She remembers the first time her blood pressure was measured.
A cuff tightened around her arm in a crowded clinic, the numbers flashing briefly before the nurse moved on. Someone said it was a little high, nothing to worry about. She was young then, busy, needed elsewhere. There were children to raise, meals to cook, and a household to hold together. She did not ask what the numbers meant. No one asked her if she understood.
Years later, pills appeared in her life. Small, white, daily reminders delivered without conversation. When she missed them, the word non-adherent was used — a clinical shorthand that never asked why. No one asked about fatigue, about caregiving, about money, about the cost of being careful in a life that never paused. She learned that her story was less important than her compliance.
When symptoms arrived, they did not announce themselves dramatically. Breathlessness crept in. Fatigue settled deep into her bones. Chest discomfort came and went, never sharp enough to alarm. She was told it was anxiety. Stress. Age. Menopause. Her pain did not resemble the diagrams on the wall, so it was minimised. She learned, quietly, to minimise herself.
Her heart changed slowly. Walls thickened. Vessels stiffened. Strength was mistaken for resilience, stiffness for normal ageing. Tests were reassuring enough to send her home again. And again. When heart failure was finally named, it came softened by language. Your heart’s pumping is preserved, she was told, as if that settled the matter. It sounded almost like good news. But preserved ejection fraction did not mean preserved life. It meant breathlessness without urgency, suffering without alarm. She was advised to manage. She had been managing all her life.
Later, something else began to slip. Words escaped her. Memory loosened. Blood pressure rose and fell like a tide no one was carefully watching anymore. Her body remembered what the system had forgotten. The woman herself began to fade.
In the end, her heart was not broken dramatically. It was simply tired, worn thin by years of being unheard. She left quietly, as she had lived medically: unseen, unheard, left out of the story until it was too late.
This is not a rare story. It is the story of women and cardiovascular disease across the world, and acutely so in Pakistan.
When clinicians ignore patients and systems value speed over empathy, trust breaks, symptoms are dismissed, adherence falters, and care itself fails
Cardiovascular disease is the leading cause of death among women globally, yet it remains persistently under-recognised as a women’s health issue. In Pakistan, awareness is particularly low. Heart disease is still widely perceived as a “man’s problem,” while women’s symptoms are frequently dismissed, misattributed, or normalised as stress, ageing, or emotional distress.
Hypertension — often called the “silent killer” — plays a central role in this story. Although biologically silent, it generates rich illness narratives: fear of numbers, confusion around medications, anxiety about devices, and a quiet resignation to lifelong treatment. For many women, these narratives unfold within the context of caregiving, economic dependence, limited health literacy, and restricted access to consistent care. Yet clinical encounters rarely leave space for these stories to be told.
In medical practice, we often prioritise measurements over meaning. Blood pressure targets, laboratory values, and imaging findings take precedence, while the patient’s lived experience is relegated to the margins. When women do not fit the classic patterns of disease — when their pain is atypical, their ECGs “almost normal,” their hearts still “pumping well” — they fall through the cracks.
Heart failure with preserved ejection fraction, a condition that disproportionately affects older women with long-standing hypertension, is a striking example. It is a diagnosis that sounds reassuring but often delivers significant suffering. Because it lacks the dramatic markers of advanced heart failure, it is frequently under-treated and under-prioritised. Women are told to cope, to adjust, to manage — advice they have followed all their lives.
The American Heart Association’s Go Red for Women campaign, observed each year on 6 February, was created to confront this silence. Its message is simple but urgent: heart disease in women is common, serious, and often overlooked. While the campaign began in high-income countries, its relevance to Pakistan cannot be overstated. Here, delayed diagnosis, fragmented care, and gendered expectations intersect to produce avoidable suffering.
What is missing from our healthcare system is not knowledge alone, but listening. The sociologist Arthur Frank describes illness narratives as restitution (“I will be cured”), chaos (“nothing makes sense”), or quest (“this has meaning”). Many women with hypertension and heart disease are pushed into chaos narratives not because their disease is incomprehensible, but because their care is.
When clinicians ignore patients and systems value speed over empathy, trust breaks, symptoms are dismissed, adherence falters, and care itself fails.
Rehumanising cardiovascular medicine requires us to recognise women not as difficult patients or non-compliant bodies, but as narrators of their own illness. It requires asking not only what your blood pressure is, but also what this illness means in your life. It requires acknowledging that numbers alone do not tell the whole story and that ignoring stories carries its own cost.
On Go Red for Women Day, wearing red is not enough. Awareness campaigns must translate into gender-sensitive clinical practice, public education, and policies that recognise cardiovascular disease as a women’s health priority in Pakistan. More importantly, they must remind us that behind every reading, every prescription, every diagnosis, there is a life unfolding — quietly, complexly, and too often unheard.
Narratives are fluid, not fixed. And when care does not listen, chaos follows.