Cut the salt
Under about 5 to 6 grams a day, roughly a level teaspoon. Most of it arrives already in the food, so the wins are less gravy and sauce, and checking labels.
Medically Reviewed By: Dr Paul Lim – MBBS, M.Med (Int Med), MRCP (UK), FAMS (Cardiology)
Hypertension
Dr Paul Lim Chun Yih
Senior Consultant Cardiologist & Electrophysiologist
High Blood Pressure Readings, Symptoms & What to Do
High blood pressure is a reading of 140/90 or above that stays up over time. It almost never causes symptoms, so most people find out from a cuff rather than from how they feel. Been handed a number you are unsure about? Our friendly Dr Paul Lim will explain your numbers and tell you whether anything actually needs doing.
Dr Paul Lim Chun Yih
Senior Consultant Cardiologist & Electrophysiologist
Start Here
Blood Pressure Readings: What the Numbers Mean
Every reading comes as two figures. Find yours in the table below and read across.
| Category | Top number | Bottom number | What it means |
|---|---|---|---|
| Normal | Below 130 | Below 85 | Nothing to act on. Keep to a routine check once a year. |
| High-normal | 130–139 | 85–89 | Above ideal, below the diagnostic line. Worth lifestyle change and a cardiovascular risk review, particularly if you carry other risk factors. |
| High blood pressure | 140 or above | 90 or above | Hypertension, once confirmed over repeat readings. This is the point at which treatment is considered. |
| Severely raised | 180 or above | 110 or above | Get seen promptly, and treat it as an emergency if chest pain, breathlessness or visual disturbance come with it. |
Clinic figures. Home readings run lower: a clinic reading of 140/90 corresponds to roughly 135/85 at home. Thresholds follow the blood pressure levels used in Singapore clinical guidance.
Which number matters more?
Both do, and you only need one of them to be raised. A reading of 128/94 sits in the same band as 145/85, which surprises people who have been watching only the top figure. As a rough guide, a raised bottom number on its own is more common under 50, while the top number tends to be the one that climbs with age as the larger arteries stiffen. Neither pattern is benign, and neither is diagnosed from a single measurement.
Does the normal range change with age?
The threshold does not. 140/90 marks high blood pressure at 35 and at 75 alike. Charts that show a higher “normal” for older adults are describing what is common in that age group, which is a different thing from what is healthy, and reading one can talk you out of a result worth acting on.
Your target may be lower than 140/90
140/90 is the line for diagnosis, and it is the same for everyone. The number you aim for afterwards is set by your overall cardiovascular risk, and for some people it is deliberately lower. Singapore’s clinical guidance sets it out as:
- Below 130/80 if your individual risk factors place you at high cardiovascular risk. Whether yours do is something to work through at a consultation.
- Below 140/90 at lower risk, with room to aim for 130/80 where you tolerate it comfortably.
- Around 150/90 if you are older, frail or have a limited life expectancy. Pushing the number down hard in this group can cause more trouble than it prevents, through falls, dizziness and side effects.
Below 120/70 the evidence of further benefit becomes inconsistent, so lower is not automatically better.
Local Picture
High Blood Pressure in Singapore
It also becomes more common with age. Central obesity carries cardiovascular risk at a lower body mass index in Asian populations than the thresholds derived from Western data, so a normal-looking BMI is not by itself a reason to skip the check.
Get screened today and know your heart risk. Basic Heart Check-Up, S$368 (NETT, incl. GST). Consultation and results review included.
What You Will and Will Not Feel
Symptoms of High Blood Pressure
It does not usually cause any symptoms, and can run high for years while you feel perfectly well. The exceptions are worth knowing, because the commonest one is widely misunderstood.
Does high blood pressure cause headaches?
Usually not. Mild and moderate high blood pressure does not appear to cause headache at all, and when pressure is tracked across a whole day, headaches do not line up with the higher readings. Everyday headaches are far more often tension, poor sleep, dehydration or caffeine.
The link becomes real only at the top of the scale, where a headache tends to arrive with other symptoms rather than on its own, and where it settles once the pressure comes down. Short of that, look for another explanation.
When to seek emergency care
Call 995 or go to the nearest A&E immediately if a very high reading — 180/110 or above — comes with chest pain or pressure, sudden breathlessness, a severe or unusual headache, visual disturbance, confusion, or weakness or numbness on one side of the body. Remember F.A.S.T. for stroke: Face drooping, Arm weakness, Speech difficulty, Time to call 995.
