Persistent increase in systemic arterial blood pressure is known as hypertension. Clinically when the systolic blood pressure rises above 150 mmHg and diastolic pressure increases above 90mmHg, it is considered as hypertension. Blood pressure is simply the physical pressure of blood in the blood vessels. Generally blood pressure is expressed as 120/80 (said as ‘120 over 80’). There are 2 numbers because the blood pressure varies with the heartbeat. The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries. This pressure is called Systolic pressure. The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats. This pressure is called Diastolic pressure.
TYPES OF HYPERTENSION
PRIMARY HYPERTENSION
In this, the blood pressure is elevated in the absence of any underlying disease. This is otherwise known as essential hypertension. The arterial pressure is increased because of increased peripheral resistance, which occurs due to some unknown cause. Primary hypertension is of two types
- Benign hypertension: in the early stages of this condition, there is a moderate increase in blood pressure with systolic pressure 200mm Hg and diastolic pressure of about 100mm Hg. However, in resting conditions and sleep, the blood pressure returns to normal level. Later there is further increase in blood pressure and it does not come back to normal level in resting conditions. The persistent increase in blood pressure over the years causes development of vascular, cardiac or renal diseases.
- Malignant hypertension: this is also called accelerated hypertension. During this, the blood pressure is elevated to a large extent of about 250mmHg systolic pressure and 150mmHg diastolic pressure. This is always developed due to the combined effects of primary and secondary hypertension. Malignant hypertension produces severe symptoms like renal disease and retinal hemorrhage. This is a fatal disease as it causes death within few years.
SECONDARY HYPERTENSION
Secondary Hypertension is due to some underlying disease. The different forms of secondary hypertension are
- Cardiovascular hypertension– produced due to the cardiovascular disorders like
- Atherosclerosis : hardening of the blood vessels
- Coarctation of aorta : narrowing of aorta
- Endocrine hypertension- this develops because of hyperactivity of some endocrine glands like
- Pheochromocytoma: tumor in adrenal medulla
- Hyperaldosteronism: excess secretion of aldosterone from adrenal cortex and
- Cushing’s syndrome excess secretion of glucocorticoids from adrenal cortex
- Renal hypertension– the renal diseases causing hypertension are
- Stenosis of renal arteries
- Tumor of juxtaglomerular cells leading to formation of excess of angiotensin 2 and
- Glomerulonephritis
- Neurogenic hypertension – the nervous disorders, which produce hypertension are
- Increased intracranial pressure
- Lesion in tractus solitarius
- Sectioning of nerve fibres from carotid sinus
- Hypertension during pregnancy – some pregnant women develop hypertension because of toxemia of pregnancy. The arterial blood pressure is elevated by the low glomerular filtration rate and retention of sodium and water. This maybe because of some autoimmune processes during pregnancy or the release of some vasoconstrictor agents from placenta or due to the excessive secretion of hormones causing rise in blood pressure. Hypertension is associated with convulsions in eclampsia.
SYMPTOMS
- Feeling of burning sensation and/or numbness in hands and feet
- Nausea
- Headache
- Feeling of tiredness
- Restlessness
- Vomiting
- Vertigo
- Pain in chest
- Loss of appetite
- Breathlessness
- Swelling in legs and under eyes
- Bleeding from nose
- Discomfort
- Haziness of vision
- Irritability
DIAGNOSING HYPERTENSION
- Blood pressure measurements are generally classified into several categories:
- Normal blood pressure : less than 120/80 mmHg
- Pre-hypertension : 120-139/80-89 mmHg
- Hypertension : greater than 140/90 mmHg
- Stage 1 Hypertension (Mild) 140-159 or 90-99
- Stage 2 Hypertension (Moderate) ≥ 160 or ≥ 100
- Stage 3 Hypertension (severe) ≥ 180 or ≥ 110
- Isolated systolic hypertension (ISH) ≥ 140 and < 90
COMPLICATIONS OF HYPERTENSION
Increased risk of
- Ischemic heart disease
- Stroke
- Peripheral vascular disease
- Cardiovascular diseases (cardiac failure)
- Aortic aneurysm
- Diffuse atherosclerosis
- Chronic kidney disease
- Pulmonary embolism
- Hypertensive retinopathy
- Hypertensive nephropathy
AYURVEDIC VIEW OF HYPERTENSION
According to Ayurveda hypertension can be correlated to a condition called raktagata vata, shiragata vatarakta vriddhi, vyanavrita vata, dhamanipratichaya raktavata etc based on the involvement of dosha dushya srotas and symptoms. In this condition, the vitiated vata gets lodged in the circulating rakta dhatu (blood) and causes disturbances in its circulation. Since rakta and pitta are in an inseparable relationship, the vitiation of rakta will result in the vitiation of pitta dosha. Therefore raktagatavata is a disorder of blood caused by vitiated vata and pitta. The kapha component will also be disturbed leading to loss of support and integrity of the cardiac functions. When the avalambaka kapha gains a pathological increase, they cause a block in the arteries and arterioles leading to atherosclerosis and peripheral resistance. This further causes hypertension and cardiac diseases. Hypertension can thus be regarded as a vata pitta predominant tridoshaja vyadi (disease) and rasa rakta are the chief culprits.
