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
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: -
The specific causes cannot be defined in case for any hypertension.
Few of the causes are:-
Excessive salt intake
Most of the patients are asymptomatic but few can complain
The diagnosis is usually made on pretreatment investigations
of the patient.
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,
- 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.
Neurological deficit due to stroke.
- Blood examination
- Urine analysis
- BUN (Blood Urea Nitrogen), Creatinine, uric acid
- Serum Electrolytes
- Blood sugar and lipid profile
- 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.
General Measures: -
Restriction of salt intake
Reduction of Alcohol
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.
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
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
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
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
Mania with increased sexual desire.
Heaviness of head.
Icy coldness of body with paralysis.
Voluntary muscular power is gone but perfectly sensible.
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-
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.