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Stress And Hypertension: Pakistan’s Silent Killers

Growing up as a quintessential dweller of this urban society some love to call the ‘City of Lights’, I was and am, along with so many others a constant witness to the dizzying successes but also to the sobering failings and consequences of the frantic lifestyles we have come to adopt as part of our aim to catch up with an increasingly interconnected global society. Consequently, the words, stress, and hypertension were, and are still bandied around with such playful frequency in our daily lives that I considered them perfectly normal by-products of the lives we lead today. As I grew up, however, my fascination with understanding the process of how, so often, small unnoticeable changes in the body can progress to dangerous and sometimes, even fatal conditions, grew so I decided to explore further, especially in medical school. Since stress and hypertension are endemic issues in Pakistan and other developing countries, I felt it necessary to analyze their subsequent effects first. The results, however, were in the mildest sense of the word, disturbing.

“Stress is defined as the body’s reaction to any change that requires an adjustment or response” (Cleveland Clinic, 2015). The body reacts to these changes with physical, mental, and emotional responses. Though this normal response is something our body has evolved to carry out, it is when stress continues without relief that it gets harmful, causing disturbances in the body's internal balance or equilibrium, leading to physical and emotional symptoms.

“Hypertension is a condition in which the blood vessels have persistently raised pressure. Blood pressure is created by the force of blood pushing against the walls of blood vessels, as it is pumped by the heart. The higher the pressure, the harder the heart has to pump.” (World Health Organization, 2020).

The reason the two terms are often used together is that a significant number of studies have proven that there is some association between stress and hypertension, at the very least. Chronically high levels of stress can cause increased blood pressure for a sustained amount of time. Besides, both conditions share a lot of common causes as well as subsequent effects.

According to the National Health Survey of Pakistan, hypertension affects 18% of adults and 33% of adults aged over 45 years (Saleem et al., 2010). While stress is much more difficult to measure as it does not have a clinical benchmark in the way hypertension does, numerous studies have still been carried out in various settings which proves its widespread prevalence through its manifestations such as depression and anxiety - in Pakistan and particularly in urban areas.

Chronic stress can wear down the body's natural defenses, leading to a variety of common physical symptoms which most of us have probably experienced at least once in our lives, such as dizziness, general aches, increase in or loss of appetite, insomnia, tiredness, weight loss or gain.

Much more serious effects include depression, panic attacks, and other forms of anxiety. Depression is, in itself, one of the biggest mental health disorders we face today as a society. Not only can it lead to extremely negative lifestyle changes, but research suggests that it can cause or bring about debilitating chronic diseases such as diabetes type 2, arthritis, and inflammatory bowel syndrome. Research suggests that stress is linked to 6 of the leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver, and suicide (Cleveland Clinic, 2020).

Stress also becomes more harmful when people engage in the compulsive use of substances or behaviors to try to relieve their stress such as excess unhealthy food, alcohol, drugs, and gambling among others. These behaviors tend to keep the distressed person trapped in a vicious circle. In short, yes, stress can kill you!

As discussed above, stress also leads us to the next topic of our discussion, namely hypertension

The reason why hypertension is referred to as a silent killer is that it can be asymptomatic for a very long time.

As the Journal of the Pakistan Medical Association describes, Hypertension has a direct relationship with many diseases and can cause damage to the heart, kidneys, brain, lungs, and is even associated with end-organ failure (Ishtiaq et al., 2017). Most of these are all leading causes of death worldwide. Heart disease and stroke, for example, both caused by hypertension, are the first and fifth leading causes of death in the US. More than 859,000 Americans die of heart disease, stroke, or other cardiovascular diseases every year. (Centers for Disease Control and Prevention, 2019).

