"But I Feel Perfectly Fine" — Why That Means Nothing
According to the National Family Health Survey, 1 in 4 Indian adults has hypertension. But here's the alarming part: among those with high blood pressure, only 12% have it under control.
The reason? High blood pressure doesn't announce itself. You could have a reading of 160/100 mmHg for years and feel perfectly fine — no headaches, no dizziness, nothing. By the time symptoms appear, the damage to your heart, brain, kidneys, and eyes is already done.
This is why it's called "the silent killer." Millions of Indians are walking around with elevated blood pressure right now, feeling perfectly healthy, while their arteries silently deteriorate.
Why "The Silent Killer" Isn't Just a Catchy Name
High blood pressure damages the body slowly, imperceptibly, year after year. By the time symptoms appear, organ damage is already present.
Think of it like water pressure in old pipes. Too much pressure doesn't cause an immediate flood — it slowly weakens the pipes, creates micro-cracks, strains the joints. One day, the pipe bursts. But the damage started years earlier.
What High Blood Pressure Does Over Years:
- Arteries: Forces them to thicken and harden (atherosclerosis)
- Heart: Makes it work harder, causing it to enlarge and weaken
- Brain: Damages small vessels, increasing stroke and dementia risk
- Kidneys: Destroys the filtering units, leading to kidney failure
- Eyes: Damages retinal blood vessels, threatening vision
The tragedy is that this damage is preventable. Not with expensive medications or complicated treatments — often with changes as simple as eating less salt, walking more, and sleeping better.
The Numbers Everyone Should Know
Blood pressure is recorded as two numbers: systolic (the pressure when your heart pumps) over diastolic (the pressure between beats).
| Category | Systolic (mmHg) | Diastolic (mmHg) | Interpretation |
|---|---|---|---|
| Optimal | Below 120 | Below 80 | Excellent — maintain this level |
| Normal | 120-129 | 80-84 | Good, but don't let it creep up |
| High Normal | 130-139 | 85-89 | Attention needed — lifestyle changes now |
| Stage 1 Hypertension | 140-159 | 90-99 | High blood pressure — action required |
| Stage 2 Hypertension | 160 or higher | 100 or higher | Serious — treatment needed now |
| Hypertensive Crisis | 180 or higher | 120 or higher | Emergency — seek immediate care |
The 2017 Guideline Shift:
American guidelines now define hypertension as 130/80 or higher (not 140/90). This is controversial — some say it over-medicalizes normal variation. A pragmatic view: at 130-139/85-89 with no other risk factors, lifestyle changes are enough. With diabetes, kidney disease, or prior cardiovascular events, that same reading might need treatment.
India's Blood Pressure Crisis
The statistics are genuinely alarming:
- 30% of urban Indians and 20% of rural Indians have hypertension
- Only 25% of those with hypertension are aware of their condition
- Only 10-11% are adequately controlled
- Every year, hypertension causes 1.6 million deaths in India
- Indians develop hypertension 10 years earlier than Western populations
India is one of the most hypertensive nations on earth, and largely in denial about it.
Why Indians Are Uniquely Vulnerable
Salt: The average Indian consumes 10-11 grams of salt daily. The recommended limit is 5 grams. Our food culture — achars, papads, processed snacks, restaurant food — is drenched in salt.
Potassium Deficiency: Salt raises blood pressure; potassium lowers it. Modern Indian diets are low in potassium-rich foods (vegetables, fruits, legumes) and high in sodium. The imbalance is devastating.
Stress: The economic and social pressures of modern Indian life — job insecurity, family obligations, urban crowding, traffic — create chronic stress that elevates blood pressure.
Sedentary Life: The transition from walking miles daily to sitting for 10+ hours. Physical inactivity is a direct contributor to hypertension.
Genetics: South Asians have higher rates of hypertension-related complications at the same blood pressure levels as other ethnicities.
The Truth About White Coat Hypertension
Many people report: "My BP is only high at the doctor's office. At home, it's normal."
