Hypertensive Heart Disease Specialist in Singapore | Dr Kua Jieli

During your first visit, the cardiologist will review your medical history in detail. This includes your blood pressure patterns, current medications, lifestyle factors, and any symptoms, such as chest pain, shortness of breath, or palpitations. Family history of heart disease or hypertension also provides context for your assessment.

Echocardiography

An echocardiogram is a cardiac ultrasound that uses sound waves to create moving images of your heart. This non-invasive test provides detailed images of your heart’s structure and function, allowing the specialist to:

• Measure heart wall thickness and chamber sizes
• Assess pumping function, including ejection fraction (the amount of blood pumped with each heartbeat
• Evaluate heart valve function
• Detect signs of diastolic dysfunction (when the heart muscle becomes stiff and relaxes poorly)
• Track changes over time with repeat studies

Additional Imaging Options

Depending on your condition, other imaging options may be recommended:

• Cardiac MRI: Provides detailed images of the heart structure and can detect subtle tissue changes
• CT coronary angiogram procedure: Uses specialized X-rays to create detailed pictures that help evaluate the coronary arteries for blockages that often accompany high blood pressure.
• Nuclear stress testing: Assesses blood flow to the heart muscle during exertion

An electrocardiogram (ECG) test records the electrical activity of your heart, detecting left ventricular hypertrophy, rhythm disturbances, or prior heart damage. If palpitations or irregular heartbeats are suspected, ambulatory monitoring using a Holter monitor or event recorder may be arranged.

Blood tests can assess cardiovascular risk and organ function, including:

• Kidney function tests (as hypertension can affect renal health)
• Lipid profile (cholesterol and cardiovascular risk)
  Blood glucose and HbA1c (blood sugar control)
• B-Type natriuretic peptide (BNP or NT-proBNP) or proteins indicating heart strain or heart failure risk
• Thyroid function (as thyroid hormone levels can influence blood pressure)

Our cardiologist will determine the appropriate tests based on your individual risk factors and clinical presentation.

Medication Optimisation

Achieving target blood pressure is fundamental to managing hypertensive heart disease. Our doctor will set targets based on your risk factors. Medication options include:

• ACE inhibitors and ARBs: Block hormonal pathways that raise blood pressure and can help reverse left ventricular hypertrophy.
• Calcium channel blockers: Relax blood vessels and support blood pressure control
• Beta-blockers: Reduce heart rate and cardiac workload, beneficial in heart failure or arrhythmias.
• Diuretics: Help remove excess fluid and lower blood pressure.

Our specialist will adjust medications based on response, side effects, and other health conditions.

Ambulatory Blood Pressure Monitoring

Home or ambulatory blood pressure monitoring tracks blood pressure throughout daily activities and sleep. This helps identify masked hypertension and white-coat syndrome and guides medication timing for optimal control.

If hypertensive heart disease progresses to heart failure, additional treatments may include :

• Heart failure medications such as mineralocorticoid receptor antagonists or newer agents like SGLT2 inhibitors
• Fluid management strategies
• Dietary sodium restriction
• Symptom and weight monitoring
• Cardiac rehabilitation programmes

In select cases, our cardiologist may consider the following interventional approaches:

• Renal denervation: A catheter-based procedure to adjust nerve activity of the kidneys, which can help lower resistant blood pressure.
• Device therapy: Pacemakers or implantable defibrillators for patients with significant heart failure or arrhythmias.

Comprehensive care addresses other cardiovascular risks :

• Coronary artery disease
• Arrhythmias
• Diabetes, obesity, and specialized high cholesterol treatment in Singapore.
• Sleep apnoea screening and treatment

Blood pressure medications are generally well-tolerated, but some patients may experience side effects depending on the medication class and individual response:

• ACE inhibitors (medications that help relax blood vessels): Dry cough in some patients, and rarely angioedema (swelling of deeper layers of the skin)
• Diuretics (medications that help remove excess fluid from the body): Changes in electrolyte levels like potassium and sodium, and increased frequency of urination
• Beta-blockers (medications that reduce heart rate and the cardiac workload ): Fatigue, cold hands or feet, and a slower heart rate
• Calcium channel blockers (medications that relax blood vessels by affecting calcium movement in cells): Ankle swelling and constipation

Side effects can often be managed through dose adjustments or by switching medications. Informing your healthcare provider promptly about any concerns allows timely review and modification of treatment where appropriate.

Even with treatment, hypertensive heart disease may progress in some individuals, particularly when:

• Blood pressure remains persistently above target levels
• Other cardiovascular risk factors, such as high cholesterol or diabetes, are not adequately controlled
• Significant structural heart changes are already present at the time of diagnosis

Regular follow-up and monitoring allow our cardiologist to detect changes early and adjust treatment plans accordingly.

In certain cases, further cardiac procedures or device-based therapies may be considered. Before any intervention, our cardiologist will explain potential risks, including bleeding, infection, and procedure-specific complications. The expected benefits and risks will be discussed to support informed decision-making.