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BLOOD
PRESSURE
- HYPERTENSION & HOMOEOPATHY
In
today’s life very often we hear that the so and so person is suffering from
High Blood Pressure or Hypertension. In social parties or gatherings it is a usual scene that some body or the other is refusing to take
certain food items or dishes and found saying No! I can't take this because of
Salt or Fat restriction on my diet
by the Doctor as I have Blood Pressure. Now this creates a lot of interest to
know more about this malady called Hypertension and also known as one of The Silent Killers of today’s society ,others being the Diabetes and
I.H.D. or Ischaemic Heart Diseases.
What
exactly is Hypertension ?
Before
this we must understand What exactly is Blood Pressure .To explain To have
proper perfusion to occur in all the tissues
of the body , Heart has to pump blood with sufficient pressure. This is called
the Arterial pressure or Blood Pressure. Or it is defined as a Lateral pressure
exerted by blood column on the arterial wall. It is simply the pressure exerted
by the blood on the vessel walls, measured in millimeters of mercury(Hg) by
Sphygmomanometer. it is of two types Systolic Pressure(when the heart muscle is
at the maximum contraction) is recorded first followed by the Diastolic Pressure
(when the left ventricle is in a state of relaxation). In normal circumstances
it is around 120/80mm of Hg. I put it as ideal B.P. but as the ideal
circumstances are not prevailing anywhere with any body so slight variation is
also considered as normal which is plus minus 10mm of Hg in both systolic and
diastolic pressure. But a reading of 140/90 mm of Hg, on two out of three random
checks, at different times of the day is to be taken as Abnormal Arterial
pressure or Hypertension and needs further follow -up and/or evaluation.
Hypertension , hyperpiesia, high
blood pressure , essential hypertension, the silent killer , problem of modern
civilization are the epithets used to describe but a feature of cardiovascular
physiology. Interestingly without blood pressure, life would be impossible. In
more than 60% of patients with "high blood pressure", the symptoms
made their appearance after they were told that they are hypertensives. It is
Amazing, but rightly, a check up clinic should be defined as, a place wherein a
person walks in and where from a patient totters out. In most cases, which fall into the category of Mild and Moderate
Hypertension , patient have NO symptoms. In about 40 -50% of cases it is
detected on a routine check, LIC or Pre employment check or as a complication
like Stroke, Infarct, Loss of vision or Renal Failure. Hence it becomes very
important for a treating physician to keep a close watch. Another reason for its significance is the attitude of the patient. They
always have a ready explanation for an abnormally high pressure reading like
"I didn't sleep well" or" I have so much of tension". Also
they all feel that they can MAKE OUT what their Blood Pressure is by way of
getting angry etc.,and since they FEEL they have normal pressure, they neither
go for regular checks nor take regular treatment, once again putting the onus on
doctor.
Hypertension can be classified in
two different ways. One is according to severity and second according to the
cause.
Mild HT- When Diastolic pressure
is less than 100mm
Moderate
HT - Diastolic pressure between 100 - 120mm
Severe HT - Diastolic pressure
between 120 - 140 mm
Gross
or Malignant HT - Diastolic pressure more than 140 mm of Hg.
Another
way of classifying the HT is Causes , which can be either Primary or Secondary.
Primary
Hypertension
: Also known as Essential hypertension with obscure cause or where No cause can
be found. Blood pressure is high without any physical complaints and has to be
treated on the basis of constitution. It is the most common type and it affects
both sexes.
Secondary
Hypertension
- Where there is a demonstrable cause for the HT and treatment of the same cures
the patient of HT.
Hypertension is said to be the
disease of modern urbanization and fast life. As a matter of fact hypertension
itself is not a disease in itself
but it is one of the indicators alarming a person to take care of probable
emergency. An enzyme called RENIN in the kidneys is responsible for control of
Blood Pressure. When there is a fall in volume of blood flowing through the
kidneys, kidneys secrete Renin. This Renin cause formation of a substance called Angiotensin which leads to constriction of arteries
thus raising the Blood Pressure. Angiotensin also causes excess of Aldosterone,
a harmone from Adrenal Glands. This Aldosterone causes sodium retention in the
body, we all know that water follows sodium, hence sodium retention leads to
water retention causing volume overload thereby
raising the BP even further. Here I
must make a mention about the stress also. HT is sad to be the outcome or a
derivative of fast life, people always rushing against time, trying to realize
their ambitions, setting up newer goals , intensely competitive nature all take
their toll. This permanent stance of fight leads to increased secretion of
Adrenaline, which causes Hypertension.
