usually not reversible. Thus, prevention is better than cure. It is important for you to monitor your blood pressure regularly and ensure it is under control. Your average blood pressure should ideally be less than 135/85 mmHg.

40. Question by A*****

Dear Doctor, kindly see my question below?

a) I measure 140 for the first time in the morning, 1 min later i took another reading it was 135, then another minutes later I took the measurement and it become 125. So what is the correct reading or do I average the 3 readings.

b) what is the main different for medication Nifedipine to Telmisartan,

c) As some article said 140 is in the borderline, should I stop the taking telmisartan as I heard there are side effects. Thanks.

Answer by Dr Sun Jingfeng

Dear A*****,

Blood pressure can naturally fluctuates throughout the day depending on many factors. When you are anxious, taking a walk for a while, or just smoked or drank coffee, can cause your blood pressure to rise. When you sit down and relax for 5-10 minutes, your blood pressure may come down. As blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns on a patient’s blood pressure. A normal blood pressure should be less than 135/85 mmHg.

If your average blood pressure over 4 weeks is less than 135/85 mmHg, your blood pressure is under control. However, if your average blood pressure over 4 weeks is more than 135/85 mmHg, you should seek a doctor for advice. It is important to bring your blood pressure records when you see the doctor.

b) Both Nifedipine and Telmisartan are medications used to treat high blood pressure. They are different blood pressure medicines, which help to bring down blood pressure in different ways. Nifedipine (calcium channel blocker) works by widening the blood vessels, thereby lowering blood pressure, while Telmisartan helps in lowering blood pressure by blocking a certain hormone that may raise blood pressure (angiotensin-receptor blocker), it also has kidney protective effect and the ability to reduce excess protein in the urine by reducing the pressure in the kidneys.

In general, blood pressure medicines do not damage any organs, including the liver and kidneys. Not controlling your blood pressure actually causes damage to organs. If hypertension is not controlled, it can lead to organ damage, such as heart attacks, stroke and kidney failure. The damage may occur over many years but once set in, is usually not reversible. Thus, prevention is better than cure. It is important for you to monitor your blood pressure regularly and ensure it is under control. Your average blood pressure should ideally be less than 135/85 mmHg.

If you are already on Telmisartan for hypertension, please do not stop taking it without checking with your doctor first, even if your blood pressure is under control. If you choose to stop your medicine, you should continue to check your blood pressure. If it rises again, this means that you need the medication to control your blood pressure.

41. Question by R*****

Dear Dr,

What would cause the lower blood pressure number to be high but the top number to be normal?

Answer by Dr Sun Jingfeng

Dear R*****,

The top reading is the systolic blood pressure. This is when your heart is squeezing to pump the blood through your blood vessels. This value should be less than 135 mmHg (on average) if measured at home.

The second (“lower”) reading is the diastolic blood pressure. This is when your heart relaxes to allow blood to fill up in your heart. This value should be less than 85 mmHg (on average) if measured at home.

If only the diastolic blood pressure is high, you may have diastolic hypertension. Doctors are unsure why some people have this, and others have systolic hypertension (which is more common).

However, there seems to be an association with obesity, smoking, or excessive alcohol consumption. Regardless of the type of hypertension, both needs medication to keep blood pressure under control.

42. Question by P****

Dear Dr Sun,

I have been taking Nifedipine LA 30mg daily since 28 Sep 2022. If my BP has been stable since then, can I stop taking this medication? If this is not possible now, under what condition(s) could I ask for a review to see if I could stop taking it?

Another question is: for some reason if I miss taking the pill for a day or two, what is the implication to my health? Thank you.

Answer by Dr Sun Jingfeng

Dear P****,

If you are already on Nifedipine for hypertension, please do not stop taking it without checking with your doctor first, even if your blood pressure is under control. If you choose to stop your medicine, you should continue to check your blood pressure. If it rises again, this means that you need the medication to control your blood pressure.

The need to continue hypertension medications varies for different individuals and their health conditions. Thus, it is important for you to monitor your blood pressure regularly, especially if you have missed your medication, and consult your doctor to determine if you need to continue taking it. Your average blood pressure should ideally be less than 135/85 mmHg. It is also important to bring your blood pressure records when you see the doctor.

If you miss taking Nifedipine for a day or two, it should not have much implication on your health, as high blood pressure causes damage to your body over many years. However, you should set reminders, such as setting an alert reminder in our phone to take your medication regularly, as consistently missing your medication may result in high blood pressure, which in the long run can put you at risk of heart disease, stroke and kidney problems.

