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Dr. Sujata Singh |
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28-Jul-2020

ROLE OF HOMOEOPATHY IN HYPERTENSION

It is a condition characterized by an increase in the arterial pressure of individuals. It is most common cardiovascular disease all over the world. It is a clinical condition in which there is persistence elevation of blood pressure by above the lower limits & depends upon the age & sex.

Higher the blood pressure, higher is the risk of complications like stroke, renal failure, myocardial infaraction.

Classification of blood pressure according to WHO

Stages	Systolic	Diastolic
Stage 1^{st "}Mild"	140 - 159	90 - 99
Stage 2^nd "Moderate"	160 - 179	100 - 109
Stage 3^{rd "}Severe"	> 180	> 110

Blood pressure of an individual is measured by used an instrument known as sphygmomanometer.
Hypertension is a life style disorder. It is a global problem. In 'India' it is estimated to range "4 - 8%" & trend is increase due to life style.
A recent report indicates that nearly "1 Billion Adult" globally had HTN in 2000 & this is predicted to increase to "1.56 Billion" by 2025.
According to WHO (World Health Organization) blood pressure should be recorded in the sitting position of the patient only one (either right or left) to be used consistently 'korot koff sound' is 1st heard is considered as systolic pressure and at which the K sound disappears, as diastolic pressure.
According the expert of WHO committee at least 3 reading should be taken over a period of '3 minutes' and the lowest reading is recorded hypertension is classified into two types

Primary Hypertension - When the cause is unknown. This accounts for nearly 90 percent of cases.

Secondary Hypertension HTN - when the cause is known such as disease kidney tumor of adrenal gland ,consumption of drugs like steroids oral pills congenital narrowing of the aorta. This accounts for about 10 percent of all cases.

Primary Hypertension	Secondary Hypertension
Primary Hypertension also known as essential HTN when the causes are generally unknown.	Secondary Hypertension is when the causes is known it is called as secondary hypertension.
85 - 90 % of all cases	10 % of all cases
Essential Hypertension
Etiological classification of primary Hypertension. Genetic factor Racial factor Environmental	Etiological classification of secondary Hypertension 1. Renal Renovascular Renal parenchymal disease 2. Endocrine Adrenocortical Hypertension Hyperparathyroidism Oral contraceptives 3. Coarctation of aorta 4. Neurogenic

Hypertension is the silent killer of mankind, most suffer (85%) are asymptomatic and hence early diagnosis in a problem. The dividing line between normal and abnormal blood pressure is arbitrary because blood pressure is dependent upon many factors like age, race, sex.

Target Blood Pressure

The target blood pressure is <140mm hg systolic and <90mm hg

For diabetics or chronic renal failure blood pressure should be

<130 mm hg systolic, <80 mmhg diastolic

For diabetics with chronic renal failure blood pressure should be

<125 mmhg systolic, <75mm hg diastolic.

Hypertension Emergencies (Malignant Hypertension)

It is characterized by severe elevation in blood pressure (> 180/120 mm hg) with evidence of impending or progressive target organ dysfunction they requires immediate blood pressure reducing (papilledema, retinal exuadates, retinal hemorrhages, nephropathy, hypertensive encephalopathy, intracerebral hemorrhage, acute myocardial infaraction, acute left ventricular failure with pulmonary edema, unstable angina pectoris, dissecting aortic aneurysm, eclampsia.

Hypertensive Urgencies (Accelerated Hypertension)

It is associated with several elevation in blood pressure without progressive target organ dysfunction (e.g. Upper level of stage 2nd hypertension associated with severe headache, shortness of breath, epixtaxis). Retinal damage may be present but without papilledema.

Isolated Systolic Hypertension

When systolic blood pressure >140 mm of hg and diastolic blood pressure <90 mmhg. It is seen in predominantly in elderly due to arteriosclerosis. It may fluctuate from time to time, higher in morning, lower at night.

Pulse Pressure SBP - DBP (normal 30 - 60mmhg)

Mean Blood Pressure - 2/3 DBP + 1/3 SBP

White Coat Hypertension - The patient's BP is high when measured by a professional but is normal when measured in casual circumstance (at home). It is dignosed by 24 hours ambulatory BP monitoring.

Labile Hypertension - The patient is hypertension at one time and normotension at another time.

Risk Factor of Essential Hypertension

Age - Usually the prevalence of hypertension is high above 40 years of age .its prevalence rises with age.
Sex - Young age - during young age there is no difference in hypertension in both genders.

Middle age - males are preponderance.

Later age - In later life women are more prone, may be because of post-menopausal changes.