Aetiological
Factors for Essential Hypertension are:-
1.
Heriditary factor
: Commonly seen in the children of hypertensive patients, twins. This is due to
abnormality in trans-cellular sodium transport which is one of the genetic
defect.
2. Mental Stress
:
Stress in everyday life is one of the most common aetiological factors found in
now a days life style.
3. Dietry factor
: Excessive intake of Salt and Fats in rich
diet through pickles, papads, fast foods etc. and over use of salt in daily
diet.
4. Low Potassium diet
:
5. Alcohol
: Alcoholics often suffer from hypertension. Although alcohol does not have any
direct effect on hypertension, yet it effects
indirectly and is seen during the withdrawl stage which is mediated by sympathetic nervous system.
6. Obesity
: Caused due to more salt, fat and crbohydrate intake and sedentary habits.
7. Smoking.
Aetiological
factors for Secondary Hypertension can be:-
1.
RENAL
:- Hydronephrosis, Renal Artery Stenosis, Glomerulo-Nephritis Polycystic renal
disease, Diabetes.
2.
ENDOCRINAL:-Cushing's
syndrome, Adrenal Carcinoma, Hyperparathyroidism, Hypothyroidism,
Pheochromocytoma.
3.
CARDIO - VASCULAR
: - Raised Systolic pressure in
Aortic Regurgitation or
in
Complete Heart Block, Coarctation of Aorta.
4.
CEREBRAL
:- Cerebral Trauma, Encephalitis, Increased Intracranial Pressure due to any
causes, Bulbar Poliomyelitis.
5.
TOXIC
:- Toxaemia of Pregnancy, Intake of Oral Contraceptives Steroids or Lead
toxicity, Estrogen therapy.
6.
POLYCYTHEMIA VERA
:-
7. DRUGS INDUCED :-
Out
of all these mentioned types, essential hypertension is commonly seen. Most of
the times such causes are ignored and patient comes with the complications.
Thus, knowledge about the type and its management becomes must for all of us.
Most
symptoms of hypertension generally
start after a patient knows that he/she has HT. Usually it is asymptomatic. In
early stages the hypertension is fluctuant. It rises to abnormal levels under
the influence of emotional changes etc. and later on it becomes permanently
elevated even at rest. Occasionally patient may complain of vague complaints
like Headache, Headache is usually occipital which starts on waking and improves
with the day. Heaviness of head, Giddiness, Palpitation, Paroxysmal Nocturnal
Dyspnoea. The commonest presentation is patient says that nowadays I feel
very angry or the accompnying person tells
that he/she feels very angry and agitated on trival matters, so please check my
or his/her BP. Symptoms generally are of dangerous complications due to effects
on Target Organs namely Brain, Heart, Kidneys and Eyes. Sudden rise in BP can
cause an artery to burst in the brain causing a Stroke. Heart has to pump harder
leading to either Ischemia (IHD) or Pump failure(LVF) . Renal failure can occur
by reduction of blood flow to the kidneys. Tiny haemorrhages occur in the
Retinal vessels leading to diminution of the
Vision and finally may be to total Blindness.
Complications
which can arise
:
-
1.
ARTERIOSCLEROSIS
2.
ARTERIOLAR INFLAMMATION
3.
HEART FAILURE
4.
ANGINA PECTORIS
5. CEREBRO-VASCULAR ACCIDENT- CEREBRAL HAEMORRHAGE
6.
THROMBOSIS AND SUBARACHNOID HAEMORRHAGE
7.
HYPERTENSIVE ENCEPHALOPATHY
8.
MALIGNANT HYPERTENSION
9.
