AND ITS

UNDER GUIDANCE OF -

Dr. V.PUSHKAR
National Homoeopathic Medical College & Hospital, Lucknow
Submitted by: SAUMYA KUMAR MISRA 2002 BATCH FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE
Lecturer

& HOSPITAL, MANGALORE

ACKNOWLEDGEMENT
First of all I would like to thank Almighty & Supreme power LORD KRISHNA for showering his blessings on me. This is a great honour to offer my sincere thanks to Rev. Fr STANY TAURO Administrator FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE., Dr.S.K.TIWARI Principal FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE,MANGALORE, Dr. A.N.MISHRA Principal, National Homoeopathic Medical College, Lucknow, under whose guidance I completed this dissertation..I would like to express my heartiest thanks to Dr. S.Misra

and to my family for their encouragement and never ending support.

I also offer my thanks to Dr. V.PUSHKAR, Lecturer National homoeopathic medical college; lucknow who extended their kind help in every possible way, whenever required.

Dr. SAUMYA KUMAR MISRA, ern Batch Int 2002,

CERTIFICATE
This is to certify that Intern Dr. SAUMYA KUMAR MISRA, 2002 Batch has completed his dissertation titled Hypertension and its homoeopathic treatment, under my guidance. He has worked hard.

V.PUSHKAR ) Guide

(Dr.

National Homoeopathic Medical College

CERTIFICATE

This is to certify that Intern Dr.SAUMYA KUMAR MISRA 2002 Batch has completed his dissertation titled Hypertension and its homoeopathic treatment, under my guidance. He has worked hard.

f. Dr.A.N.Mishra ) Principal al Homoeopathic College & Hospital

(Pro

Nation Medical

INDEX
CONTENTS PAGE NO. 1) Introduction

5 2) Aims and objectives 9 3) Review of general medical literature 10 4) Review of homoeopathic literature 34 5) Material and methods 44 6) Management and treatment 47

7) Annexure i. ) Case Proforma 57 ii. ) Graphs 61 iii. ) Synopsis of cases 63 8) Bibliography 68

INTRODUCTION
Blood pressure is a pressure exerted by flowing blood on the walls of arteries, veins and capillaries. Hypertension , Hyperpiesia, High blood pressure , Essential hypertension, the silent killer , problem of modern civilization are the epithets used to describe but a feature of cardiovascular physiology. Normal blood pressure refers to a range of values rather than a specific set of numbers and varies with factors such as age, race, and gender. However, a blood pressure reading greater than 140/90 mm Hg (millimeters of mercury pressure) is generally considered to be elevated. In this measurement, 140 refers to the systolic pressure (the maximum pressure in the arteries when the heart contracts). The 90 refers to the diastolic pressure (the lowest pressure in the arteries when the heart is between contractions). More than 95% of all elevated blood pressure can be classified as hypertension. When a disease, other physical problems, medications, or even temporary physical exertion or stress causes high blood

pressure, the condition is called Secondary hypertension. Blood pressure refers to the force exerted by blood against the interior walls of the body's blood vessels. There are three categories of blood pressure, corresponding to the three types of blood vessels: Arterial, capillary, and Venous. In individuals with hypertension, arterial pressure (recorded as two numbers: systolic and diastolic pressure) is the most important measurement to obtain. The reason is that because of their relative proximity to blood flowing forcefully from the heart, arteries must withstand the highest pressures of all the body's blood vessels. The body requires a relatively constant blood pressure level to ensure adequate passage of nutrients and oxygen to organs and tissues. To maintain a constant level of pressure, the body must balance and react to a number of factors such as :

Volume of blood in the circulatory system Amount of blood ejected by the heart (stroke volume Heart rate Thickness of the blood (viscosity

Elasticity of the arteries When the systolic or diastolic pressure is elevated for an extended period of time, such as months or years, the heart has to work harder and may become damaged, along with the blood vessels. If it remains untreated, high blood pressure can lead to a variety of serious health problems, including heart disease, stroke, and kidney failure. HISTORY The ancient Chinese emperor Huang ti (2000 BC.) is eradicated with first observation that people with full volume pulses develop strokes. He also noted that people who eat a lot of salt have full volume and hard pulse . He was the first person to appreciate the importance of estimating the blood pressure within the circulation although he died .Thus by palpating the pulse noting its character Raverdson steven holes a biologist of Teddingilon England first recorded blood pressure in 1730,he introduced canula into artery in the neck of a horse and measured height of column of rising up a glass tube .He also observed that

when the horse struggled the blood pressure rise .Sir George Pickering develop the intrarterial method of measuring the blood pressure in humans. DEMOGRAPHICS It is estimated that one in four Americans suffer from high blood pressure; it is also estimated that one in three people who have high blood pressure are unaware of the problem. Also, hypertension is much more common among African-Americans and Mexican-Americans than in Caucasian populations. Low levels of nitric oxide, which have been observed in individuals particularly African-Americans with elevated blood pressure, may be an important factor in the development of essential hypertension. The prevalence of essential hypertension increases with age until at least the age of 80. Statistics indicate that more than half of all Americans over the age of 65 have hypertension. In those under the age of 55, essential hypertension is more common in males than females. Over age 55, there is

an equal distribution among males and females. PREVALENCE In white sub urban population likes that in framengham study of 1/5 of individual have blood pressure greater than 140/90 mmhg. An even higher prevalence is closely related to age with substantial and increase after the age of 50 yr. This increase is presumably related to hormonal change of menopause. Prevalence in India The data derived from, two well planed studies which increased all persons aged 20-60yrs. The study group in Rohtak represented the urban population. The other group in Haryana represented the rural population in urban population the prevalence was 59.9 and 69.9 per thousand male and females respectively.

