{"id":22268,"date":"2026-08-10T14:31:36","date_gmt":"2026-08-10T08:46:36","guid":{"rendered":"https:\/\/eng.dragonmedia.com.np\/?p=22268"},"modified":"2026-08-10T14:31:36","modified_gmt":"2026-08-10T08:46:36","slug":"hypertension-nepals-growing-silent-risk-and-the-persistent-gap-from-detection-to-control","status":"publish","type":"post","link":"https:\/\/eng.dragonmedia.com.np\/?p=22268","title":{"rendered":"Hypertension: Nepal\u2019s Growing \u2018Silent Risk\u2019 and the Persistent Gap from Detection to Control<\/strong>"},"content":{"rendered":"

# Adrian Mercer<\/strong><\/p>\n

Hypertension may appear to be a common health condition, but globally it has become one of the leading preventable risk factors for heart disease, stroke, kidney damage and premature death. Its most difficult feature is that many people can live with high blood pressure for years without experiencing any obvious symptoms. According to the World Health Organization, around 1.4 billion people aged 30 to 79 were living with hypertension in 2024. A large proportion were unaware of their condition, while effective blood pressure control remained limited even among those receiving treatment.<\/p>\n

Nepal is no exception. According to a World Health Organization fact sheet based on Nepal\u2019s 2019 STEPS survey, 24.5 percent of people aged 15 to 69 had elevated blood pressure. The prevalence rose sharply with age: 13 percent among those aged 15 to 29, 25.6 percent among people aged 30 to 44, and 42.9 percent among those aged 45 to 69. At the time, an estimated 4.7 million people in Nepal were living with hypertension. These figures represent a national baseline from 2019 rather than the actual prevalence in 2026, making the need for an updated national survey increasingly important.<\/p>\n

Even more concerning is the gap between detection and control. According to the 2019 estimates, of the approximately 4.7 million people with hypertension, only about one million were aware of their condition, around 400,000 were receiving treatment, and only about 200,000 were estimated to have their blood pressure under control. Although these figures are now several years old, they expose Nepal\u2019s central challenge: not merely the prevalence of hypertension, but weaknesses throughout the chain of early detection, access to treatment, regular medication use and long-term control.<\/p>\n

What Exactly Is Hypertension?<\/h3>\n

Blood pressure refers to the force exerted by circulating blood against the walls of the arteries as the heart pumps blood throughout the body. The upper number, known as systolic blood pressure, reflects the pressure when the heart contracts. The lower number, or diastolic blood pressure, represents the pressure when the heart relaxes between beats.<\/p>\n

According to the World Health Organization, hypertension can be diagnosed when measurements taken on separate days consistently show a systolic blood pressure of 140 millimetres of mercury or higher, or a diastolic pressure of 90 or higher. A single elevated reading, however, should not automatically be treated as a definitive diagnosis.<\/p>\n

This is why accurate measurement is critically important. Stress, physical activity, caffeine, smoking and even the environment in which blood pressure is measured can temporarily influence the result. More reliable readings are obtained after several minutes of rest, using a properly fitting cuff, with the back supported, feet placed on the floor and the arm positioned at heart level. Automatic home blood pressure monitors can be useful, but assessment of long-term cardiovascular risk, associated medical conditions and the need for treatment should still be carried out by qualified health professionals.<\/p>\n

The belief that \u201cI do not have a headache, so I cannot have high blood pressure\u201d is particularly dangerous. Many people with hypertension experience no symptoms at all. This is why it is often described as a \u201csilent risk.\u201d Without routine measurement, the condition can remain undetected for years while gradually damaging the heart, brain, kidneys and blood vessels.<\/p>\n

Why Does the Risk of Hypertension Increase?<\/h3>\n

There is no single cause of hypertension. Age, family history and certain chronic diseases are risk factors that cannot be changed. However, several important factors can be modified, including diets high in salt, inadequate physical activity, excess body weight, tobacco use, harmful alcohol consumption and unhealthy eating patterns.<\/p>\n

People with diabetes and kidney disease may also face a greater risk of hypertension and its complications. Air pollution is increasingly recognized as an important environmental factor associated with cardiovascular disease and elevated blood pressure.<\/p>\n

In Nepal, the issue cannot be reduced to personal behaviour alone. Increasingly urban lifestyles, lower levels of physical activity, greater consumption of prepared and processed foods, excessive hidden salt and the growing burden of non-communicable diseases have made hypertension control a public health policy challenge.<\/p>\n

Simply advising patients to \u201ceat less salt\u201d is not enough. Prevention must be linked to routine screening in primary health care, reliable blood pressure equipment, uninterrupted access to essential medicines and long-term follow-up.<\/p>\n

