Latest on Hypertension Management

Palpitation

What are you going to address today?

Let’s talk about a really common condition – hypertension

Why this topic? Based on your experience, what is the prevalence in Singapore?

Hypertension, or high blood pressure, is a serious medical condition. The World Health Organization estimates that 1.28 billion people have hypertension, and fewer than one in five have it under control. In Singapore, is it estimated that 1 in 4 Singapore residents aged 30 to 69 years have hypertension.

How has the management of this disease changed over the years?

There is little doubt that we have better antihypertensive medications over the last decades. However, medications and lifestyle changes don’t always provide sufficient blood pressure control. In addition, many people struggle to stick to their medications. Patients with prolonged periods of uncontrolled hypertension are at significantly increased risk of heart attack, stroke, heart and kidney failure, and premature mortality. Improvements in blood pressure translate into meaningful reductions in risk.
The Hypertension Procedure also known as Renal Denervation (RDN) may provide an additional mean to control blood pressure. In RDN, energy is delivered to the autonomic nerves leading to the kidneys, which help regulate blood pressure. Overactivity of the renal nerves can cause high blood pressure and ablating them using heat energy helps manage blood pressure. RDN works independently of patient compliance and thus provide protection throughout the 24 hours period. This doesn’t mean patients stop taking their medications. However, RDN works even if patients forget to take their medications, helping to alleviate the challenges with adherence. This is why we talk about RDN as a complementary approach, not as a replacement for medication.
The procedure lasts approximately one hour and is done under sedation. A catheter is inserted through the groin vessel under x-ray screening and find its way into each renal artery. Energy is delivered from the catheter through the arterial wall, ablating the renal nerves.

What are the goals / monitoring parameters you would recommend for management of such disease?

We should encourage our patients to self-monitor their BP at home and aim for the blood pressure target of SBP less than 120 and DBP less than 80mmHg.

What advices would you provide for primary care providers / patients reading this when it comes to managing this disease?

We should be continue to encourage lifestyle modification and initiate appropriate medication to patients with hypertension. But we should be not consider RDN for patients with resistant hypertension or those who failed to tolerate the side effects of such drugs. Renal Denervation offers a complementary approach to treating hypertension with “always-on” efficacy, which can help our patients achieve a sustained, clinically meaningful blood pressure reduction.
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Our Doctor

Dr. Paul Ong

Senior Consultant Cardiologist

BA (Cambridge)
MB BChir (Cambridge)
MA (Cambridge)
MRCP (UK)
CCST Cardiology (UK)
FRCP (London)
FESC (Europe)