AIMS AND OBJECTIVES

o To see the place of deep acting & short acting medicines in treatment. o To see homoeopathic dosage directions.

o To see miasmatic and constitutional background in the treatment. o To see the auxiliary management in the treatment.

REVIEW OF GENERAL MEDICAL LITERATURE

HYPERTENSIONDEFINITIONIt is a silent killer which produces disability and death manifested as persistent rise of blood pressure above the arbitrary level of systolic pressure of 140mmhg or above or diastolic pressure of 90 mm hg or above recorded on three or more successive occasions under satisfactory condition of measurement.

Systolic pressure is measured while the heart contracts and pumps blood into the arteries. Diastolic pressure is measured while the heart fills with blood.

Primary Hypertension : Also known as Essential hypertension with obscure cause or where No cause can be found.It is the most common type and it affects both sexes. Secondary Hypertension - Where there is a demonstrable cause for the HT. Genetic profile Studies suggest that some people with essential hypertension may inherit abnormalities of the sympathetic nervous system the part of the nervous system that controls heart rate, blood pressure, and the diameter of blood vessels. It is estimated that the risk of developing essential hypertension is increased two- to four-fold if one or both parents are diagnosed with the disorder.

Researchers have identified the chromosomes (11 and 18) that house the genes responsible for blood pressure regulation, although narrowing down the range of specific genes involved in hypertension is more difficult. Genes under intense study are those that regulate a group of hormones known as the angiotensin-renin aldosterone system. This system influences all aspects of blood pressure control, including blood vessel contraction, sodium and water balance, and cell development in the heart. When blood pressure drops, the kidneys release an enzyme called Renin, which initiates a chain reaction to bring blood pressure back up. Renin acts on angiotensinogen (a plasma protein) to produce the hormone, angiotensin I (an inactive form), which is then converted to angiotensin II (an active form of the hormone) by the angiotensin-converting enzyme (ACE). Angiotensin II then stimulates the adrenal glands to release the hormone aldosterone, which decreases kidney sodium excretion, thereby causing blood vessels to constrict. When blood vessels constrict, blood pressure goes up.

Researchers believe that this angiotensin-renin aldosterone system evolved millions of years ago to protect humans. By retaining salt and water and narrowing blood vessels, the body was ensured an adequate blood flow and the ability to repair injured tissue. Over time, however, this system outlived its original protective function and led to serious health complications. CLASSIFICATION WHO and guidlines1999 WHO - World health organization ISH - International society of hypertension CATEGORY Optimal Normal High normal Hypertension Grade1(mild/bord erline) Grade2(mod./sus tained) Grade3(severe) SYSTOLIC B.P (In mm hg ) <120 120-129 130-139 140-159 160-179 180-209 DIASTOLIC B.P (In mm hg) < 80 80-84 85-89 90-99 100-109 110-119

( accelerat > 210 ed)

120

Primary (Essential) Hypertension Primary hypertension accounts for approximately 90-95% of patients diagnosed with hypertension. Unlike secondary hypertension, there is no known cause of primary hypertension. Despite many years of active research, there is no unifying hypothesis to account for the pathogenesis of primary hypertension. There is a natural progression of this disease that suggests early elevations in blood volume and cardiac output might initiate subsequent changes in the systemic vasculature (increased resistance). This has suggested to some researchers that a basic underlying defect in many hypertensive patients is an inability of the kidneys to adequately handle sodium. Increased sodium retention could then account for the increase in blood volume. In chronic, longstanding hypertension, blood volume and cardiac output are often normal, therefore the hypertension is sustained by an elevation in systemic vascular resistance rather than by an increase in cardiac output. This increased resistance is caused by a thickening of the walls of resistance

vessels and by a reduction in lumen diameters. There is also evidence for increased vascular tone. This could be mediated by enhanced sympathetic activity or by increased circulating levels of angiotensin II. In recent years, considerable evidence has suggested that changes in vascular endothelial function may cause the increase in vascular tone. For example, in hypertensive patients, the vascular endothelium produces less nitric oxide and the vascular smooth muscle is less sensitive to the actions of this powerful vasodilator. There is also an increase in endothelin production, which can enhance vasoconstrictor tone. There is compelling evidence that hyperinsulinemia and hyperglycemia in type 2 diabetes (noninsulin dependent diabetes) causes endothelial dysfunction by enhanced oxygen free radical mediated damage and decreased nitric oxide bioavailability. Therefore, the underlying cause of primary hypertension is not clear. Furthermore, many mechanisms may operate to initiate and sustain hypertension. Treatment of patients with primary hypertension is in reality a pharmacologic intervention to modify factors (e.g., angiotensin II, sympathetic activity, calcium entry into

cells) in a way that leads to a reduction in arterial pressure. However, these treatments do not target the cause(s) of the underlying disease. Nevertheless, treatment of hypertension with antihypertensive drugs is vitally important because hypertension increases the risk for coronary artery disease, stroke, renal disease and other disorders. The three broad classes of drugs used to treat primary hypertension are diuretics (to reduce blood volume), vasodilators (to decrease systemic vascular resistance), and cardioinhibitory drugs (to decrease cardiac output). Go to: secondary hypertension Secondary Hypertension Secondary hypertension accounts for approximately 5-10% of all cases of hypertension, with the remaining being primary hypertension. Secondary hypertension has an identifiable cause whereas primary hypertension has no known cause (i.e., idiopathic).