Having been sufficiently warned as to the dire effects of the above conditions, the next step is, as always, to search for ways to dodge the landmines before we step on them. Some of the causes and possible solutions are hence listed below:

1. Smoking

Unfortunately, Pakistan is among the top 15 countries in the world with widespread tobacco consumption and higher rates of tobacco-related health issues (Ejaz, 2020). As smoking is one of the biggest risk factors for hypertension, one of the biggest solutions would be to target this population. Anti-smoking campaigns could be run aggressively in an organized fashion, at the grassroots level. The aim should be to dispel the myth of macho and status that comes along with smoking for young people and is a big reason why they take up smoking. For older populations,

efforts should be made to enlighten them about the lethal side effects to get them to stop.

2. Being overweight or obese

According to WHO statistics mentioned in the Journal of the Pakistan Medical Association, 20.8% of the population is overweight and 4.8% is obese (Hasan et al., 2017). A major cause of obesity is the extremely unhealthy diet that has become part of our culture. An excess of all things sugary and a more than generous addition of unhealthy oil to every dish is part of our culinary signature.

3. Too much salt in the diet

Another particular cultural manifestation that has become a culinary signature of the south Asian people. Unfortunately, our love for excessively salty foods is a significant risk factor for hypertension as well. On a larger level, campaigns and protests could be held by members of civil society to force food industries to cut down on the level of salt in their particular products. This could be applied to obesity-related foods as well. These cheap manufactured products are the major cause of obesity in the population and as they are affordable and can be bought as the staple of their diet.

4. Adrenal and thyroid disorders and family history of hypertension

Screening tests should be conducted on as large a scale as possible so that risk factors like these disorders and many other similar ones can be identified. People can then be counseled appropriately about the specific precautions they need to start taking and arrangements for follow-ups can be made.

As the causes of stress, however, are more obvious, we will simply go through a few possible solutions.

1. Exercise

Exercise is one of the most important things you can do to combat stress. Exercise reduces the release of stress hormones such as cortisol in the body and releases hormones which act as natural painkillers and improve mood. Furthermore, it can also improve your sleep quality and confidence which goes on to benefit your mental health as well.

2. Reduce caffeine intake

Caffeine is a mild stimulant found in coffee, tea, and chocolates. Although studies have shown it is useful in moderation, excessive caffeine intake (5 cups a day) can cause a definite increase in anxiety, one of the manifestations of stress (Jennings, 2018).

3. Write it down

One useful way to handle stress is to write it down. Jotting down, on paper, what you are stressed about as well as what you’re grateful for is one great way to reduce stress.

4. Eat healthy, well-balanced meals

The old saying goes “you are what you eat”. In many senses of the word, that maxim has been proven to ring true. Our diet has a big effect on how we feel since specific nutrients induce different hormonal changes in our bodies that affect how we feel. For example, complex carbohydrates, such as whole grains, fruits, and vegetables, can help reduce stress by inducing the brain to increase serotonin production. Additionally, they can play a role in stabilizing blood pressure.

In conclusion, as we have seen above – hypertension and stress are silently causing a drop in both the quality of life as well as the number of years we have. It is absolutely essential then, that we start to recognize these conditions as serious, life-threatening issues and advocate for a more aggressive approach to solve these issues, both at the individual and community level.


Stress: Signs, Symptoms, Management & Prevention. (n.d.). Retrieved July 20, 2020, from

Hypertension. (n.d.). Retrieved July 20, 2020, from

Jennings, K. (2018, August 28). 16 Simple Ways to Relieve Stress and Anxiety. Retrieved July 20, 2020, from

Hasan, F., & Hasan, B. (2007). Is obesity endemic to Pakistan? Journal Of Pakistan Medical Association.

Ejaz, H. (2020, May 30). Tobacco use in Pakistan: The clock is ticking. Retrieved July 20, 2020, from

Ishtiaq, S., Naz, S., Altaf, R., Afzaal, H., Muhammad, S. A., Imran, M. . . . Zaman, S. U. (2017). Assessment of the risk factors of hypertension among adult & elderly group in twin cities of Pakistan. Journal Of Pakistan Medical Association.

Saleem, F., Hassali, A., & Shafie, A. (2010, June). Hypertension in Pakistan: Time to take some serious action. Retrieved July 29, 2020, from

Heart Disease and Stroke. (2019, March 21). Retrieved July 29, 2020, from

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