You can feel completely fine on the outside while your blood vessels are under critical, destructive strain on the inside.
Known as the "silent killer", hypertension often gives no warning before causing a sudden stroke or heart attack.
With September highlighting cardiovascular risk during Heart Health Awareness Month, it is essential to recognise the key factors involved, including chronic job stress, hormonal changes, and critical gaps in managing medication.
It is a matter of daily survival for South African families.
To tackle this crisis, it is important to understand some key medical terms. Cardiovascular disease (CVD) is an umbrella term for all conditions that affect the heart and blood vessels. Hypertension means having high blood pressure over time, which puts extra strain on the arteries and increases risk.
A heart attack occurs when blood flow to the heart muscle is physically blocked, causing muscle tissue damage, while a stroke occurs when blood supply to the brain is suddenly cut off.
Ultimately, cardiovascular mortality refers to deaths caused directly by these vascular emergencies.
Currently, CVD is the second biggest killer in South Africa, right after HIV/AIDS, claiming roughly 210 lives every single day. Yet, we treat this structural national crisis as an individual lifestyle flaw.
The real eye-opener here is who this is affecting. This isn't just an "older person’s disease" anymore. The reality is that more than half of all heart attack deaths in South Africa happen to people under the age of 65.
We are talking about working-age breadwinners who are being hit during their peak years.
It's a quiet crisis driven by things far bigger than personal choices, like a broken food economy, the lingering design of spatial apartheid, hidden hormonal shifts, and the pure physical toll of trying to survive the daily grind.
The inequality behind risk
The advice to "stay active" just doesn't work when your environment forces you indoors to stay safe," explains Professor Pamela Naidoo, CEO of the Heart and Stroke Foundation South Africa, in an interview with "The National".
On top of this environmental strain, South Africans are caught in a massive salt trap. Naidoo broke down why our sodium intake is an economic issue, not a personal failure:
- The salt trap: The World Health Organization (WHO) recommends a maximum of five grams of salt a day, but the average South African consumes closer to eight. A broken food system: This isn't because people are overusing the salt shaker at the table. It is the direct result of a food market flooded with cheap, unregulated, hyper-processed foods that use hidden sodium as a cheap preservative to extend shelf life.
- The biology: Biochemically, all that extra sodium forces excess fluid into your bloodstream, which directly drives up your arterial pressure.
The silent burden hypertension
Mainstream wellness culture loves to tell us to "listen to our body", assuming that if something is wrong inside, we’ll feel it. When it comes to blood pressure, that is a dangerous myth. Hypertension is completely silent.
Aside from the odd headache or just feeling a bit off, it doesn't cause any real physical pain.
The scary truth is that you can feel completely fine on the outside while your blood vessels are under massive, critical strain on the inside. This lack of symptoms triggers what Professor Pamela Naidoo calls the "Panado Paradox".
According to Naidoo, many people treat a serious, lifelong condition like high blood pressure as if it were nothing more than a passing headache. They mistakenly assume that once their reading looks good, they are completely cured.
"This leads to a dangerous habit of self-diagnosing and skipping medication, which actually causes their blood pressure to bounce around wildly, placing them at a much higher risk for organ damage over time," she says.
According to her, consistent systolic readings above 130 or 140 mmHg represent a state of chronic high strain that directly increases the risk of a heart attack or stroke.
"However, rather than causing an immediate mechanical 'blowout' or sudden physical failure, she emphasises that this prolonged pressure leads to the gradual, structural degradation of your arteries over many years."
Stress, gender, and life-course risk
To understand how the daily grind turns into actual heart damage, look at how our bodies handle stress.
Nicole Jennings from Pharma Dynamics shares an insightful example.
"Consider our ancestors facing the threat of a wild animal attack - their bodies instinctively triggered a 'fight-or-flight' survival response. To provide the instant surge of energy needed to either fight or flee, the heart rate spikes, blood vessels constrict, and the liver releases sugar directly into the bloodstream.
"Most importantly, after the threat subsides, the body is given the essential recovery time required to relax and restore balance.
Today, South Africans live in a permanent state of chronic flight mode with zero recovery time.
According to Jennings, waking up to a barrage of missed calls, urgent emails, WhatsApps, and Teams notifications, layered beneath relentless financial pressures and family demands, forces the nervous system into overdrive.
"Because your body doesn't burn off that extra energy, all that floating blood sugar gets stored as stubborn belly fat. This isn't just about appearance; it's a highly toxic type of fat that wraps itself tightly around your internal organs.
"It sits there actively leaking nasty, inflammatory chemicals straight into your heart," says Jennings.
"This hormonal mess creates a vicious cycle. It wrecks your sleep, drains your mental health, and makes it even harder for your body to handle the next stressful day," she says.
On top of all that internal strain, women face massive health blind spots as they go through different stages of life. "Women's bodies go through major hormonal shifts that make them far more vulnerable to heart issues than men," Naidoo explains.
"The risk shifts again as women approach their 50s. Going through menopause means losing the heart-protecting benefits of estrogen and progesterone. As these hormone levels drop, it leaves a woman's blood vessels highly vulnerable to rapid damage," she says.
What readers can do, and what policymakers must change
"We always talk about stress as a mental burden, but it leaves real physical scars. It is easy to tell ourselves we are too busy for a clinic checkup because we are working around the clock to provide for our loved ones," says Jennings.
"Choosing not to prioritise your health means risking the well-being of the very people you are working tirelessly to support. Routine health screenings are not a luxury, but an absolute necessity for protecting your family's future."
To combat this silent erosion, South Africans need to master three basic metrics, according to these experts:
- Blood pressure: For adults, a healthy resting blood pressure is defined by global medical guidelines as less than 120/80 mmHg. (Systolic- top number) The pressure in your arteries when your heart beats should be less than 120 mmHg. (Diastolic bottom number) The pressure in your arteries when your heart rests between beats should be less than 80 mmHg. It should be checked twice a year starting at age 35, or earlier with a family history of heart health issues.
- 150 to 160 minutes of weekly exercise: This target does not require an expensive gym membership; it can be achieved by accumulating minutes during your daily commute, walking to the taxi or bus stop, or taking active pacing steps while at work.
- 5 Grams (daily salt limit): Reclaiming our plates from the high-sodium trap of processed condiments and fast foods.
True healthcare self-management requires accessible, real-world tools. These medical professionals concur that medication is only one pillar of survival. True prevention means providing home-grown, culturally rich, and affordable nutritional strategies that fit seamlessly into South African life.
vuyile.madwantsi@national.co.za