Understanding hypertension
Also known as high blood pressure, it is a condition where the force of blood pushing against the walls of your arteries is consistently too high. Imagine your heart as a pump and your arteries as pipes. If the pressure inside those pipes becomes too strong over time, it can damage the walls and strain your heart.
Measuring blood pressure
There are two numbers: systolic (when the heart beats) and diastolic (when the heart rests between beats). For example, if your reading is 120/80mmHg, 120 is the systolic and 80 is the diastolic pressure. A normal blood pressure reading is less than 120/80mmHg. When blood pressure remains high for a long time, it increases the risk of problems like heart attack, stroke, kidney disease and vision loss. The danger with hypertension is that it often shows no symptoms, which is why it is commonly called a ‘silent killer’.
Understanding the ranges
At stage one, systolic is between 130 and 139, and diastolic between 80 and 89. Stage two is when systolic is 140 or higher, while diastolic is 90 or higher. It is a hypertensive crisis when systolic is over 180 and diastolic is over 120.
How Indians differ from Caucasians
Indians tend to develop heart disease at a younger age and at lower body weights compared with western populations. We also have a higher prevalence of salt sensitivity, central obesity, insulin resistance and early onset of diabetes. All of these make us more vulnerable even at borderline blood pressure readings. Many Indian doctors prefer to intervene earlier, sometimes even during the ‘elevated’ phase, especially if the person has additional risk factors like family history, diabetes or obesity. This is because studies have shown that cardiovascular events in Indians often occur without warning and at lower blood pressure thresholds.
Do not ignore even slightly elevated readings
Blood pressure above 130/80mmHg should raise concern, especially with other risk factors. Early diagnosis and proactive intervention are critical.
Types
Primary (essential) hypertension: This is the most common and develops gradually. It is usually linked to a combination of genetic and lifestyle factors. Secondary hypertension: Caused by an underlying condition such as kidney disease, thyroid disorders, adrenal gland problems or certain medications (like birth control pills, steroids or overuse of painkillers).
The first type has no identifiable cause. Secondary hypertension often appears suddenly and may be more severe. Diagnosing and treating the root cause of secondary hypertension can sometimes lead to a complete resolution.
Age is a risk factor
Especially for men. Those over 65 or maybe even before that can have it. Hence, frequent check-ups are advised. Women may develop high blood pressure after 65.
Heredity
If your parents or close relatives have high blood pressure, you may have a higher chance of developing it. Inherited traits combined with unhealthy lifestyle habits can trigger it sooner. In India, where family medical histories are often poorly documented, it is even more important to proactively monitor blood pressure.
A weighty issue
Indian diets are often high in salt because of pickles, papads and packaged foods, which increases risk. Fat tissue, especially around the abdomen, produces substances that promote inflammation, insulin resistance and hormonal changes, all of which can elevate blood pressure.
Losing even 5 to 10 per cent of body weight can significantly improve blood pressure control. In some cases, patients who lose significant weight are able to reduce or even stop their blood pressure medications under medical guidance.
Hypertension in children
Though less common, it can occur because of underlying health problems like kidney disease or heart defects. But with increasing obesity and sedentary habits, even healthy children are now showing higher blood pressure levels. Early diagnosis is important.
Sleep is crucial
This is the time the body regulates several processes, including blood pressure. People with sleep apnoea—a condition where breathing repeatedly stops and starts during sleep—experience drops in oxygen levels and repeated awakenings. These disturbances activate the body’s stress response, keeping blood pressure elevated even during the night. Over time, this can lead to chronic hypertension. Poor sleep quality, even without apnoea, also increases stress hormone levels, disrupts natural blood pressure rhythms, and might lead to daytime fatigue and weight gain, further worsening blood pressure. Maintaining good sleep hygiene, such as avoiding screens before bed and sticking to a routine, can have a significant positive effect.
The power of small lifestyle changes
Regular physical activity (even 30 minutes of brisk walking daily), mindful eating, stress-relief practices (like meditation or yoga), adequate sleeping and quitting tobacco can significantly reduce blood pressure. Reduced salt intake means less sodium, hence less fluid retention that can raise blood pressure. However, any decision to reduce or stop medication must be made under doctor’s assistance. Some patients with more advanced hypertension might still need medication, but even in these cases, lifestyle changes enhance the effectiveness of treatment.
The DASH diet
The Dietary Approaches to Stop Hypertension diet is a proven eating plan designed to lower blood pressure. It emphasises fruits, vegetables, whole grains, low-fat dairy, lean protein, nuts and seeds. It also limits foods high in salt, sugar and saturated fat. This diet increases your intake of nutrients like potassium, calcium and magnesium, which are minerals that help control blood pressure. This diet can lower blood pressure within a few weeks, especially when combined with regular exercise.
