The Indian Guide to Blood Pressure

The silent killer in Indian homes

Hypertension rarely causes symptoms until it causes heart attack, stroke or kidney failure. The only way to know is to measure — correctly, repeatedly.

Home averages ≥135/85 or clinic ≥140/90 on repeat define hypertension. Single readings never diagnose.

Salt: the 5-gram challenge

Indians average 10–11 g salt/day; target is <5 g. Papad, pickle, namkeen, bread, biscuits, sauces and restaurant gravies hide most of it.

Measure one teaspoon for the full day's cooking; flavour with lemon, amchur, herbs and pepper instead.

• Read labels: >400 mg sodium/100 g is high
• Potassium foods help unless kidney-restricted
• Restaurant meals: request less salt

Medicines without fear

Amlodipine, losartan/telmisartan and thiazides are safe, cheap and effective — often combined. They are not addictive; stopping lets pressure rebound.

Home logs (seated, rested, correct cuff, twice daily for a week) guide titration far better than casual clinic readings.

How to measure BP correctly at home

Technique decides truth. Rest seated for 5 minutes, back supported, feet flat, arm at heart level on a table, correct cuff size (bladder covering 80% of arm), no talking, no chai/coffee/exercise/smoking in the prior 30 minutes. Take two readings a minute apart and average them.

For diagnosis or titration, log morning (before medicines/breakfast) and evening readings for 7 days, discard day one, and average the rest. Bring the log — not a single casual reading — to every visit.

• Upper-arm monitors beat wrist devices for accuracy; validate against ESH/STRIDE lists
• Check both arms first; use the higher arm thereafter
• Recalibrate yearly and replace cuffs that no longer fit snugly

The Indian low-salt kitchen: where sodium actually hides

Table salt is only the visible third. Bread (300–500 mg sodium per 100 g), biscuits, namkeen, pickles (a single amla pickle can carry 500+ mg), papad, sauces, processed cheese and restaurant gravies deliver the rest. Reading labels for one month permanently changes shopping habits.

Potassium-rich foods — banana, moong, curd, coconut water — help most hypertensives, but kidney disease and ARB/spironolactone users must restrict potassium. Salt substitutes (potassium chloride) need the same caution.

• Cook with 1 measured teaspoon of salt for the full day; flavour with lemon, amchur, pepper, herbs
• Restaurant hack: request less salt, gravies on the side, extra salad
• Track BP 2 weeks after each salt cut — visible drops reinforce the habit

Medicines: combinations, timing and adherence

Most Indians need two agents for sustained control — commonly amlodipine plus an ARB (losartan/telmisartan), with a thiazide-type diuretic added next. Single-pill combinations improve adherence dramatically and are preferred when available.

Take medicines at the same time daily, linked to an existing habit (after brushing). Ankle swelling with amlodipine is common and usually harmless; a dry cough suggests ACE-inhibitor class and warrants a switch discussion — never a silent stop.

Hypertensive emergency vs urgency: know the difference

Readings above 180/120 with chest pain, breathlessness, vision change, weakness or confusion are an emergency — go to hospital immediately without trying to 'bring it down' at home. The same numbers without any symptoms still need same-day (not same-minute) evaluation.

Never chew extra BP tablets, take someone else's medicine, or use sublingual nifedipine at home — rapid uncontrolled drops can precipitate stroke. Call your doctor or emergency services for guidance.