As hypertension emerges as one of India’s most pressing non-communicable diseases, lifestyle choices, early intervention, and public awareness have become critical in managing its growing burden. Several modifiable factors play a role in its onset and progression, from dietary habits and stress to sleep quality and tobacco use. The challenge is especially complex across various age groups, during pregnancy, and in the presence of comorbidities such as kidney and heart disease.
Dr. Vinay Kumar Bahl, Director of Ramaiah Institute of Cardiac Sciences, spoke to Firstpost about key modifiable risk factors, prevention strategies and treatment options to manage hypertension and reduce its serious complications.
Lifestyle Factors That Reduce Hypertension Risk
Dr. Vinay Bahl: Modifiable lifestyle factors such as diet, weight management, physical activity, alcohol and tobacco consumption and stress control influence blood pressure levels. Excessive salt intake—common in Indian pickles and processed foods—is a major contributor. Following the DASH (Dietary Approaches to Stop Hypertension) diet rich in fruits, vegetables, whole grains and low-fat dairy can significantly lower blood pressure.
Maintaining a healthy weight is crucial. Women with a waist size above 32 inches and men above 38 inches face a higher risk of hypertension. Only 5–10% of young adults can lower their hypertension risk through lifestyle changes, while in older adults, weight loss significantly reduces cardiovascular stress.
Physical activity like walking, cycling, or swimming improves vascular function. However, in certain cases, it can trigger a “fight or flight” response. Older adults tend to benefit more from dietary changes, while weight loss markedly reduces cardiovascular stress in this group. Physical activity improves vascular health, but urban youth should also limit alcohol consumption and avoid tobacco. These early lifestyle interventions have long-term health benefits.
Hypertension During Pregnancy: Diagnosis and Treatment
Dr. Vinay Bahl: According to Indian guidelines, pregnancy-induced hypertension (PIH) is diagnosed with two BP readings of ≥140/90 mmHg, taken at least four hours apart. Severe hypertension is defined as systolic BP ≥160 mmHg or diastolic BP ≥110 mmHg. Hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, are among the leading causes of maternal mortality and perinatal morbidity in India. Early detection and management are key to maternal and fetal safety.
Common first-line medications include labetalol, nifedipine, and methyldopa. Other options include hydralazine and low-dose aspirin for high-risk patients to prevent preeclampsia. Regular monitoring of both maternal and fetal health is vital to ensure treatment effectiveness and safety. Monitoring includes fetal growth, hematocrit levels, and maternal well-being. In cases of preeclampsia or severe hypertension, prompt intervention can prevent complications such as eclampsia, placental abruption, or intrauterine growth restriction (IUGR). Delivery planning depends on gestational age and risks to both the mother and fetus. A multidisciplinary team of obstetricians, physicians, and neonatologists plays a crucial role in ensuring safe outcomes.
Stress, Sleep and Processed Food’s Impact
Dr. Vinay Bahl: Stress, poor sleep habits, and reliance on processed foods are major contributors to hypertension in India. Chronic stress elevates hormones like cortisol and adrenaline, leading to artery constriction and increased heart rate, which raise blood pressure over time. Inadequate sleep—especially less than six hours—disrupts the body’s circadian rhythm and weakens the heart’s capacity to regulate blood pressure.
These lifestyle habits also promote weight gain, insulin resistance, and vascular inflammation. Evidence-based strategies like deep breathing, yoga, and regular exercise help manage stress. Healthy sleep practices include maintaining consistent sleep times and sleeping in dark, quiet environments. Finally, a diet low in sodium and rich in fresh fruits and vegetables is essential to reduce long-term hypertension risk.
Smoking’s Effect on Blood Pressure and Heart Health
Dr. Vinay Bahl: Smoking is a leading contributor to hypertension. Nicotine stimulates the sympathetic nervous system, releasing catecholamines (adrenaline and noradrenaline), resulting in vasoconstriction, increased heart rate, and elevated cardiac output. It also causes endothelial dysfunction and reduces nitric oxide availability, which stiffens arteries.