Genetic factor - If both parents are hypertensive offsprings have 45 % possibility of developing hypertension and if the parents are normotensive, the possibility is only 3 %.
Ethnicity - Study have shower higher blood pressure levels among black people than among whites.

Racial and environmental factors

Surveys in the us have revealed higher incidence of essential hypertension in African American than in whites. A no of environmental factors have been implicated in the development of hypertension including salt intake, obesity, skilled occupation, higher living standard and individuals under high stress.

Other risk factor

Other factors which are the alter the prognosis in hypertension include - smoking, excess of alcohol intake, diabetic mellitus, persistently high diastolic pressure above normal and evidence of end - organ damage (i.e heart, eye, kidney, nervous system).

The pathogenetic mechanism in essential hypertension is explained by many theories

High level (plasma level) of catecholamines
Increase in blood volume i.e arterial overfilling (volume hypertension) and arteriolar concentration (vasoconstrictor hypertension).
Increased cardiac output.
Low renin essential hypertension found in approximately 20%patients due to altered responsiveness to renin release.
High renin essential hypertension seen in about 15% cases due to decrease adrenal responsiveness to angiotensin 2nd.

Effects of hypertension

Systemic hypertension causes major effects in three main organs heart and it's blood vessels, nervous system and kidney. The renal effects in the form of benign and malignant nephrosclerosis. The organs are damaged by long standing hypertension.

1.CVS - Increased myocardial work leads to concentric hypertrophy of left ventricle, angina pectoris and accelerated coronary artery disease. There is systolic as well as diastolic dysfunction.

2.Kidney - progressive arteriosclerosis involves both the efferent and afferent renal arterioles and capillaries of glomerular tuft. The leads to compromise in the renal function, shrinkage of kidney, proteinuria.

3.CNS - hypertension may cause micro-aneurysms(Charcot bouchard aneurysm ) which may rupture and cause cerebral hemorrhage. Accelerated atherosclerosis may cause cerebral thrombosis, embolism and infarction cerebral arteriolar spasm may cause hypertension encephalopathy.

4.Fundus - Keith Wagner classification.

Grade 1	Grade 2	Grade 3	Grade 4
Mild generalized arteriolar attenuation.	Deflection of veins at AV crossing (AV nickling) + marked generalized arteriolar attenuation.	Grade 2 + copper wire + cotton woolspot + flame shaped hemorrhage + hard exudate.	Grade 3 + silver wire + papilledema.

Clinical feature of hypertension

Symptoms due to hypertension

Headache - The occurs usually in the morning hours .It is throbbing and usually frontal .

Dizziness - The patient feels unsteady.

Epistaxis - This is occur due to increased pressure causing rupture of the capillaries of nose .The bleeding would reduce the circulating volume ,and lower bp ( nature way of lowering the BP and prevention of the hemorrhage in the vital organs).

Symptoms due to affection of the target organs

CVS

Dyspnea on exertion
Anginal chest pain
Palpitations

Kidney

Hematuria
Pocturia
Polyuria

CNS

Transient ischemic attacks with focal neurological deficit.
Hypertensive encephalopathy (Headache, Vomiting, Convulsions, Unconsciousness focal neurological deficit).

Retina

Blurred vision or sudden blindness.

Symptoms due to underlying diseases

Edema and puffy face - acute nephritis.
Weight gain, hirsutism - Cushing's syndrome.
Weight loss, tremors, palpitation and sweating - hyperthyroidism/pheochromocytoma.
Weakness - primary hyperaldosteronism.
Joint pains, bronchospasm, peripheral vascular disease symptoms - poly a rteritis nodosa.

Signs

General examination

Moon face, buffalo hump and truncal obesity - Cushing syndrome.
Puffy eyes, rough skin, obesity - myxedema.
Tremors, Tachycardia, Exophthalmos, thyroid dermopathy and goitre - hyperthyroidism.
Prognathism, Clubbed hand, Coarse features - acromegaly.
Pigmentation - Neurofibromatosis.
Radio femoral delay and collateral vessels over the chest wall - coarctation of aorta.
Weaker left radial - preductual coarctation.
Water hammer pulse - aortic incompetence.

Cardiological symptoms

Cardiomegaly.
Third and fourth heart sound gallop.
Loud second heart sound.
Early diastolic murmur - due to AI.

Respiratory symptoms

Basal crepitations - LVF.
Rhonchi - LVF, Polyarthritis nodosa.

