It doesn’t knock. It doesn’t scream. And by the time it makes itself known, it may have already left irreversible damage in its wake. Hypertension, the condition that quietly strangles the health of millions of South Africans, is claiming lives and limbs — and for vascular surgeons like Dr Vinesh Padayachy, the crisis is all too real.

As one of Durban’s foremost experts in vascular health, Dr Padayachy - who practices from the world-class Lenmed eThekwini Hospital and Heart Centre - sees daily what most of us ignore — the devastating, often preventable consequences of untreated high blood pressure.

“Hypertension is called the ‘silent killer’ because it often presents with no obvious symptoms—until significant damage has already occurred,” he explains. “It can quietly ravage the blood vessels, heart, kidneys, and brain over many years without a patient being aware.”

A Hidden Epidemic in Plain Sight

In South Africa, hypertension is widespread — and growing. According to the South African Medical Research Council, more than one in three adults over 30 is hypertensive. But what worries Dr Padayachy more is how few people know it.

“You can’t feel your blood pressure,” he says matter-of-factly. “The only way to know your numbers is to measure them regularly, especially if you have risk factors.”

The cost of not knowing?

Strokes, amputations, aneurysms, kidney failure — the kind of dramatic, life-altering conditions Dr Padayachy treats surgically when the damage has already been done.

“Persistent high pressure in the arteries causes the inner lining of the vessels to become damaged,” he explains. “This triggers inflammation, thickening of vessel walls, and narrowing of arteries. Over time, arteries become stiff and less elastic, making it harder for blood to flow.” And when blood doesn’t flow, the consequences are dire.

South Africa’s Unique Risk Profile

South Africans face a perfect storm of hypertension risk factors: high salt diets, sedentary lifestyles, chronic stress, poor access to primary healthcare, and high levels of smoking and alcohol use. Genetics also play a role.

“Many of our patients only seek help once complications arise — often in their 40s or 50s, which is tragically young,” says Dr Padayachy.

He recommends blood pressure checks from the age of 18, especially for those with a family history of the condition. By age 40, he says, annual screenings should be non-negotiable.

Preventing the Preventable

When it comes to prevention, Dr Padayachy is clear: there are no silver bullets, but there are powerful choices.

“It starts with diet—reducing salt intake is key. I recommend a Mediterranean-style diet rich in vegetables, whole grains, lean protein, and healthy fats. Even brisk walking for 30 minutes a day can lower blood pressure dramatically.” But even with education, the battle is uphill.

“Denial and misinformation are massive barriers. Many patients stop taking medication once they feel better, not realizing hypertension doesn’t ‘go away’. Others are afraid of side effects. Access to healthcare and affordability of medication also remain big challenges.”

The Vascular Frontline

The operating theatre, Dr Padayachy faces the final stage of a disease that should have been caught far earlier. He regularly treats carotid artery stenosis (narrowing of neck arteries, which can cause strokes), aortic aneurysms, and renal artery blockages that compromise kidney function — all often rooted in hypertension.

“Hypertension is the common thread,” he says. “It accelerates atherosclerosis — the buildup of plaques — which can block blood flow to the brain, legs, or cause vessels to rupture.” He also warns of the close relationship between hypertension and stroke, especially in South Africa, where strokes remain a leading cause of death and disability.

“In stroke, hypertension is the single most important modifiable risk factor. The higher the pressure, the higher the risk.”

Changing the System —and the Story

Despite the rising toll, Dr Padayachy is not without hope. He believes that better coordination between specialists and primary care providers could significantly improve outcomes. “Vascular care is a team sport. I work closely with GPs, cardiologists, nephrologists, and dietitians. They manage the long-term risk factors; I handle the interventions when damage becomes critical.”

But systemic change is needed. In many clinics, he says, hypertension is diagnosed but not aggressively followed up on. “There’s often a ‘treat-and-forget’ approach. Follow-up is poor, and medication adherence isn’t monitored. We need a stronger push for public awareness and better integration of hypertension care into routine health services — especially in rural and underserved areas.

A Final Word to South Africans

If he could deliver one message to the nation, Dr Padayachy doesn’t hesitate:

“Don’t wait for symptoms. Know your numbers. Hypertension is treatable, but the damage it causes isn’t always reversible. A simple blood pressure check can save your limbs, your kidneys - even your life.”

In a country already burdened by multiple health challenges, the silent threat of hypertension is one we can no longer afford to ignore.

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Hypertension: The silent killer affecting South Africans