43. Question by Y*****

Hi doctor,

I wish to ask if 129/74 is on the brink of hypertension?

Is it need to see doctor for this reading? I'm 40+ years old and took this reading recently.

And second qn is: are there any natural foods that can lower bp? Thanks.

Answer by Dr Sun Jingfeng

Dear Y*****,

Because blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns for a patient’s blood pressure. If your average blood pressure over 4 weeks is less than 135/85 mmHg, your blood pressure is under control. However, if your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension and should seek a doctor for advice. It is important to bring your blood pressure records when you see the doctor.

You can adopt the following lifestyle measures to lower/ control your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

44. Question by D******

Hi DR. Sun,

I have been taking half a tablet of Hyzaar Forte ( 25 mg ) prescribed by my family GP since 2015. Then my BP was about 150/100 on the average. I have no other health issues. Then I was running 3 times week (about 5 to 10 km each run)

After 2 weeks, my BP dropped to 125/85 . No change in diet nor running. Since then till now, especially since 2020 ( because of Covid ) ..I decided to monitor my diet , running , and taking my Hyzaar (initially only on days I don't run , since 2023 - on alternate days regardless of run).

I realise the following observations :

with taking medicine plus running - BP can go down to 110/70
without medication and no running - BP back to 145/95 - 150/100 range
without medication plus running - BP usually around 130/85

My curiosity is " what if I run daily, does that imply that I can skip the medication " If so ..any health impact ?

Last observation is - Eating out and fried food, saltish dishes...regardless will have higher BP readings...

I am a male, age 60. I have been a sporty guy all my life… non-smoker or drinker ..Guess my weakness is proper eating habits , I guess...

Thanks for your time, Dr Sun.

Answer by Dr Sun Jingfeng

Dear D******,

Running does help to lower blood pressure. Regular aerobic exercises such as running, cycling, or swimming has been found to lower blood pressure. You should keep up the good work and continue your regular running.

The food that you consume also has a significant impact on blood pressure. Try to watch your diet, take less salt in the form of sauces, seasoning or gravy. Consume less red meats like beef and mutton, and eat more lean white meats like chicken and fish, and more fruits and vegetables.

Your blood pressure of 130/85mmHg (when you are not on medication but running) is borderline, especially the diastolic. Please do not stop taking Hyzaar forte without checking with your doctor first even if your blood pressure is under control. There may be other reasons to be on Losartan (a component of Hyzaar forte), such as to raise protein in your urine.

If you choose to stop your medicine, you should continue to check your blood pressure regularly. If it rises again, this means that you need the medication to control your blood pressure. Your average blood pressure should ideally be less than 135/85 mmHg. Having a high blood pressure (e.g. blood pressure of more than 135/85 mmHg) in the long run, can put you at risk of heart disease, stroke and kidney problems.

45. Question by B*****

Dear Dr. Sun,

I am 63 and have high blood pressure for many years.

I am prescribed with Losartan 100mg. It started from 17 May 2023.

I was taking losartan 75mg and amlodipine 2.5mg before switch to losartan 100mg.

I have a question, why is my diastolic blood pressure was high from 80 to 91, while my systolic blood pressure was from 117 to 130?

Could you advise me why my BP diastolic reading was high and what problem will it cause if it continues? Thank you for your time.

Answer by Dr Sun Jingfeng

Dear B*****,

Your average systolic blood pressure should be less than 135 mmHg, while your average diastolic blood pressure should be less than 85 mmHg if measured at home.

As blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns on a patient’s blood pressure.

If your diastolic blood pressure is persistently higher than 85mmHg (on average), you may have diastolic hypertension and should consult your doctor who may adjust your medications. Doctors are not sure why some people have diastolic hypertension, and others have systolic hypertension (which is more common). However, there seems to be an association with obesity, smoking, or excessive alcohol consumption. Regardless of the type of hypertension, both need to be kept under control. Having a high diastolic blood pressure in the long run can put you at risk of heart disease, stroke and kidney problems.

You may also check with your doctor the reason for changing your hypertension drug regime from losartan 75 mg and amlodipine 2.5 mg to just losartan 100 mg. Often, 2 drugs combination would result in a lower blood pressure, than a higher dose of a single drug. However, sometimes doctors may increase losartan for reasons other than blood pressure, such as when there is protein in your urine.

