Hypertension : Ayurvedic and Allopathic Treatment

Hypertension- Chronic elevation in bp (blood pressure). 140/90 mmHg

Cause is unknown in 80-95%.

Isolated systolic hypertension (only systolic bp increases) is most common in elderly patients, due to reduced vascular compliance (compliance is the ability of blood vessels to expand and contract passively) in old age.

◾Secondary hypertension

1. Renal artery stenosis (stenosis means narrowing)- It occurs either due to artherosclerosis(old men) or fibromuscular dysplasia(young women)
   • Abdominal bruit(sound from abdomen, heard with stethoscope) in 50%.
   • Mild hypokalemia (decreased potassium level), due to activation of mild renin in angiotensin aldosterone system.
2. Renal parenchymal disease- Increased serum creatinine and/or abnormal urinalysis, containing protein cells/cyst.
3. Coarctation of aorta- Present in children or young adults, constriction in aorta occurs at origin of left subclavian artery. On examination.
   • Diminished, delayed femoral pulsation
   • Late systolic murmur
   • Chest x-ray shows indentation of aorta at the level of coarctation and rib notching.
4. Pheochromocytoma- Catecholamine(it raises heart rate and BP) secreting tumour, typically of adrenal medulla. In young-middle aged.
   • sudden headache, palpitation(heart beat rapid) and profuse diaphoresis (sweating)
   • Associated chronic weight loss, orthostatic hypotension and impaired glucose tolerance.
   • Pheochromocytoma may be localised to bladder wall and may be present with micturition associated symptoms of catecholamine excess.
   • Diagnosis- CT scan or MRI for tumour
5. Hyperaldosteronism– Aldosterone secreting adenoma/bilateral adrenal hyperplasia.
   • It occurs when hypokalemia is present in hypertensive diuretic patient.

✅Other causes-

• Oral contraceptive usage
• Obstructive sleep apnea
• Cushing’s syndrome (cortisol increases) and adrenogenital syndrome
• Hyperparathyroidism and acromegaly (Growth hormone level elevates)
• Consider thyrotoxicosis in systolic hypertension patients and wide pulse pressure. (wide pulse pressure is large difference in systolic and diastolic BP)

✅ Symptoms of headache, dizziness and blurred vision

◾Clues to secondary hypertension

• Use of medications (oral contraceptive pills, glucocorticoids, decongestants, erythropoietin, NSAID’s- Non steroidal anti-inflammatory drugs, cyclosporine)
• Paraoxyms of headache, sweating, tachycardia
• History of renal disease/abdominal trauma.
• Day time sleepiness/snoring

◾Physical examination

• Measure BP, both arms and legs
• Retinal arteriolar changes
• Left ventricular lift
• Loud A²S⁴
• Cushingoid appearance
• Thyromegaly
• Abdominal bruit
• Delayed femoral pulses

◾Investigations

1. S. Creatinine, BUN (blood urea nitrogen)
2. Urinalysis (urine frequency decreases, BP increases)
3. Serum potassium (diuretics)
4. CXR (rib, notch/indentation)
5. ECG and Blood screening test
6. TSH (Thyroid stimulating hormone)

✅Further investigations-

• Renal artery stenosis- magnetic resonance angiography, captopril renogram, duplex ultrasound
• Cushing syndrome- dexamethasone suppression test
• Pheochromocytoma
• Hyperaldosteronism
• Renal parenchymal disease

Ayurvedic aspect of hypertension

उच्चरक्तचाप

• वातज – irregular BP, heart rate and pulse
• पित्तज – excessive heat symptoms, red face
• कफज – obesity and high triglycerides

◾Life style modifications

• Weight reduction (BMI<25kg/m²)
• Sodium restriction
• Diet rich in fruits, vegetables and low fat dairy products
• Regular exercise
• Moderation of alcohol consumption

◾ Emergency hypertensive medicines (IV doses)