There are many known conditions that can cause secondary hypertension. Regardless of the cause, arterial pressure becomes elevated either due to an increase in cardiac output, an increase in systemic vascular resistance, or both. When cardiac output is elevated, it is generally due to either increased neurohumoral activation of the heart or increased blood volume. Patients with secondary hypertension are best treated by controlling or removing the underlying disease or pathology, although they may still require antihypertensive drugs. Some causes for secondary hypertension are listed below:

Renal artery stenosis Chronic renal disease Primary hyperaldosteronism Stress Sleep apnea Hyper- or hypothyroidism Pheochromocytoma Preeclampsia Aortic coarctation Renal artery stenosis (renovascular disease) Renal artery disease can cause of narrowing of the vessel lumen (stenosis). The reduced lumen diameter increases the pressure drop along the length of the diseased artery, which reduces the pressure at the afferent arteriole in the kidney. Reduced arteriolar pressure and reduced renal perfusion stimulate renin release by the kidney. This increases circulating angiotensin II (AII) and aldosterone. These hormones increase blood volume by enhancing renal reabsorption of sodium and water. Increased AII causes systemic vasoconstriction and enhances sympathetic activity. Chronic elevation of AII promotes cardiac and vascular hypertrophy. The net effect of these renal mechanisms is an

increase in blood volume that augments cardiac output by the Frank-Starling mechanism. Therefore, hypertension caused by renal artery stenosis results from both an increase in systemic vascular resistance and an increase in cardiac output. Chronic renal disease Any number of pathologic processes (e.g., diabetic nephropathy, glomerulonephritis) can damage nephrons in the kidney. When this occurs, the kidney cannot excrete normal amounts of sodium which leads to sodium and water retention, increased blood volume, and increased cardiac output by the Frank-Starling mechanism. Renal disease may also result in increased release of renin leading to a renindependent form of hypertension. The elevation in arterial pressure secondary to renal disease can be viewed as an attempt by the kidney to increase renal perfusion and restore glomerular filtration. Primary hyperaldosteronism Increased secretion of aldosterone generally results from adrenal adenoma or adrenal hyperplasia. Increased circulating aldosterone causes renal retention of

sodium and water, so blood volume and arterial pressure increase. Plasma renin levels are generally decreased as the body attempts to suppress the renin-angiotensin system; there is also hypokalemia associated with the high levels of aldosterone. Stress Emotional stress leads to activation of the sympathetic nervous system, which causes increased release of norepinephrine from sympathetic nerves in the heart and blood vessels, leading to increased cardiac output and increased systemic vascular resistance. Furthermore, the adrenal medulla secretes more catecholamines (epinephrine and norepinephrine). Activation of the sympathetic nervous system increases circulating angiotensin II, aldosterone, and vasopressin, which can increase systemic vascular resistance. Prolonged elevation of angiotensin II and catecholamines can lead to cardiac and vascular hypertrophy, both of which can contribute to a sustained increase in blood pressure. Sleep Apnea

Sleep apnea is a disorder in which people repeatedly stop breathing for short periods of time (10-30 seconds) during their sleep. This condition is often associated with obesity, although it can have other causes such as airway obstruction or disorders of the central nervous system. These individuals have a higher incidence of hypertension. The mechanism of hypertension may be related to sympathetic activation and hormonal changes associated with repeated periods of apnea-induced hypoxia and hypercapnea, and from stress associated with the loss of sleep. Hyper- or hypothyroidism Excessive thyroid hormone induces systemic vasoconstriction, an increase in blood volume, and increased cardiac activity, all of which can lead to hypertension. It is less clear why some patients with hypothyroidism develop hypertension, but it may be related to decreased tissue metabolism reducing the release of vasodilator metabolites, thereby producing vasoconstriction and increased systemic vascular resistance. Pheochromocytoma