46. Question by Y** C*****

Hi Dr Sun,

I am male, 103kg, 44 this year and I recently had blood pressure reading about 150 to 160 constantly. I am not on medication yet. I would like to ask:

a) Should I be on medication?

b) Once I am on medication, can I stop halfway? or I have to take medication for life once I start?

c) What are the possible side effects of medication?

d) What should I do to manage high blood pressure better besides lose weight and less sodium/salt in my diet?

e) In the last 3 years to 5 years, I have had a lot of very severe cramps and headaches (at the back of my head). The cramp was so bad that I had to call for an ambulance at one time. Are these cramps and headache related to high blood pressure issues?

Thanks.

Answer by Dr Sun Jingfeng

Dear Y** C*****,

a) Your average blood pressure should ideally be less than 135/85 mmHg. If your average systolic blood pressure is constantly around 150-160mmHg (i.e. more than 135/85 mmHg), you will require medications to lower your blood pressure and should seek a doctor for advice. It is important to bring your blood pressure records when you visit the doctor.

b) If you have started on hypertension medication, it is likely that you will need to keep taking it for a long time. However, it is not necessarily for everyone to take it for a lifetime. The need to continue hypertension medications varies for different individuals and their health conditions. Thus, it is important for you to monitor your blood pressure regularly and consult your doctor to determine if you need to continue your medications.

Being obese is likely a significant factor contributing to your blood pressure, and a significant weight loss (e.g. 5-10%) will be needed to reduce your blood pressure without medicine.

c) As with any medications, blood pressure medications can have side effects. However, not everyone will experience them and the side effects are different depending on the type of blood pressure medication. If you are concerned about side effects of your blood pressure medication, please consult your doctor.

Blood pressure medications generally do not damage any organs, including the liver and kidneys. Not controlling your blood pressure actually causes damage to organs. If hypertension is not controlled, it can lead to organ damage, such as heart attacks, stroke and kidney failure. The damage may occur over many years but once set in, is usually not reversible.

d) You can adopt the following lifestyle measures to lower your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30mins 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight as much as possible (especially if you are overweight , i.e. BMI >23 kg/m2)

e) For your severe cramps, do you mean muscle cramps?

High blood pressure rarely causes headaches. A pressure of around 150-160mmHg usually does not cause headache or any symptoms. Most people do not experience any symptoms unless blood pressure increase to a very high level (e.g. more than 180/110 mmHg), and even at these levels, many are still without symptoms.

High blood pressure does not cause muscle cramps. The headaches and muscle cramps that you have been experiencing frequently over the past few years are likely not due to your high blood pressure.

There are many possible causes of muscle cramps. Some possible causes includes overexertion, poor blood circulation or electrolyte imbalance (abnormal concentration of salt in the blood).

Similarly, there are many factors that can cause headache. Some causes of long-term recurrent headaches include migraine headache, and tension headache, which may be due to stress, excessive coffee, alcohol, smoking, and/or poor sleep. Frequent recurrent migraine may need regular medications (e.g. amitriptyline, or propranolol) to control.

If you have recurrent severe cramps and headaches, you should consult a doctor to see if there are other conditions that are causing your symptoms. Having frequent headaches, muscle cramps and stress from the pain can cause increase in blood pressure. You can consider taking some paracetamol for your headaches and cramps to help relieve the pain.

47. Question by S*** K***

Good evening Dr Sun,

I’m 68 and using blood pressure meter daily, what’s your idea if the readings at times are 150/85 and 65? What should be the norm for the Systolic reading?

Answer by Dr Sun Jingfeng

Dear S*** K***,

There are generally 3 numbers to look at when you use your blood pressure meter daily

The first reading is the systolic blood pressure. This is when your heart is squeezing to pump the blood through your blood vessels. This value should be less than 135 mmHg if measured at home.
The second reading is the diastolic blood pressure. This is when your heart relaxes to allow blood to fill up in your heart. This value should be less than 85 mmHg if measured at home.
The third value (of 65) is your pulse rate or how fast your heart is beating per minute. The normal rate is 60 – 90 beats per minute, but it can sometimes be as low as 50 per minute. If you are feeling normal you probably need not worry about a slightly low heart rate. If your average heart rate is more than 100 or less than 50 a minute, please consult your doctor.

A normal blood pressure should ideally be less than 135/85 mmHg. If your average systolic blood pressure is constantly around 150 mmHg on average (e.g. more than 135 mmHg), you may have systolic hypertension and should seek a doctor for advice. Systolic hypertension tends to occur in people of older age and may be due to stiffening of the blood vessels as we age. If systolic hypertension is not controlled, it can put you at risk of heart disease, stroke and kidney problems in the long run.

48. Question by L***

Hi Dr. Sun, can you please clarify this issue:

I am on Amlodipine 5mg every night. However, about 15 minutes upon rising, after washing up, every morning, my Bp is still around 150/85. I monitor my Bp regularly and it is always around 120/70, or even down to 105/60 during the other different times of the day. Please enlighten why it is such high when I am on medication, and especially during the other times of the day it is rather low.