The buzz about alcohol
When you drink alcohol, your heart starts beating faster, and your blood vessels become narrower. This causes your blood pressure to go up. If this happens occasionally, your body may recover, but if you drink regularly, especially in large amounts, it can lead to sustained high blood pressure, also known as hypertension. Alcohol also affects your nervous system and causes the release of hormones like adrenaline, which make the heart work harder and increase blood pressure even more. Over time, this added pressure can strain your heart, arteries, kidneys and brain, increasing the risk of heart attack, stroke and kidney problems.
Drinking alcohol also adds extra calories, which can lead to weight gain. It can interfere with blood pressure medications, making them less effective. People who already have high blood pressure are usually advised to limit alcohol or avoid it entirely.
Low blood pressure
While it is not always harmful, if it drops too low, it can reduce the flow of blood to the brain and other organs, causing symptoms like dizziness, fainting, blurred vision, fatigue and nausea. Drinking more fluids, eating small frequent meals, avoiding sudden position changes and wearing compression stockings may help. In some cases, medication is required.
Symptoms
In rare cases when symptoms do occur, they may include persistent morning headaches, dizziness, blurred vision, shortness of breath, chest discomfort, nosebleeds, fatigue or confusion—especially when it reaches crisis levels. Such situations demand urgent medical attention.
The illusion of normal
As symptoms are unreliable indicators, regular blood pressure monitoring remains the most effective way to detect and manage hypertension. Most people with high blood pressure will have no noticeable symptoms even if their readings are dangerously high. This asymptomatic nature makes hypertension particularly hazardous because damage to the heart, kidneys, brain and blood vessels can occur quietly over time.
When to start monitoring
Ideally around 18, and earlier if there are risk factors such as obesity, diabetes or family history. For healthy adults, blood pressure should be measured at least once every two years. After 40, or if you are at high risk because of lifestyle or genetic factors, annual monitoring is advisable. People already diagnosed or with related conditions like diabetes or kidney disease should monitor it more frequently, as per their doctor’s advice. Regular monitoring at home can also be helpful to track trends and avoid ‘white-coat hypertension’, where blood pressure rises only in clinical settings.
Diagnosis
Is by use of a blood pressure monitor (sphygmomanometer or digital BP machine). If readings are consistently above 140/90mmHg on different days, a doctor may diagnose it as hypertension. In certain cases, doctors may recommend ambulatory blood pressure monitoring, where a device records your blood pressure over 24 hours during normal daily activities.
At-home monitoring
It helps track how well your treatment is working and detects any sudden changes. For most patients, checking it once in the morning and once in the evening for the first week gives a clear picture. After that, once or twice a week may be sufficient unless your doctor advises more frequent readings. It is important to take the readings at the same time each day, sitting quietly for five minutes beforehand, and using a validated, properly fitting arm-cuff device.
A question of reliability
Home blood pressure monitors are generally reliable if used correctly. Devices with an upper arm cuff are preferred over wrist or finger monitors. Calibration and checking the device against your doctor’s readings from time to time ensures accuracy.
The harms of excess sodium
WHO recommends limiting salt intake to less than 5g per day, about one tea spoon. Reading food labels and choosing ‘low sodium’ or ‘no added salt’ products can help. Cooking at home with minimal salt and avoiding restaurant food is an effective strategy.
Do we need salt in our food?
In many cases, the natural sodium found in fruits, vegetables, grains and dairy products is sufficient to meet our body’s needs. Sodium is essential for fluid balance, nerve function and muscle activity, but only in small amounts.
Is rock salt healthier?
While rock salt may have trace minerals like magnesium and potassium, the difference in health impact is minimal.
Common medications
Doctors have a range of medications to treat high blood pressure, often chosen based on age, other health conditions, and how high the blood pressure is. Common classes include ACE inhibitors (which relax blood vessels), ARBs (which block hormones that raise blood pressure), diuretics (water pills that help the body remove excess sodium and fluid), beta-blockers (which reduce heart rate and output), and calcium channel blockers (which prevent blood vessels from tightening). Medications are often lifelong, but their doses may be adjusted over time based on response and side effects.
Potential side effects
Common issues include frequent urination (from diuretics), dry cough (often from ACE inhibitors), dizziness or light-headedness, fatigue, leg swelling or cold extremities. In rare cases, medications may affect potassium levels, kidney function or cause allergic reactions. The key is to not stop medication suddenly, as this can cause a dangerous spike in blood pressure. If side effects occur, your doctor can switch you to another drug or adjust the dosage.
The slow damage to the heart
Over time, high blood pressure makes the heart work harder than it should. This continuous strain causes the heart muscles, particularly in the left ventricle, to thicken. This is known as left ventricular hypertrophy. While this might initially help the heart pump more forcefully, it eventually reduces efficiency and leads to heart failure. High blood pressure also damages the arteries supplying the heart, accelerating the build-up of plaque (atherosclerosis), which increases the risk of heart attacks, angina and arrhythmias.
