Heart attacks/diseases and strokes are commonly and collectively referred to as cardiovascular disease.

Cardiovascular disease is a significant healthcare burden in Singapore. It contributed about 29.5% of the almost 19,000 deaths in 2013. This means that, 1 in 3 of us are likely to die from a heart attack, heart disease or stroke. If we exclude children and infants, this percentage will be even higher.

The main risk factors for cardiovascular disease are:

• Hypertension
• Diabetes Mellitus
• High Cholesterol (Dyslipidaemia)
• Obesity and Smoking

In addition, hypertension and diabetes are the top causes of kidney failure in Singapore and around the world.

One in 4 Singaporeans aged 18-69 years has hypertension. The prevalence of hypertension and dyslipidaemia above 18 year olds in Singapore remain high at 23.5% and 17.4% respectively. Diabetes mellitus, obesity and smoking are also slowly increasing over the past 1-2 decades. (See table below)

Source: https://www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Principal_Causes_of_Death.html (Last accessed 5th March 2015)

Together with the common cough, cold and fever; hypertension, dyslipidaemia and diabetes mellitus are the top 4 reasons for the nearly 4.7 million polyclinic attendances in Singapore each year. Statistically, this means that 1 in 2 who visit the polyclinic consult the doctor for either hypertension, diabetes, dyslipidaemia, flu or all of the above. Hence, regular blood pressure (BP) screening is vital for early detection.

Hypertension is defined as having a BP reading consistently above 140/90mmHg. An ideal method of diagnosing hypertension is a 24-hour BP reading (ambulatory BP monitor). Most of the time, BP readings on 2 separate occasions above 140/90mmHG are sufficient. Some patients only have high BP at the clinic/hospital, and normal BP at other times of the day and place. They are referred to as having ‘white coat hypertension’ and do not generally require treatment. 24-hour BP monitors will be especially useful in such cases. (We have both BP measurement sets for sale and for loan in our clinic.)

It is shown in large observational studies of up to 1 million individuals that cardiovascular risk increases with blood pressure in a ‘positive, strong, continuous, graded and predictive’ manner.

1. Deaths arising from cardiovascular diseases also increased linearly with blood pressure readings, with readings as low as 115mmHg (systolic) and 75mmHg (diastolic).

2. It is for this reason that major bodies such as the 7th American Joint National Committee (JNC 7) on Prevention, Detection, Evaluation and Treatment of High Blood Pressure introduced in 2004 a new classification with the term prehypertension to include those with blood pressures of between 120-139mmHg and 80-89mmHg. These individuals do not have a medical problem, and do not need treatment. But they are simply at risk of developing hypertension and require regular screening. JNC 8 released the latest guidelines on hypertension in 2014, largely refining the points on treatment of hypertension after taking into account results of newer studies.

A middle aged gentleman in his late 50s, who also was obese, had high cholesterol and was a heavy smoker asked me recently, “What are the risks and side effects of taking hypertension medications in the long run?”

I replied, “The risks are not as high, and the side effects are not as bad as if you do not take them and continue to have a poorly controlled blood pressure in the long run.”

We will discuss about treatment in the subsequent issues.

References:

V. Franco, S. Oparil, OA. Carretero. Circulation 2004; 109: 2953- 2958. DOI: 10.1161/01.CIR.0000132614.41493.B5
Lewington S, Clarke R, Qizilbash N, et al. Lancet 2002;360: 1903-1913

Article contributed by Frontier Healthcare Clinical Content Team

About Frontier Healthcare Group

Frontier Healthcare (as part of the Qualitas Primary Care Division) runs 18 GP clinics, 2 Family Medicine Clinics (Clementi and MacPherson) and has 37 affiliated GP clinics under its Frontier Primary Care Network Program. Frontier Healthcare supports national schemes such as the Community Health Assist Scheme (Pioneer, Merdeka, CHAS Green, CHAS Orange, CHAS Blue), Baby Bonus, Healthier SG, MBS@Gov etc, as well as partnerships with major Insurers, Corporates and TPA partners to bring quality and affordable healthcare closer to the community.