Hypertension

Overview of Hypertension

• In general, Epidemiologic studies have revealed that with elevation in systolic also diastolic blood pressure above normal in adults, there is a continuous increased risk of cardiovascular disease, stroke and renal disease.
• Furthermore, Cardiovascular risk doubles with every 20 mmHg increase in systolic and 10 mmHg increase in diastolic blood pressure above normal levels.
• Recently, criteria for normal blood pressure, prehypertension and hypertension (stage 1 and stage 2) have been laid by the National Institutes of Health (NIH), US.
• Additionally, According to these criteria, normal cut-off values for systolic also diastolic blood pressure are taken as < 120 and < 80 mmHg respectively.
• In detail, As per this criteria, arterial or systemic hypertension in adults is defined clinically as persistently elevated systolic blood pressure of 140-159 mmHg, or diastolic pressure of 90-99 mmHg as stage 1 hypertension, and corresponding values above 160 or above 100 mmHg as stage 2 hypertension.
• Besides this, Cases falling between upper normal values for systolic and diastolic blood pressure (i.e. above 120/80 mmHg) and those for stage 1 hypertension (120- 139/80-89 mmHg) are grouped under prehypertension requiring monitoring and follow-up.
• The diastolic pressure is often considered more significant.
• All in all, Since blood pressure varies with many factors such as age of the patient, exercise, emotional disturbances like fear and anxiety, it is important to measure blood pressure at least twice during two separate examinations under least stressful conditions.[3]

Indian epidemiology then other

Causes of Hypertension:

1. Alcohol
2. Obesity
3. Pregnancy (in other words, pre-eclampsia)
4. Renal disease

• Parenchymal renal disease, particularly glomerulonephritis
• Renal vascular disease
• Polycystic kidney disease

5. Endocrine disease i.e.

• Pheochromocytoma
• Cushing’s syndrome
• Primary hyperaldosteronism (e.g. Conn’s syndrome)
• Glucocorticoid-suppressible hyperaldosteronism
• Hyperparathyroidism
• Acromegaly
• Primary hypothyroidism
• Thyrotoxicosis
• Congenital adrenal hyperplasia

6. Drugs i.e.

• E.g. Oral contraceptives containing oestrogen, anabolic steroids, corticosteroids, NSAIDs, carbenoxolone, sympathomimetic agents

7. Coarctation of the aorta.[2]

Classification of Hypertension

Hypertension is generally classified into 2 types i.e.:

1. Firstly, Primary or essential hypertension:

• In which the cause of increase in blood pressure is unknown. Essential hypertension constitutes about 80-95% patients of hypertension.
• Genetic factors
• Racial and environmental factors
• Risk factors modifying the course

2. Secondly, Secondary hypertension:

• In which the increase in blood pressure is caused by diseases of the kidneys, endocrines or some other organs.
• Secondary hypertension comprises remaining 5-20% cases of hypertension.

a) Renal:

• Renovascular
• Renal parenchymal diseases

b) Endocrine:

• Adrenocortical hyperfunction
• Hyperparathyroidism
• Oral contraceptives

c) Coarctation of Aorta

d) Neurogenic [2]

Risk factor of Hypertension

• Age: Younger the age at which hypertension is first noted but left untreated, lower the life expectancy.
• Sex: Females with hypertension appear to do better than males.
• Atherosclerosis: Accelerated atherosclerosis invariably accompanies essential hypertension. This could be due to contributory role of other independent factors like cigarette smoking, elevated serum cholesterol, glucose intolerance and obesity.
• Other risk factors i.e.: Other factors which alter the prognosis in hypertension include: smoking, excess of alcohol intake, diabetes mellitus, persistently high diastolic pressure above normal and evidence of end-organ damage (i.e. heart, eyes, kidney and nervous system).[2]

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology of Hypertension

• The pathogenetic mechanism in essential hypertension is explained by many theories.
• These are as under i.e.:

1. High plasma level of catecholamines.
2. Increase in blood volume i.e. arterial overfilling (e.g. volume hypertension) and arteriolar constriction (e.g. vasoconstrictor hypertension).
3. Increased cardiac output.
4. Low-renin essential hypertension found in approximately 20% patients due to altered responsiveness to renin release.
5. High rennin essential hypertension seen in about 15% cases due to decreased adrenal responsiveness to angiotensin II. [3]

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Sign & Symptoms of Hypertension

