Think about what goes on in a cath lab when someone has an angioplasty. There's a patient in pain, brought in urgently because his arteries were nearly closed and circulation to his heart was being impeded. This particular procedure involves making a small incision in the patient's wrist, rather than the older method of opening him up for open-heart bypass surgery. A guidewire is fed through the blockage, and then a stent is inserted to hold the passage open. The whole procedure takes less than an hour.
It's part of the modern medicine marvel. A procedure that used to require someone to be opened up in a far more brutal surgery with an extended recovery period now takes under an hour. I've been in this field long enough that this just doesn't impress me anymore. What impresses me and worries me deeply is what happened before the problem got down to the point where they needed a stent or a bypass or any kind of surgery to resolve it.
A few months ago, I discharged a man in his sixties after an angioplasty. His grandson, 25 years old, waited outside through most of it. From that day, the grandfather became one of the most closely tracked people in the health system – periodic echocardiograms, titrated medication, and a structured follow-up plan. The grandson has never had his blood pressure measured, not once that he could recall. Same family, and an almost complete inversion in how closely each is watched by medicine.
This, I think, is the real gap. We are extraordinarily attentive to people after they nearly lose their hearts, and largely silent about the decades before. All of it, except the one number that would tell the grandson something real about his own cardiovascular future. A blood pressure reading takes a cuff and thirty seconds. Almost no one his age bothers.
Even our NCD screening under Ayushman Arogya Mandirs begins at 30, leaving most of this decade unscreened by design. According to data from the National Family Health Survey, between NFHS-4 (2015–16) and NFHS-5 (2019–21), the prevalence of prehypertension among 15-to-24-year-olds climbed significantly from 38.9% to 44.5% in men and from 21.1% to 26.9% in women. Over the same period, hypertension among young men increased from 5.2% to 6.2%, while remaining stable at approximately 4.0% among young women.
That same gap shows up in a different form when I look at who actually walks into my OPD. Some of the young adults I now see are visibly active: gym, protein shakes, running marathons. What has not necessarily improved alongside it is the invisible layer – blood pressure, fasting blood sugar, lipid profiles.
What is actually driving this
Sodium (salt) intake of Indian adults remains significantly above the 5 grams of salt recommended by WHO. The primary contributors are salt added during and after home cooking, ultra-processed and delivery-ordered foods.
Stopping hypertension before it starts, or at least postponing it, is still our strongest defence against cardiovascular disease. From the age of 18 onward, an annual health checkup ought to be given. Not only for blood pressure, but also for blood sugar and lipid levels, since together they provide a complete view of your vascular health. Beyond screening, a healthy heart demands a holistic daily effort: reducing sugar and salt.
Remaining physically active by walking whenever you can, making quality sleep a priority, and faithfully sticking to prescribed medications. Keeping your blood pressure in check is not a passive waiting game; it is an active, everyday investment in living longer.
Where I think we are headed and what would help
There are some promising signs that the environment around food is beginning to change, with proposals for clearer front-of-pack labelling on salt, sugar, and fat content currently under active discussion at the regulatory level and, if implemented correctly, could make the healthier choice the easier choice to see.
On my side of the table, the shift I try to make is in how I counsel. Young patients often resist the idea of long-term treatment; a diagnosis at twenty-six can feel like an identity, not a number to be managed. I try to reframe it as such, and where medication is necessary, I lean towards the simplest possible regimen, a single pill combination where appropriate, because it is usually adherence, not willpower, that determines long-term outcomes. I ask about caffeine and sleep as routinely as I do family history. And increasingly, I ask the patient to open their food delivery app and simply look at what they have ordered in the last month. It is often the most honest dietary history I get.
Closing the loop
That grandfather walked out fine. Weeks later, that was modern cardiology doing what it does best. His grandson's story is still unwritten, and how it ends isn't a question of medicine's limits, but of whether anyone watches the decade before, not just the hour after.
Prof. Surender Deora, Professor & HOD, Department of Cardiology, AIIMS Jodhpur.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