Long-term exposure to smoking leads to oxidative stress and vascular inflammation, resulting in atherosclerosis. Hypertensive smokers are at significantly increased risk of myocardial infarction, stroke, heart failure, peripheral artery disease, aortic aneurysm, and sudden cardiac death. Smoking amplifies damage to an already stressed heart. Therefore, smoking cessation is critical. Clinical data shows progressive normalization of blood pressure and improved heart health after quitting.
Pre-Hypertension in Youth: Early Warning and Prevention
Dr. Vinay Bahl: In Indian youth, pre-hypertension is linked to obesity, high sodium intake, physical inactivity, and family history. Abdominal fat and junk food consumption contribute to early increases in blood pressure and elevate lifelong cardiovascular risks.
Lifestyle interventions—such as reducing sodium and saturated fat intake, managing weight, and exercising regularly—can significantly improve heart health. Regular BP checkups, especially with a family history of hypertension, allow for early detection. If untreated, pre-hypertension increases the lifetime risk of heart failure.
How Uncontrolled Hypertension Harms the Heart
Dr. Vinay Bahl: Chronic high blood pressure strains the heart, leading to left ventricular hypertrophy (thickened heart muscle), reducing the heart’s pumping efficiency and raising the risk of coronary artery disease and heart failure. Hypertension can stretch and scar heart tissue, disrupting electrical impulses and causing arrhythmias or abnormal heart rhythms. It also increases the risk of clot formation, which can lead to strokes.
Warning signs include breathlessness, chest pain, palpitations, dizziness, fainting, and swollen legs. These symptoms are often overlooked in India but should prompt immediate medical attention.
Kidney Damage and Hypertension
Dr. Vinay Bahl: Uncontrolled hypertension is a leading cause of kidney failure in India. It damages blood vessels in the kidneys, leading to protein leakage in urine and reduced kidney function. As the kidneys deteriorate, they retain sodium and water and activate the renin-angiotensin system, further raising blood pressure.
Most Indians remain undiagnosed until late stages, presenting with edema, weakness, and reduced urine output. Early screening, including urine protein tests and monitoring creatinine levels, helps detect damage. ACE inhibitors are effective in managing hypertension and protecting kidney function.
Common Antihypertensive Drugs and Their Use
Dr. Vinay Bahl: In India, hypertension is managed using a variety of drug classes tailored to patient-specific factors and comorbidities. Common classes include diuretics, beta-blockers, ACE inhibitors, ARBs, calcium channel blockers, and alpha-blockers.
Diuretics are cost-effective first-line options but may cause electrolyte imbalances. Beta-blockers are preferred in cases of myocardial infarction and heart failure but used cautiously in asthma.
ACE inhibitors and ARBs are kidney-protective and ideal for diabetic patients but require monitoring for hyperkalemia and renal dysfunction. ACE inhibitors may cause chronic cough in some patients and can be substituted with ARBs.
Calcium channel blockers are effective in older patients and have minimal metabolic side effects, although they may reduce peripheral perfusion.
Alpha-blockers are not first-line but useful in patients with benign prostatic hypertrophy.
During pregnancy, ACE inhibitors and ARBs are contraindicated. Labetalol and methyldopa are safer alternatives. Drug selection depends on patient history, comorbidities, and monitoring capabilities.
Advanced Treatments for Resistant Hypertension
Dr. Vinay Bahl: In cases where blood pressure remains uncontrolled despite lifestyle changes and three or more medications, the condition is termed resistant hypertension. Before advanced treatments, clinicians must rule out pseudo-resistance (due to poor compliance or dosing) and secondary hypertension.
Renal artery angioplasty is used for renovascular hypertension. Renal denervation (RDN), a minimally invasive procedure, deactivates sympathetic nerves in the kidney. Baroreceptor stimulation is another device-based treatment targeting the heart’s pressure regulation systems. These options are reserved for select patients after careful evaluation. With increasing availability of these therapies in India, personalized treatment for resistant hypertension is becoming more feasible.
Dr. Vinay Bahl: Tests include ophthalmoscopy, urine protein analysis, chest X-rays, ECG, echocardiography, and arterial stiffness measurement. Screening frequency depends on individual risk but annual eye and kidney tests are generally recommended.