What is Blood Pressure — Complete Guide to Hypertension in Pakistan

What is Blood Pressure?

Blood pressure (BP) is the force that your blood exerts against the walls of your arteries as the heart pumps. It is measured as two numbers:

Two Numbers:

• Systolic (top number): Pressure when the heart contracts (when it beats)
• Diastolic (bottom number): Pressure when the heart is at rest (between beats)

Example: In 120/80 mmHg, 120 is systolic, 80 is diastolic, and mmHg = millimeters of mercury (the unit of measurement).

The Blood Pressure Crisis in Pakistan

• 33% of the adult population has high blood pressure
• 50% of those affected are undiagnosed
• Only 20% have it controlled (within the normal range)
• The single top risk factor for heart attack
• The most common cause of stroke

Why Is It Called the "Silent Killer"?

High BP is called the silent killer because 95% of people have no symptoms until serious damage has already occurred:

• Heart attack
• Stroke
• Kidney failure
• Eye damage (retinopathy)
• Heart failure

It silently causes damage over years — which is why regular screening is essential.

Types of Hypertension

1. Primary (Essential) Hypertension — 90% of Cases

No specific cause can be identified. Multiple contributing factors:

• Genetics
• Lifestyle
• Diet (excess salt)
• Stress
• Age

2. Secondary Hypertension — 10% of Cases

A specific underlying cause:

• Kidney disease
• Adrenal gland tumours
• Thyroid problems
• Sleep apnoea
• Birth control pills
• Certain medications (steroids, NSAIDs)
• Pregnancy (gestational hypertension)

Risk Factors

Modifiable (Within Your Control):

• Excess salt — Pakistani diets average 12+ grams daily (recommended: under 5)
• Overweight / obesity
• Physical inactivity
• Smoking and paan/chalia use
• Stress
• Alcohol
• High cholesterol
• Diabetes

Non-Modifiable:

• Genetics / family history
• Age (risk increases after 40)
• Ethnicity (South Asians at higher risk)
• Gender (men under 55 at higher risk; women over 65 at higher risk)

Symptoms of High BP (Usually None)

Most people have no symptoms. However, these may occasionally occur:

• Headache (especially at the back of the neck, in the morning)
• Dizziness
• Nosebleeds
• Shortness of breath
• Tightness in the chest
• Blood spots in the eyes
• Fatigue
• Confusion (in severe cases)

Symptoms of Hypertensive Crisis (180/120+):

• Severe, intense headache
• Chest pain
• Extreme shortness of breath
• Weakness on one side of the body
• Blurred vision
• Loss of consciousness

Call 1122 or go to the ER immediately!

How to Measure Blood Pressure Correctly

Before Measurement:

• Avoid caffeine, smoking, and exercise for 30 minutes beforehand
• Empty your bladder
• Rest for 5 minutes
• Sit quietly

During Measurement:

• Sit in a chair with your back supported
• Feet flat on the floor
• Arm at heart level on a table
• Cuff on bare skin (no clothing underneath)
• Ensure the cuff is the correct size
• Do not talk during the measurement

Multiple Readings:

• Take 2–3 readings, 1 minute apart
• Record the average
• Morning and evening for 1 week
• A single high reading is not sufficient for diagnosis

Complications of High BP

Heart:

• Heart attack
• Heart failure
• Atrial fibrillation
• Coronary artery disease

Brain:

• Stroke (number 1 cause)
• Dementia
• Mini-strokes (TIA)

Kidneys:

• Kidney damage
• Kidney failure
• The top cause of dialysis in Pakistan

Eyes:

• Retinopathy
• Vision loss

Sexual Function:

• Erectile dysfunction
• Reduced libido

Low Blood Pressure (Hypotension)

BP below 90/60 mmHg = low BP. Common in:

• Athletes (often normal)
• Pregnancy (usually safe)
• Dehydration
• Severe blood loss
• Heart problems
• Endocrine disorders (Addison's disease, hypothyroidism)
• Severe infections (sepsis)
• Allergic reactions
• Medications (BP drug overdose)

Symptoms of Low BP:

• Dizziness, especially when standing up
• Fainting
• Blurred vision
• Nausea
• Fatigue
• Difficulty concentrating
• Sweating

Blood Pressure in Pregnancy

BP changes during pregnancy:

• BP may drop slightly in the 2nd trimester
• Returns to normal in the 3rd trimester
• Pre-eclampsia: 140/90+ during pregnancy — serious, see a doctor immediately
• Symptoms: headache, blurred vision, swelling of hands and feet, upper abdominal pain

Blood Pressure and Pakistan

Why is high BP epidemic in Pakistan?

• Diet: Pickles (achaar), pappadums (papar), salted biscuits, fast food — all high in sodium
• Sedentary lifestyle
• Stress: Economic and family pressures
• Smoking and paan culture
• Low awareness
• Genetic predisposition

Diagnosis and Monitoring

Initial Diagnosis:

A single reading is not enough. 2–3 separate visits or home monitoring for 1 week:

• Average BP above 130/80 = consider Stage 1 hypertension
• Average BP above 140/90 = Stage 2
• Lab tests: kidney function, electrolytes, lipid profile, blood sugar, urine

White Coat Hypertension:

BP rises in a doctor's clinic (from anxiety) but is normal at home. Use a home BP monitor. This is common in Pakistan.

Prevention

• Keep salt below 5 grams per day
• DASH diet (Dietary Approaches to Stop Hypertension)
• Walk 30 minutes daily
• Maintain a healthy weight
• Stop smoking
• Manage stress
• Regular sleep
• Annual BP check from age 18 onwards
• Limit caffeine

Conclusion

Blood pressure is a vital sign of your health. High BP — the "silent killer" — affects 33% of people in Pakistan, yet 50% are unaware of it. With regular screening, lifestyle changes, and medication when necessary, it is completely manageable. An annual BP check, especially from age 30 onwards, can be life-saving. Chat with a cardiologist on Ilaaj AI for consultation and BP monitoring guidance from home.