Catecholamine secreting tumors in the adrenal medulla can lead to very high levels of circulating catecholamines (both epinephrine and norepinephrine). This leads to alpha-adrenoceptor mediated systemic vasoconstriction and betaadrenoceptor mediated cardiac stimulation, both of which contribute to significant elevations in arterial pressure.. Despite the elevation in arterial pressure, tachycardia occurs because of the direct effects of the catecholamines on the heart and vasculature. Excessive beta-adrenoceptor stimulation in the heart often leads to arrhythmias. The pheochromocytoma is diagnosed by measuring plasma or urine catecholamine levels and their metabolites (vanillylmandelic acid and metanephrine). Preeclampsia This is a condition that sometimes develops during the third trimester of pregnancy that causes hypertension due to increased blood volume and tachycardia. The former increases cardiac output by the FrankStarling mechanism. Aortic coarctation Coarctation, or narrowing of the aorta (typically just distal to the left subclavian

artery), is a congenital defect that obstructs aortic outflow leading to elevated pressures proximal to the coarctation (i.e., elevated arterial pressures in the head and arms). Distal pressures, however, are not necessarily reduced as would be expected from the hemodynamics associated with a stenosis. The reason for this is that reduced systemic blood flow, and in particular reduced renal blood flow, leads to an increase in the release of renin and an activation of the renin-angiotensinaldosterone system. This in turn elevates blood volume and arterial pressure. Although the aortic arch and carotid sinus baroreceptors are exposed to higher than normal pressures, the baroreceptor reflex in blunted due to structural changes in the walls of vessels where the baroreceptors are located. Also, baroreceptors become desensitized to chronic elevation in pressure and become "reset" to the higher pressure.

CAUSES AND RISK FACTORS Most people have essential hypertension, which has no identifiable cause. Some think it may be due in part to a

genetic predisposition. The probability of developing this condition increases with age. In approximately 5% of patients, a secondary cause exists. Secondary causes include certain types of kidney disease, abnormal functioning of certain glands (adrenal glands, thyroid gland, parathyroid glands), chronic intake of certain substances and medications (e.g., alcohol, steroids), and the presence of a rare tumor (e.g., pheochromocytoma, which secretes adrenaline-like substances). Systolic hypertension with wide pulse pressurea) Decreased compliance of aorta - e.g. arteriosclerosis. b) Increased stroke volume1. Aorta regurgitation 2. Thyrotoxicosis 3. Arterio venous fistula 4. Patent ductus arteriosus Systolic and diastolic hypertensionIncreased peripheral vascular resistance.

a) Renal cause1. Chronic pyelonephritis 2 Acute and chronic 3. Polycystic disease of 4. Reno vascular 5. Diabetic nephropathy b) Endocrine cause1. Oral contraceptives 2. Cushings disease 3. Primary hyperaldosteronism . 4. Phaeochromocytoma 5. Myxoedema 6. Acromegaly

glomerulonephritis kidney stenosis

c) Neurogenic causesyndrome 1. Diencephalic 2. Psychogenic 3. Polyneuritis

4. Increased intra cranial pressure d) Miscellaneous1. 2. 3. 4. glucocorticoids e) Unknown etiology1. Essential hypertension 2. Toxemia of pregnancy RISK FACTORNon modifiable risk factor 1. Heredity 2. Male sex 3. Aging Major modifiable risk factor 1. Smoking 2. Hyperlipidimia 3. Diabetes mellitus Minor modifiable risk factorCoarctation of aorta Polyarteritis nodusa Hypercalceamia Medication

1. 2. 3. 4. 5. HEREDITY-

Dietary factors Obesity Sedentary life styles Type A personality Stress and anxiety

It plays an important role. The studies carried out by ISH if both parents are normotensive the rise in children will be 2-5 %. When one is hypertensive and other is normotensive the rise in children will be 20%. If both parents are hypertensive risk in children will be more than 50%.

AGE Age results in gradually increasing rigidity and decreasing elasticity of arterial wall due to wear and tear process. Onset is rare in first two decades of life. The average of onset being 30 to 40 years. SEX . a) ENDOGENOUS FACTORMale -There are many factors

Thicker intima of artery in males. Macho complex interferes and men consciously or unconsciously deny their problems. b) EXOGENOUS FACTORSMales are more expose to competitive stress, males do not react naturally to stress, rather suppress it. Higher intake of sugar and saturated fats in males. Males are prone to heavier cigarette smoking and alcohol. Major modifiable risk factor SMOKING Smoking is independent risk factor for cardiovascular death from hypertension. After smoking one or two cigarette blood pressure rises sharply. A standard cigarette contains 20 mg of nicotine. A considerable amount is destroyed by heat and rest is dispersed inside stream. An average smoker absorbs about 2 micro grams per kg body weight per minute, nicotine from single cigarette. The incidence of smoking hazards are increasing more due to passive smoking

because the passive smoking unable to exhale the smokes. MechanismSmoking increasing heart rate and cardiac output their by increasing blood pressure. Smoking stimulate chromofinn cells in the heart and blood vessels to release adrenaline and nor adrenaline. These catecholamine cause vasoconstriction and mobilize the fatty acids from adipose tissue thus accelerating the process of arteriosclerosis. HYPERLIPIDEMIASubject with total cholesterol level above 250% have four times major risk than with level of less than 200 mg% . HDLAbout 20% of total plasma cholesterol are found in HDL.HDL are encountered in those who are engaged in physical activity and exercise. Low HDL level are encountered in subjects with obesity, smoking, eating sugar and low roughage diet.

