Silent Risks: Blood Pressure, Cholesterol, Prediabetes, Kidneys & Liver

A practical guide to health problems that may progress before you feel unwell

This book provides general health education and does not replace individual diagnosis or emergency medical care.

CHAPTER 1

Home Blood Pressure: How to Get a Reading That Is Actually Useful

Home blood pressure can be useful when technique is consistent. Learn about rest, cuff position, repeated readings and what not to do with one isolated number.

Key points

Sit quietly before measuring and support the arm.

Use the same general time and method when tracking trends.

Repeated very high or very low readings deserve medical advice; do not self-adjust medicines from one reading.

Why this deserves attention

Home blood-pressure monitoring can reveal patterns that a single clinic reading may miss, but poor technique can create confusing numbers. Recent exercise, caffeine, smoking, talking, a full bladder, an unsupported arm or the wrong cuff size can all affect the result. The aim is not to chase the lowest possible number; it is to create readings that are comparable over time.

What makes it more important

The meaning of a reading depends on context. Pain, fever, anxiety and poor sleep can temporarily raise blood pressure. Some medicines can lower it or make standing dizziness worse. A person already diagnosed with hypertension should follow the monitoring plan and target discussed with the treating doctor rather than adopting a generic internet target.

What to do next

Write down the date, time, readings, pulse and anything unusual such as headache, dizziness, missed medication or illness. Bring the log and your monitor to a medical appointment if readings seem inconsistent. Regular screening remains important for people who have never been diagnosed because hypertension often causes no symptoms.

Where TCM may fit

TCM treatment should not be used to “correct” a single home reading. If you receive acupuncture, Tuina or herbs while taking blood-pressure medicines, tell the practitioner about your diagnosis, current medicines and whether you have dizziness or fainting.

When not to wait

If very high blood pressure is accompanied by chest pain, severe breathlessness, new neurological symptoms, confusion or collapse, seek emergency care rather than repeating the measurement again and again at home.

CHAPTER 2

High Cholesterol: A Silent Risk You Cannot Feel

High cholesterol often causes no symptoms. Learn why blood tests, overall cardiovascular risk and follow-up matter even when you feel well.

Key points

A normal-looking body does not guarantee normal cholesterol.

A single number should be interpreted together with your overall cardiovascular risk.

If treatment is prescribed, do not stop it because you “feel fine”.

Why this deserves attention

Cholesterol is carried in the blood and is essential for normal body function, but an unhealthy lipid pattern can contribute to plaque formation in arteries over time. The difficult part is that high cholesterol generally does not make a person feel unwell. Energy level, body size and fitness are poor substitutes for a blood test. A person can exercise regularly and still have a lipid problem because age, genetics, diabetes, smoking, blood pressure and other factors all influence cardiovascular risk.

What makes it more important

Family history of early heart disease, smoking, diabetes, high blood pressure, kidney disease and increasing age can make an abnormal lipid result more important. Extremely high LDL can also suggest inherited cholesterol disorders. The practical question is therefore not simply “Is my cholesterol high?” but “What does this result mean for my personal risk, and what target is appropriate for me?”

What to do next

Use routine screening rather than symptoms to find out. Keep copies of results so you can see trends. Discuss diet, activity, weight, smoking and medicines with a primary-care doctor rather than relying on supplements marketed as “cholesterol cleansers”. If you are eligible for Healthier SG Screening, cardiovascular risk screening can help identify high blood cholesterol together with other silent risk factors.

Where TCM may fit

TCM can be discussed for other concerns such as sleep, stress or musculoskeletal discomfort, but a traditional pattern diagnosis cannot tell you whether LDL or total cardiovascular risk is controlled. Herbal products should also be disclosed because some may interact with prescribed medicines or affect the liver.

When not to wait

Chest pressure, severe breathlessness, collapse, new weakness on one side or other possible heart-attack/stroke symptoms are emergencies and should not be treated as a cholesterol problem to “manage later”.

CHAPTER 3

Prediabetes: Why “I Feel Fine” Is Not Reassuring

Prediabetes often has no obvious symptoms. Learn why screening, weight, activity, sleep and follow-up matter before complications appear.

