Hypertension (high blood pressure)

Hypertension — "high BP" — is the most common chronic condition we treat. About 1 in 4 Indian adults has it, but fewer than half know they have it, and only about a third of those diagnosed achieve good control. The numbers are similar in Kalyana-Karnataka. The condition is called the "silent killer" because most people have no symptoms until the damage is already done — a heart attack at 50, a stroke at 55, kidney failure at 60.

What is "high"?

The bar has tightened over the last decade:

• Normal — below 120/80
• Elevated — 120-129 / below 80
• Stage 1 hypertension — 130-139 / 80-89
• Stage 2 hypertension — 140/90 or higher

A single reading isn't diagnostic. We diagnose hypertension after at least two elevated readings, taken on separate occasions, in a calm setting. White-coat hypertension (high BP in clinic but normal at home) is real — that's why we often ask patients to do home-monitoring for 2 weeks before starting medication.

How we diagnose and work up

For every new BP patient at Asian Hospital we do:

• Two clinic measurements (or one clinic + a 2-week home log).
• ECG to look for left ventricular hypertrophy — a sign of long-standing untreated BP.
• Lipid profile + fasting sugar + creatinine + urine routine — to check for the co-travellers (cholesterol, diabetes, kidney effect).
• Secondary-cause screen when the BP is unusually high or in a young patient — thyroid, renal artery imaging, hormones.

Treatment

Mild BP (Stage 1 in low-risk patients) starts with lifestyle: lower salt intake (target under 5 g/day — a Tier-2 challenge given how much salt is in our pickles, papad, namkeen), 30 min of walking 5 days a week, weight loss if applicable, alcohol moderation. Many patients can avoid medication entirely on lifestyle alone.

Moderate-to-severe BP needs medication. We typically start with one of:

• ACE inhibitors / ARBs (ramipril, telmisartan) — especially when there is diabetes or kidney involvement.
• Calcium channel blockers (amlodipine) — well-tolerated, the most-prescribed first-line in India.
• Diuretics (chlorthalidone, hydrochlorothiazide) — often added as a second drug.

The target is below 130/80 for most patients, lower (under 120) for diabetics and patients with kidney disease. BP is rarely controlled on one drug long-term — it is normal to need two or even three medications in combination, and that is not a sign of failure.

Why bother

Bringing BP from 160/100 down to 130/80 reduces stroke risk by about 40% and heart attack risk by about 25%. Those are the numbers that should sit on your kitchen wall. If a family member has BP and is not on regular medication, please bring them in — the visit pays for itself many times over.