LDL- It is directly associated with coronary artery disease (CAD) and premature atheriosclerosis. VLDLit is associated with periphery vascular disease. Minor modifiable risk factor DIET vegetarians have lower blood pressure than the non vegetarians. This is probably due to intake of high animal fat and proteins, increase salt content of non veg meals .High fiber content of vegetarian diet has a protective effects. Salts use of salts more than 10 gm/day cause hypertension that is why hypertension is more common in Japanese who take maximum amount of salt .Excessive salt intake causes increased vascular reactivity resulting in increased peripheral resistance. Saturated fatty acids Excessive intake of saturated fatty acids is associated with increase incidence of hypertension.eg. Ghee and butter, eggs.

Polysaturated fatty acidsVegetable oil contains polysaturated fatty acids that do not become solid at room temperature i.e. sunflower, soyabean, and mustered oil. Hypertension is rare in Eskimos because they take up fish marines oil in food. Dietary factorsa) ALCOHOL- prolonged alcohol consumption causeReduction in cardiac contractibility and cardiac output. Increase in lt. ventricular end diastolic pressure. b) TEA AND COFFEEthey contain caffeine that interferes with functioning of heart and blood vessels. they increase the heart rate and predispose tp cardiac arrhythmia. c) Obesity -- short stickey and thick chest and short necked subject are more prone to hypertension. Obesity is expressed by body mass Index. BMI=wt. in kg. /ht. in meters

*FRAHMINGHUM studies suggest that when weight is more than 10 kg from 70 kg causing risk of hypertension. PHYSICAL ACTIVITY- Regular aerobic exercise within the limits of cardiovascular appears to have a protective effect. It causes increase in cardiac contractibility. Increase in HDL decrease in LDL. Lack of exercise is responsible for obesity and hypertension. PERSONALITY Type A personality carries an increase risk of developing hypertension .these traits have been recognized as1- Sense of urgency. 2-Impatience 3-aggressive 4-easily angered 5-Can not bear contradiction 6- Competitive 7-Compare him with others 8-Exaggerated needs for achievements power public recognition 9-fear of failure 10-does not left to be slower down achieve more.

MENTAL STRESS AND ANXIETYMiddle age is the most predisposed age in this respect .the subject is at the peak of their carrier and anticipates promotion if he fail to get, there is an emotional trauma due to lack of fulfillment. He or she at this stage trying for excellence in the professional field .at home wife and children feel neglected which created stress in family reaction .parents are now old and sick and demand attention. Children are opting for higher studies for which they need money at the same time mostly house is also constructed which adds to financial problem. PATHOLOGICAL EFFECT OF HYPERTENSION 1. Blood vessel 2. Retina 3. Heart 4. Brain 5. Kidney 1. BLOOD VESSEL Hypertension is one of the chief causes of a disease of the arteries called atherosclerosis, where a build-up of fatty deposits occurs in the lining of the artery

walls. These fatty deposits called plaques can thicken, calcify and narrow the arteries to the point where they restrict the flow of blood. Hypertension is one of the chief causes of a disease of the arteries called atherosclerosis, where a build-up of fatty deposits occurs in the lining of the artery walls. These fatty deposits called plaques can thicken, calcify and narrow the arteries to the point where they restrict the flow of blood. This can result in the formation of a blood clot (called a thrombus) at the site of the plaque, which may block the artery altogether. If it's severe and sudden enough, the tissues normally supplied by the artery can die from lack of oxygen. It can happen in just about any organ in the body, but it's most common in the heart, brain, the arteries of the limbs, the kidneys and the retina (the light sensitive part of eye).

Hypertension is a cause of atherosclerosis; a build-up of fatty deposits in artery walls. RETINA grade.

. 2.

Retinopathy of 1st 2nd and 3rd

3. HEART LVH compensatory and finally decompensatory Coronary artheroscleroma. 4. BRAIN a) Cerebral ischemia b) Cerebral hemorrhage c) Hypertensive encephalopathy. 5. KIDNEY

a) Reduced renal effusion b) Abrupt decline in renal function c) Contracted granular kidney d) Nephrosclerosis e) Tubular atrophy. CLINICAL FEATURESigns and symptoms Essential hypertension may cause no symptoms for years. For this reason, high blood pressure is often called the "silent killer." The first symptom may be a heart attack or stroke. The assessment of the patient with hypertension has three main objectives; 1) To ascertain the extent of organ damage that has already resulted from high blood pressure. 2) To detect any treatable cause. 3) To define when possible to reduce the factors that determine a high risk of CVS disease. The information relevant to these factors can be obtained from the history, physical examination and lab investigation. However, many people with hypertension may experience one or more of the following symptoms: Severe headache

 Excessive tiredness or giddiness Confusion Visual changes Nausea and vomiting Chest pain Shortness of breath Significant sweating

HeadacheMost headache including those in the majority of patients with high blood pressure bearing no relationship to the level of blood pressure. However patient with diastolic hypertension exceeding about 110 mm hg especially younger patient often complain of morning headache. These headache are related to level of blood pressure. GiddinessThis is common in patient with untreated hypertension. Visual changesBlurred vision usually indicate the presence of cotton wool spots under macular

oedema but also arise as a result occlusion of retinal veins. Breathlessness or slow walking are also common symptoms of high blood pressure but many patient with these complains also have ischemic heart disease.

