High blood pressure (hypertension) means the force of blood against your artery walls stays too high over time. It usually causes no symptoms, which is why it is called a silent risk, yet it is a leading cause of heart attack, stroke and kidney failure. In most guidelines a reading of 140/90 mmHg or higher on repeated measurements means hypertension, and the only way to know your numbers is to get them checked.
Key takeaways
- More than one in three Indian adults has high blood pressure, and many do not know it.
- A normal reading is below 120/80 mmHg. Readings of 140/90 or more on two different days confirm hypertension under WHO criteria.
- Home monitoring with a validated upper-arm machine, done the right way, gives a truer picture than an occasional clinic reading.
- WHO advises adults to eat less than 5 g of salt a day, just under one teaspoon, including salt already in food.
- Very high readings with chest pain, breathlessness, weakness, confusion or vision changes need emergency care: call 108 or 112.
What the numbers mean
Blood pressure is written as two numbers. The top number (systolic) is the pressure when your heart beats. The bottom number (diastolic) is the pressure when the heart rests between beats. Both are measured in millimetres of mercury (mmHg).
Blood pressure categories
The American Heart Association groups adult readings as follows.
| Category | Systolic (top) | Diastolic (bottom) |
|---|---|---|
| Normal | Below 120 | and below 80 |
| Elevated | 120 to 129 | and below 80 |
| Stage 1 hypertension | 130 to 139 | or 80 to 89 |
| Stage 2 hypertension | 140 or higher | or 90 or higher |
| Hypertensive crisis | Above 180 | and/or above 120 |
WHO and many Indian programmes use 140/90 as the diagnostic threshold. Do not worry too much about which label applies to a reading of, say, 132/84. What matters is that anything above normal deserves attention, lifestyle changes and a follow-up plan with your doctor.
Why it is called a silent risk
Most people with high blood pressure feel perfectly well. The WHO estimates that about 44% of adults with hypertension worldwide, roughly 600 million people, are unaware they have it.
In India the picture is similar. The ICMR-INDIAB national study found that 35.5% of adults had hypertension. The India Hypertension Control Initiative estimates that around 20 crore Indian adults have high blood pressure, but only about 2 crore have it under control.
What uncontrolled BP does over time
Constant high pressure strains the artery walls and the heart. Over years, it can lead to:
- Heart attack and heart failure
- Stroke and vascular dementia
- Chronic kidney disease
- Damage to the blood vessels of the eyes
Who is at higher risk
Risk rises with age and with a family history of hypertension. People of South Asian origin are among the groups at higher risk.
Factors you can change include a salty diet, excess weight (especially around the waist), physical inactivity, smoking or chewing tobacco, heavy drinking, long-term stress and poor sleep. Diabetes and kidney disease also often go hand in hand with high blood pressure.
How to measure blood pressure at home correctly
A home monitor helps you and your doctor see your usual blood pressure, outside the stress of a clinic. Choose an automatic upper-arm device that has been clinically validated, with a cuff that fits your arm. Wrist devices are generally less reliable.
Step-by-step
- Measure at the same times each day, for example morning and evening.
- For 30 minutes beforehand, avoid eating, exercise, tea, coffee, smoking and alcohol. Empty your bladder.
- Sit in a chair with back support for at least 5 minutes, feet flat on the floor and legs uncrossed.
- Rest your arm on a table so the cuff is at chest level.
- Wrap the cuff on bare skin of the upper arm, snug but not tight.
- Stay still and do not talk during the reading.
- Take two or more readings 1 to 2 minutes apart.
- Write down every reading, with date and time, and bring the log to your appointments.
Common mistakes
Measuring over clothing, letting the arm hang down, crossing your legs or talking can all push the reading up. A single high reading is not a diagnosis. Look at the average over several days.
Everyday ways to lower blood pressure
Cut the salt
The WHO recommends less than 5 g of salt a day for adults, which is under a teaspoon. Global average intake is around 11 g a day, more than double that target. Most of the salt we eat comes from food rather than the salt shaker.
