High blood pressure: the silent one
Roughly one in three South African adults has high blood pressure, and most feel completely well — which is exactly what makes it dangerous.
What the numbers mean
A blood pressure reading has two numbers. The top one is the pressure as the heart pushes blood out; the bottom one is the pressure while it refills. Both matter, and either one being high counts as high blood pressure.
- Normal — below 130 over 85.
- High-normal — 130 to 139 on top, or 85 to 89 on the bottom. Worth watching and worth changing habits over.
- High — 140 or above on top, or 90 or above on the bottom. This is the level at which treatment is usually discussed.
- Very high — 180 or above on top, or 110 or above on the bottom. This needs medical attention rather than a wait-and-see.
Why it matters when you feel fine
High blood pressure usually causes no symptoms at all. It is often called the silent killer for that reason. The damage is slow and cumulative: it stiffens and narrows arteries, thickens the heart muscle, and injures the small vessels in the kidneys and eyes.
The consequences — stroke, heart attack, heart failure, kidney failure — arrive without warning years later. That is the whole argument for taking a tablet daily for something you cannot feel: you are not treating today's symptoms, you are preventing an event a decade out.
The medicines, and why you may be on more than one
Blood pressure medicines work through different mechanisms, and combining two at a lower dose often controls pressure better — with fewer side effects — than pushing one to its maximum. Being on two or three tablets is normal and is not a sign that things are going badly.
The classes used most commonly in South Africa:
Amlodipine — Amloc, Norvasc, Adco-Amlodipine, Pharmapress Amlo
Hypertension; stable angina
Enalapril — Pharmapress, Enap, Adco-Enalapril, Renitec
Hypertension; heart failure; diabetic nephropathy
Losartan — Zartan, Cozaar, Adco-Losartan, Pharmapress Losartan
Hypertension; diabetic nephropathy; heart failure; alternative when ACE inhibitor causes cough
Hydrochlorothiazide (HCT) — Ridaq, Adco-HCT, HCT Pharmacare
Hypertension; oedema
Indapamide — Natrilix, Natrilix SR
Hypertension — thiazide-like diuretic
A few side effects are worth recognising rather than suffering through. enalapril and related medicines cause a persistent dry cough in some people — that is a known effect and there are alternatives, so tell your clinician rather than stopping on your own. amlodipine can cause ankle swelling. Diuretics such as hydrochlorothiazide (hct) (Ridaq) make you pass more urine, which is why they are taken in the morning.
What actually moves the number
- Salt. This is the big one in a South African diet — most of it comes from bread, stock cubes, soup powders, processed meat and takeaways rather than the salt shaker. Cutting back is one of the few changes that shifts blood pressure within weeks.
- Weight. Losing even a few kilograms measurably lowers pressure.
- Movement. Around 30 minutes of brisk walking most days is enough to matter; it does not need to be a gym.
- Alcohol. Heavy drinking raises blood pressure directly and makes medication less effective.
- Smoking. It does not raise baseline pressure much, but it multiplies the damage that high pressure does to arteries.
Common questions
- Do I have to take blood pressure tablets forever?
- Often yes, though not always. Some people who lose significant weight, cut salt substantially and become more active can reduce or stop treatment — but that is a decision made with a clinician and with monitoring, never by stopping and hoping.
- Can I get blood pressure medicine free at a clinic?
- The commonly used blood pressure medicines are on the Essential Medicines List and are supplied through public sector clinics. Many provinces also run repeat collection programmes so stable patients can collect without queueing for a full consultation each time — ask at your clinic.
- What should I do about a very high reading at home?
- Sit quietly for five minutes and repeat it. If it stays at 180 or above on top, or 110 or above on the bottom, seek medical attention. If it comes with chest pain, breathlessness, weakness on one side, confusion or vision changes, treat it as an emergency.
Sources
- Adult Hospital Level and Primary Healthcare Standard Treatment Guidelines and EMLNational Department of Health, South Africa
- ISH Global Hypertension Practice Guidelines (endorsed for South African practice)International Society of Hypertension / South African Hypertension Society
Last reviewed 4 August 2026.