SINGAPORE: The American Heart Association’s (AHA) new standards for high blood pressure may be "the impetus" that Singaporeans need "to be more aggressive with lifestyle modifications”, said Dr Paul Chiam, cardiologist with Mount Elizabeth Novena Hospital.
This is especially so since the AHA announced that 130/80mmHg now qualifies as high blood pressure instead of the previous limit of 140/90mmHg in the journal, Hypertension, and the Journal of the American College of Cardiology on Monday (Nov 13).
The last time the AHA amended its guidelines on blood pressure and treatment was 2003.
Singaporeans are generally not aware of their own blood pressure levels or the numbers they should keep to.
"I'm not sure what the healthy numbers are," said research writer Leonard Lai, 36, who typically has his blood pressure measured twice a year - during his health check and when he donates blood. "My blood pressure was okay the last time I checked. I assume it is okay now."
Even those with a history of elevated blood pressure aren't vigilant. "The last time I had my blood pressure taken was before I had a medical procedure. I think it was on the high side," she said. "I don't check my blood pressure otherwise," said marketing manager Lily Yap, 45.
Local doctors, too, have observed this mentality among the population. "The ones who check their blood pressure levels intermittently are in the minority," said Dr Chiam.
"Most are probably nonchalant about their blood pressure levels, and will try to justify a high reading by saying they've just walked or didn't sleep well," said Dr Chiam.
Many people adopt this mindset because they are likely trying to avoid being put on a regime of high blood pressure medication. "They erroneously believe that once they start on such medications, they can't stop. Or worse, they have to increase the dosage with time," said Dr Chiam.
The AHA's new recommendations did not come as a surprise for those in Singapore's medical fraternity.
Dr Daniel Yeo, a cardiologist with Gleneagles Hospital, said that two years ago, the results of a landmark clinical trial called the Systolic Blood Pressure Intervention Trial or SPRINT, had already shown that adults with uncomplicated hypertension benefitted "when the systolic blood pressure is reduced beyond the previous guideline target of 140mmHg, down to less than 120mmHg”.
The SPRINT was based on 9,361 people and was published in the New England Journal of Medicine in November 2015.
The AHA is not the first to advocate lowering the blood pressure limits, said Dr Yeo. The American College of Physicians and the American Academy of Family Physicians have already incorporated the new guidelines in January, he said.
According to Dr Yeo, Canada kicked off its Hypertension Canada’s education programme in 2016, while the National Heart Foundation of Australia launched theirs last year.
Dr Chiam said that Singapore should adopt AHA’s new guidelines as it is good for patients and the general population to be aware that stricter blood pressure control can reduce the risk of stroke, and heart or kidney disease.
He added that the new recommendations would take some getting used to as “the current ones have been around for many years”.
The normal limit for blood pressure is considered to be 120 for systolic (amount of pressure the blood places on the artery walls when the heart beats); and 80 for diastolic (amount of pressure the blood exerts against the artery walls while the heart is resting between beats).
With the new guidelines, it is even more important to know your blood pressure readings. For instance, reaching the old 130/80mmHg limit would double "your risk of cardiovascular complications compared to those with a normal level of blood pressure", said Paul Whelton, lead author of the guidelines.
Checks on blood pressure levels should be done at least once every six months for those without hypertension. Individuals with hypertension or have elevated readings by the new cut-offs should monitor theirs every two to three months, said Dr Chiam.
There is no need for medication or major lifestyle changes if your blood pressure is between 130/80mmHg and 140/90mmHg, said Dr Chiam.
For patients who have had a heart attack or stroke, or are at high risk of heart attack or stroke, such as those with diabetes or chronic kidney failure, starting medications at that level may be required, he said.