Medicine	Dose
1. Nitroprusside	Inital 0.3mg/kg Usually 2-4 mg/kg
2. Nicardipine	Initial 5mg/h, titrate by 2.5 mg/h at 5-15 min interval
3. Labetolol	2mg/min/20mg over 20 min then 40-80mg at 10 min interval
4. Enalprilat	Usually 0.625-1.25mg over 5 min every 6-8 hour
5. Esmolol	Initial 80-500mg/lg over 1 min, then 50-500mg/kg/min
6. Phentolamine	5-15 mg bolus
7. Nitroglycerine	Initial 5mg/min, then titrate by 5mg/min at 3-5 min interval If no response, then 20 mg/min
8. Hydralazine	10-50mg at 30 min interval

◾Gradual attainment of normal BP value

◾ Allopathic medicines

Drug class	Example	Total daily dose
1. Diuretics
Thiazide	Hydrochlorothiazide	6.25-50mg(1-2)
Thiazides like	Chlorthalidone	25-50mg(1)
Loop diuretics	Furosemide	40-80mg(2-3)
K retaining	Spironolactone Eplerenone Amiloride Triamterene	25-100mg 50-100mg 5-10mg 50-100mg
2. Beta- blockers
Beta 1 selective	Atenolol Metaprolol	25-100mg(1-2) for both
Non-selective	Propanolol Propanolol LA	40-160mg(2) 60-180mg(1)
Combined alpha/beta	Labetolol Carvedilol	200-800mg(2) 12.5-50mg(2)
3. ACE inhibitors	Captopril Lisinopril Ramipril	25-200mg(2) 10-40mg(1) 2.5-4 mg(1)
4. Angiotensin II Receptor Blockers	Losartan Valsartan Candesartan	25-100mg(2) 80-320mg(1) 2-32mg(1-2)
5. Ca channel antagonist	Digitalis glycosides (Increase output of heart)
Dihydro pyridines	Nifedipine long acting	30-60mg(1)
Non-Dihydro pyridines	Verapamil Ditiazem	120-360mg 180-420mg

◾ Indications and contraindications

Class of drug	Compelling Indications	Possible Indications	Compelling Contra indications
Diuretics	Heart fail Elderly pt. Systolic HT		Gout
Beta- blockers	Angina After MI Tachyarrhythmias	Heart fail Pregnancy	Asthama and COPD Heart failure
ACE Inhibitor	Heart fail LV dysfunction After MI Diabetic Neuropathy	Chronic renal parenchymal disease	Pregnancy Hyperkalemia Bilateral renal artery stenosis
Angiotensin Receptor Blocker	ACE inhibitor cough Heart failure Diabetic Neuropathy	same as above	same as above
Ca channel Blockers	Angina Elderly pts. Systolic HT	Peripheral vascular disease	Heart block

◾ Ayurvedic remedies for hypertension

1. मुक्ता वटी – 1-2 tablets with water BD (twice a day), morning and evening, 1 hour before food.
   • मुक्ता वटी is more beneficial when taken with अर्जुन क्षीर पाक
2. एक कप लोकी स्वरस में आंवला स्वरस, सेब स्वरस तथा पुदीना व धनिया मिलाकर नियमित सेवन लाभप्रद है।
3. 1tsf coriander with 1 pinch cardamom in 1 cup of peach juice lowers blood pressure.
4. Daily consumption of Cucumber raita helps in hypertension as it is a good diuretic.
5. Try consuming moong Dal soup, it helps reduces blood pressure
6. Avoid salt, fatty, fried and hot spicy food.
7. Consume more water after having meal.
8. Consuming raw Garlic can help in वातज hypertension
9. For कफज hypertension, त्रिकटु can prove to be effective.

◾दैवव्यपाश्रय चिकित्सा – आचार्य बालकृष्ण व Dr. Priyavart Sharma के अनुसार रुद्राक्ष की माला धारण करने से रक्तभार आधिक्य नियंत्रित होता है।

◾Yoga for hypertension

1. उत्तानासन
2. विपरीत करणी
3. पश्चिमोत्तानासन
4. सेतु बन्धासन
5. शवासन
6. भुजंगासन

Bhujangasana (भुजंगासन / सर्पासन ) -Cobra pose