Hypertension due to some unforeseen reasons like global warming is being seen in a much younger population than it used to be seen some two decades ago. In our times, high blood pressure was something that came up in one’s life in their 40’s if not 50’s. A few years ago, I started detecting it in patients as young as in their 20’s.

So, initially I thought the reason must be lifestyle changes like going for western food, compounded by pollution, etc. But when I presented this case scenario to my western colleagues, I found out that the same problem was being detected there too. Thus to our unpleasant surprise it is now a global phenomenon.
15% of hypertension occurs due to renal & adrenal causes, but the cause for the other 85% is still unknown. There are certain predisposed risk factors like hereditary, lifestyle, smoking, excessive alcohol, inability to handle stress/tension, sedentary life style, etc.

As I sit in my clinic and explain to my patient that he or she has to start medication, invariably the question put up will be-“But, do I have to take it life long?” Then, I have to explain that I am not prescribing poison and how hypertension is an ‘aging process hardening’ and so wrinkling not only occurs externally on our skin but that the blood vessels also start hardening. Thus, the narrower the blood vessels, the more the heart has to pump to keep up the blood supply. The primary complication of prolonged high blood pressure is cerebral/brain stroke with resultant death or paralysis. I have to convince my patients that one stroke is enough; it does not have to occur twice.

Unfortunately, hypertension is asymptomatic in the majority of cases even if one’s blood pressure recording is over 200/100. That is probably the reason we see so many stroke or paralysis cases because usually people visit a hospital or doctor only if they have some symptoms or uneasiness. Headache or dizziness, symptoms of hypertension occurs in only a minority, 15% of cases. There is also the issue of “white coat syndrome” where blood pressure shoots up in some people when they see a doctor or are in a hospital environment. Thus, these days I normally use ABP (ambulatory blood pressure) test. This is a device where the patient wears the BP monitor for 24 hours and can do all his activities besides bathing and does not have to stay in the hospital. This will give us a 24 hour blood pressure recording when one is sleeping, walking and working which will aid us by and large to determine whether one needs medication at all, if the medication used is adequate, inadequate, or has to be titrated or tapered down.

Salt is a known enemy of blood pressure. We, Nepali people unfortunately indulge in very high salt consumption. Thus, one has to maintain a salt restricted diet. Our mind may stay young but not our bodies, thus one cannot keep on eating rich, tasty food all the time. We must learn to accordingly adjust with the aging process and give priority to vegetables, fruits, nuts (not all nuts), fish, etc.

There are different types of medication. Since high blood pressure means narrowing or hardening of the blood vessels, some medicines help to dilate the blood vessels, others reduce the pumping intensity of the heart and still others reduce the blood volume. Thus, depending upon patient selection according to age, other associated diseases, heart condition, etc, medicines too have to be judiciously selected.



One can never over emphasize the importance of exercise. One can never be too busy. I always make it a point to tell my patients that life after 40 is like going downhill in a vehicle with no brakes, and exercise is your only brake. So, go to the gym, go jogging, walking, try the treadmill, team events like tennis or badminton, yoga, jumba, any of the many options. Many a time I see people playing for very long hours. Like the old dictum-“Too much of anything is bad”, our bodies also suffer from wear and tear. Over playing will result in joint problems, ligament tear, sprains, or some kind of muscle/bone/ligament/cartilage/tendon damage. Thus, one’s playing career will be shortened. Do remember, warming up is also very crucial in maintaining a healthy body. Lastly, team events are slightly better than solo events because one’s concentration would be solely on the ball or cork and your mind would not be diverted to other problem related to business, office or household matters. Then, there is the added benefit of developing comradeship with people of different walks of life, where laughter is shared which plays a major role in relaxing our nerves and alleviating our mood.

In conclusion, in a nutshell, I hope the above information will help to elucidate the importance of hypertension’s treatment, prevention and to do away with misconceptions.