The Ministry of Health (MOH) has announced that Singapore will continue to use existing high blood pressure limits of 140/90mmHg. This comes after the American Heart Association (AHA) recommended a new limit of of 130/80mmHg, in its latest Clinical Guidelines for Hypertension.

A MOH spokesperson reminded that the new guidelines are suggested in the US context, and “they do not change the approach to management (of high blood pressure) in a major way.”

However, the spokesperson also assured that the ministry will persist to review the supporting evidence of the new AHA guidelines and its pertinence to the local citizens.

The 140/90mmHg reading is also currently used across Europe and Australia, among global societies such as the International Society of Hypertension, the European Society of Cardiology and the National Heart Foundation of Australia.

Same treatment approach despite new guidelines

The new AHA guidelines defines individuals with a systolic blood pressure between 130 and 139, and a diastolic blood pressure between 80 and 89, as having low-risk Stage 1 hypertension.

Due to the new adjustment, it could mean that up to 46% of Americans are considered as hypertensive – when previously it was about 36%. For Singapore, nearly one in three, or one in four Singaporeans would be classified as hypertensives.

MOH said these individuals will not require medication but lifestyle changes, which include reduction of salt intake, alcohol and smoking.

They should also have their blood pressures checked after three to six months. Only those with risk factors will receive drug interventions, such as individuals with previous heart attack, diabetes, high cholesterol, obstructive sleep apnea and renal failure.

Stricter blood pressure limits – does it matter?

The new blood pressure limit could “increase awareness of the dangers associated with high blood pressure, and hence an earlier drive for individuals to optimise their blood pressure,” observed Dr Chin Chee Tang, a senior cardiologist at the National Heart Centre Singapore.

He added that “the lower the blood pressure is, the lower the risk of adverse outcomes. This has to be tempered with the increased risk of potential side-effects of treatment.”

Dr Chin Chee Tang is checking the blood pressure of one of his patients. Photo credit: National Heart Centre Singapore.
Dr Chin Chee Tang is checking the blood pressure of one of his patients. Photo credit: National Heart Centre Singapore.

However, if Singapore adopts the new AHA guidelines, it may result in unnecessary treatments for many, especially those who are only at low-risk of high blood pressure, expressed Dr Chia Shi Lu, head of the Government Parliamentary Committee for Health.

He acknowledged the MOH’s decision to keep with the existing blood pressure limit, as “there is no solid basis for saying now that a systolic pressure of 130 is significantly riskier”.

Dr Chin agreed that an individual would not abruptly change from “healthy” to “not healthy” at a certain point, when effects of blood pressure on health are on a continuum. Thus, thresholds for “normal or “not normal” in blood pressure readings may not always be useful.

Both Dr Chin and Dr Chia concurred that the new high blood pressure limits may bring implications for health insurance coverage, particularly when there could be an increase in premiums to cover the additional risk that can be “very little”.

The lower blood pressure limits may also influence future research and treatments, by complicating comparisons. MIMS

Read more:

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Hypertension rates in low income nations now greater than in high income nations
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