This is "white coat hypertension" — a real phenomenon. The anxiety of a medical setting can raise blood pressure by 10-20 points.
But here's the reality:
White Coat Hypertension Isn't Harmless:
Studies show that people with white coat hypertension have higher cardiovascular risk than those with truly normal blood pressure. It's a marker of blood pressure variability and often predicts future sustained hypertension.
White coat hypertension needs monitoring — not dismissal.
Conversely, some people have normal readings at the doctor but high readings elsewhere — "masked hypertension." This is even more dangerous because it goes undetected and untreated.
The solution? Home monitoring.
How to Measure Blood Pressure Properly
Most people measure blood pressure wrong. Here's how to do it correctly:
Equipment
- Use an automatic upper arm cuff — wrist devices are less accurate
- Buy a validated device (Omron is a reliable brand)
- Make sure the cuff size fits your arm (too small = falsely high readings)
Preparation
- Don't eat, exercise, smoke, or drink caffeine for 30 minutes before
- Empty your bladder (a full bladder can raise BP by 10 points)
- Sit quietly for 5 minutes before measuring
Position
- Sit with back supported, feet flat on the floor (not crossed)
- Rest arm on a table at heart level
- Don't talk during measurement
Technique
- Take 2-3 readings, 1 minute apart
- Average the readings
- Measure at the same time daily (morning is ideal)
- Keep a log to show your doctor
When Lifestyle Is Enough — And When It Isn't
Not everyone with high blood pressure needs medication. Here's the framework:
Lifestyle Changes Only (No Medication):
- BP 130-139/85-89 with no other risk factors
- Newly diagnosed Stage 1 hypertension (140-159/90-99) in otherwise healthy young adults
- Willing to make and sustain significant lifestyle changes
Lifestyle Plus Medication:
- Stage 1 hypertension with diabetes, kidney disease, or heart disease
- Stage 1 hypertension not controlled after 3-6 months of lifestyle changes
- Stage 2 hypertension (160+/100+) — medication from the start
- Any hypertension with target organ damage
The DASH Diet Effect:
The DASH diet (Dietary Approaches to Stop Hypertension) can lower blood pressure by 8-14 mmHg — as much as some medications. It emphasizes fruits, vegetables, whole grains, lean proteins, and low sodium. It works. The challenge is that most people struggle to stick with it.
The Lifestyle Changes That Actually Work
Here's what the evidence shows — with realistic expectations:
| Intervention | Expected BP Reduction | Practical Advice |
|---|---|---|
| Weight loss (5-10 kg) | 5-20 mmHg | Biggest impact. Even 5 kg makes a difference. |
| DASH diet | 8-14 mmHg | More vegetables, less processed food. |
| Sodium reduction (to 5g/day) | 5-8 mmHg | Cook at home. Avoid restaurant food and processed snacks. |
| Exercise (30 min/day) | 4-9 mmHg | Walking counts. Consistency beats intensity. |
| Limit alcohol | 2-4 mmHg | Maximum 2 drinks/day for men, 1 for women. |
| Potassium increase | 4-5 mmHg | Bananas, potatoes, coconut water, leafy greens. |
Combined, these interventions can reduce blood pressure by 20-30 mmHg — equivalent to 2-3 medications. But they require sustained effort.
The Medications: What You Should Know
If medication is needed, here's a plain-English guide:
ACE Inhibitors (names ending in -pril)
Examples: Enalapril, Ramipril, Lisinopril
How they work: Block a hormone that raises blood pressure
Bonus: Protect kidneys and heart
Side effect: Dry cough in some people (10-15%)
ARBs (names ending in -sartan)
Examples: Losartan, Telmisartan, Olmesartan
How they work: Similar to ACE inhibitors but without the cough
Bonus: Good for diabetics, protect kidneys
Calcium Channel Blockers
Examples: Amlodipine, Cilnidipine
How they work: Relax blood vessels
Side effect: Ankle swelling (especially with amlodipine)
Diuretics ("Water Pills")
Examples: Hydrochlorothiazide, Chlorthalidone
How they work: Remove excess salt and water
Side effect: Increased urination, may affect potassium
Beta Blockers
Examples: Metoprolol, Atenolol, Bisoprolol
How they work: Slow heart rate and reduce pumping force
Side effect: Fatigue, cold hands, exercise intolerance
Many people need 2-3 medications to control blood pressure adequately. This isn't failure — it's physiology. Different drugs target different mechanisms.
