Beyond salt reduction, experts stressed that controlling hypertension requires a comprehensive approach. Regular exercise, maintaining a healthy body weight, reducing alcohol intake, quitting tobacco, and consuming a balanced diet rich in fruits and vegetables are essential
With cases of hypertension steadily rising in India, particularly among young adults, the American Heart Association’s (AHA) revised guidelines on blood pressure could prove timely and impactful. The new recommendations define normal blood pressure as anything below 120/80 mm Hg, a more stringent threshold than the previous 130/90 mm Hg. Experts believe this shift, though controversial, may help raise awareness in India and push for earlier lifestyle changes and treatment interventions.
Hypertension—often called the “silent killer”—is one of the leading risk factors for cardiovascular disease, stroke, kidney damage, and premature death. India is estimated to have nearly 200 million people living with high blood pressure, and a significant proportion of them remain undiagnosed until complications set in.
“Hypertension produces no symptoms in its early stages. That is why many patients remain unaware of their condition until it manifests in the form of a stroke, heart attack, or kidney failure,” explained Dr. Rajeev Jayadevan, Chairman, Scientific Committee, IMA Cochin. “Even among those who are receiving treatment, not all achieve adequate control.”
This underdiagnosis and undertreatment highlight the urgent need for stricter monitoring and awareness. The AHA’s decision to lower the diagnostic threshold brings more people under the “at-risk” category, which experts say could serve as a wake-up call.
According to Dr. Mukesh Goel, Senior Consultant, Cardiothoracic and Cardiovascular Surgery, Heart and Lung Transplant Surgery, “For India, these changes are significant. With nearly 200 million individuals estimated to have hypertension, lowering the BP threshold for diagnosis means a much larger segment of the population is now classified as hypertensive. This can help combat the ‘silent killer’ effect, as many Indians don’t know they have high BP until complications arise.”
The new guidelines are based on evidence from recent large-scale trials showing that more intensive control of blood pressure can reduce the risk of cardiovascular events. However, some trials also indicate that aggressive treatment may not always improve outcomes and could, in fact, lead to side effects such as excessively low blood pressure, fainting, and kidney injury.
“This is why treatment must be individualised,” Dr. Jayadevan emphasised. “While tighter control is beneficial for some, others may require a more measured approach depending on age, co-existing conditions, and tolerance to medication.”
The guidelines also advocate for simple dietary interventions that are particularly relevant to Indian households. Notably, they recommend potassium-based salt substitutes for food preparation, except in individuals with chronic kidney disease or those on certain medications.
“This is particularly relevant to Indian diets, where home-cooked, salty foods are commonly consumed,” noted Dr. Vivekanand Jha, Executive Director, The George Institute for Global Health, India. “Promoting the use of healthier salt alternatives can be an effective step in reducing sodium intake at the community level.”
Beyond salt reduction, experts stressed that controlling hypertension requires a comprehensive approach. Regular exercise, maintaining a healthy body weight, reducing alcohol intake, quitting tobacco, and consuming a balanced diet rich in fruits and vegetables are essential.
Another crucial element in the updated guidelines is the emphasis on team-based care, involving not just doctors but also nurses, community health workers, and other allied professionals. For India, where healthcare resources are unevenly distributed and primary care often falls short in rural areas, this model aligns well with existing public health strategies.
“The promotion of team-based management, with involvement of community health workers like ASHAs, fits India’s health system well, especially in rural or primary care settings,” Dr. Jha said. Such an approach could improve early detection and ensure better follow-up for millions of patients.
The Way Forward
While the lowered threshold may increase the number of Indians labeled as hypertensive, experts say this is not necessarily a drawback. Instead, it provides an opportunity to raise awareness, encourage preventive lifestyle changes earlier, and avoid the long-term complications of uncontrolled blood pressure.
As Dr. Goel summed it up: “Hypertension is one of the most important modifiable risk factors for heart disease and stroke. If adopting stricter guidelines leads to more people checking their blood pressure, making dietary changes, and seeking timely medical help, then it can only be good for India.”
