Primary Hypertension, aka “The Silent Killer”

Hello! It's me again, this time bringing you Primary Hypertension, an extremely important health condition which is rapidly rising among Indians in the US.  

Large scale studies such as the MASALA study report that hypertension affects roughly 35-43% of South Asian adults in the US. Asian Indians in the U.S. have a significantly higher prevalence of hypertension before age 50 compared to other populations.  

What is Blood Pressure?  

Blood pressure is the force of your blood pushing against the walls of your arteries as your heart pumps it through your body. Blood pressure is measured in millimeters of mercury (mm Hg). Blood pressure readings have two important numbers. 

• Top number, called systolic pressure. The top number measures the pressure in the arteries when the heart beats. 

• Bottom number, called diastolic pressure. The bottom number measures the pressure in the arteries between heartbeats. 

A diagnosis of high blood pressure (hypertension) is usually based on the average of two or more readings taken on separate visits. The American Heart Association has five categories for blood pressure, which you can see in the picture below. 

Which number is more important? 

A higher systolic or diastolic reading may be used to diagnose high blood pressure. But the systolic blood pressure is more informative about heart disease risk factors for people over 50. As people get older, their systolic blood pressure usually goes up because: 

• Large arteries become stiffer 

• Plaque builds up in their arteries 

• They have higher rates of heart and blood vessel diseases 

  
  

Types of Hypertension 

Hypertension is classified into two main types, primary and secondary. Primary hypertension is high blood pressure that’s not caused by an underlying medical condition. It accounts for 90–95% of all hypertension cases, develops gradually, and is primarily driven by genetics, lifestyle, age, and salt consumption. More information on lifestyle below. 

Secondary hypertension is much more prevalent in young adults than in older populations. Causes include  

• Renal issues: Kidney disease or narrowed arteries supplying the kidneys. 

• Endocrine disorders: Thyroid issues, adrenal gland disorders (like primary aldosteronism), or hormone imbalances. 

• Medications/Substances: Oral contraceptives, over usage of over-the-counter medications like Motrin & Naproxen, decongestants like Pseudofed, or illicit substances. 

• Sleep disorders: Obstructive sleep apnea 

  
  

The Impact of Stress 

There are multiple causes of primary hypertension, but in Indians, stress and unhealthy lifestyle habits are among the most significant contributors. 

Stress can be of two types: 

• Acute stress, which is short-term and usually triggered by immediate challenges. 

• Chronic stress, which lasts over a longer period and often stems from unresolved or persistent issues. 

  
  

In both types, your body releases hormones like adrenaline and cortisol that increase heart rate and blood pressure temporarily. But when stress becomes chronic, this pressure doesn’t ease up, increasing your risk of developing hypertension and other cardiovascular diseases over time. 

Diagnosis and testing: 

Healthcare providers diagnose high blood pressure (hypertension) by using a blood pressure cuff placed around your upper arm. This is a quick, painless test that gives two numbers  systolic and diastolic pressure  to assess how hard your heart is working. 

People with high blood pressure may not feel symptoms. Blood pressure is usually checked during annual health checkups or other routine visits. If your readings are consistently high across two or more visits, your physician may confirm a diagnosis of hypertension. Monitoring can also be done by you at home or at the pharmacy 

Why treat Hypertension 

1. Prevents Heart Attacks and Heart Failure: High blood pressure forces your heart to work harder. Over time, this extra strain thickens the heart muscle and narrows the arteries, leading to coronary artery disease, heart attacks, or heart failure.  

2. Lowers Stroke Risk: High blood pressure is the leading cause of strokes. It can weaken the blood vessels in the brain, causing them to narrow, rupture, or leak. 

3. Protects Kidney Function: Hypertension is a major cause of kidney damage and end-stage renal disease, which can lead to dialysis. It damages the delicate blood vessels in the kidneys, hindering their ability to filter waste from the blood.  

4. Preserves Vision: The tiny, delicate blood vessels in the eyes can be easily damaged by high blood pressure, which can lead to retinopathy, fluid buildup under the retina, and vision loss. 