DIAGNOSIS Hypertension is usually diagnosed in the course of a general physical checkup, or while a person is seeing a doctor for some other unrelated condition. A nurse tests the blood pressure of a patient using a sphygmomanometer. Sometimes a person may be diagnosed as having had a stroke or a heart attack and are then found to have high blood pressure.

The standard way blood pressure is measured is by using an instrument called a sphygmomanometer, which first appeared in doctors' surgeries in the 1880s. Invented by a German, Samuel Siegfried Karl Ritter von Basch, and subsequently modified to its present design in 1896 by Italian paediatrician Scipione Riva-Rocci, it has strengthened the forearm muscles of many a nurse . The modern sphygmomanometer has an inflatable cuff that is wrapped around the upper arm and inflated with air via a rubber bulb that is repeatedly squeezed. When the pressure in the cuff gets high enough, it cuts off the blood flow in the main artery of the upper arm. The air is then slowly released from the cuff via a valve. As the pressure in the cuff falls (as measured by a mercury barometer) sounds of the blood rushing through the artery are heard through

a stethoscope placed over the artery. These sounds are called Korotkoff sounds. The pressure at which sound is first heard as the cuff is released is the systolic pressure. The pressure at which the last sound is heard that is, the pressure at which the sound disappears as the blood returns to its silent, unimpeded flow is the diastolic pressure. One problem with the sphygmomanometer is the mercury it uses, which is poisonous and can be released into the environment, after an old machine is broken or discarded, for example. So increasingly, the sphygmomanometer is being replaced with automatic electronic measuring devices which do the same thing but are more accurate, easier to use, and can be used by patients for home blood pressure monitoring. Because blood pressure fluctuates, doctors don't diagnose hypertension on the basis of one abnormal reading. Usually three consecutive abnormally high readings taken on different occasions are needed before a diagnosis of hypertension can be made.

The point at which a high blood pressure reading is considered abnormal depends a lot on a person's age. The National Heart Foundation of Australia recommends that people under the age of 65 years should have a blood pressure at rest of no greater than 130/85 mm Hg. Those over 65 years of age should aim for a blood pressure reading of no more than 140/90 mm Hg. If the blood pressure is found to be consistently high, a doctor will do a physical examination to see if there is any underlying disease causing the hypertension (usually there's not). The examination can also reveal whether there are signs of damage to the body's organs such as absent pulses in the limbs, evidence of artery disease in the retina of the eye, or microscopic traces of blood in the urine (a sign of kidney disease). Just because a person's blood pressure is found after three checks to be normal, doesn't mean it will always be normal. Blood pressure should be checked every now and then. The earlier hypertension is diagnosed and brought under control, the less damage there will be to the heart, brain, kidney and other organs.

The Heart Foundation advises that if your blood pressure is normal and you have no personal or family history of the condition, a check every two years and during routine visits to your doctor are recommended. If it is approaching the upper limit of normal (or higher) or you have a personal or family history of high blood pressure, stroke or heart attack, it is best to have it checked more frequently, as advised by your doctor. COMPLICATION Complications Which Can Arise : 1. Arteriosclerosis 2. Arteriolar inflammation 3. Heart failure 4. Angina pectoris 5. Cerebro-vascular accident- cerebral haemorrhage 6. Thrombosis and subarachnoid haemorrhage 7. Hypertensive encephalopathy 8. Malignant hypertension 9. Renal damage 10. Hemorrhages - epistaxis, haematamesis, haemoptysis 11. Reduced life expectancy or death

MATERIAL AND METHODS

Investigations: On examination and Investigating a patient of HT , we must obeserve following :-

a) Blood Pressure level of Diastolic Pressure is important and according to its level the patient is put into the category of Mild, Moderate, Severe and Gross HT. b) Pulse - Radial pulse bounding and hard. Femoral pulse also must be palpated. c) CVS - Heaving cardiac impulse . d) Eye Fundus - Arteriolar narrowing, compression, haemorrhage or oedema of disc may be seen. e) ECG - Left Ventricular enlargement with or without T wave inversion in Lead I, AVL, V5 and V6. f) X-Ray Chest - Left Ventricle is dense, It's left border is rounded. Hyperaemic lung, prominent hilar shadow. Usually the same format is useful to investigate a newly detected case or follow up of case under going treatment. A routine package is generally recommended which gives an insight into important organ systems. In case a particular organ system showing signs of damage, detailed

investigations of that system becomes mandatory. In addition to the complete Blood Count the basic investigations should be; 1) Urine routine - To look for the presence of Albumin and Casts, which indicate Renal involvement. Presence of Occult Blood indicates Calculus. 2) Blood Sugar - Diabetes and HT if present together becomes all the more important for management as chances of Target Organ damage increase. (Normal Fasting 70-100 and P/P. 100-140 mg) 3) Serum Creatinine - elevated Creatinine suggests early renal Failure, and in absence of another cause, indicates that HT may be of long standing in that patient (Normal 0.6 1.4 mg/dl) 4) Serum Cholesterol - Hyperlipidaemia can both be a cause and effect of HT. If present unless treated will not let BP come under control. Preferably 12hrs. fasting should be observed for this test. Lipid Profile should be carried out if Myocardial involvement is

suspected, as it tells more about blood lipids i.e. HDL, the good friendly Cholesterol and LDL,the bad and unfriendly Cholesterol. HDL- normal 35-65 mg% LDL -normal upto 150 mg% VLDL-normal 23-45 mg% 5) Serum Uric Acid - Hyperuricemia is one of the most common cause for HT not responding to the treatment. 6) X-Ray Chest PA view - For Cardiomegaly specially. LVH.indicates that HT is chronic and has been present for some time. Since LVH is reversible with very good control of BP ,X-Ray should be repeated to see the progress and control of BP. 7) E.C.G. - Tells about Myocardial insolvents and Ischemic changes in the heart. 8) Fundoscopy - To see the Retinal Haemorrhage andPapilloedema which again indicates hypertensive state.