• There is variable elevation of the blood pressure with headache, dizziness, palpitation, perspiration also nervousness.
• Moreover, Eye ground changes may be found but papilledema is absent.
• Renal function tests and urine examination are normal in early stage.
• Besides this, In long-standing cases, there may be mild proteinuria with some hyaline or granular casts.
• occasionally, renal failure and uremia may occur.[3]

Clinical / Physical Examination For Hypertension

• Record 3 BP reading separated by 2 minutes, with patient either supine or sitting position and after standing for at least 2 minutes
• Examination of pulse and the extremities for delayed or absent femoral and peripheral arterial pulsations, bruits and pedal Oedema
• Examination of the neck for carotid murmurs, raised JVP or an enlarged thyroid gland.
• Cardiac examination for location of apex beat, abnormalities of rate and rhythm, fourth heart sound also murmur.
• Examination of lungs for rales and rhonchi.
• Abdominal examination for bruits, enlarged kidneys, masses and abnormal aortic pulsation.
• Neurological assessment and optic fundus examination. [2]

Diagnosis of Hypertension

• Normal: SBP < 120mm Hg and DBP< 80mm Hg
• Prehypertension: SBP 120-139mm Hg or DBP 80-89mm Hg
• Stage 1 hypertension: SBP 140-159mm Hg or DBP 90-99mm Hg
• Stage 2 hypertension: SBP >160mm Hg or DBP >100mm Hg. [1]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Hypertension

Routine i.e.:

• Urine examination for protein and glucose also microscopic for RBCs and other sediments.
• HB, fasting blood sugar, serum creatinine, total cholesterol also potassium

Additional investigations in special circumstances i.e.

• Fasting lipid profile also uric acid
• Radiograph of chest
• Echocardiogram
• USG for renal sizes
• Renal Doppler study to rule out renovascular disease
• Examination of Fundus
• Thyroid hormone profile and urinary metanephrine study in young patients. [1]

Treatment of Hypertension

Secondary hypertension is cured by treating the disease causing hypertension.

Primary hypertension can be controlled but cannot be cured.

Following are the antihypertensive drugs to control primary hypertension:

• Beta adrenoceptor blockers: Beta adrenoceptor blockers or beta antagonists (adrenergic beta blockers or beta blockers) block the effect of sympathetic nerves on heart also blood vessels by binding with beta adrenoceptors, so that there is reduction in cardiac output and inhibition of vasoconstriction, leading to fall in blood pressure.
• Alpha adrenoceptor blockers: Alpha adrenoceptor blockers or alpha antagonists (either adrenergic alpha blockers or alpha blockers) block the effect of sympathetic nerves on blood vessels by binding with alpha adrenoceptors, leading to vasodilatation and fall in blood pressure.
• Calcium channel blockers: Calcium channel blockers are drugs, which block the calcium channels in myocardium and thereby, reduce the contractility of myocardium. It causes decrease in cardiac output and fall in blood pressure.
• Vasodilators: Vasodilator agents reduce blood pressure by vasodilatation.
• Diuretics: Diuretics cause diuresis and reduce the ECF volume and blood volume. So, blood pressure is decreased.
• Inhibitors of angiotensin-converting enzyme (in other words, ACE inhibitors): ACE inhibitors reduce the blood pressure by blocking the formation of angiotensin.
• Depressors of vasomotor center: Depressor drugs act on vasomotor center and reduce the vasomotor tone. So, vasoconstriction is prevented.
• Angiotensin II receptor blockers: Angiotensin II receptor blockers or antagonists are the antihypertensive drugs that decrease the blood pressure by blocking the effect of angiotensin II (vasoconstriction and secretion of aldosterone). [4]

Prevention of Hypertension

• Relief of stress
• Dietary management
• Regular aerobic exercise
• Weight reduction (if needed)
• Control of other risk factors contributing to the development of arteriosclerosis. [5]

Homeopathic Treatment of Hypertension

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Hypertension

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Homoeopathic Approach:

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution, family history, presenting symptoms, underlying pathology, possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions. A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’. The disease diagnosis is important but in homeopathy, the cause of disease is not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness are also looked for.

Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition. The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology is not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can be greatly improved with homeopathic medicines.

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications are also taken into account for selecting a remedy.