The Government of Nepal has recognized the problem and introduced various programmes. In 2023, a hypertension care cascade initiative was launched to strengthen screening, diagnosis, evidence-based treatment and follow-up within primary health services. A broader goal was also established to bring large numbers of people living with hypertension and diabetes into standardized treatment systems.<\/p>\n

The real success of such programmes, however, should not be measured by announced targets alone. It should be assessed by how many people are identified, how many remain in treatment, and how many ultimately achieve sustained blood pressure control.<\/p>\n

Continuity Matters as Much as Medication<\/h3>\n

Misunderstandings about medication remain another major challenge in hypertension management. Some people stop taking their medicines once their blood pressure returns to normal, use medications prescribed to others, or conclude that treatment is unnecessary because they have no symptoms. Such behaviour can increase health risks.<\/p>\n

A normal blood pressure reading may itself be the result of effective medication and lifestyle management. Decisions to reduce, change or discontinue medication should therefore be made on the basis of professional medical assessment.<\/p>\n

A healthy diet, lower salt intake, regular physical activity, weight management and avoiding tobacco are fundamental elements of hypertension care. But lifestyle changes alone are not sufficient for everyone. Depending on age, blood pressure levels, diabetes, kidney disease and the risk of heart disease or stroke, medication may also be necessary.<\/p>\n

Modern hypertension management is therefore not centered on a single drug. It is a combined process involving accurate measurement, overall risk assessment, lifestyle improvement, appropriate medication where needed and continuous follow-up.<\/p>\n

Regular physical activity is also important. Adults are generally advised to undertake at least 150 minutes of moderate-intensity physical activity each week, or around 75 minutes of vigorous activity. However, people with heart disease, chronic medical conditions or long periods of inactivity should seek advice appropriate to their individual health status.<\/p>\n

The purpose of prevention is not to impose extreme or temporary routines, but to build healthy habits that can be maintained over the long term.<\/p>\n

When Is Immediate Medical Attention Necessary?<\/h3>\n

Although hypertension is usually asymptomatic, extremely high blood pressure should never be treated casually. If blood pressure rises above 180\/120 millimetres of mercury and is accompanied by symptoms such as chest pain, difficulty breathing, sudden weakness or numbness in part of the body, changes in vision or difficulty speaking, urgent medical attention may be required.<\/p>\n

In such circumstances, simply waiting at home for blood pressure to fall may not be safe.<\/p>\n

Under normal circumstances, however, the most effective way to identify hypertension is not to wait for symptoms but to measure blood pressure correctly at appropriate intervals. Regular screening is particularly important for older adults, people with a family history of hypertension, those with diabetes or kidney disease, and people with other cardiovascular risk factors.<\/p>\n

Nepal\u2019s Next Challenge<\/h3>\n

Nepal\u2019s central difficulty in controlling hypertension is not a lack of medical knowledge. Effective medicines exist, the major risk-reduction measures are well established, and measuring blood pressure is relatively simple.<\/p>\n

The weakest link lies in continuity: moving people from the community to screening, from screening to diagnosis, from diagnosis to treatment, and from treatment to sustained long-term control.<\/p>\n

Global experience reflects the same problem. A large proportion of people with hypertension remain unaware of their condition, while blood pressure is still not adequately controlled among many of those receiving treatment. The lesson for Nepal is clear: success cannot be measured simply by building health facilities or making medicines available. The ultimate measure should be how many people maintain their blood pressure at safer levels over the long term.<\/p>\n

Three priorities now appear particularly important for Nepal. First, a new and nationally representative survey is needed to establish the current scale of the problem. Second, blood pressure screening, treatment and follow-up should become an integral part of routine primary health care. Third, the public needs to develop a culture of testing based on awareness of risk rather than waiting for symptoms to appear.<\/p>\n

The danger of hypertension lies not in how loudly it announces itself, but in how silently it progresses. Without obvious warning signs, it can damage the heart, brain, kidneys and blood vessels over many years.<\/p>\n

The first step against hypertension is therefore simple but powerful: accurate blood pressure measurement at the right time. If necessary, that should be followed by professional medical assessment, sustainable lifestyle changes, regular treatment and continuous monitoring.<\/p>\n

Nepal\u2019s challenge is not to invent a new treatment. It is to ensure that existing knowledge, screening and effective care reach millions of people in an organized and sustained way.<\/p>\n

If the country can close the gap between detection, treatment and long-term control, a substantial proportion of heart disease, stroke, kidney damage and premature deaths associated with hypertension could be prevented.<\/p>\n

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