She pores over the prints of the black and white photographs of Delhi from the 1950s for the wall art posters she retails online. An alert beeps on the phone; it’s time to take a break and do 10 minutes of incline walking on a treadmill in her studio at Delhi’s Safdarjung Enclave. “This one thing in between work has helped me keep my blood pressure (BP) in check. Now I have a consistent normal reading of 118-20/72 mm Hg,” says 29-year-old Ria, who has been battling hypertension over the last two years, which seemed stubbornly stuck at 145/105 mm Hg. “Yes, I was just 27 then and I found that all of it was triggered by my lifestyle. I had latent risk with a family history of hypertension. I realised my health was not in a good place and turned my life around,” she adds.Ria is among the increasing number of young Indian adults living with hypertension, one of the risk factors for early onset of heart disease, heart attacks and strokes. Hypertension in this group is rising, with prevalence estimates between 25% and 42% in some studies. Dr Manish Bansal, Senior Director, Clinical & Preventive Cardiology, Medanta, Gurugram reports that about 35-45% of India’s adult population is hypertensive, reflecting a serious public health concern.What triggers the BP spiral?Juggling between a competitive work life, wound-up weekdays and zero relaxation, young Indians are trapped in work stress, poor diet, inactivity, obesity, smoking and alcohol. This pushes up their BP. Yet it is the one easily identifiable and modifiable risk factor that may prevent heart attacks and sudden deaths.One patient of Dr Bansal, a 38-year-old entrepreneur, had dangerously high readings of 160/100 mm Hg and a racing heart. Damage from high BP led to cholesterol buildup in his heart vessels, risking an early heart attack. With major lifestyle shifts, he now has normal readings.For Indians, genetically prone to earlier heart disease, the ideal BP should be below 120/80 mm Hg, says Dr Bansal. The top reading measures systolic (heart pumping pressure) and the bottom figure diastolic (pressure when the heart relaxes) values.Two case histories, one solutionThe lockdown years hit Ria hard. “I lost my aunt and couldn’t process the loss. That was the beginning of my stress and anxiety. Both my parents are hypertensive; my mother is a diabetic and tends to have a higher heart rate. The restlessness of grief was enough to pace up my heartbeat,” she says. She didn’t think much of a headache that clawed into her skull till she visited Dr Rommel Tickoo, Director, Internal Medicine, Max Healthcare, Delhi, for a routine checkup. “They check heart rate and BP before evaluation; it was 135/90 mm Hg. I thought it could be a one-off because of my anxiety. But the doctor insisted that I recheck it again. On three different occasions, the reading continued to be high. Dr Tickoo suggested that I sleep well, begin exercising, clean up my diet and report back in four weeks. I did some tweaks but still my BP shot up to 145/105 mm Hg,” says Ria.Given her family history, Dr Tickoo put her on BP medication though she was hesitant about it. “Nobody wants to have drugs lifelong but apart from high BP, her resting heart rate was high too, at 105-plus. She not only needed drugs but an aggressive lifestyle overhaul to keep her levels in check. Since the damage done by BP is progressive and unseen, many do not see it as risky enough to take medicines. This non-adherence is the reason why BP spirals further, ” he says. Now Ria measures her BP after long gaps. “In fact, even if my routine goes slightly off during vacations, my BP stays 120/75 mm Hg. Also, I had borderline cholesterol which is in range now. I am glad my test report has no bold lines to indicate something is off,” she says.Story continues below this adDr Bansal’s entrepreneur patient had neither family history, nor diabetes. His hypertension was driven by work stress, smoking, obesity and a sedentary life. He had normal kidney and liver function. Yet with a high BP of 160/105 mm Hg, he was in a high-risk stage that needed both medication and lifestyle management. “I was very reluctant to take drugs but the doctor told me that uncontrolled, my BP could damage every organ system of my body. He told me that dosage could be regulated once I changed everything about my life that I had lived so far,” he says.The changes that yielded resultsAll through the lockdown, Ria gained almost 8 to 10 kg as she worked out of home and had a more sedentary life. “I would binge-eat as I had not addressed my grief, seeking solace in food. I would order meals at odd times at least four times a week and had turned into a couch potato. I stayed awake till 2 am and slept barely five hours. Once I started taking medicines, I realised they would not work if I continued my old life,” says Ria.She stopped eating outside, had home-cooked meals, slept by 11 pm and decided Friday to be her cheat day. “This was the day I indulged myself in moderation. That leeway was needed or else I would have slipped back. Then I worked out at the gym for four days, walked on an incline and did cardio routines like cycling and the elliptical trainer. This combination I did for 25 minutes. The remaining 20 minutes I did strength training by lifting weights,” says Ria.Dr Tickoo deliberately gave her mixed routines. Cardio, he explains, controls blood pressure by strengthening the heart to pump blood more efficiently, which reduces the pressure on blood vessel walls. “Regular cardio improves circulation, widens capillaries for better oxygen delivery, reduces fat and builds muscle. Weights improve the function of blood vessels, strengthen the heart and increase the production of nitric oxide, which relaxes blood vessels. Ria also did mindfulness exercises. The mind and muscle connection makes for a wholesome workout,” says Dr Tickoo. She even tracked her BP twice a day to understand patterns and see if her new routines were having an impact.Story continues below this adMeanwhile Dr Bansal had some difficulties with his entrepreneur-patient. “When he came on his first follow-up, he was taking his medicine regularly but had not followed lifestyle advice. So his BP came down to 135-140/85-90 mmHg, pulse rate to 75-80/minute. At this point, a CT coronary calcium score was also done which showed a score of 18 (which was too high for a person of his age). The knowledge that he had already started having significant cholesterol deposition in his coronary arteries had a great impact on him. We put him on statin as well as a lifestyle routine,” he says. Since cholesterol piles up quickly in damaged blood vessels, anybody with high BP should take a statin too, insists Dr Bansal. After losing weight and having a diet rich in wholegrains, legumes, fruits, vegetables, nuts, probiotics and lean proteins, the entrepreneur’s BP is now 130/80 mm Hg with a pulse rate 70-75 per minute.“About 10 to 15 years ago we never saw hypertension in 20 to 35-year-olds. Now I say, monitor patterns in cases of childhood obesity, annually if you are 20 and more frequently if readings are out of range in any age group,” says Dr Bansal.