Hypertension and kidneys
The kidneys filter waste and excess fluid from the blood, and they need healthy blood vessels to function properly. High blood pressure damages these tiny blood vessels. Over time, this leads to chronic kidney disease. As kidney function declines, fluid and waste accumulate, which in turn can further raise blood pressure, creating a vicious cycle. Many people with uncontrolled hypertension end up needing dialysis or kidney transplants.
The link to the brain
The brain is highly sensitive to changes in blood pressure because it relies on a steady, uninterrupted flow of oxygen-rich blood. When blood pressure is consistently high, it damages arteries in the brain. A blocked artery causes an ischaemic stroke, while a ruptured vessel leads to a haemorrhagic stroke, both of which can be life-threatening. High blood pressure is also linked to vascular dementia, where poor circulation gradually damages the brain’s ability to think, remember or reason.
The role of stress
When you’re stressed, your body releases hormones like adrenaline and cortisol, which prepare you for a ‘fight-or-flight’ response. These hormones temporarily increase your heart rate and narrow your blood vessels, resulting in a spike in blood pressure. If stress is constant, these temporary spikes can turn into a long-term issue.
The eyes have it, too
Hypertension can harm the tiny, delicate blood vessels in the retina, leading to a condition called hypertensive retinopathy. This damage might cause symptoms like blurred vision, reduced clarity or, in severe cases, sudden vision loss because of bleeding or fluid leakage in the eye. Long-term high blood pressure can also lead to optic nerve damage and other complications. As these eye changes can occur silently, regular eye exams are essential.
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Possible damage to arteries
Arteries become stiffer and narrower, a process called atherosclerosis, which reduces blood flow to critical organs and heightens the risk of heart attack or stroke. Peripheral artery disease occurs when arteries outside the heart, especially in the legs, become narrowed or blocked due to a build-up of plaque. High blood pressure contributes to this process by damaging the inner lining of arteries, making them more susceptible to plaque build-up. This reduces blood flow to the limbs, causing pain, cramps and weakness, particularly during walking or exercise. In severe cases, it can lead to ulcers, infections or even amputation. Managing hypertension is a critical step in preventing or slowing the progression of PAD, alongside controlling cholesterol, blood sugar and quitting tobacco.
A connection to sexual dysfunction
High blood pressure can lead to reduced blood flow to various parts of the body, including the reproductive organs. In men, this often causes erectile dysfunction, as the blood vessels in the penis may not dilate properly to maintain an erection. In women, hypertension may reduce sexual desire and arousal because of decreased blood flow or medication side effects.
Pregnancy induced hypertension
Although blood pressure often returns to normal post-partum, women who experience high blood pressure during pregnancy have a risk of developing chronic hypertension, heart disease and stroke later in life. It is important for these women to have regular follow-ups, maintain a heart-healthy lifestyle and monitor their blood pressure even after pregnancy ends.
Management during pregnancy
This has to be careful as it affects both the mother and the baby. Only certain medications are considered safe during pregnancy. Some severe cases necessitate early delivery. Regular postnatal check-ups help identify if treatment is still needed.
Hypertensive crisis
There are two types: hypertensive urgency and hypertensive emergency. In the first, the blood pressure is very high but without any signs of organ damage. It still needs prompt medical attention, but not necessarily emergency hospitalisation. In contrast, a hypertensive emergency includes symptoms such as chest pain, severe headache, vision changes, confusion, difficulty breathing or signs of stroke. This is life-threatening and requires immediate hospital care. Always monitor for symptoms and don’t wait to see if they subside.
The possibility of a reversal
With sustained lifestyle improvements such as weight loss, exercise, dietary changes and stress reduction, many people can achieve normal blood pressure levels. However, for most patients, the goal is to manage and control hypertension effectively rather than cure it.
Yoga and alternative therapies
These and other practices like meditation and deep-breathing exercises have been shown to help lower blood pressure. While not a substitute for medication, these therapies can be powerful complementary strategies.
Challenges in adhering to treatment
These include forgetfulness, side effects from medications, a lack of symptoms, cost of medicines and a poor understanding of the long-term consequences. Cultural beliefs and lack of family support can also play a role. Regular follow-ups, patient education, simple medication schedules and digital reminders can help improve adherence.
Management for the elderly
Requires a balanced approach to prevent complications like dizziness, falls or kidney dysfunction. Blood pressure targets may be adjusted based on overall health and other existing conditions. Doctors often start with lower doses of medication and increase gradually. It is also essential to monitor kidney function and watch for side effects. Lifestyle changes and proper hydration are equally important.
Misconceptions
The major one is that high blood pressure always causes symptoms. Another is the belief that once it is controlled, medication can be stopped. Many also assume that only older people get hypertension or that it’s solely caused by stress.
Quick advice
Don’t panic. Understand that it is a long-term condition and needs continuous attention. Start by making small but steady changes. Knowledge, consistency and a positive mindset can go a long way in ensuring a healthy life.