Medicines:

1. Aurum Met:

• High blood-pressure with despondency also suicidal tendency.
• Sensation as if the heart stopped beating. Palpitation, which compels him to remain still.
• Irregular beatings, Pulse irregular, rapid and feeble. [6]
• Sensation as if the stopped beating, immediately followed by hard rebound.
• Oppressions at the heart.
• Violent palpitation, at puberty.
• Cardiac hypertrophy.
• Pulse, rapid, feeble, also irregular. [7]

2. Lycopodium:

• Blood-pressure of the dyspeptics.
• Weak memory.
• Dreads Company wants to be alone.
• Irritable, thinks his end is coming. Additionally, Vertigo.
• Palpitation sensation as if the circulation stopped.
• Pulse accelerated.
• Great emaciation also of the heart.
• Sleepy during day, wakeful at night.[6]

3. Sulphur:

• Weak memory, dullness, vertigo.
• Palpitation of heart, worse when going up-stairs, pulse full, hard, accelerated, intermittent. [6]
• Palpitation, aggravation especially by lying, at night, in bed, going up an ascent.
• Comparatively Pulse more rapid in morning, than in the evening.
• Pericarditis with effusion.
• Sharp pains go through chest in between shoulders. [7]

4. Gelsemium:

• Generally; Dullness, drowsiness, dizziness, or trembling is the keynotes of this remedy.
• Desire to be left alone and to remain quite.
• Vertigo also giddiness.
• Fear of death.
• Besides this, Excessive action of the heart, palpitation.
• Sensation as if heart’s action would cease.
• Pulse slow and full, frequent soft and weak, almost imperceptible, intermittent. [6]

5. Strontium Carb:

• Affects the circulation causing congestive feeling of tension.
• Heart, kidneys, marrow, ankles also right side are also affected.
• Pains are fleeting; can hardly tell where they are, seemingly felt in marrow of bones; increase and decrease gradually or make the patient faint and sick all over.
• Burning, gnawing.
• Violent involuntary starts of the body.
• Immobility; of one side. – Sense of paralytic weakness.[7]

6. Lycopus virginicus:

• A heart remedy, lowers the blood pressure, reduces the rate of heart and increases the length of systole.
• Heart with many side symptoms, or associated with rapid tumultuous heart beats.
• Haemorrhages due to valvular heart diseases, or passive, from nose, piles, lungs etc.
• Shifting pains, from heart to eyes, head to heart, from heart to wrist etc.
• Ill effects of suppressed Haemorrhoidal flow. [7]

7. Glonoine:

• Wawes of terrible, bursting, pounding, headache, with feeling as if standing on the head.
• With expanding and contracting sensation or as if blood were surging back and forth in the head, from carotids to heart.
• Amelioration vomiting.
• Alternating between temples
• Aggravation by sunshine, damp days.
• Cracking, snapping, shocks, explosions or soreness deep in brain.
• Head heavy but cannot lay it on a pillow.
• Headache before, during, after or in place of menses.
• Headache ameliorates from long sleep. [7]

Diet & Regimen of Hypertension

• Maintain normal body weight.
• Adopt eating plan Diet rich in fruits, vegetables and low-fat dairy products with reduced content of saturated and total fat.
• Dietary sodium intake not more than reduction 2.4 g sodium or 6 g sodium chloride.
• Regular physical activity such as brisk walking (at least 30 minutes per day, most days of the week).
• Moderation of alcohol: No more than 2 drinks (e.g. 24 oz. beer, 10 oz. wine, or 3 oz. whiskey per day consumption in men, and no more than one drink per day in women.
• Avoid smoking.
• Do Yoga, meditation.[1]

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References use for Article Hypertension:

• Golwala’s medicine for students 25^th edition 2017
• Davidson’s principles and practice of medicine 22^nd
• Textbook of pathology by Harsh Mohan 6^th
• Essentials of medical physiology by K. Sembuligam 6^th
• Harrison’s Principle of external medicine 16^th
• The homoeopathic family practice by M.Bhattacharya

Frequently Asked Questions

What is Hypertension?

Hypertension in adults age 18 years and older, is defined as systolic BP of 140 mm Hg or more and/or diastolic BP of 90 mmHg or more or any level of BP in patients taking antihypertensive medication.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Hypertension?

• Aurum Met
• Lycopodium
• Sulphur
• Gelsemium
• Strontium Carb
• Lycopus virginicus
• Glonoine

What causes Hypertension?

• Alcohol
• Obesity
• Pregnancy (pre-eclampsia)
• Renal disease
• Endocrine disease

What are the symptoms of Hypertension?

• Variable elevation of the blood pressure
• Headache
• Dizziness
• Palpitation
• Perspiration
• Nervousness.
• Eye ground changes may be found but papilledema is absent

Give the types of Hypertension?

• Primary or essential hypertension
• Secondary hypertension