Introduction
Hypertension is a condition in which the blood pressure is chronically elevated. It is considered to be present when a person's systolic blood pressure is consistently 140 mm Hg or higher, and/or their diastolic blood pressure is consistently 90 mm Hg or higher. Various epidemiologic studies had consistently demonstrated that increasing levels of systolic BP correlate directly with the risk of developing cardiovascular events and stroke leading to mortality. In old age systolic blood pressure becomes a stronger predictor of risk than diastolic blood pressure or other standard risk factors besides age. Based on WHO definition the incidence of hypertension in urban population is around 40% and rural around 18%. High blood pressure is dangerous because it makes the heart work harder to pump blood to the body and it contributes to hardening of the arteries or atherosclerosis.
However, there is no doubt that this disease must have been existed in the past as well, though may not in the same form, incidence and severity due to different kind of life style in those days. The change in social and economic conditions, life style, dietary habits and an increasing stress and strain in earning the livelihood have increased the prevalence of this disease. Though a suitable term for the disease condition hypertension is not directly mentioned in the Ayurvedic classics, its symptomatology can be found in the chapters of vata vyadhi, prameha and hridroga. A disease condition vyanabala vaishamya, which can be correlated with hypertension, seems to be resulted from the vaishamya / vikriti of vyana vayu. Thish condition of vaishamya(Disharmony/Disproportion) can be of two types either vriddhi(Increase) or kshaya(Decrease). Hypertension comes under vriddhi type of vaishamya.
Types of Hypertension
Primary or essential hypertension - The hypertension of unknown origin.
Secondary hypertension - Hypertension with an identifiable cause secondary to another disease such as renal disease or tumor.
Isolated systolic hypertension - Most common in old age due to reduced vascular compliance, systolic B.P > 160 mm of Hg with Diastolic pressure < 90 mm of Hg.
Neurogenic hypertension - It can be caused by strong stimulation of sympathetic nervous system. (e.g. when a person becomes excited for any reason or state of anxiety).
Classification of Hypertension
Systolic B.P. Diastolic B.P.
Optimal B.P < 120 < 80
Normal B.P. < 130 < 85
High normal 130-139 85-89
Stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension 160-179 100-109
Stage 3 Hypertension 180 > 110
Aetiology
1. Hereditary
2. Excess salt intake
3. Sleep apnea
4. Secondary to disease (e.g. polycystic kidney disease or chronic glomerulonephritis,adrenal disease, cushing's syndrome and coarctation of aorta etc.)
5. Certain medication (e.g. NSAIDS, steroids, throat lozenges and peptic ulcer medicines)
Pathogenesis
It is incorrect that hypertension is a simple physiological feature of ageing. Blood pressure tends to be normal or even low in the aged population. Development of Hypertension more depends on environmental factors, rather than simple ageing. Pathophysiological mechanism includes an increase in peripheral vascular resistance, secondary to arteriolar smooth muscle vasoconstriction with the lower plasma renin activity and low aldosterone levels.
Risk factors
1. Child of Hypertensive parents
2. Obese person
3. Age > 45 years
4. Gender (men and postmenopausal women)
5. Diabetes mellitus, dyslipidaemia
6. Physical inactivity
7. Smoking, alcoholism
Clinical features
Hypertension is usually found incidentally by healthcare professionals during a routine checkup, usually produces no symptoms although there may be
1. Headache
2. Fatigue
3. Dizziness
4. Transient insomnia
5. Difficulty in sleeping due to feeling of hot or flushed
6. Tinnitus
Complications
While elevated blood pressure alone is not an illness, it often requires treatment due to the following short and long term effects like:
1. Cerebrovascular accidents (CVA) or strokes
2. Myocardial infarction
3. Hypertensive cardiomyopathy (heart failure)
4. Hypertensive retinopathy, nephropathy and encephalopathy
5. Congestion in the lungs
6. Left ventricular hypertrophy
7. Epistaxis
8. Blurring of vision owing to retinal changes
9. Impotence
10. Angina pectoris
Investigations
1. 24 hour ambulatory blood pressure monitoring
2. Urine for protein, blood and glucose
3. Serum electrolytes
4. Serum creatnine
5. Renal function test
6. Blood sugar fasting
7. Lipid profile
8. Electro cardiogram (ECG)
9. Chest X Ray (PA view)
Management approaches
a. Prevention
1. Consume plenty of fruits and vegetables such as apple, banana, blackberrie, broccoli,cabbage, carrot, garlic, grape fruit, green leafy vegetable, onion, pea, tomato etc.
2. Consume preferably vegetarian, low fat, low calory diet rich in whole grain, high fibre and nuts
3. Use of garlic and onion in regular diet
4. Practice physical exercises such as brisk walking daily for 30 - 45 minutes
5. Weight reduction (in obese)
6. Limit use of salt (<5 gm/ day), fats and sweets
7. Avoid day sleep, anger, anxiety, hyper activity, over exertion
8. Avoid use of caffeine, alcohol and tobacco
b. Medical management
Line of treatment (Charaka Chikitsa.28/92)
1. Nidana parivarjana (avoidance of aetiological factors) -According to Ayurveda, avoidance of the causative factor is the first line of treatment for all diseases. Excess intakes of salt and fatty substance should be avoided and certain medicines such asNSAIDS, steroids, cough syrups etc. are also to be taken carefully.
