I am glad that exercise has helped Madam Teo Yok Wan to manage her spiralling blood pressure and cholesterol ("Teo exercises option to manage health"; last Sunday).

However, there are certain factors which need to be kept in mind when we approach the management of hypertension and hyperlipidaemia. Although diet and exercise are helpful, there are instances when these are not sufficient to bring blood pressure and cholesterol back to normal levels, or to prevent risks of strokes and cardiac complications.

Hypertension and high cholesterol in some individuals are not due primarily to weight and diet; family history and genetic predisposition may be involved.

This is particularly so in cases of spiralling hypertension and hyperlipidaemia, where medications may be needed to control the situation.

Diet and exercise are complementary but they may not be enough to bring the levels down in a shorter time and prevent risks of strokes and cardiac complications. For those with such risks, the conditions may have persisted for some time without their knowledge, and some cardiac decompensation and narrowing of blood vessels may already have taken place.

It may not be a wise option for such individuals to embark on strenuous exercises, such as long-distance running, without checking with their doctors and excluding various risk factors.

There has been a study that demonstrated "pulmonary oedema", that is, water in the lungs, after a marathon in a majority of runners, which lasted for hours. This did not affect the fit runners subsequently, but for those with underlying medical problems, the warning bell is sounded.

By all means, diet and exercise, but be open to medications in situations where it is necessary as part of the management.

Also, do not embark on strenuous exercise without first clearing it with your doctor.

Quek Koh Choon (Dr)