High blood pressure, or hypertension, is now increasingly being diagnosed in Indians in their 20s and 30s. But nearly half of those affected are unaware of their condition, leading to episodes like sudden heart attacks in the young being reported frequently. Dr Prashant Mishra, senior cardiac surgeon at Thunga Group of Hospitals, Mumbai, tells Lata Mishra why hypertension is striking younger people and how it can be reversed
What factors push hypertension to such early ages in India?
Long working hours, high stress levels, physical inactivity, excessive screen time and chronic sleep deprivation — especially among the urban youth — play a major role in early onset of hypertension. Besides, Indian diets are typically high in salt, much of it hidden in pickles, papads, packaged snacks, bakery foods, instant meals and restaurant food. World Health Organisation (WHO) recommends limiting salt intake to less than 5 grams per day. But Indians consume nearly double the amount while intake of fruits, vegetables, and potassium-rich foods is relatively low. Many young patients with hypertension also have prediabetes, abnormal cholesterol levels, or fatty liver disease. According to WHO estimates, India has over 200 million adults living with hypertension and nearly half are unaware of it. Among those diagnosed, only about one in five has their blood pressure adequately controlled, reflecting gaps in early screening and treatment. WHO’s HEARTS technical package and global hypertension guidelines strongly emphasise early detection, lifestyle modification, salt reduction, and regular blood pressure monitoring — steps that are particularly critical for India’s young population.
How does excess salt raise blood pressure and what changes does it trigger in the body?
Consuming too much salt builds up sodium in the bloodstream. To dilute this excess, the body pulls in more water, which increases the volume of blood. This puts extra pressure on artery walls, leading to a rise in blood pressure. Over time, high salt intake also makes blood vessels stiffer, affects the lining of arteries (endothelium), reduces nitric oxide — which normally helps vessels widen — and increases resistance to blood flow. The kidneys, which regulate sodium and fluid balance, are forced to work harder. In salt-sensitive individuals (which most Indians are), the kidneys are less efficient at excreting excess sodium, further worsening BP. People under stress may eat more salty or processed food, drink alcohol, smoke or skip exercise, all of which further increase risk. Reducing salt intake has shown to lower blood pressure within weeks and significantly cut heart attack and stroke risks, making it one of the most effective and affordable strategies to control hypertension in India.
Does moving to home-cooked meals help? Is homemade Indian food actually low in salt?
Homemade food is better, but it’s not automatically low in salt. Indian cooking uses many hidden salt sources — pickles, papads, chutneys, readymade masalas and sauces. When you add up multiple dishes in one meal, the salt intake can easily cross the safe limit, even without eating outside food. Then, if a person has grown up eating salty food from childhood, the elevated level starts to feel ‘normal’. It’s called taste conditioning. Over years, this habit keeps blood pressure slightly elevated. This repeated excess salt intake makes BP rise more easily and stay high.
Are rock salt and Himalayan pink salt any healthier?
No. All these salts are primarily sodium chloride and raise BP similarly. Trace minerals in pink salt are too small to offer any health benefit. Also, many of these salts are not iodised, which can increase the risk of iodine deficiency. What matters is how much salt you consume, not the colour of it.
Have you seen salt reduction lowering BP in your patients?
I often see changes within six months. Over a few years, patients who once needed three BP pills are sometimes able to cut down to one tablet, simply by sticking to salt reduction and lifestyle changes.
Despite diagnosis and treatment, many Indians fail to keep their BP under control. Why so?
The biggest issue is inconsistency. Once BP improves, patients often relax adherence to diet, physical activity and medications. I often notice pills being skipped owing to perceived side effects, cost concerns or pill burden. Poor adherence, combined with persistent stress and a high-salt diet, makes BP gradually rise again, without the patient being aware of it.
Why does BP stay symptom-free for so long — and how often should a healthy person check it?
Hypertension is often called a silent killer as rising blood pressure inside the arteries does not trigger pain signals. In the early stages, the heart and blood vessels compensate: arterial walls stretch, the heart muscle gradually thickens to pump against higher pressure, and the inner lining of blood vessels becomes less responsive. As these changes occur slowly, most don’t get warning symptoms such as headache, dizziness or chest discomfort until much damage has been done. Adults with normal readings can check BP every 2-5 years. Those over 40, or with a family history, obesity, sedentary lifestyle, high salt intake, or diabetes, should check it at least once a year. Early detection allows timely lifestyle changes.