Key points

Prediabetes is usually found by testing, not symptoms.

Weight, waist size, family history, previous gestational diabetes and activity level affect risk.

Improvement is possible, but follow-up matters even after lifestyle changes.

Why this deserves attention

Prediabetes means blood glucose is higher than normal but not yet in the diabetes range. Most people do not feel different. Waiting for thirst, frequent urination or weight loss is therefore a poor strategy; those symptoms can appear later or may have other causes. Screening identifies risk while there is still time to make meaningful changes.

What makes it more important

Sleep deprivation, highly sedentary routines and weight gain around the abdomen can add to metabolic risk. In Singapore, irregular meals, sweet drinks, long work hours and limited activity can make change feel difficult; small repeatable changes are more useful than a short extreme diet.

What to do next

Use screening and your doctor’s follow-up plan to understand fasting glucose/HbA1c and other cardiovascular risk factors. If eligible, Healthier SG Screening can help identify diabetes risk together with blood pressure, cholesterol and obesity measures.

Where TCM may fit

TCM food advice may be used as a way to think about regular meals and overall dietary habits, but it should not replace glucose testing. Be cautious with herbal products claiming to “lower sugar” because they may interact with medicines or affect liver/kidney function.

When not to wait

Severe dehydration, persistent vomiting, confusion, collapse or breathing difficulty in a person with very high or very low glucose requires urgent medical care.

CHAPTER 4

Waist, Weight and Metabolic Health: Look Beyond the Scale

BMI and waist size are imperfect but useful risk markers. Learn how they connect with blood pressure, glucose, cholesterol and fatty liver.

Key points

Track trends rather than obsessing over a single weight.

Blood pressure, glucose and lipids often provide more useful health information than appearance.

Large rapid weight changes need explanation, not just celebration or blame.

Why this deserves attention

Body weight alone does not describe health. Where fat is stored, muscle mass, blood pressure, glucose and cholesterol all matter. Abdominal fat is particularly associated with metabolic risk. This does not mean every larger person is unhealthy or every thin person is healthy; it means visible appearance cannot replace measurement.

What makes it more important

Shift work, poor sleep, long sitting hours, sugary drinks and frequent eating out can all make metabolic health harder to manage. A realistic plan can include walking, resistance exercise, regular sleep where possible, more minimally processed foods and smaller portions of calorie-dense foods without banning familiar Singapore meals.

What to do next

Ask your primary-care doctor what measurements are appropriate for your age and risk. Healthier SG Screening includes cardiovascular risk assessment for eligible people and can provide a more complete picture than body weight alone.

Where TCM may fit

TCM lifestyle or food discussions can complement a sensible health plan, but claims about “dampness” or “metabolism” should not substitute for measurable markers such as blood pressure, glucose and lipids.

When not to wait

Unexpected rapid weight loss with weakness, persistent fever, bleeding, severe thirst or other concerning symptoms should be medically assessed rather than treated as successful dieting.

CHAPTER 5

Chronic Kidney Disease: Damage Can Begin Before Symptoms

Early chronic kidney disease may cause few symptoms. Learn why diabetes, blood pressure and blood/urine tests matter before swelling or fatigue appear.

Key points

Diabetes and high blood pressure are major CKD risk factors.

Kidney health is assessed with blood and urine tests, not simply urine colour.

Swelling and fatigue can occur later but are not specific to kidney disease.

Why this deserves attention

The kidneys filter waste, balance fluid and electrolytes and support several hormone functions. Chronic kidney disease (CKD) often develops gradually, particularly in people with diabetes or high blood pressure. Early CKD can cause few or no noticeable symptoms, which is why waiting for pain or reduced urine can miss years of opportunity for prevention.

What makes it more important

Other risk factors include older age, previous kidney injury, some autoimmune diseases and certain medicines. Long-term use of medications that can affect kidney function should be reviewed with a clinician rather than stopped abruptly. Herbal products are also not automatically kidney-safe simply because they are natural.

