Hypertension, or high blood pressure, is a chronic non-communicable disease - NCDs are chronic, long-lasting conditions that are not transmissible between people - whose prevalence has steadily increased worldwide. It is often called a "silent killer” because it may not produce symptoms initially, yet can gradually damage vital organs.

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While hypertension can sometimes be linked to genetics or aging, it is often strongly influenced by lifestyle and dietary habits.

Common risk factors include an unhealthy diet high in sodium and processed food preservatives, excess body weight, physical inactivity, chronic stress, smoking, and excessive alcohol consumption.

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Symptoms usually appear only after significant damage has occurred. Treatment generally involves lifelong lifestyle changes and medicines, the doses of which may be adjusted according to blood pressure levels and the patient’s overall condition.

Hypertension can indirectly cause body weakness through several mechanisms.

Blood pressure-lowering medicines which manage hypertension to protect against heart attacks and strokes may sometimes reduce blood pressure excessively, causing weakness, dizziness, or light-headedness, especially while changing posture, such as standing up from sitting or lying down.

Some medicines also slow the heart rate, which may contribute to fatigue and weakness. Diuretics, or "water pills,” commonly used in hypertension and heart failure, remove excess fluid and salt from the body, sometimes resulting in low blood pressure and muscular weakness.

Long-standing hypertension damages vital organs, particularly the eyes, kidneys, brain, heart, nerves, and blood vessels. Reduced blood supply to muscles and nerves may lead to muscular weakness and abnormal sensations. The heart also has to work harder to pump blood against increased pressure, which over time can result in heart failure. This commonly presents as progressive breathlessness on exertion and generalized weakness.

Gradual kidney damage due to hypertension may cause anaemia - a condition where you lack enough healthy red blood cells or haemoglobin to carry adequate oxygen to your body's tissues, making the person feel weak despite good blood pressure control. Hypertension frequently coexists with obesity, diabetes, and high cholesterol as part of metabolic syndrome. These conditions increase the risk of non-alcoholic fatty liver disease (NAFLD), which can also cause fatigue and weakness. Advanced liver damage may progress to fibrosis or cirrhosis, leading to poor appetite, vomiting, and worsening weakness.

Diabetes is another common co-morbidity associated with hypertension. Poorly controlled diabetes can itself cause marked body weakness. Other conditions such as anaemia and hypothyroidism may further aggravate fatigue.

Severe or long-standing hypertension can damage blood vessels in the brain and lead to stroke. This may cause sudden paralysis or weakness in one or more parts of the body, depending on the area affected, and in severe cases may even result in sudden death.

Although hypertension does not directly cause loss of appetite, associated stress, chronic kidney disease, and side effects of medications may indirectly affect appetite and energy levels.

Despite having hypertension, one can remain healthy and active with proper care. Blood pressure should be adequately controlled through a healthy lifestyle, regular exercise, stress reduction, and good compliance with medicines.

Associated illnesses should also be treated appropriately. A balanced diet containing adequate nutrients according to age, body weight, physical activity, and overall health is essential. Nutritional deficiencies, if present, should be corrected. Persistent weakness should never be ignored and should be medically evaluated.

The writer is a specialist in internal medicine.