Controlling blood pressure for heart health

Blood pressure is important for cardiovascular health for a few reasons, Dr Chiam says.

We know that the higher your blood pressure is in the long term, the stronger the correlation with having a stroke. This is the single most important reason why we need to control blood pressure.

Next to that, higher blood pressure also leads to what we call Hypertensive Heart Disease. This can be manifested through increased risk of heart attacks, or in the long term even if you don’t have a heart attack, there may be heart failure just from the hypertensive heart disease that’s been with the patient for a long time.

The other way that high blood pressure can also affect us is that it tends to increase sheer stress in the artery. This leads to further narrowing in the vessels in the heart or even in the arteries that supply the lower limbs.

For most patients who have high blood pressure, it is quite important to control this pressure, even if it’s just to reduce the risk of stroke – it’s one of the most devastating things that can happen to anybody.

For patients who struggle to control their blood pressure, we often forget that it is not just medicines alone but the entire lifestyle that we need to look at. One good way to control blood pressure is to lose weight and that can happen through diet and exercise.

What’s also been shown to help is to have a low salt diet, and that means that you don’t add more salt to the food you already eat. That alone can reduce blood pressure somewhat, at least in population-based studies. Nowadays the thinking is also that a low refined sugar diet may also help with blood pressure control.

For many of these patients unfortunately these changes are not enough and we have to use medication. We have four first line drugs that we can choose from, and most patients will need two of them. Some patients will need all four classes of drugs and even more.

In the recent years there has been a therapy that’s come out called Renal Denervation, where we use a special catheter, a rubber tube, that we insert through the groin into the arteries in the kidney to sort of burn off some of the nerves that supply the kidney. This therapy has been shown to reduce blood pressure, and it could become a therapy for some patients whose blood pressure is not controlled with many medications and have no other options. This surgery is really for a select group of patients, as for most, blood pressure can be controlled with a combination of drug therapy and lifestyle change.

Dr Paul T.L. Chiam is a consultant cardiologist with a subspecialty interest in interventional cardiology. He is in private practice at The Heart and Vascular Centre at Mount Elizabeth Medical Centre in Singapore and can be reached at +65 6735 3022.