What to do next

If you have diabetes, hypertension or known kidney risk, ask how often kidney blood tests and urine protein checks are appropriate. Control of blood pressure, glucose, smoking and medication safety can help slow progression when problems are found early.

Where TCM may fit

Tell both your doctor and TCM practitioner about reduced kidney function before using herbal formulas. Some herbs or concentrated supplements may be unsuitable in kidney disease or may alter potassium, fluid balance or medicine levels.

When not to wait

Seek urgent care for severe breathlessness, confusion, very little/no urine, rapidly worsening swelling, persistent vomiting or other severe illness in a person with kidney disease.

CHAPTER 6

Fatty Liver: A Common Problem That May Stay Silent

Fatty liver can occur without pain or obvious symptoms. Learn how metabolic risk, alcohol, blood tests and medical follow-up fit together.

Key points

Fatty liver may cause no symptoms for years.

Normal-looking weight does not completely exclude metabolic liver risk.

Liver blood tests and scans answer different questions and need clinical interpretation.

Why this deserves attention

Fat accumulation in the liver is common and often discovered on imaging or blood tests rather than because the person feels ill. It is strongly linked with obesity, diabetes, abnormal lipids and other metabolic risk factors, although not every person with fatty liver is overweight. Alcohol and some medicines can also affect the liver.

What makes it more important

Progression risk differs between people. Diabetes, significant obesity, high blood pressure and other metabolic problems can increase concern about inflammation and scarring. The useful goal is not simply to “remove fat from the liver” but to improve overall metabolic health and identify people who need closer follow-up.

What to do next

Discuss weight, waist size, glucose, cholesterol, alcohol intake and medicines with a doctor. Sustainable activity and dietary change are usually more valuable than aggressive detox diets. If liver tests remain abnormal, further assessment may be needed.

Where TCM may fit

Do not assume herbal “liver cleansing” products are harmless. Some herbal and supplement ingredients can injure the liver. If you use TCM, disclose known fatty liver and recent liver-test results when relevant.

When not to wait

Jaundice, confusion, vomiting blood, black stools, marked abdominal swelling or severe illness requires prompt medical care and should not be managed as ordinary “fatty liver”.

CHAPTER 7

Health Screening When You Feel Well: A Singapore Guide

Screening is designed to detect certain conditions before symptoms appear. Learn how Healthier SG Screening and personalised primary-care advice fit together.

Key points

Screening recommendations depend on age, sex, risk factors and previous results.

More tests are not automatically better; unnecessary tests can create false alarms and follow-up procedures.

A primary-care doctor can help choose appropriate screening and follow up abnormal results.

Why this deserves attention

A common reason for avoiding screening is “I feel fine”. But screening is specifically meant for people who may have no symptoms. High blood pressure, high cholesterol, diabetes and several cancers can be present before a person feels ill. The goal is not to search for every possible disease; it is to use evidence-based tests that have more benefit than harm for the right people.

What makes it more important

Singapore’s 2026 Screening Test Review Committee updated recommendations for several cancers and chronic diseases. MOH emphasises screening in primary care where results can be interpreted and followed up properly. Healthier SG Screening provides subsidised nationally recommended screening for eligible Singaporeans.

What to do next

Ask your enrolled Healthier SG clinic or usual GP what is due rather than relying on a checklist saved years ago. Screening schedules can change and higher-risk people may need a different plan. Keep a simple record of when each test was done and what follow-up was recommended.

Where TCM may fit

TCM health maintenance should not replace evidence-based screening. Feeling more energetic after lifestyle or TCM care also does not confirm that blood pressure, cholesterol, glucose or cancer screening is normal.

When not to wait

Screening is for people without concerning symptoms. If you have unexplained bleeding, a new lump, major weight loss, persistent chest/breathing symptoms or other red flags, seek medical assessment rather than waiting for a routine screening appointment.

References & Further Reading

Singapore Ministry of Health — Screening Test Review Committee 2026

HealthHub / Healthier SG Screening

HealthHub public education on stroke, chronic kidney disease and screening