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 chris

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 Chris,

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.

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. Thus, it is important to bring your blood pressure records when you visit the 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 Mdm Kim

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 Mdm Kim,

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 Takumi

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 Takumi, 

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 Dennis

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 Dennis,

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 Marilyn

Hi Dr, 

How do I manage low blood pressure? Thanks

Answer by Dr Sun Jingfeng

Dear Marilyn, 

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 Helen

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 Helen, 

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 Deh Gee

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 Deh Gee,

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 Jeremy

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 Jeremy,

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 JJ

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 JJ,

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 Jamie

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 Jamie,

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 Henry

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 Henry,

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 Sanford

Hello Dr, 

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

Answer by Dr Sun Jingfeng

Dear Sanford, 

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 Boon Cheng

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 Boon Cheng,

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 Andy

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 Andy,

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 Ted

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 Ted,

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 Agnes

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 Agnes,

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 Ken

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 Ken,

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 Aileen

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 Aileen,

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 Mong Song

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 Mong Song,

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 Winnie

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 Winnie,

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.

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, or blurred vision.

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 Divakar

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 Divakar,

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 Alex

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 Alex,

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 Dino

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 Dino,

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 Asta

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 Asta,

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 Ms Tan

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 Ms Tan, 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 YM

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 YM,

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 David

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 David,

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 YC

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 YC, keep up the good work in adopting a healthier lifestyle!

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, have long walks 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 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 OCC

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 OCC,

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.

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. 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 Alice

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 Alice,

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 Mdm Loh

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 Mdm Loh,

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 Janhangeer

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 Jahangeer,

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 Jimmy

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 Jimmy,

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.

Ref: I23