In Indian kitchens, the biggest sources are often pickles, papad, chutneys, namkeen and chips, instant noodles, bakery items, sauces and restaurant food. Practical steps:
- Add salt at the end of cooking and taste before adding more.
- Use lemon, herbs, garlic, ginger and spices for flavour.
- Keep pickles and papad as an occasional treat.
- Read labels and compare sodium in packaged foods.
- Use iodised salt, because cutting salt does not mean cutting iodine.
Low-sodium salt substitutes that contain potassium can help some people, but check with your doctor first if you have kidney disease or take BP medicines that affect potassium.
Follow a DASH-style eating pattern
DASH (Dietary Approaches to Stop Hypertension) is an eating plan proven to lower blood pressure. It focuses on vegetables, fruit, whole grains, pulses, nuts, low-fat dairy and moderate amounts of fish or poultry, while limiting saturated fat, sweets and sugary drinks.
An Indian version is easy: more sabzi, dal, chana and rajma, curd or buttermilk without added salt, whole fruit, and millets or whole wheat in place of refined flour.
Move more, weigh less
The WHO advises at least 150 minutes of moderate activity a week, such as brisk walking, plus muscle-strengthening on two or more days. If you are overweight, even modest weight loss can bring readings down.
Tobacco, alcohol, stress and sleep
Stop all forms of tobacco. Limit alcohol or, better, avoid it. Regular sleep, time outdoors, yoga or breathing practices can help manage stress, which supports healthier blood pressure.
Treatment and India's control efforts
If lifestyle changes are not enough, or your readings are high, your doctor may prescribe medicine. Many people need more than one drug, and treatment is often long term. Never stop or change your medicine just because you feel fine, since high blood pressure rarely causes symptoms.
The India Hypertension Control Initiative was launched in November 2017 by the Ministry of Health and Family Welfare, ICMR, state governments and WHO India. It uses simple treatment protocols, reliable medicine supply, team-based follow-up and care closer to home through primary health centres and Ayushman Arogya Mandirs. Adults aged 30 and above can also get BP screening at government health facilities under the national NCD programme.
When to see a doctor
Book a doctor's visit if your home readings are often 140/90 or above, if you have frequent headaches or blurred vision, or if you are pregnant and your BP is raised.
Call 108 or 112 immediately if a reading is above 180/120 and you have any of the following:
- Chest pain or pressure
- Shortness of breath
- Weakness or numbness, especially on one side of the body
- Difficulty speaking, confusion or sudden severe headache
- Sudden changes in vision
These can signal a heart attack, stroke or other emergency. Do not drive yourself to hospital.
Frequently asked questions
What is a normal blood pressure for adults?
A reading below 120/80 mmHg is considered normal. Readings slightly above this are common and should be rechecked. Your doctor may set a personal target based on your age and other conditions.
Can high blood pressure cause headaches?
Most people with high blood pressure have no headaches at all. Very high blood pressure can cause severe headache, often with other symptoms such as vision changes or confusion, and needs urgent care.
How often should I check my BP at home?
If you are being diagnosed or your medicine was just changed, your doctor may ask for twice-daily readings for a week. Once your BP is stable, a few readings a week or month is often enough. Follow your doctor's plan.
Does rock salt or pink salt help with high blood pressure?
No. Rock salt, pink salt and sea salt are all mostly sodium chloride and raise blood pressure much like regular salt. They also usually lack added iodine. The amount of salt matters more than the type.
Once my BP is normal, can I stop my medicine?
Normal readings often mean the medicine is working. Stopping it suddenly can make blood pressure rise again. Talk to your doctor before making any change.
Sources
- WHO: Hypertension fact sheet
- WHO: Salt reduction fact sheet
- American Heart Association: Understanding blood pressure readings
- CDC: Measuring your blood pressure
- NHLBI: DASH eating plan
- India Hypertension Control Initiative
- NHS: High blood pressure