REVIEW OF HOMOEOPATHIC LITERATURE

Miasmatic analysis for hypertension 1.Aging or premature old age identifies by degenerative featuressyphilitic 2 .Female sex hormonal disturbance post menopausal sycotic .Build obesity sycotic 4 .Family history of diabetes mellitus sycco-syphilitic 5 .Hyperlipidimiasycotic 6 .Mental strees and anxietypsoric 7 .Desire for salt sycotic 8 .Fatty pungent salty food sweets sycotic 9 .Strong stimulants things syphilitic COMPLAIN Onset insidious sycotic Slow progress sycotic Silent painless but overt in its manifestation sycotic

PATHOLOGY 1. Duplication of elastic lamina sycotic 2. Inter proliferation sycotic 3. Atherosclerosis syco syphilitic 4. Fibroid necrosis syphilitic 5. Aneurysm syphilitic 6. Infarction syco syphilitic 7. Organ failure syphilitic

HOMOEOPATHIC APPROACH FOR THE TREATMENT

Homoeopathic treatment for the hypertension involves two approaches depending upon the severity and duration of disease. The two approaches are Constitutional treatment Therapeutic treatment Constitutional treatment - Since there is involvement of blood vessel and symptoms

given by patient. The treatment is aimed for the suffering constitution who is prone to develop such a symptoms. than for the , the reason being many times patient asymptomatic and then suddenly one fine day they may develop symptoms of mild to moderate or severe form. Also it has been observed that often, symptoms disappear after indicated homoeopathic remedy is given but the changes in the blood vessel persist.

A detailed homoeopathic history is the first step in treatment of hypertension.The essence of homoeopathic history lies not only in recording the sufferings or the complaints of the patient but to try and get information of the individual i. e. to inquire about the whole evolution of the patient`s illness considering the causative factor which can be physical or mental, also one should inquire about the state of mind at the time of presentation. In chronic cases, one should explore the evolution of the whole personality in relation to time, dimension e.g. birth history, early childhood, puberty, parental background, schooling and college, nature of the person as a child premarital and marital relationships, career and occupation, sleep pattern and dreams, all the above should be taken into consideration before selecting the remedy.

Drug dosage and its repetition- A simillimum(usually a deep acting medicine) is selected on the basis of above guidelines and a dose of it is given in high potency (usually 1m) . After that we see for the action to commence. As long as the medicine acts no medicine is required. When the action of the medicine ceases, a detailed history is taken again and on the basis of new picture a similar medicine is given. Therapeutic treatment In this, few symptoms of the patient are taken into consideration that are peculiar to a remedy. In this only local symptoms are taken, such as character of headache, vertigo , nose bleeding, modality, concomitant, etc.. After selecting a remedy, it is administered to the patient usually in the low potency with frequent repetition. The medicine is given as long as the symptoms persist. Therapeutic treatment is given when the complaints are of recent origin, or there is acute exacerbation of chronic ailments. Sometimes the patient is in such a severe condition that we cannot give constitutional treatment as it may aggravate the symptoms of the patient, in such condition we opt for therapeutic treatment.

HOMOEOPATHIC TREATMENT OF HYPERTENSION

HOMOEOPATHIC THERAPEUTICS PRECLINICAL STAGE- Antimismatic drug based on family history and predominant miasmatic drugs. 1. Carcinosin 2. Sulphur 3. Syphilinum 4. Thuja SUB CLINICAL STAGE-life style personality and causation drugs are following:1 ) Argentum nitricum 2 ) Arsenic album 3 ) Aurum met 4 ) Lycopodium clavatum 5 ) Natrum mur 6 ) Nux vomica 7 ) staphysagria 8) Strophantus 9) Glonoine 10) Baryta muraticum 11) Veratrum viride

12) Belladonna CLINICAL STAGE Symptomatic indicate organospecific drugs. Suitable drugs are 1) Aconite 2) Allium sativum 3) Iberius amara 4) Lachesis 5) Naja tripudians 6) Rauwolfia serpentine 7) Spigielia PRECLINICAL STAGE Mix miasmatic drug used as an intercurrent remedy. Family history of hypertension diabetes mallitrusd or malignancy extremely sensiytive easily offended easily fear of anxiety fear of cancer (from anger before menses m)after sleep. SULPHUR It is an predominant antipsoric drug used as an intercurrent remedy .it can be used during course of treatment to arouse reactionary power esp when the indicated remedy fails to act .relapsing nature of complaints skin unhealthy rough or scaly

