Undetected & untreated, hypertension cases soar globally

Food, culture, stress and awareness shape outcomes

Hypertension affects over 1.28 billion adults globally, driven by lifestyle and stress. Cultural attitudes, along with food, and mental health significantly impact management, highlighting the need for awareness, early detection and supportive care.

Hypertension, commonly known as high blood pressure, is a silent but formidable health threat that continues to escalate worldwide. According to the World Health Organisation (WHO), between 1990 and 2019, the number of people living with hypertension doubled, soaring from 650 million to 1.28 billion adults, with projections by the Journal of Global Health suggesting this could rise to over 1.6 billion by this year.

The consequences of untreated hypertension are dire, with increased risks of heart attacks, strokes, kidney failure and premature death. The symptoms of hypertension are often subtle or absent, earning it the moniker “the silent killer.” However, when symptoms do appear, they may include severe headaches, fatigue, vision problems, chest pain, difficulty in breathing and an irregular heartbeat.

The causes are multifaceted, ranging from high salt intake, physical inactivity, tobacco use and excessive alcohol consumption to obesity, chronic stress and underlying conditions such as diabetes and kidney disease.

The burden of hypertension is not distributed equally throughout the world. With more than 244 million cases, China topped the list in 2023. India came in second with 188.3 million adults afflicted. While Peru, Switzerland, Canada, Iceland, and Japan had the lowest prevalence, the United States, Indonesia and Brazil also reported high numbers.

Regional differences were noted in a 2024 Biomed Medical Centre report for India, with lower prevalence reported in Rajasthan, Dadra & Nagar Haveli, Daman & Diu, and Bihar, and higher rates in Sikkim, Kerala, Odisha and West Bengal.

In India, the prevalence of obesity has skyrocketed. According to the National Family Health Survey (NFHS-5, 2019–21), 24 pc of women and 23 pc of men are now considered overweight or obese, a significant rise from prior years. Because excess body fat alters metabolism, raises cardiac output and raises blood pressure, this rise in obesity is a major cause of hypertension. Obesity dramatically increases the risk of hypertension, according to studies and Indian populations are more likely than the global average to experience these problems at younger ages.

In England, for instance, recent data shows that 34 pc of men and 27 pc of women are living with hypertension, with women facing a higher risk of stroke and men a greater risk of ischaemic heart disease.

While some progress has been made in reducing average blood pressure levels, the proportion of adults with untreated high blood pressure remains significant, placing a considerable strain on health systems.

“Cultural attitudes towards everything affect your physical and psychological health. So cultural attitudes, if cultural attitudes about mental health are regressive, if it is a taboo or a stigma to talk about how stressed you are or how anxious you are or how your mental health or your psychological well-being is affecting your hypertension, then people are not going to be able to talk about it or seek support or rely on others, which is going to definitely make your hypertension worse. And if your cultural attitudes are reversed, for example, if people are open to talking to people, they are open to vulnerability, not just being vulnerable but also being good listeners and people are supportive, then it is going to definitely elevate some pressure on your psychological well-being as well as your physical one,” Princy Saini, Co-founder and Psychologist, Get Me Therapy, a Delhi-based mental healthcare provider tells Media India Group.

According to mental health experts, psychological distress activates the sympathetic nervous system, priming the body for threat. In the modern world, these threats are often psychological-worries about the future, deadlines, or personal failures-leading to a state where the body remains on high alert for extended periods. This chronic stress response can worsen or trigger hypertension, as the body’s natural mechanisms for relaxation and recovery become impaired.

There is a reciprocal relationship between mental health and hypertension. When people feel helpless or overpowered by uncertainty, knowing they have high blood pressure can exacerbate their anxiety or depression.

“Accepting your situation and understanding more about it, gaining more information and control and awareness about your own body and mind can help you cope and deal with this situation a lot better, improving on practices like meditation, exercising, eating well, or sleeping well might very well reduce the risk of anxiety or depression for a person who is aware that they have hypertension,” Saini adds.

People’s perceptions, management, and treatment of hypertension are significantly influenced by their cultural practices and beliefs. While community support and culturally specific interventions have shown promise in improving outcomes in some societies, traditional remedies or misconceptions about medication can impede effective management in others. In order to change attitudes and promote proactive management of hypertension, public health campaigns must acknowledge and take into account cultural contexts.

“There is constant pressure to perform well. I frequently wake up in the middle of the night with a racing heart, worrying about expectations and outcomes. It felt like yet another challenge when I received a diagnosis of hypertension. However, discussing it with friends and asking for assistance had an impact. Knowing that I am not alone helps me manage my health and my studies, even though it is still difficult,” Sahaj Arora, a Delhi-based Chartered Accountant (CA) aspirant, tells Media India Group.

There has never been a greater need for awareness, early detection, and culturally sensitive support as the world deals with a growing hypertension crisis. In addition to medical treatment, managing hypertension necessitates a greater comprehension of the psychological and cultural determinants of health.