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Your Cardiologist
Reviewed by Dr Paul Lim
Senior Consultant Cardiologist & Cardiac Electrophysiologist
Dr Paul Lim is a Senior Consultant Cardiologist who assesses blood pressure as part of overall cardiovascular risk rather than as a number on its own. Sustained high blood pressure is among the commonest drivers of atrial fibrillation, which sits within his subspecialty in heart rhythm disorders. He completed advanced fellowship training at Barts Heart Centre, London under Singapore’s HMDP award.
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Why It Happens
What Causes High Blood Pressure
In roughly nine cases out of ten there is no single identifiable cause. Pressure creeps up over years through a combination of what you inherit and how you live.
What pushes it up
- Salt. The largest single dietary contributor, and in Singapore most of it arrives already in the food rather than from the shaker: sauces, stock, preserved items, instant noodles and hawker gravies.
- Excess weight, particularly around the abdomen
- Physical inactivity
- Alcohol, where the effect is dose-related and reverses when intake falls
- Age. Pressure drifts up over the decades even in people who do everything else right
- Family history: a strong predictor, and the reason a young, lean person can still be affected
- Poor sleep, especially obstructive sleep apnoea, which is under-recognised and treatable
When there is an underlying cause
A minority of cases are driven by something specific, and finding it changes the treatment. This is worth looking for when blood pressure appears young, rises abruptly, reaches severe levels, or fails to settle despite several medications. The usual candidates are chronic kidney disease, thyroid and adrenal gland disorders, obstructive sleep apnoea, and certain medications, including some anti-inflammatory painkillers and decongestants.
Finding Out
How High Blood Pressure Is Diagnosed
-
1
Repeat readings, not a single one
Blood pressure moves through the day and rises with pain, stress, caffeine and a full bladder. A diagnosis is made from several readings taken on separate occasions, which is why one high figure at a health screening is a prompt to look further rather than a verdict.
-
2
Readings from home
Home readings carry real weight, and they are judged against a lower threshold than clinic ones. To make yours usable, sit for five minutes first, keep your back supported and feet flat on the floor, rest your arm at heart level, and use a cuff that fits your upper arm rather than a wrist device. Take two readings each session, about a minute apart, once in the morning and once in the evening. Seven days is ideal and three is the minimum. Note them all down and bring the log with you.
-
3
Separating white-coat readings from the real thing
Some people read consistently high in a clinic and entirely normal everywhere else. It is common, and a week of home readings tells the two apart. The reverse also exists: readings that look acceptable in a clinic while sitting high through the rest of the day.
-
4
Checking what the pressure has already affected
Once a diagnosis is confirmed, the questions become how long it has been raised and what it has reached. An ECG looks for thickening and strain in the heart muscle, and a 2D echocardiogram measures it directly. Blood and urine tests check kidney function and look for an underlying cause. Because raised pressure rarely arrives alone, a cholesterol test and an HbA1c are usually done at the same time, and all of this is bundled into a heart screening package.
Costs for individual tests and consultations are listed on the cardiology fees page.
What Happens Next
If Your Blood Pressure Is Raised
A raised reading is information, arriving early enough to act on. For readings in the high-normal band or just over the line, lifestyle change is often enough on its own.
Eat the DASH pattern
More vegetables, fruit, wholegrains and beans, less saturated fat. It lowers blood pressure in its own right, partly by raising potassium.
Move regularly
Around 30 minutes on most days, building towards 150 minutes a week. See how to build a stronger heart.
Lose weight around the middle
A modest loss often shifts the reading more than expected.
Drink less
No more than two standard drinks a day for men and one for women. The reduction shows in the reading within weeks.
Stop smoking
Every cigarette raises pressure acutely, and stopping is among the most effective things you can do for your arteries.
Medications that lower blood pressure
Whether to start depends on how high the reading is and your overall risk. Someone at the lower end with room to change their habits should be given a fair chance to; someone at higher risk usually starts treatment alongside those changes rather than after them. Which medicine suits you depends on your age, your other conditions and how you respond, and more than one is often needed.
| Class | How it works | Examples in Singapore |
|---|---|---|
| Calcium channel blockers | Relax and widen the arteries, so blood meets less resistance. | Amlodipine (Norvasc), nifedipine (Adalat), felodipine |
| ARBs | Block a hormone that tightens blood vessels. | Losartan (Cozaar), valsartan (Diovan), telmisartan (Micardis) |
| ACE inhibitors | Act on the same hormone pathway, one step earlier. A dry cough is their most recognisable side effect, and a common reason to switch to an ARB. | Lisinopril (Zestril), perindopril (Coversyl), ramipril (Tritace), enalapril |
| Thiazide diuretics | Help the kidneys clear excess salt and water, lowering the volume the heart moves. | Hydrochlorothiazide, indapamide (Natrilix) |
| Beta-blockers | Slow the heart and reduce the force of each beat. Usually added when there is a second reason for them, such as angina, a previous heart attack or a fast heart rhythm, rather than as a first choice for blood pressure alone. | Bisoprolol (Concor), metoprolol (Betaloc), atenolol (Tenormin), carvedilol (Dilatrend) |
| Combination tablets | Two classes in a single pill, which makes a daily routine easier to keep to. | Amlodipine with valsartan (Exforge), perindopril with amlodipine (Coveram) |
Listed for recognition, not as a recommendation, and set out in more detail in a national guide to blood pressure medicines. Brands change over time and generic versions are widely used. Always speak to your own doctor before starting, stopping or changing a dose.
