Hypertension, the clinical term for high blood pressure, is often underrecognized and undertreated in women, especially in India. This condition increases the stress on the heart, damages arteries, and heightens the risk of heart disease, stroke, kidney failure, and eye damage. Although hypertension is not a gender-specific disorder, it is a major threat to women’s health due to its relationship with factors like hormonal changes, pregnancy, pregnancy prevention (birth control), and menopause. Despite its seriousness, hypertension is frequently underestimated in women, which often leads to delays in diagnosis and treatment and causes adverse health effects. This is largely due to the misconception that hypertension and heart disease are identified as “men’s problems”. However, high blood pressure is an equal opportunity killer and does not spare women. Heart disease is the leading cause of premature death among women today. Women account for almost 52% of deaths due to high blood pressure globally, and heart disease claims the lives of as many women as the next four to five causes of death in this population.
In India, about 11.3% of women aged 15–49 suffer from hypertension, with an alarming number of them remaining undiagnosed. This translates to roughly 282.5 million women who require medical attention for hypertension management. Importantly, uneducated women have a higher prevalence of hypertension (14.4%) compared to their more educated counterparts (8.5%), highlighting the socio-cultural and educational factors that exacerbate this problem. As the rates of hypertension continue to rise in India, studies predict that more women than men will be affected in the future, underscoring the urgent need to address this growing women’s health crisis.
While hypertension is more common in men at younger ages, the trend shifts around the age of 65 years. In fact, postmenopausal women are particularly at risk for hypertension, and hormonal changes at this stage complicate treatment. Hypertension causes more damage in middle-aged women than in middle-aged men, significantly increasing the risk of heart attack and stroke. Even mild increases in blood pressure can lead to a higher risk for heart diseases in women. In fact, hypertension triples the risk of heart failure in women, compared to the two-fold increase seen in men. Additionally, women with hypertension often develop a form of heart failure characterized by stiffened heart muscles, a condition that is difficult to treat.
Importantly, the control of blood pressure also appears more challenging in older women. Research shows that the decline in blood pressure control with age is more pronounced in women than in men. Blood pressure levels in women are also more sensitive to factors such as salt intake and conditions such as obesity and diabetes, which can exacerbate hypertension. Furthermore, certain antihypertensive medications often cause more side effects in women, which can make managing the condition even more difficult. These features of hypertension have somewhat been overlooked so far. But, it is clear that hypertension in women presents with unique challenges and is a threat that must be taken seriously.
One of the most significant barriers to managing hypertension in women is the disparity in healthcare access and timely medical care. Socio-cultural factors, lack of awareness, poverty, and inadequate healthcare infrastructure contribute to this issue, particularly in rural areas. In many regions, traditional gender roles dictate that women prioritize family needs over personal health. As a result, the diagnosis and treatment of hypertension is often delayed until the condition becomes more serious. Treatment costs may also prevent women from seeking and undergoing treatment for hypertension. Unfortunately, studies show that nearly half of women with hypertension are unaware of their condition, and the limited access to healthcare facilities in rural areas further exacerbates this problem. As mentioned previously, this is compounded by the widespread misconception that women are at a lower risk for heart diseases, which leads to insufficient screening and treatment in women.
The Indian government has recognized the threat of hypertension, especially in women, and its efforts to address this issue have gained momentum in recent years. Programs like the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS) aim to reduce illness and death from non-communicable diseases like hypertension and heart disease through early detection and management. Meanwhile, the India Hypertension Control Initiative (IHCI), supported by the Indian Council of Medical Research (ICMR) and the World Health Organization (WHO), has also made strides in enhancing hypertension screening and treatment across the country.
Prime Minister Narendra Modi has emphasized the importance of women’s health in achieving holistic national development by highlighting the role of “Nari Shakti” — or “women’s power” — in shaping a New India. Initiatives such as the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) aim to reduce maternal and infant mortality rates by ensuring safe pregnancies and deliveries, and hypertension management is a crucial aspect of these initiatives. These projects reflect the encouraging efforts of the Government of India towards improving women’s health in the country.
There are still some steps we need to take to close the gap in awareness and treatment of hypertension among Indian women. To achieve this, public health campaigns will be paramount. These campaigns should focus on educating women about the risks and symptoms of hypertension, using social media and community outreach programs to spread awareness. Improving healthcare infrastructure in rural areas is also vital. For instance, mobile health clinics could help bring screening services to remote populations. Moreover, healthcare workers can be trained to recognize and address hypertension specifically in women, considering the unique physiological nature of this condition. Furthermore, community-based screening programs targeting vulnerable groups, like pregnant women or those with a family history of cardiovascular diseases, could also help in the early detection of hypertension. Last but not the least, more research into the gender-specific attributes of hypertension and tailored treatment strategies could facilitate effective interventions for women.
To summarize, hypertension among women in India is an urgent public health issue that demands immediate attention. Government initiatives have made strides in addressing women’s health, and the future roadmap should focus on improving awareness, healthcare access, and treatment outcomes. By recognizing these challenges and acting decisively, we can work toward reducing gender disparities in healthcare and ensuring that women’s health is prioritized in national health policies. It is essential for society at large — the government, policy makers, healthcare providers, and families — to recognize that women’s health is essential, not just for individual well-being but for the overall progress of our nation. It is time to take high blood pressure among women seriously, diagnose it early, and achieve optimal and safe blood pressure levels. Their health and well-being is our future.
The author is Nationally and globally recognized high-blood-pressure expert
Senior member of the Advisory Board, India Hypertension Control Initiative, an Indian govt undertaking by ICMR, Apollo Hospitals, Hyderabad, India And University of Texas, Dallas, USA