World Heart Day: Why every Indian must pay attention to blood pressure

Hypertension’s cruelty is that it asks nothing of you until it takes everything. Most people feel no pain or symptoms, though a small minority get warning signs like headaches or dizziness. For years, it slowly damages the heart, brain and kidneys, then, without warning, speaks all at once with a stroke, a heart attack, or failed kidneys. A parent driving to work may struggle to speak, walk, or recognise loved ones. Survivors call stroke worse than death; families ask too late how this happened when all seemed normal.

Often, the answer is a number no one thought to check: blood pressure. High blood pressure is quietly at work for years before it declares itself. This World Heart Day, observed under the theme “Don’t Miss a Beat”, the most important beat may be the pressure pulsing, unnoticed, through our arteries.

Cardiovascular disease is the world’s leading killer, claiming nearly 20 million lives a year, and in India it strikes earlier: heart attacks and strokes are increasingly common among adults in their forties and fifties, with uncontrolled blood pressure driving many premature deaths. The WHO estimates 1.4 billion adults aged 30-79 live with hypertension; only 1 in 5 have it controlled. India’s numbers are more sobering: the ICMR-INDIAB study estimated 315 million Indian adults have hypertension, and a survey found fewer than three in ten were aware of it, one in seven were on treatment, and just one in eight had it controlled. Hypertension is a key modifiable driver of India’s cardiovascular epidemic, raising the risk of heart attack, stroke and kidney disease.

The consequences ripple far beyond the patient. Stroke is now India’s fourth leading cause of death and fifth leading cause of disability, leaving many survivors unable to walk, speak or work independently. Families bear the brunt: incomes vanish, caregiving shifts, and parents postpone children’s education or weddings. A survey found nearly three in ten households seeking stroke treatment in public hospitals face catastrophic expenditure, while more than a third resort to distress financing, selling assets or taking on debt. Hypertension prevention thus protects household stability and dignity, not just health.

There is real progress to build on. The India Hypertension Control Initiative by the ICMR, the Ministry of Health and Family Welfare, and global partners including the WHO and Resolve to Save Lives showed what is possible. Blood pressure control in public facilities increased from 37 to 48 per cent between 2018 and 2024, while out-of-pocket medicine costs fell from 47 to 9 per cent. This proves that simple, well-run systems with reliable drug supplies, standard treatment protocols and follow-up care can result in favourable outcomes. Extending this further, the ICMR’s STAR NCD programme is evaluating system-level interventions for ambulatory care, particularly to improve the care cascade for hypertension and diabetes.

Hypertension is predictable and largely preventable, and small, consistent choices can make a measurable difference. Indians consume 8 to 11 grams of salt a day, nearly double the WHO’s recommended limit of under 5 grams; reducing intake by reducing total salt consumption, or by using low-sodium, potassium-enriched substitutes, can be highly effective. A large Chinese trial followed nearly 21,000 people for five years and found such a substitute reduced strokes by 14 per cent, major cardiovascular events by 13 per cent and deaths by 12 per cent. Diets rich in fruits and vegetables, regular activity, managing weight, and limiting alcohol and tobacco all help in controlling high blood pressure. Routine check-ups, even when well, can catch the condition before a catastrophic emergency. Therefore, every adult should measure BP around age 20 and every five years thereafter if normal. Those with prehypertension (BP 120/80 to 140/90) should check annually, and those diagnosed should stay compliant with prescribed medication and follow a healthy lifestyle.

Hypertension prevention does not demand reinvention, only consistency. These modest choices compound into a lower risk of heart attacks and strokes that can upend not just one life, but an entire family’s future. This World Heart Day, the message is clear: do not wait for symptoms that may never come. Know your numbers, get checked, and encourage your family to do the same. High blood pressure may be silent, but our response must not be, and the time to act is today.

The writer is the Executive Director, Centre for Chronic Disease Control; Views presented are personal.