CAUSES
All the causes are that of rakta dusti(vitiation of blood)
- Intake of pradusttikshna ushna madhya(unwholesome, hot and pungent wine)
- Atilavana kshara amla and katu rasa sevana (excessive salt, alkaline ,acidic and bitter ingredients intake)
- Intake of horsegram, urad dal, sesame oil, radish, green eatables etc
- Intake of anupa mamsa (meat of aquatic animals)
- Dadhi (curd), mastu (sour whey), sukta sura and sauvirka
- Sleeping during day time after taking drava(liquid), snigdha (unctuous), guru (heavy) food
- Atikrodha (excessive anger)
- Excessive exposure to the sun and fire,
- Chardi vegadharana(suppression of the urge for vomiting),
- Avoidance of raktamokshana (bloodletting) therapy
- Shrama( exertion),
- Abhighata (external injury)
- Santapa (excessive heat)
- Ajeerna and Adhyashana (taking food before previous food is digested)
SYMPTOMS
All these symptoms are similar to rakta pradosaja vikara(blood vitiated disorders)
- Shiroruk/ Headache
- Anidra / Insomnia
- Klama/ Fatigue
- Krodha prachurya/ Anger or irritability
- Buddhi, sammoha, arti, mada, santapa/ Anxiety complex
- Akshiraaga /Sub conjunctival / Retinal hemorrhage
- Tandra/ Drowsiness
- Agnisada, Aruchi /Anorexia complex
.
TREATMENT
- Nidana Parivarjana (Avoidance of etiological factors)
- Life Style Modifications
- Samshodhana Chikitsa (Bio-cleanising therapies/ Purificatory procedures) Samshodhana chikitsa is a specialized therapeutic approach of Ayurveda to eliminate toxins from the body by giving bio-cleansing procedures i.e. Panchakarma.
- Lekhana Vasti (a specific variety of medicated enema)
- Virechana Karma (Purgation) with Eranda taila (Castor oil); eliminates the morbid pitta dosha and associated vata
- Shirodhara with medicated liquids, Takra (Butter milk), milk, water, medicated oils as per the specifications/ procedure & severity of roga.
- Rakta mokshan (Blood-letting) ; removes the vitiated blood corrects metabolism and provides lightness to the body
- It is usually followed by Shamana (Palliative) treatment
Shamana Chikitisa (Palliative therapy). However, it is decided by the physician according to the condition of the patient whether shodhana therapy is indicated or not.
- Rasayana (Rejuvenation therapy):–
- Brahmi Rasayana
- Shankhpushpi kalka
- Yashtimadhu churna
- Guduchi rasa
- Mandookparni swarasa
- Takra shirodhara: The patient is made to lie in supine position on droni (traditional Ayurveda treatment table ) and stream of buttermilk is poured over head for 30-45 minutes
- Ksheera dhara: The patient is made to lie in supine position on droni (traditional Ayurveda treatment table) and medicated milk is poured over head or whole body for 30-45 minutes
- Tailadhara: The patient is made to lie in supine position on droni (traditional Ayurveda treatment table) and medicated oil is poured over head or whole body for 30-45 minutes
- Shiro pichu: keeping cotton pieces dipped in medicated oil on the scalp and securing it in place
- Shiro basti: pooling of medicated oil in a cabin created on the head
- Shirolepa: medicated poultice or paste to be applied on scalp and head
- Avagaha: tub bath in medicated oil
MEDICINES
Single Drugs:
- Sarpagandha churna: 250 mg twice daily with honey
- Ashwagandha churna : 2grams at bedtime with a glass of warm milk
- Arjuna twaka churna : 2grams twice daily with a glass of warm milk or lukewarm water :
- Jatamamsi churna : 500 mg once a day with a glass of warm milk
- Rasona ksheerpaka: 10 ml; twice daily
- Amalaki/ Indian gooseberry : juice once in a day
Compound Formulations:
- Sarpgandha ghana vati : 1 tablet(375 mg); bedtime; after food
- Brahmi vati: 1 to 2 tablets (125mg ) twice a day
- Prabhakara vati : 1 tablets (250 mg); twice daily
- Arogyavardhini Vati : 2 tablets twice daily; after food with warm milk
- Sutashekhar Ras : 2 tablets (125 mg); twice daily after food with warm milk
- Rasapachaka Vati : 2 tablets (125 mg); twice daily after food with warm milk
- Laghutashekhar Rasa : 2 tablets (125 mg); twice daily after food with warm milk
- Mahatikta Ghria : ¼ to ½ teaspoon with water; twice daily before food
- Arjunarishta : 30 ml; twice daily after food
- Pravala pishti : 125 to 1000 mg, along with adjuvants like ghee, butter or honey, twice a day,
- Sveta parpati: : 125 to 500 mg, twice daily
- Nagarjunabhra rasa : 125 to 500 mg, twice daily
- Hridayarnava rasa: 125 to 500 mg, twice daily with kakamachi or triphala decoction
- Mukta bhasma: 125 mg, twice daily with honey, butter or milk
- Akika pishti : 125 to 500 mg, twice daily
PREVENTIVE MEASURES
- Regular physical activity
- Smoking cessation may not directly reduce BP but markedly reduces overall cardiovascular risk.
