High blood pressure doesn’t announce itself with pain or discomfort. It creeps in silently, often unnoticed until it triggers something devastating, like a stroke, a heart attack, or kidney damage. That’s why hypertension is called the “silent killer.” Globally, more than a billion people live with it, and in South Africa, it is one of the leading drivers of cardiovascular disease. Yet because it doesn’t feel like anything, many underestimate it or assume they’re safe. This World Hypertension Day is a reminder that silence can be dangerous, and that awareness is the first step toward control (1,2).

One of the most common misconceptions is that you’ll know if you have high blood pressure because you’ll feel it. The reality is that hypertension rarely causes noticeable symptoms. You can feel perfectly fine and still have dangerously high readings. Waiting for signs is like waiting for smoke before checking if there’s a fire; by the time you notice, damage may already be done. That’s why routine screening is so important (1,3).

Another myth is that hypertension is only about salt. In truth, the real issue lies in ultra‑processed foods, which are loaded with excessive amounts of hidden sodium. Bread, processed meats, sauces, and convenience snacks contribute far more to daily salt intake than the pinch you add at the table. When people shift to a low‑carb, high‑fat, whole‑food approach, the kind of eating the Noakes Foundation advocates for, those processed foods fall away. Suddenly, you’re cooking with fresh ingredients, and you may even need to add salt manually to your meals because the hidden sodium has been stripped out. This week is Salt Awareness Week, and it’s a good reminder that the problem isn’t salt itself, but the way it’s packaged into processed foods that drive both hypertension and poor metabolic health (4,5).

There’s also the belief that taking medication means you’ve failed at self-care. In truth, medication is not a punishment; it’s a protective tool. For many, lifestyle changes alone aren’t enough to bring blood pressure down. Stigma around medication leads people to avoid or stop treatment, increasing their risk of complications. Medication provides a safety net while lifestyle changes, like diet and exercise, reduce the dose needed and prevent further damage (4,6).

Finally, many assume that hypertension only affects older people. Rising rates in younger adults show otherwise (7), driven by stress, processed diets, and sedentary lifestyles. Prevention starts early. Small shifts, such as swapping sugary drinks for water, walking daily, and cooking more meals at home, build resilience for decades to come (8).

Hypertension is invisible, but its consequences are not. The good news is that it’s one of the most preventable and manageable health risks you’ll face. By busting myths, checking your numbers, and making small, sustainable changes, you can turn silence into strength. This World Hypertension Day, let’s move beyond awareness to action because the health risk you can’t feel is the one you most need to control.

References

1.       World Health Organization. (2025, September 23). Uncontrolled high blood pressure puts over a billion people at risk. World Health Organization. https://www.who.int/news/item/23-09-2025-uncontrolled-high-blood-pressure-puts-over-a-billion-people-at-risk
2.       Heart and Stroke Foundation South Africa. (2016). Cardiovascular disease statistics reference document: For media. Heart and Stroke Foundation South Africa. https://www.heartfoundation.co.za/wp-content/uploads/2017/10/CVD-Stats-Reference-Document-2016-FOR-MEDIA-1.pdf
3.     Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16, 223–237. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998524/ [overview of global burden and outcomes]
4.       World Health Organization. (2025). Hypertension. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hypertension
5.     Monteiro, C. A., et al. (2019). Ultra‑processed foods: what they are and how to identify them. Public Health Nutrition, 22(5), 936–941. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731016/
6.     Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2018). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006
7.   Putri, L. R., Azam, M., Nisa, A. A., Fibriana, A. I., Kanthawee, P., & Shabbir, S. A. (2025). Prevalence and risk factors of hypertension among young adults: An Indonesian basic health survey. Open Public Health Journal, 18, e18749445361291. https://doi.org/10.2174/0118749445361291241129094132

8.       Meher, Meghanad & Pradhan, Sourabh & Pradhan, Soumya. (2023). Risk Factors Associated With Hypertension in Young Adults: A Systematic Review. Cureus. 15. 10.7759/cureus.37467. https://www.researchgate.net/publication/369986630_Risk_Factors_Associated_With_Hypertension_in_Young_Adults_A_Systematic_Review