RENAL DAMAGE
10.
HAEMORRHAGES - EPISTAXIS, HAEMATAMESIS, HAEMOPTYSIS
11.
REDUCED LIFE EXPECTANCY OR DEATH
On
examination and Investigating a patient of HT , we must obeserve following :-
a)
Blood Pressure level of Diastolic Pressure is important and according to its
level the patient is put into the category of Mild, Moderate, Severe and Gross
HT
b)
Pulse - Radial pulse bounding and hard. Femoral pulse also must be palpated.
c)
CVS - Heaving cardiac impulse.
d)
Eye Fundus - Arteriolar narrowing, compression, haemorrhage or oedema of disc
may be seen.
e)
ECG - Left Ventricular enlargement with or without T wave inversion in Lead I,
AVL,V5 and V6.
f)
X-Ray Chest - Left Ventricle is dense, It's left border is rounded. Hyperaemic
lung, prominent hilar shadow.
Usually the same format is useful
to investigate a newly detected case or follow up of case under going treatment
. A routine package is generally recomended which gives an insight into
important organ systems. In case a particular organ system showing signs of
damage, detailed investigations of that system becomes mandatory.
In
addition to the complete Blood Count the basic investigations should be ;
1)Urine
routine - To look for the presence of Albumin and Casts ,which indicate Renal
involvement., presence of Occult Blood indicate Calculus.
2)Blood
Sugar - Diabetes and HT if presnt togather becomes all the more important for
management as chances of Target Organ damage increase.
(
Normal Fasting 70-100 and P/P. 100-140 mg )
3)Serum
Creatinine - elevated Creatinine suggests early renal Failure, and in absence of
another cause, indicates that HT may be of long standing in that patient ( Normal 0.6 - 1.4 mg/dl)
4)
Serum Cholestrol - Hyperlipidaemia can both be a cause and effect of HT. If
present unless treated will not let BP come under control.Preferably 12hrs.
fasting should be observed for this test. Lipid Profile should be carried out if
Myocardial involvement is suspected, as it tells more about blood lipids i.e.
HDL, the good friendly Cholestrol(Normal M 35-45,F 45-65mg/dl) and LDL, the bad
and unfriendly Cholestrol(Normal upto
150mg/dl).
5)Serum
Uric Acid - Hyperuricemia is one of the most common cause for HT not responding
to the treatment.
6)X-Ray
Chest PA view - For Cardiomegaly sply. LVH.indicates that HT is chronic and has
been present for some time. Since LVH is reversible with very good control of BP
,X-Ray should be repeated to see the progress and control of BP.
7)E.C.G.-
Tells about Myocardial involvent and Ischaemic changes in the heart.
8)Fundoscopy
- To see the Retinal Haemorrhage and Papilloedema which again
indindictes hypertensive state.
Emergencies:
-
Diastolic BP more than 120mm of Hg with major organ damage i.e.
CNS/Kidney/Cardio Vascular.
- Intracranial/subarachnoid
Haemorrhage.
- CVA, Hypertensive
Encephalopathy.
-
Acute Aortic dissection, Pulmonary Oedema.
-
Myocardial Infarction,Unstable Angina.
- Eclampsia.
-
Phaeochromocytoma.(Tumour of Adrenal Medulla)
-
Grade III or IV K.W. fundoscopic changes.
During management: Interestingly having enemized BP and linking it to the ills
of the Heart,the Brain,the Kidneys and the Blood vessels- without of course
reliable proof or data for anyone! Not knowing how exactly the God's great
creation of body computer controls blood pressure every second so thoughtfully
and dynamically, modern medicine has chosen to control some facets of the
physiology, with inevitable train of side effects ranging from increased
mortality to humiliating Impotence. In a study of celebrated multi-blind trial
on antihypertensives in UK, 90% of the physicians declared that their patients
were doing well, 80% of the relations of the patients said that the patients
were far from happy, and 100% of the patients felt they were worse off than
before. Still if HT is treated before becoming chronic, complicated and without
pathological cause can be treated better and it shoulld be patient oriented
rather than disease oriented. The basic guideline remains as following ;
-Weight
reduction in obese patients.