- Dietary salt restriction: 1 teaspoon/day/person.
- Eat a heart-healthy diet rich in fruits and vegetables, lean protein and whole grain
- Diet which is low in sodium, cholesterol, saturated and total fat, has been shown to lower high blood pressure
- Plant-based foods e.g. fruits, vegetables, pulses and a wide selection of wholegrain foods, moderate amounts of low fat or reduced-fat dairy
- Products, moderate amounts of lean unprocessed meats, poultry and fish, moderate amounts of polyunsaturated and monounsaturated fats (e.g. olive oil)
- Weight reduction: Reduction in body weight lowers systolic BP. Reduce weight if you are overweight or obese. Body mass index (BMI) and waist circumference are measures used to determine if someone is overweight or obese
- Manage stress. Learn about relaxation techniques that may relieve tension
- Suryanamaskara
- Pranayama
DASH diet: ‘Diet Approaches To Stop Hypertension’
- Dietary pattern which is promoted by the U.S. based National Heart, Lung and Blood Institute (N.H.L.B). N.H.L.B., part of National Institute of Health, an agency of the United States Department of Health and Human Services that prevents and controls hypertension
- Aims at reducing 5-6 mm/Hg of systolic pressure, due to the type of diet followed. Weight-loss also happens due to the diet but
- Main focus is on the prevention of hypertension. If precaution is taken for the future crisis then maybe we can postpone or even end it
| INCLUDE | EXCLUDE |
| · Maximum intake of fruits and vegetables | · Recommends Less use of sodium i.e. less than 6 mg of salt per day |
| · Low-fat dairy product, including fish, meat, poultry nuts and beans | · Cutting down on ready-to-eat foods, Avoiding foods containing MSG (mono sodium glutamate), |
| · Whole cereal-based foods | · Excluding or less use of baking soda and baking powder, |
| · 5 days of physical activity per week | · Shell or dried fish should be avoided or used less. |
| · Lean meat | · Bakery items made of refined flour should be consumed less. |
| · High-density lipoprotein containing foods | · Limited intake of alcohol. |
PATHYA – Do’s
- Regular blood pressure check-up.
- Timely intake of balanced diet, more
- Use of fruits and green vegetables
- Regular physical exercise
- Daily brisk walking for half an hour
- Barley (Yava)
- Sorghum (Jowar)
- Wheat
- Green gram (Mudga/Moong dal)
- Horse gram
- Drumstick (Shigru),
- Bitter gourd
- Bottle gourd (Ghia/ Lauki)
- Turnip (Shalgam)
- Carrot
- Radish
- Indian gooseberry (Amla)
- Cucumber
- Black grapes
- Pomegranate
- Apple
- Pineapple
- Cold milk
- Sleeping and awakening at regular times
- Regular practice of Yoga
- Meditation
APATHYA’S Don’ts
- Reduce intake of oily, salty, sour and spicy food items
- Excessive intake of salt
- Excessive use of Butter, Ghee, Chillies
- Red-Green Pickles
- Sesame Oil
- Mustard oil
- Bengal gram
- Sour fruits
- Curd
- Tea, Coffee
- Animal fat, processed/oily food
- Canned or processed meat
- Foods with soy sauce, seasoned salts, and baking soda.
- Fast food, frozen foods, and canned foods
- Alcohol consumption and smoking
- Day sleeping and awakening at night
