Hypertension

Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. Hypertension puts strain on the heart, leading to hypertensive heart disease and coronary artery disease. Hypertension is also a major risk factor for stroke, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and chronic kidney disease. As per WHO ISH (World Health Organization-International Society of Hypertension) define hypertension as a persistent elevation of blood pressure greater than 140/90 mm Hg. The theme for World Health Day (WHD) 2013 is “high blood pressure.” The goal of WHD 2013 is to reduce heart attacks and strokes.

Ayurvaid's treatment modality for hypertension includes both internal medications and therapies, judiciously administered after considering the patient's individual clinical condition. Therapies like Talam (anointions), Shirodhāra (pouring of medicinal liquid in a particular fashion), virechana(procedural purgation), raktamokshana(blood letting), are often employed. Significant improvement in respect to maintenance of hypertension within normal levels can be brought about by the appropriate treatment. Early intervention with ayurveda helps prevent development of complication.

Signs & symptoms of GOUT

A. Symptoms of Hypertension

• No symptoms
• Non-specific symptoms
• Headache esp. Morning headache
• Tinnitus
• Dizziness
• Confusion
• Sleepiness
• Vision problems
• Angina
• Difficulty breathing
• Irregular heartbeat
• Blood in the urine
• Epistaxis
• Many symptoms occur from complications of hypertension

B. Signs of Hypertension

• Vital Signs - Elevated blood pressure, bradycardia, bounding pulse
• Skin - Flushed, diaphoresis, pallor
• Cardio-Vascular - Distended neck veins, extremity edema, pulmonary edema
• Neurologic - Decreased level of consciousness, impaired movement, symmetry of face and extremities, seizures, unequal pupils.

The disease has been shown to place an enormous burden on society.

Some 600 million people worldwide have high blood pressure and nearly 3 million die every year as a direct result. Yet seven out of every 10 people with hypertension are not being treated adequately, according to WHO and the International Society of Hypertension (ISH). With nearly 100-million affected people, India is on the vitiation verge of becoming the "heart disease capital of the world", experts warn today. Cardiovascular disease is the world's leading killer, accounting for 16.7 million or 29.2 percent of have also been incorporated total global deaths in 2003. The World Health Organization (WHO) estimates that 60 % of the world's cardiac patients will be Indian by 2010. Although it can occur at any age, it begins most often between ages 35 and 65.

Risk Factors

Risk Factors associated with hypertension include the following:

• Age – (older than 55 for men, 65 for women)
• Family History – of premature cardiovascular disease (men under age 55 or women under age 65)
• Gender –men have an increased risk of developing hypertension than women.
• Smoking – heavy smoking increases your risk of developing hypertension.
• Obesity (body mass index ≥ 30 kg/m2)
• Physical inactivity
• Dyslipidemia – altered lipids
• Diabetes mellitus
• Microalbuminuria or estimated GFR < 60 mL/min

Diagnosis and Lab investigations

Diagnosis

Diagnosis is made clinically by recording the Blood pressure in Sphygmomanometer. A systolic blood pressure ( SBP) >139 mmHg and/or a diastolic (DBP) >89 mmHg is diagnostic. Based on the average of two or more properly measured, seated BP readings.

Testing

Testing is extremely important to determine the stage of the disease and in selection of appropriate treatment options in case of primary hypertension. Prehypertension with systolic of > 120 & < 139 mmHg and Diastolic of > 80 & < 89 mmHg. NOT a DISEASE category. Should encourage Lifestyle modification as this group has an increased risk of becoming hypertensive. Life style modifications include weight reduction adopt DASH dieting plan, regular physical activity like brisk walking for 30min , moderation of alcohol intake.

Stage 1 : hypertension with systolic ranging from 140-159 mmHg and Diastolic ranging fromm 90-99mmHg. Along with lifestyle modifications needs medical intervention too.

Stage 2 : hypertension with systolic of ≥160 mmHg and Diastolic of ≥ 100mmHg. Along with lifestyle the above two needs treatment like dhara and virechana to prevent further complications. Testing can include blood tests and/or ECG, Echo etc to rule of other secondary causes of hypertension, such as Intrinsic renal disease, Renovascular disease, harmonal excess, Sleep Breathing disorder, Pheochromocytoma Coarctation of Aorta, & Hyper/hypothyroidism

• Serum creatinine
• 24hr urine metanephrine and nor metaneprine test
• 24 hr aldosterone test, Dexamethasone suppression test
• Doppler flow study
• CT and Magnetic resonance Angiography
• Selep study with O2 saturation,
• Serum TSH , PTH and
• Serum Potassium
• Lipid Profile

Ayurveda Treaments for Hypertension.

• Ayurveda Concept
• The disease hypertension is an abnormality of Rakta Dhatu (blood) and is popularly known as Shonita Dusti(vitiated blood). Shonita Dusti includes clinical manifestation that is analogous to hypertension. The illness Shonita Mada simulates the symptom of malignant hypertension. Symptoms like Shiroruka (Headache), Klama(Nausea, Vomiting), Anidra (Sleeplessness),Bhrama, Buddi Sammoha,Kampa etc. akin to manifestations of hypertension. Different neurological deficits like delirium, Altered state of consciousness manifested as the sequel of malignant Hypertension indicate the progressive manifestation of increasing Shonita Dushti leading to Mada, Moorcha and Sanyasa. Early intervention and management of hypertension helps to arrest progress into complications like cardiovascular(myocardial infarction, ischemic heart disease) and cerebro-vascular(stroke) etc.
• Ayurveda approach to medical management
• According to the dominance of Dosha and the Avastha of disease, the plan of treatment goes on differing. The line of treatment in the disease of Shonitadushti consists of Nidana parivarjana (avoidance of causative factors of shonita dusti like excessive intake of alcohol, salty food items, Sedentary habit, Mental stress, Physical strain & cold season), Shodhana in the form of Virecana (gut purification in the form of enema), Shirovirecana (purification through nasal root), Raktamokshana (Bloodletting), Use of shirodhara(special technique to pouring medicated oil over head), pichu, talam(applying medicated tampon over head), Shamana medications (different oral medication) and Rasayana Chikitsa.
• Significant improvement in respect to maintenance of hypertension within normal levels can be brought about by the appropriate treatment. Early intervention with ayurveda helps prevent development of complication. In malignant morbidity state involving heart attack, stroke and other illness though some efficacy is evident, the benefit of the treatment is unpredictable. But management lines in terms of improving the quality of life of patients is aimed at all times
• Treatment specific information
• The nature of the disease necessitates long run treatment protocol with continuous internal medications regular therapies. The patient need to be on naimittikarasayana (rejuvenation therapy specific to the disease) during the convalescence also