5. Reduces Dementia Risk: Because hypertension damages arteries throughout the entire body, it restricts healthy blood flow to the brain, contributing to cognitive decline and memory loss as you age.   

Management  

For South Asians, management requires earlier intervention and stricter monitoring due to a genetically higher risk of early-onset cardiovascular disease.  

The treatment strategy for each stage of hypertension is given below. For each stage, the first number represents the systolic pressure, and the second number represents the diastolic pressure. 

1. Elevated Blood Pressure (120–129 / <80 mmHg) 

   • Treatment: Lifestyle modification only. 

   • Action: Adopt heart-healthy changes, such as sodium reduction. Dietary guidelines recommend that adults limit sodium intake to less than 2,300 mg per day (about one teaspoon of salt). Additionally, increase cardio exercise to prevent progressing to clinical hypertension.  

     
     

2. Stage 1 Hypertension (130–139 / 80–89 mmHg) 

   • Treatment: Lifestyle therapy is the first step. Medication is added if you have diabetes, chronic kidney disease (CKD), or a high 10-year cardiovascular disease risk score.  

   • Action: A single first-line medication (such as an ACE inhibitor, ARB, or calcium channel blocker) is generally used if BP targets are not met after 3 to 6 months of lifestyle changes 

     
     

3. Stage 2 Hypertension (≥ 140 / ≥ 90 mmHg) 

   • Lifestyle Changes: Mandatory alongside medical intervention. 

   • Medications: Requires immediate drug therapy, often starting with two drugs from different classes to get blood pressure to a healthy target.  

4. Hypertensive Crisis (≥ 180 / ≥ 120 mmHg) 

   • Urgent Care: Requires immediate medical evaluation. If you record this high reading, wait a few minutes, retest, and contact your doctor.  

   • Emergency: If you experience symptoms like chest pain, shortness of breath, numbness, weakness, or vision changes, call 911 immediately 

   
   

Lifestyle Changes 

These targeted, evidence-based lifestyle changes are highly effective and the best way to prevent and treat hypertension: 

1. Weight Loss: Shedding excess weight is the most impactful intervention. Every 1 kg reduction in weight lowers systolic blood pressure by approximately 1 mm Hg.  

   
   

2. Dietary Changes (DASH & Mediterranean): Diets rich in vegetables, fruits, and whole grains, such as the DASH Diet (dietary approach to stop hypertension) can lower systolic blood pressure by 8 to 14 mm Hg. While some herbs and spices can modestly support heart health by relaxing blood vessels and reducing inflammation, herbal remedies should never replace prescribed blood pressure medication. Many herbs can cause dangerous interactions with heart medicines, so it is essential to consult your doctor before making any changes 

   
   

3. Sodium Reduction: Aim for an ideal limit of 1,500 mg/day, but reducing your intake by even 1,000 mg daily can lower systolic blood pressure by 5 to 6 mm Hg.  

   
   

4. Regular Exercise: Engage 90–150 minutes of moderate-to-vigorous aerobic activity (like brisk walking or cycling) per week. This can decrease systolic blood pressure by 5 to 8 mm Hg.  

   
   

5. Alcohol consumption: zero intake is the best & safest option. There is no truly "safe" level of alcohol consumption, as even moderate drinking increases long-term risks for cardiovascular issues, neurological changes, and certain cancers.  

   
   

6. Stress Management: Incorporating practices like yoga, meditation, or deep breathing can aid in stabilizing heart rate and stress-induced blood pressure spikes. Chanting particularly mindful, slow-paced repetition like "Om"— can help lower both systolic and diastolic blood pressure. Scientific studies suggest that this practice immediately calms the nervous system by stimulating the vagus nerve, reducing the "fight-or-flight" response, and dilating blood vessels.  

Please know your numbers and get treatment before it is too late! Talk to your PCP if readings are elevated. Do not hesitate to start treatment if needed, since uncontrolled blood pressure can cause disabling complications.  

Stay healthy, stay happy, and take care of your heart!  

Thank you, 

Smita Saraf, MD, FAAFP 

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Smita Saraf, MD, FAAFP