-Low Sodium diet. Salt restriction.(Sodium transport hypothesis is commonly accepted.
-Stress and strain must be
avoided .
-Stop smoking and drinking if
must then Moderation of Alcohol and Smoking.
-Psychological
factors should be looked into and treated first.
-Avoidance
of Physical Strain. Rest and Relaxation. Moderation of physical
activity.Sternuous exertions, sudden and prolonged stress should be restricted
or stopped.
-Change
in the outlook and life style. Inclusion of Yogasnas ,prefereably under the
guidence of an expert ( Padmasana, Dhanurasna, Matsyasana and Shavasana are
supposed to be the best for the HT patients. Here one should caution the patient
also regarding the Shirshasana and Sarvangasana are strictly contraindicated in
which the body is held upside down.)
Case.
Mr.H.P.
41 yrs.old Exporter consulted me for known Hypertension for the last 4 -5 years.
He was on various Antihypertensive drugs time to time.His BP was 190/120 mm of
Hg.Main complaints were Feeling of Weakness,Tendency for Loose Stools,
Occasional Burning Micturation with Excessive Sweating all over the body and
Disturbed Sleep. Has two daughters, Son died soon after birth.
Sensitive++, Brooding+++, Supresses his Anger and emotions ++, Worried nature++
with Fear of Future. X- Ray Chest NAD, Hb- 15.7 gm%, ESR-6mm , TLC-9900,
P74,L25,E1 Serum Cholestrol - 260 ng/dl, Triglycerides - 800 ng/ , S.Uric acid -
7.8, BUN -16. and Urine Exam. revealed Cal. Oxalate Crystals +++, ECG - WNL
Patient was given Nat.Mur 200 C / 3 doses at the interval of 15 minutes followed
by Kali Phos 6x tds for 2 weeks. Patient reported feeling better in next visit
the BP was 140/90 mm of Hg.Sleep better, No episode of acute headache.Pain in
the legs. Further he told me that in the past he had been passing small tiny
stones off and on. He was prescribed Lyco
200 /1 dose followed by S/L for another 2 weeks. Patient reported feeling much
better BP was 136/88 mm of Hg. NO more sleep disturbance, No more headaches.
Occasional pain in the Knee joints. Nothing
significant reported in subsequent visits and the Bp recorded 132/84 to 130/80
mm of Hg. S.cholestrol 218 ng/dl, Triglycerides 227 ng/dl and Uric Acid 7.3
mg/dl.
Homoeopathic
Therapeutics for HT: As in any other case it should be Individualised and the
constitutional simillimum is the most appropriate , still following are the
medicines which I found useful in my patients.:-
Aconite , Adrenaline, Aurum Met.,
Baryta Mur, Crataeguus, Gelsemium,
Glonoine, Natrum Mur, Rauwolfia, Viscum Album etc.
-----------------------------------------------------------------------------------------------------------------------
Prof. Dr.A.K.GUPTA
DHMS(Dli),MIHL(Geneva),MGN(Med.)PH,PG(London)
Sr. HOMOEOPATHIC CONSULTANT
Founder Director-
A.K.Gs OVIHAMS
A.K.Gs Om Vidya Institute Of Homoeopathy and Allied Medical Sciences(Regd.)
Recipient- Internaional Dr. Hahnemann Award of the Millennium; Gold Medalist,
Lord Dhanwantri Award, Dr.Yudhvir Singh Award, Life Achievement Award
Member- Homoeopathic Advisory Committee Govt. of NCT Delhi.
Author- The Problem Child and Homoeopathy
J – 158 , Rajouri Garden , New Delhi – 110027, INDIA, Ph. – 25101989, 25430368
RU – 115, Pitam Pura, New Delhi –110034 , INDIA, Ph - 9811341238
158, Satya Niketan, Moti Bagh- II , New Delhi –110021, INDIA , 24100494,
M-9811341238
24 Hrs. Helpline M – 9811341238
E-Mail :
drakgupta@ovihams.com;
guptahomoeo@rediffmail.com
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http://www.ovihams.com/
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