2. Samshodhana chikikitsa (Bio-cleansing therapies) followed by Samana chikitsa (Palliative therapy) should be advocated.
i. Lekhana Vasti 350-500 ml for 8 days.
ii. Virechana karma (Purgation) with Eranda taila 15 - 30 ml with half glass of milk at night
iii.Shirodhara with medicated liquids (milk/ water/ oils (Narayana taila) daily 45-90 minutes for 21 days
iv. Takra dhara daily 45 minutes for 14 days
Note.Decision for Dhara and its medicies are required to be taken by the physician only dependinding upon its benefit3. Drug Therapy
Common medicinal pants
|
Plant name |
Dosage(perdose) |
Vehicle |
Duration |
|
Sarpagandha (Rauwolfia serpentiana Benth ex. Kurz.)Powder |
1 -3 gm |
water |
15 days |
|
Ashvagandha (Withania somnifera Dunal) Powder |
3-6 gm |
Milk |
15 days |
|
Jatamansi (Nardostachys jatamamasi DC.)Powder |
1-3 gm |
Water |
15 days |
|
Arjuna (Terminalia arjuna W.and A.) Bark Powder |
3-6 gm |
Water |
15 days |
|
Arjuna (Terminalia arjuna W.and A.)Bark ksheerapaka |
10 -30ml |
|
15 days |
|
Rasona (Allium stivum Linn.) ksheerapaka |
10-30 ml |
|
15 days |
Ksheerapaka is an easy preparation in which the milk is processed with the desired plant part.
Method of preparation of Ksheerapaka:
Prescribed amount of the Dravya (medicament) is taken.
Milk is taken in a quantity of 4 times that of the medicine.
Water is taken 4 times that of milk.
All are mixed together and heated on mild fire until all the water evaporates and only the milk remains and milk is now filtered which is taken lukewarm.
Every time the preparation shall be prepared fresh. It should neither be preserved nor refrigerated nor reused after a long time.
FORMULATIONS
|
Drug |
Dosage (per dose |
Vehicle |
Duration |
|
Mamsyadi kvatha |
10-20 ml |
Water |
15 days |
|
Sarpagandha ghana vati |
125-250 mg |
Water |
15 days |
|
Brahmi vati |
125-250 mg |
Water |
15 days |
|
Prabhakara vati |
125-250 mg |
Water/Milk |
15 days |
|
Arjunarishta |
10-15 ml |
Water |
15 days |
|
Abhayarisha |
10-15 ml |
Water |
15 days |
|
Pravala pishti |
250-500 mg |
Water |
15 days |
|
shveta parpati |
125-250 mg |
Water |
15 days |
|
Nagarjun!bhra rasa |
125-250 mg |
Water/Honey |
15 days |
|
Hridayarnava rasa |
125-250 mg |
Honey/ Triphal! kv!tha |
15 days |
Thease above mentioned medicines are prescribed Initially 2 times in a day after meal for 15 days followed by condition of patient and physician's direction.
NOTE: Formulations mentioned above any one of them or in combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy.
Lekhana Vasti (medicated enema), containing Arjuna heart wood decoction. and . Arjunavachadi yoga have shown improvement in the hypertensive patients.
Yoga Therapy- The following yogic practices are beneficial in hypertension; however, these should be performed only under the guidance of qualified Yoga therapist. Duration of every yogic practices should be decided by the Yoga therapist.1. Breathing exercises -hand strech breathing, hand in and out breathing.
2.Asana- Shavasana, Vajr!sana, Bhujangasana, Vakrasana, Gomukhasana, Pavanmuktasana,Katichakrasana, Ardhakati chakr!sana, Tadasana.
3. Pranayama -Chandra anulomaviloma,Nadisodhana, Ujjayi, Bhramari.
Counselling - Advice for,
1. Regular blood pressure monitoring
2. Maintenance of weight in ratio of height
3. Practice of regular aerobic exercises (e.g. brisk walk, jogging, weight lifting etc.)
4. Increase intake of potassium, calcium and magnesium in diet
5. Relax mind and body by yoga, meditation and other methods
6. Consumption of fruits and vegetables such as apple, banana, broccoli, cabbage, carrot, garlic, grape, green leafy vegetables, onion, pea, tomato etc in plenty.
7. Wise Use of anti-inflammatory medicines.
8. Avoidance of cheese, animal fat, aged / stored meat, chocolate, cream, wine , yogurt and artificial sweeteners.
9. Avoid the use of antihistaminic drugs unless knowingly prescribed by qualified a physician.
10. Restricted use of sugar and salt in diet
11. Discontinuation of tobacco and alcohol in any form.
Indications for referral
Ppatients may be reffered in following conditions
1. Refractory hypertension - suboptimal control of blood pressure in spite of appropriate therapy
2. Target organ damage
3. Secondary hypertension not responding to medication
Reference
AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS,CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA,Department of AYUSH, Ministry of Health & Family Welfare,Government of India, New Delhi - 110 058