Common Questions About Blood Pressure
"Can I stop my medication once my BP is normal?"
Usually no. The medication is keeping it normal. Stop the medication, and BP typically rises again. Some people with mild hypertension who make substantial lifestyle changes can taper off, but this should be done under medical supervision.
"I don't want to take medication for life."
An understandable concern. But think of it this way: teeth are brushed for life, glasses are worn for life if needed, exercise is done for life. Blood pressure medication prevents strokes and heart attacks. The minor inconvenience is worth the protection.
"Are there natural alternatives?"
Lifestyle changes are natural and effective. Some supplements (hibiscus tea, omega-3s, magnesium, coenzyme Q10) have modest effects. But none are as reliable as medication when truly needed. "Natural" doesn't always mean "enough."
"My BP varies a lot. Is that dangerous?"
Some variation is normal. But excessive variability (swinging from 130 to 180) is itself a risk factor for stroke. This often indicates blood vessel stiffness and needs attention.
"What about home remedies like lauki juice or bitter gourd?"
These won't hurt, but they won't reliably control hypertension either. Don't delay proper treatment hoping for a home remedy to work.
Special Situations
Pregnancy
High blood pressure during pregnancy is dangerous — it can lead to preeclampsia, a life-threatening condition. Many BP medications are unsafe during pregnancy, so management is specialized. If pregnant or planning to be, discuss this with a doctor immediately.
Elderly
Blood pressure tends to rise with age as arteries stiffen. Treatment goals may be slightly more relaxed in very elderly patients (below 150 rather than below 140) to avoid falls and dizziness.
Diabetes
Diabetics should target below 130/80 — tighter control is important because they're already at higher cardiovascular risk. ACE inhibitors or ARBs are preferred because they protect the kidneys.
Kidney Disease
A vicious cycle: hypertension damages kidneys, and damaged kidneys raise blood pressure. Aggressive BP control slows kidney decline. Target is typically below 130/80.
Your Blood Pressure Action Plan
Key Takeaways:
- Get checked: Every adult should know their blood pressure. Buy a home monitor if over 40.
- Don't wait for symptoms: The absence of symptoms means nothing. Damage happens silently.
- Track over time: One reading means little. Trends tell the story.
- Cut the salt: This alone can prevent hypertension in many people.
- Move daily: Even 20 minutes of walking helps.
- Take medication if needed: Don't let fear of pills lead to a stroke.
- Stay consistent: Control today doesn't mean cure. This is a lifelong condition.
The Conversation India Needs to Have
In India, diabetes, thyroid, and cholesterol are discussed freely. But blood pressure remains in the shadows — perhaps because it's so asymptomatic, so easy to ignore.
Every family gathering has that uncle who says, "My BP was high once, but I felt fine so I didn't take the tablets." Every office has that colleague who jokes about their "tension" while ignoring their hypertension.
Ramesh's story is tragically common. Young, successful, with decades of life ahead. He felt fine. He ignored his blood pressure because it didn't seem urgent.
High blood pressure is one of the most treatable conditions in medicine. There are effective medications, proven lifestyle interventions, and clear targets. There's no reason for anyone to have a stroke or heart attack from uncontrolled hypertension.
The only barrier is awareness and action.
Check your blood pressure. Know your numbers. Don't wait until you feel something, because you probably never will.
The silent killer only wins when it's allowed to stay silent.
Track your blood pressure trends with ExaHealth. Log your readings and understand your patterns — because the numbers over time tell a story that a single reading never can.
