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Hypertension

DEFINITION-

It is very important first to know what is meant by Blood Pressure?

Blood Pressure means the force exerted by the blood against the unit area of the vessel through which it is flowing. In other words, it means the force exerted by the blood.usually,this force is sufficient to push the column of mercury to a level of 50 mm or 100 mm of Hg.

Patients with raised blood pressure remain a symptomatic, but the blood pressure abnormality is brought to the notice only when the patient goes for regular medical checking or life insurance checkup or regular physical examination.

This raised blood pressure is responsible for causing secondary organ damage and hence it should be properly evaluated and tested. It is a known fact that anxiety, excess physical activity, stress can raise the blood pressure temporarily.Before examining the patient for blood pressure, he should be made to rest for at least 10-15 minutes to come to a normal state.One should not label any patient any hypertensive unless the doctor documents rise in the pressure on 2-3 occasions minimum and each time examining and taking the reading twice.
The blood pressure is recorded as the upper one called Systolic pressure and lower one called Diastolic pressure.The mechanism of hypertension is the heamodynamic abnormality seen in patients with increased peripheral resistance at the level of arteries and arterioles.The peripheral resistance is determined by the physical characteristics of the vessel i.e. the ratio of lumen (Inner diameter) to the wall thickness.

TYPES OF HYPERTENSION -

Primary Hypertension (Essential): -

Secondary Hypertension: -

CAUSES -


The specific causes cannot be defined in case for any hypertension.
Few of the causes are:-

Genetic factors
Obesity
Alcohol/Smoking
Excessive salt intake
Stress

SYMPTOMS -

Primary Hypertension
Most of the patients are asymptomatic but few can complain of-

Headache
Giddiness
Weakness

DIAGNOSIS -

Primary Hypertension

The diagnosis is usually made on pretreatment investigations of the patient.

Initial history
Physical Examination
Investigations.

Initial History: -

- Family history or personal history of hypertension
- Drugs like steroids, oral contraceptives, hormones.
- Dietary factor like high salt intake.
- Risk factors like Diabetes Mellitus, smoking, hyperlipidemia, renal diseases.
- Headache, palpitation and sweating.
- Muscle cramps and weakness.

Physical Examination: -

Height and Weight
Blood pressure in lying down, sitting and standing position.
Eye examination for fundus
Assessment of Thyroid
Peripheral pulses- basically looking for synchrony in upper and lower extremities.
Examination of the heart- size, rate, murmur and gallop.
Examination of lungs.
Examination of abdomen for any mass.
Kidney size.
Neurological deficit due to stroke.

Investigations: -

- Blood examination
- Urine analysis
- BUN (Blood Urea Nitrogen), Creatinine, uric acid
- Serum Electrolytes
- Blood sugar and lipid profile
- ECG
- X- ray chest- PA view

MALIGNANT HYPERTENSION -

This is seen in small group of patients who have diastolic pressure more than 120mm Hg. These patients normally are prone to develop eye complications and renal failure leading to death. The patients who have malignant hypertension die within 1-2 years after they are diagnosed.

TREATMENT-

Primary Hypertension

General Measures: -

Weight Reduction
Restriction of salt intake
Regular exercise
Reassurance
Reduction of Alcohol
Sleep and rest
Sedative/tranquilisers.

The decision to commence specific drug therapy should be made after a careful period of assessment with repeated measurements of blood pressure.
The aim of treatment is to reduce the risk of complications of hypertension. As all the drugs have side effects and the benefit of the drug treatment is not immediately apparent, compliance is a major problem.

Hypertension cannot be completely cured but one must keep in mind that one has to continue taking regular medicines throughout one's life to have a quality of life. One should try to be away from the risk factors or in fact control them as far as possible.

There are wrong notions that the patients carry in their mind regarding the medicines. For example- patient complains that they pass more urine, they feel giddy, they have lot of weakness, the throat feels dry and so many and so on.

This might be an excuse for not continuing the medicines, but ultimately who are the sufferers? The doctor is not going to be benefited, but the patient is going to in trouble.

Some patients say that they forget taking medicine in a day or the medicines are costly and hence they cannot afford them. The family physician on many occasions has to compromise by reducing the dose of medicine and has to convince the patient that his B. P. is quite under control, but needs to continue the prescribed medicine.

