In fast-paced Hong Kong, heavy work pressure, a diet high in fat and sugar, and insufficient physical activity have made the “Three Highs” one of the most common urban chronic diseases. So, what exactly are the “Three Highs”? Traditionally, they refer to hypertension, hyperglycemia, and hyperlipidemia. However, with the rising number of patients suffering from high uric acid, the medical community has begun to pay attention to the threat of the “Fourth High.” This article will provide a comprehensive explanation of the “Three Highs” and the “Fourth High,” including their definitions, causes, and impacts on health, as well as practical tips for screening and prevention to help you manage your health more effectively.
Definitions and Diagnostic Criteria of the“Three Highs” (High Blood Pressure, High Blood Sugar, and High Blood Lipids)
The“Three Highs”refer to three major risk factors related to metabolic and cardiovascular health. Because they often present with no obvious symptoms, they are commonly known as“silent killers.”
| High-Risk Factor | Disease Name | Definition of the “Three Highs” (Common Reference Standards) | Potential Health Risks |
| The First High | Hypertension | According to the American Heart Association (AHA), blood pressure in the range of 120–129 / <80 mmHg is classified as “elevated.” | Stroke, Heart failure, Kidney failure |
| The Second High | Hyperglycemia | According to the American Diabetes Association** (ADA), an HbA1c level of 5.7–6.4% is classified as “prediabetes,” while a level of ≥6.5% indicates diabetes. | Diabetes (Type 1 or Type 2), Retinopathy, Nephropathy |
| The Third High | Hyperlipidemia | Total cholesterol ≥5.2 mmol/L or low‑density lipoprotein cholesterol (LDL‑C, “bad” cholesterol) ≥3.4 mmol/L | Atherosclerosis, Coronary heart disease (CHD), Myocardial infarction (heart attack) |
Both the Hospital Authority and the Department of Health recommend regular health check‑ups, with treatment decisions based on a doctor’s clinical assessment and relevant medical guidelines.
Reference：
*American Heart Association
**American Diabetes Association
The Fourth“High”— High Uric Acid
In recent years, elevated uric acid has been regarded as the “fourth high” following the three major chronic conditions (high blood pressure, high blood sugar, and high cholesterol). Uric acid is a byproduct of the body’s metabolism of purines. It is generally defined as serum uric acid levels >420 μmol/L in men and >360 μmol/L in women. When uric acid production is excessive or its excretion is impaired, the concentration of uric acid in the blood rises, leading to hyperuricemia.
Moreover, high uric acid is not only the direct cause of gout but has also been proven to be closely associated with the development of hypertension, hyperglycemia, and kidney disease. Therefore, incorporating it into chronic disease management is of great importance.
Understanding the Causes of the Three Highs and High Uric Acid
These chronic conditions share interconnected causes and are closely linked to modern lifestyle habits:
High Blood Pressure
- Primary hypertension: The exact cause is unknown, but it is associated with factors such as genetics, high-salt diets, stress, obesity, and smoking.
- Secondary hypertension: Caused by underlying medical conditions, such as kidney disease or endocrine disorders.
Hyperglycemia
- Insulin resistance: Obesity and lack of exercise cause cells to respond sluggishly to insulin.
- Insufficient insulin secretion: Genetic factors or impaired pancreatic function.
- Lifestyle habits: Long-term consumption of high-sugar, high-calorie diets.
Hyperlipidemia
- Dietary factors: Excessive intake of saturated fats and trans fats (such as fried foods and animal organs) leads to elevated levels of “bad cholesterol” (LDL cholesterol).
- Genetic factors: Familial hypercholesterolemia.
- Other diseases: Diabetes, hypothyroidism.
Hyperuricemia
- Purine metabolism disorder: Excessive intake of purines (such as seafood, red meat, alcohol—especially beer).
- Impaired uric acid excretion: Decline in kidney function or use of certain medications.
Common Symptoms of the “Three Highs” and Hyperuricemia
The biggest problem is that in the early stages, the “Three Highs” almost have no symptoms, causing many patients to miss the best timing for treatment.
- Hypertension, hyperglycemia, hyperlipidemia: Usually asymptomatic in the early stages, or only present with nonspecific symptoms such as dizziness and fatigue. When obvious symptoms appear (such as chest pain or blurred vision), complications have often already developed.
- Hyperuricemia: Elevated uric acid levels are also asymptomatic in the early stages. Once urate crystals form in the joints, they can trigger acute gout (joint redness, swelling, and severe pain).
How to Detect the “Three Highs” and Hyperuricemia
Because of the lack of early symptoms, regular health check-ups are the only effective method.
| Test Items | Examination Methods | Purpose |
| Hypertension | Blood pressure monitor (self-measurement or at clinic) | Measure systolic and diastolic blood pressure |
| Hyperglycemia | Fasting blood glucose, glycated hemoglobin (HbA1c) | Assess immediate blood glucose levels and the average blood glucose level over the past 3 months |
| Hyperlipidemia | Lipid profile | Measure total cholesterol, LDL-C, HDL-C (“good cholesterol”), and triglycerides |
| High Uric Acid (Hyperuricemia) | Blood Uric Acid Test | Measures the concentration of uric acid in the blood |
Who Are Considered High-Risk Groups?