Investigation

To assess target organ damage

X-ray chest for heart size.
ECG for LV hypertrophy and evidence of IHD.
Echocardiogram for LV systolic and diastolic function.
Urinalysis - proteinuria >200mg/day and hematuria suggest renal involvement, Further investigation include serum creatinine, renal sonography, isotopic renogram, renal biopsy.

To detect the cause of hypertension

1. X-ray chest

Rib notching suggests coarctation of aorta.
Mediastinal widening suggest aortic dissection.

2. Imaging of abdomen (sonography, CT scan, MRI) to detect

Polycystic kidney
Tumour of kidney
Adrenal tumour
Renal calculi
Pheochromocytoma

3. Urinary catechols or breakdown products - pheochromocytoma.

4. Echocardiogram - coarctation of aorta.

5. IVP - for renovascular hypertension, Kidney tumour and stones.

6. Aortography - for aneurysm and coarctation of aorta.

Treatment of hypertension

1. Non pharmacological treatment / lifestyle disorder

These have been practice over the years, even when no drugs available and their value established. They help to control hypertension in some, but are useful as adjuvants to drug treatment in almost all patients.

Salt restriction - modest sodium restriction to up to 110 mmoles / day (2.4g sodium or 6 g sodium chloride) is effective in controlling hypertension in mild to moderate hypertension because sodium and water retention is involved in large proportion of hypertensive.
Weight reducing - In over weight persons, reducing of 1 kg may reduce 1.6/1.3 mmhg bp.It also modifies other cvs risk factor like diabetes and dyslipidema. BP is lowed by - reduced circulating volume which reduce venous return and cardiac output.
Reduced symptomatic activity and plasma non - epineohrine - reduction in hyperinsulinemia.
Stop smoking - smoking acutely raises B.P. In addition,it is an independent and most important reversible coronary risk factor.since tolerance develops to nicotine -induced hemodynamic effects, chronic smoking may not be associated with high BP.
Diet - Lactovegeterian diet and high intake of polyunsaturated fish oil have high potassium levels and lower BP by.
Increased sodium excertion.
Decreased sympathetic activity.
Decreased renin - angiotension secretion and direct dilatation of renal arteries.
Adequate calcium, magnesium intake should be maintained in the diet.
Saturated fat and cholesterol intake should be reduced for overall cardiovascular health.
Limit of alcohol intake

< 1 ounce / day of ethanal

(24 ocunces beer, 8 ocunces wine or 2 ocunces 100-proof whiskey).

Relaxation - various forms of relaxation like yoga, biofeedback and psychotherapy lower BP, especially in those with sympathetic.
Regular exercise

2. Pharmacological treatment

Diuretics - oral diuretics were the most widely used anti - hypertension agents.They are effective alone in 50% of mild hypertensive .Thiazides are very effective. They are well tolerated and need to be give only once a day .The enhance the potency of other anti-hypertensive.They act by reducing extracellular fluid volume and cardiac output and they help to counteract the hypertensive effect of high salt intake. They can aggravated diabetes by suppression release of insulin due to hypokalemia.Hyperlipidemia, hypomagnesemia, hyponatremia, hypokalemia, hyperuricemia may occur. Now they are usually used in combination therapy.

Beta blockers - Reduce cardiac output and lower BP but raise the peripheral resistance on a acute administration (which increases BP). However, on chronic administration, BP falls to pretreatment levels .In mild to moderate hypertension, it lower the BP > 50% patients.Drugs withdrawal, if needed, should be done slowly, or rebound hypertension may occur. They can be combined with diuretics, calcium blockers, ace inhibitors and vasodilations .They may be precipitate bronchospasm, cardiac failure, peripheral vascular disease, impotence and depression.

Calcium channel blockers

Lower BP by -

Natriuresis and diuresis due to increased GFR and decreased aldosterone.
Anti-angios tensin - 2 effect
Direct negative effects inotropic effect which lower cardiac output.
Peripheral vasodilation
Nifedipine was the commonest used calcium blockers. Now Amlodipine is replacing it. Felodipine, nicardipine, nitrendipine and clinidipine are other useful calcium blockers. These drugs are especially useful in elderly hypertensive flushing, headache, palpitation, edema, hypotension may occur.