Why it is worth treating
Pressure that stays high asks the heart to work against resistance for years. The muscle thickens, the upper chambers stretch, and that stretching is one of the commonest routes into atrial fibrillation, which raises stroke risk again. The same pressure damages the small vessels of the brain, kidneys and eyes. Treating it early is among the most reliable ways to prevent a stroke.
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See Dr Paul Lim to have your blood pressure readings interpreted alongside the rest of your cardiovascular risk.
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| Sunday & Public Holidays | Closed |
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Common Questions
High Blood Pressure FAQ
The questions people most often arrive with about blood pressure readings, symptoms and treatment.
What is considered high blood pressure in Singapore?
A clinic reading of 140/90 mmHg or above, confirmed over repeat readings, is high blood pressure. Measured at home the equivalent is 135/85 mmHg, because home readings run lower than clinic ones. Readings of 130–139 over 85–89 are classed as high-normal: not a diagnosis, but a signal worth acting on. Either number puts you in the band, so a reading of 128 over 94 counts just as much as 145 over 85.
Can high blood pressure cause headaches?
Usually not. Mild and moderate high blood pressure does not appear to cause headache, and when pressure is tracked across a whole day, headaches do not line up with the higher readings. Everyday headaches are far more often explained by tension, poor sleep, dehydration, caffeine or screen time. The link becomes real only at very high readings, where a headache tends to arrive alongside other symptoms such as blurred vision or chest discomfort, and settles once the pressure comes down. A severe headache with a reading of 180/110 or above should be treated as urgent; below that, look for another explanation.
What if only the bottom number is high?
It still counts. High blood pressure is diagnosed on either number, so 128 over 94 sits in the same band as 145 over 85. A raised diastolic reading on its own is more common in younger adults and carries genuine cardiovascular risk. As with any reading, confirm it over several measurements rather than acting on one.
Does normal blood pressure change with age?
The diagnostic threshold does not. 140/90 marks high blood pressure at 35 and at 75 alike, and charts showing a higher “normal” for older adults describe what is common rather than what is healthy. The treatment target is what changes. Singapore’s clinical guidance sets a target below 130/80 for people at high cardiovascular risk, below 140/90 for those at lower risk, and a less stringent target of around 150/90 for people who are older, frail or have a limited life expectancy, where lowering pressure hard can cause more trouble than it prevents.
What should I do if I get a high reading at home?
One high reading is not a diagnosis. Sit quietly for five minutes and measure again, with your back supported, feet flat on the floor and your arm resting at heart level. If it stays up, start a log: two readings about a minute apart, morning and evening, for seven days where you can and three at minimum. Bring it to a consultation, because the pattern is far more useful than any single figure. Call 995 or go to the nearest A&E if a very high reading comes with chest pain, breathlessness, a severe headache, visual disturbance or weakness on one side.
Can high blood pressure be lowered without medication?
Often, yes, particularly where the reading sits in the high-normal band or just over the line. Cutting salt, losing excess weight, moving regularly, drinking less alcohol and stopping smoking all lower blood pressure, and together they can be enough. Where the reading is substantially raised, or where your individual risk factors place you at higher risk, medication is usually started alongside those changes rather than after them. Which applies to you is a judgement made at a consultation with your own readings in front of you.
What is white coat hypertension?
Blood pressure that reads high in a clinic but sits normal elsewhere. It is common, and it is the reason a diagnosis is rarely made from a single clinic reading. Home readings run lower as a rule: a clinic reading of 140/90 corresponds to roughly 135/85 at home. A week of home readings settles most of these cases.
How often should I check my blood pressure?
For most healthy adults, at least once a year. It takes a minute, and because the condition is silent, a scheduled check is the only thing that will catch it. Check more often if a previous reading was high-normal, if you have diabetes, kidney disease or a family history of high blood pressure, or if you are over 50. Anyone already on treatment should follow the interval their own doctor sets.