Thank you!

Answer by Dr Sun Jingfeng

Dear L***,

Blood pressure can also fluctuate throughout the day depending on many factors. When you are anxious, have a long walk for a while, or drank coffee, can cause your blood pressure to rise. It is possible that your "washing up" activity in the morning may cause a transient rise in your blood pressure.

When you sit down and relax for 5-10 minutes, your blood pressure may come down. As blood pressure fluctuates, doctors often do not rely on any single value, but rather we take the average blood pressure over the last 1 month to decide if there are concerns on a patient’s blood pressure. A normal blood pressure should be less than 135/85 mmHg.

If your blood pressure is less than 135/85 mmHg (on average), your blood pressure is under control. However, if your average blood pressure over 4 weeks is more than 135/85 mmHg, your blood pressure may not be well-controlled and you should seek a doctor for advice. It is important to bring your blood pressure records when you see the doctor.

49. Question by S*****

Dear Dr. Sun,

I have the blood pressure measuring devices at my workplace and home to help me to check my BP regularly since 2020.

I noticed that I have an elevated Diastolic Blood Pressure reading of an average of 85-90mmgh most of the time. My systolic blood pressure readings are usually fluctuating at 120-140mmgh.

I also read a lot to help myself to cut down on salts intake and exercise regularly. It helps however 30% of the time is 125/83 and 70% of the time is 135/90.

I read there are some side effects taking the BP medication as such I tried to avoid it.

I hope you can advise my case if it is necessary to start the medication. I am 47 years old this year.

Answer by Dr Sun Jingfeng

Dear S*****,

The ideal diastolic blood pressure should be on average less than 85 mmHg if measured at home. While systolic blood pressure should be on average less than 135mmHg if measured at home.

Blood pressure can fluctuate throughout the day depending on many factors. Your blood pressure can rise when you are anxious or stressed from work, having long walks, just smoked, or after a cup of coffee. When you sit down and relax for 5-10 minutes, your blood pressure may come down.

It is good that you have been cutting down on salt intake and exercise regularly, keep up the good work.

These are some general lifestyle measures to lower your blood pressure:

Stay physically active. Aim to walk, cycle or swim about 30 min 3-5 times a week.
Watch your diet. Take less salt in the form of sauces, seasoning or gravy. Take lesser red meats like beef and mutton, and more lean white meats like chicken and fish, and more fruits and vegetables
Consume alcohol only in moderation or not at all.
Avoid smoking
Keep a healthy weight

Blood pressure medicines do not damage any organs, including the liver and kidneys. Not controlling your blood pressure actually causes damage to organs, which may shorten one’s lifespan. If hypertension is not controlled, it can lead to organ damage, such as heart attacks, stroke and kidney failure. The damage may occur over many years but once set in, is not usually reversible.

If your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension and should consult your doctor who may start you on hypertension medications. It is important to bring your blood pressure records when you see the doctor.

50. Question by A***** C***

Hi Dr Sun,

I am a 50-year-old women who exercise regularly, does not smoke, and drinks. Did a health check recently and my BP has been high.

My BP is around this range when I measured it in the morning when I just woke up.

SYS: 157-120 (range)
DIA: 100-89 (range)

Do I need to start BP medication? Is this a cause of concern? Appreciate your advice.

Answer by Dr Sun Jingfeng

Dear A***** C***,

Blood pressure tends to be highest soon after you wake, and lowest before sleep. You can consider checking your blood pressure at night as well.

As you are less than 80 years old, we will recommend having a blood pressure reading of below 135/85 mmHg at home. The systolic blood pressure reading should be less than 135 mmHg and the diastolic blood pressure reading should be less than 85 mmHg if measured at home. Just based on your morning blood pressures alone, it does seem like your diastolic blood pressure is persistently high. Averaging this with your evening blood pressure will help determine if your daily average is indeed high.

If your average blood pressure over 4 weeks is more than 135/85 mmHg, you may have hypertension and should consult your doctor who may start you on medications. If hypertension is not controlled, it can lead to organ damage such as heart attacks, stroke and kidney failure. The damage may occur over many years but once set in, is not usually reversible.

Besides exercising regularly, and not smoking or drinking, ensure that you’re not taking salty food, such as adding sauces to your foods, eating "fast foods", any meat that is "smoked", or salted snacks. Take fruits and vegetables daily.

Ref: I23


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High Blood Pressure (Hypertension) - Doctor Q&A