ACE inhibitors - renin released from the kidney act on circulating angiotensin ogen to produce angiotensin 1st, which is converted to angiotensin second by converting enzyme. Angiotensin second is a potent vasoconstriction and its stimulates aldosterone, which retains sodium and cause hyper-tension ACE inhibitors acts by inhibiting the converting enzyme preventing the formation of angiotensin second and lowering the BP. They also act by reducing the degradation of bradykinin-a potent vasodilation, which lowers the BP. ACE inhibitors causes regression of ventricular hypertrophy, attenuation of reperfusion injury induced ventricular arrhythmias, preload and after load reduction and coronary vasodilation. These drugs have no adverse effects of lipid, urine acid glucose metabolism. They lower the BP by 15-25%.Diastolic pressure is lowered more than systolic pressure. Concomitant sodium restriction and diuretics further lower by 15-25%. ACE inhibitors are useful in renovascular hypertension. High angiotensin second is however required to maintained adequate filtration pressure behind the stenotic lesion. ACE inhibitors decrease perfusion pressure and lead to azotemia. Thus they are contraindicated in bilateral renal artery stenosis. These drugs are useful in hypertensive diabetic because of neutral effect of carbohydrates metabolism. In addition they decrease microalbuminuria.
Captopril also improve insulin sensitivity. It has a short duration of action and use for cardiac failure.
Enalapril, Perindoril, Ramipril, etc. are longer acting. ACE inhibitors and useful in hypotension. Tissue specific ACE inhibitors like Quinapril, ramipril, perindopril, fosinopril are available.
Angiotensin second blockers are useful in patients with ACE inhibitors - induced cough and in elderly hypertensive Losartan, Isbesartan, valsartan, candersartan are available .
Alpha blockers - Adrenergic stimulation of alpha 1 receptors in smooth muscles cause vasoconstriction and hypertension. Alpha blockers attenuation vasoconstriction and there by decrease vascular resistance and BP Prazosin was the first alpha blockers with short duration of action.
Terazosin ana doxazosin are longer acting once a day alpha blockers. The efficacy can be enhanced by the concomitant used of diuretics. The most dramatic adverse effects is the 1st dose postural hypotension/syncope. Alpha blockers also have other beneficial effects like lowering the lipids, regression of left ventricular hypertrophy enhancing insulin sensitivity (hence idea for diabetic hypertensive) and releif of obstructive symptoms in benign prostatic hypertrophy.
Vasodilators - These drugs act on the arteriolar smooth muscles, causing vasodilation and lowering BP. However, reflex tachycardia and increase in cardiac output limits its usefulness in severe coronary artery disease. These effects can be reduced by combining hydralazine with beta blockers. Minoxidil is the other vasodilatior whose usefulness is limited due to hirsutism in females. Diazoxide and Nitroprusside are parenteral vasodilators useful in hypertensive emergencies.

HOMOEOPATHIC MEDICINE FOR HYPERTENSION

1. Rauwalfia Serpentia

High blood pressure without atheromatous changes in the vessels.

Irritative condition of central nervous system, violent maniacal symptom.

Rauwalfia is a safe and effective treatment for hypertension. Rauwalfia is also used in mental disease like sychizopernia, insomnia. It is made up of plant kingdom, apocynaceae family. It helps to reduce diastolic blood pressure.

2. Glonoinum

Glonoinum is very useful remedy for hypertension. glonoinum is used when patient is suffering from congestive type of headache with hypertension, hyperemia of brain from excess of heat or cold. Surging of blood to head and heart. Tendency to sudden and violent irregularities in circulation. Violent headache. Violent convulsion associated with cerebral congestion called as meningitis, sensation of pulsation throughout the body. pulsating pain. In hypertension condition, patient is confused with dizziness effects of sunstroke. Heat on head, as in type setters and person who work under gas and electric light. Head heavy, but can not lay it on a pillow. Can not bear any heat on head. throbbing headache. Vertigo on assuming an upright position. cerebral congestion.

3. Natrum Mur

Hypertension due to prolonged intake of excessive salt. Blending headache. Aches as if a thousand little hammers were knocking on the brain in the morning on awakening, after menstruation from sun rise to sun set. Chronic headache, semi lateral congestive from sun rise to sunset, with pale face nausea vomiting, periodical from eye strain before attack, numbness and tingling in the lips, tongue and nose, relevied by sleep. Fiery and zigzag appearance around all objects. Burning in eyes. Sensation of coldness

in heart fluttering, palpitations of the heart shake the body. Music and noise aggravated his complaints. Hypertension due to grief and anger. Consolation aggravated his complaints. oversensitiveness. It is great remedy in hypertension where history of grief and worriness. natrum mur patient is very much weak marked debility. throbbing headache due to hypertension.