If the diastolic pressure is above 100mm Hg, during the assessment period, then the drug therapy should be initiated. If the pressure is between 90-100mm Hg, treatment should be started provided there is a presence of risk factor like Diabetes Mellitus and old age.

Patients with raised systolic pressure say about 160mm Hg; carry higher cardiovascular risk. The systolic blood pressure is a better predictor of cardiovascular risk, the treatment in such individual should be initiated. Treatment in elderly individuals above 80 yr. is controversial, hence it is inappropriate to apply any age limit in deciding the treatment.

HOMOEOPATHIC REMEDIES

Note -
It is a MUST to continue the antihypertensive drugs even after starting homoeopathic treatment as these drugs have to be tapered down under a medical consultants advice before stopping the treatment, as the abrupt stoppage of these drugs can aggravate the preexisting disease.


Aconite, Coffea Cruda, Glonine, Veratrum Viride, Strophanthus, Viscum Alb, Baryta Mur, Ferrum Phos, Kali Mur

The 3 major causative factors according to which drugs are also selected are as follows -

1) Stress induced - Mental

Physical like sunstroke overexertion

2) Renal cause due to renal pathology

3) Increased lipid levels - Increased viscosity of blood

The best treatment is constitutional remedy prescribed after proper case taking.

1) Aconite -

It is indicated when there is acute or sudden rise in blood pressure. A/F physical or mental stress.
There is great fear and anxiety of mind.
The person has great fear of death and believes he will die soon.
He even predicts the day and time of death.
Also there is a great fear of future.
Lot of restlessness and patient must change the position often. Music is unbearable and makes the patient sad.
Pulse is full strong hard.
Fullness in head with pain drives person crazy.
Burning, bursting, pulsating feeling in head as if brain were moved by boiling water.
Vertigo << rising.
Aconite is indicated when there is no pathology and hypertension is on functional level.

2) Coffea cruda -

Bad effects of sudden emotions or pleasurable surprises.
Weeping from delight.
Unusual activity of mind and body.
Over sensitiveness of all senses. Full of ideas.
No sleep because of activity of brain.
Headache with sensation as if brain were torn to pieces as if nail were driven in head << open air.
Pains driving patient to despair.
Patient tosses about in anguish.

3) Glonine -

Bad effects of sun (sunstroke), mental excitement, fear, fright. Fullness in region of heart,
Pulsating throbbing headache.
Holds head with both hands.
Cannot lie down.
Head feels too large as if skull was too small for the brain.
Throbbing << every jar << step.
Throbbing of carotids.
Headache >> uncovering head << heat.
Mentally there is great lassitude.
No inclination to work with extreme irritability and easy excitation by slightest opposition.

4) Veratrum Viride -

Effects of sunstroke.
Headache intense, congestive.
Head hot. Face flushed. Throbbing arteries.
Bloodshot eyes. Pupils dilated.
Violent nausea and vomiting with headache.
Pulse suddenly increases and gradually decreases below normal, Soft, slow, weak, irregular, intermittent << motion.
Mentally person is quarrelsome and delirious.
Marked sensitivity to sound, cannot tolerate it.

5) Strophanthus -

Useful remedy in renal hypertension causing heart failure in the aged.
Irritable heart with tense arteries and a free discharge of urine. Temporal pain with double vision.
Impaired sight. Face flushed.
Vertigo of aged. Pulse quick.
Urine is increased or scanty albuminous with swollen extremities.

6) Viscum Album-

Useful in arteriosclerosis.
Hypertension with small weak pulse.
Dyspnoea << lying on left.
Weight on heart as if hand was squeezing it.
Headache with feeling as if whole vault of skull were lifted up.

7) Baryta Mur -

Indicated in high Systolic pressure with comparatively low diastolic pressure with cerebral and cardiac symptoms.
Convulsions which occur periodically with starting and excessive tossing.
Mania with increased sexual desire.
Heaviness of head.
Icy coldness of body with paralysis.
Voluntary muscular power is gone but perfectly sensible.

BIOCHEMIC REMEDIES

1) Ferrum Phos-


First or congestive stage of arteritis, carditis, endocarditis.
In aneurism to establish normal circulation
Remove complications on heart due to more action.
Hypertension with palpation.
Pulse rapid and quick, full bound.

2) Kali Mur-

Hypertension.
Embolism due to increased viscosity of blood which favours formation of clot which acts a plug.
Second stage of a disease where pathology has begun.
Palpitation from excessive flow of blood to heart.

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