- Individuals aged 40 or above
- Those who are overweight or obese (especially with central obesity)
- Individuals with a family history of hypertension, diabetes, or cardiovascular disease
- People with a sedentary lifestyle
- Those with unhealthy eating habits (high in salt, sugar, fat, or purines)
- Long-term smokers and heavy drinkers
- Individuals under high work stress or with chronic sleep deprivation
Long-Term Complications of the “Three Highs” and Hyperuricemia
If left uncontrolled, the four major conditions can severely damage organs throughout the body.
| High-Risk Factors | Major Long-Term Complications |
| Hypertension | Stroke, Heart Failure, Kidney Failure, Aneurysm |
| Hyperglycemia | Diabetic Foot, Retinopathy (Blindness), Nephropathy (Uremia), Neuropathy |
| Hyperlipidemia | Coronary Heart Disease (Angina, Myocardial Infarction), Atherosclerosis |
| Hyperuricemia | Gouty Arthritis, Tophi, Kidney Stones, Chronic Kidney Disease (CKD) |
How to Improve and Control the “Three Highs”?
The key to managing the “Three Highs” lies in lifestyle modifications combined with appropriate medication.
- Dietary adjustments: Adopt the DASH Diet or Mediterranean diet, and limit sodium, saturated fat, sugar, and purine intake.
- Regular exercise: Engage in at least 150 minutes of moderate-intensity aerobic activity per week (e.g., brisk walking, swimming).
- Body Weight & Composition Management: Overweight individuals should aim for a 5% - 10% weight loss to improve health markers; those with a normal BMI should focus on optimizing body composition to maintain a healthy waistline and body fat percentage.
- Quit smoking and limit alcohol: Stop smoking immediately and reduce alcohol consumption.
What foods should people with hypertension, hyperlipidemia, and hyperglycemia avoid?
| Risk Factor | Foods to Avoid or Limit | Recommendations |
| Hypertension (High Blood Pressure) | High-sodium foods (processed, preserved, and canned products) | Daily sodium intake should be limited to less than 2,300 mg |
| Hyperglycemia (High Blood Sugar) | Foods and beverages with added sugar (soft drinks, fruit juice, desserts) | Choose foods with a low glycemic index (GI) |
| Hyperlipidemia (High Blood Lipids) | Saturated and trans fats (red meat, fatty cuts, organ meats, fried foods) | Choose foods rich in unsaturated fats (such as fish, nuts, and olive oil) |
| Hyperuricemia (High Uric Acid Levels) | Foods high in purines (such as organ meats, seafood, red meat, and beer) | Drink more than 2,000 ml of water daily to help excrete uric acid |
Practical Health Tips for Preventing the Three Highs
- Monitor blood pressure at home: Encourage the public to develop the habit of measuring blood pressure at home in the morning and evening, and record the data for doctors’ reference.
- Regular health check-ups: Especially after the age of 40, annual tests for blood lipids, blood sugar, and uric acid are recommended.
- Choose a healthy diet: Eat more vegetables and less meat, and use steaming or boiling instead of deep-frying.
FAQs on Hypertension, Hyperglycemia, and Hyperlipidemia
How Common Are the “Three Highs” in Hong Kong?
According to the Population Health Survey Report 2020–2022, among people aged 15 to 84, 54.6% were overweight or obese, 51.9% had hypercholesterolemia, 29.5% had hypertension, and 8.5% had diabetes. This shows that the prevalence of the “Three Highs” is significant. With an aging population, the “Three Highs” and their complications pose major challenges to Hong Kong’s healthcare system.
At What Age Should You Start Screening for the “Three Highs”?
It is recommended to begin comprehensive screening for the “Three Highs” at the age of 40, with annual check-ups thereafter. However, if you have a family history of related conditions or maintain unhealthy lifestyle habits, it is advisable to consult a family doctor earlier (for example, starting at age 30) to undergo screening.
What Is the Relationship Between Heart Disease and the “Three Highs”?
Heart disease is closely related to the “Three Highs.” They are major risk factors for cardiovascular diseases such as coronary heart disease, myocardial infarction, and heart failure. Hypertension increases pressure on the blood vessel walls, causing them to harden and narrow; hyperlipidemia easily leads to the formation of atherosclerotic plaques inside blood vessels, obstructing blood flow; and prolonged hyperglycemia damages endothelial function, weakens the protective role of blood vessels, and accelerates arteriosclerosis.
Facing the threat of the “Three Highs” or even the “Four Highs,” the best approach is to take proactive action. It is recommended that you schedule a consultation with a family doctor or a specialist at the Hong Kong Heart Center to develop the most suitable prevention and management plan based on your personal condition.