4. Belledona

Belledona is great remedy for hypertension when symptoms come suddenly with congestive and throbbing type of headache with hot and red face. Patient is suffering from severe headache due to hypertension. all complaints are aggravated by slight noise, jar motion, light, lying down afternoon, patient is better by pressure and tight banding wrapping up, lying the hand on head, bending head backward in high blood pressure. Headache with sleepiness but patient can not sleep. Temporal headache. Patient is suffering from vertigo when stooping or when rising after stopping at night or turning backward. There is rush blood to head and face in case of high blood pressure. Marked congestion to head with delirium. great desire to escape and hide himself. fear of imaginary things, wants to run away from there. anxiety due to hypertension. Anxiety and fear with no thirst .

5. Argentum Nitricum

Argentum nitricum is very useful remedy in case of hypertension where blood pressure is high due to anxiety and nervousness. vertigo with buzzing in the ears and with nervous affection. Patient is better by tight banding and pressure. Intolerance of heat. It is best suited to the person who premature aged look. It is a great remedy for high blood pressure in which patient losses his control. Patient has great desire of sweet things. There is melancholic apprehensive of severe disease. Patient is very much impulsive and wants to do everything in hurry. There is hypertension due to emotional disturbances. There is headache due to mental exertion. It is great remedy for debility and trembling. Palpitation, pulses irregular and intermittent worse lying on right side. Claustrophobia is marked symptom argentum nitricum patient.

6. Lachesis

Lachesis is used in hypertension when there is a great loquacity. Jealousy is the marked symptom of Lachesis. Patient can not bear any thing tight anywhere There is ill effect of suppressed discharge. There is palpitation with fainting spells especially during climacteric. All complaints worse after sleep and better by appearance of discharge. There is irregular beats constricted feeling causing palpitation with anxiety in the case of hypertension. There is pulse slow, weak and intermittent, irregular, Patient want to be fanned but slowly and at a distance. Lachesis is best suited to women who have not recovered from the changes of life, have never felt well since that time.

It is a great remedy for hypertension at the age of climacteric. There is congested and throbbing type of headache of headache. There is headache due to hypertension. weary of life, looks at everything from dark side .

Patient is very much suspicious. There is rush of blood to head. Vertigo due to hypertension and turning to right, closing eyes in looking at any object closely, from walking in open air.

7. Nux Vomica

Nux vomica is a great remedy for high blood pressure in person who adapted to sedentary lifestyle.

The patient of nux vomica is quick, irritable, nervous, ctive, lin thin. There is hypertension due to prolonged office work, over study and close application to the business. There is zealous fiery temperament. Headache in sunshine. Nux vomica patient easily chilled avoid open air Always seems to be out of tune, inharmonious spasmodic action, Nuc vomica is a preeminently male remedy. These condition produce an irritable, nervous system, hypersensitive and over impressionable. There is hypertension with headache in occiput or over the eyes, with vertigo, brains feels as if turning in a circle. Oversensitive, vertigo will momentary loss of consciousness. Congestive headache. Frontal headache with a desire to press the head against something. Complaints worse in morning and mental exertio, tobacco, alcohol, open air. All complaints worse moving and touching. There is vertigo with momentary loss of consciousness. Better after a short sleep after 3 AM till towards in the morning. Nux vomica is great useful remedy in the case where history of sedentary lifestyle habits like smoking, alcohol sedation effect of tobacco.

8. Aconite

Aconite is a great remedy for high blood pressure due to anxiety and restlessness, fear of death and worry There is state of fear and anguish. Physical and mental restlessness. There is palpation with anxiety and fainting and tingling in fingers. Pulse full hard and tense and bounding, sometime intermittent. Temporal and carotid artery felt when sitting. Tachycardia, affection of the heart with pain in left shoulder, stitching type of pain. There is fullness heavy, pulsating, hot, bursting, burning sensation. Vertigo worse on rising and shaking head. Fear of death, he believes that he will soon die, predicted the day. Fear of future.Does not want to be touched, complaints and tension cause by exposure to dry cold weather draught of cold air checked perspiration, also complaints from very hot weather. Tension in arteries. There is emotional physical and mental symptoms. Great restlessness and tossing about, music is unbearable.

9. Baryta Mur

Baryta mur is an effective remedy in high blood pressure. There is arteriosclerosis with a high systolic pressure and a comparatively low diastolic tension is attended by cerebral and cardiac symptoms.

Baryta mur is a very useful remedy in the case of hypertension there is vascular degeneration. Generally feeling of lassitude in morning. Increase tension in pulse. There is thickening of arteries with cardiac dilation. There is voluntary muscular power lost but perfectly sensible.

The selection of homoeopathic remedies based on symptom similarities and doses according to the Susceptibility of patient.

Don't take homoeopathic medicine without any prescription / without any advise of physician