.standing is the worst position .craving for sweets .aversion to washing cat nap sleep <standing rest bathing morning dry warm weather lying on the right side open air. SYPHILINUM Family hisoryor past history positive for syphilitic dyscrasia with craving for alcohol <night .patient is afraid to go sleep offensive discharges profuse perspiration in night and excessive salivation during day morning about slowly. THUJA Predominant antisycotic drug used as constitutionl medicine.family history of hyper tension coronary artery disease.diabetes mellitusand cardiovascular accidents.hormonal disturbances with hydrogenoid constitution central obesity fleshy subject with dark hair and shiny unhealthy skin .rapid exhaustion and emaciation persistent insomnia, obstinate constipation (at night from cold damp air tea coffee alcohol tobacco fat,3 a. m. to 3p .m) lying on affected side ,open air, movement and pressure. MEDORRHINUM

Difficulty of breathing because of oppression of chest . fluttering about heart and throbbing pain in the heart ; acute quick dull sharp pain at apex , worse on movement . burning in heart extending to back and left arm . SUBCLINICAL STAGE AGENTUM NITRICUMEmotional and psychological insight into the mind of arg. Nit is one of the very essential areas to be understood subject is very prone to strong and irrational impulses. There is an impulse to jump down when looping down from height or out of the window. Anticipatory anxiety ,examination going to a function ,meting.the subject becomes apprehensive and palpitation dizziness and diarrhea may accompany.craving for sweets ,intolerance of heat < mental exertion and better on tight bandaging and pressure.

ARSENIC ALBUMAnxiety is predominant due to emotional and physical insecurity that has

manifested in the form of obscession and compulsion nwith fastidiousness.patient is very aristocratic and contemptuous and very cautious .peripheral atherosclerosis burning pain ,ischaemic neuritis and gangrene (after midnight ,from cold cold food and drinks slightest exertion. AURUM METSubject is extremely sensitive to criticism , neglect and rejection. In order to avoid this situation and to achieve a prestigious position . socially and professionally he tries to do best at al time and drive him for overwork .patient continues to function efficiently until the last moment .when he commit suicide or is struck with some serious illness .eg. Hypertension or coronary artery disease .sensation of heart beat stopped beating for 2-3 seconds immediately followed by tumultousrebound < night in cold weather when getting cold from sunset to sunrise. NATRUM MURATICUM One of the very important deep and long acting intercurrent drug which is useful in subject having history of chronic grief weeps in solitude.consolation <great weepiness and weariness great

liability to take cold oversensitive to all expression .intense craving for salt .<noise ,music, warm room.>open air ,cold bathing. CLINICAL STAGE ACONITE It is frequently used in acute condition which associated with anguish of mind and body. Onset is sudden and violent precipated by dry cold wind ,fright and anger , anxiety fear restlessness, bursting headache slight noise is unbearable .palpitation with pain .pulse is rapid and bounding < warm room, night > open air , sweating. ALLIUM SATIVUM It is very important drug for palliative in case of hypertension and dops the blood pressure to normal level within 3045 minutes after 20-40 drops of mother tincture within the interval of every 15 minutes. Adapted to fleshy subjects with dyspepsia and catarrhal affection . IBERIS AMARAHypertension with lvf controls excessive nervous excitement. <Lying down, on its side least motion ,>rest.

LACHESISuseful during menopause ,when hypertension due to hormonal disturbance< during sleep, warmth , hot , alcohol.> open air , cold application. NAJA TRIPUDIANS Useful in hypertension leading to LVF and atrial fibrillation.< use of stimulants , cold.> walkng , open air. RAUWOLFIA SERPENTINAUsed as a palliative in hypertension cause depletion of nor adrenaline from peripheral nerve ending thus reducing peripheral resistance cause depletion of dopamine in bain causing sedation. SPIGELIAHyperytensive headache and coronary artery disease< touch > lying on right side with head high. STROPHANTHUSuseful for aged in heart trouble dependent on kidney diseases. irritable heart with tense arteries and a free discharge of

urine . increases systole and diminishes the rapidity of heart. GLONOINELassitude; no inclination to work. Irritability and excitement by opposition end in congestive headache. Rush of blood to head and heart. Pulsating pain. Fluttering heart. Constipation with itching hemorrhoids. BARYTA MURATICUMArteriosclerosis and cerebral affection in the aged. Vertigo and noises in the ears. Increased tension of pulse. Icy cold body with paralysis. Thickening of arteries with cardiac dilatation and bronchial affection in old person. VERATRUM VIRIDEFull blooded plethoric patient who are quarrelsome. Prostration, pulse hard and full with congestive symptoms. BELLADONNAViolent palpitation, prolonged echoing sound in head with labored breath. Palpitation from least exertion. Skin flushed and hot anxiety or fear; no thirst. Vertigo with falling on left side or backward. Worse from touch, noise, jar and lying down.

LILIUM TIGRINUM sensation as if heart was grasped or squeezed in a vice , as if blood had all gone to heart producing a feeling of bending double ,inability to walk straight. heart as if violently grasped , than suddenly released , alternatively constrictive , pain about heart running nearly constant , worse by eating , no matter how little ; frequent palpitation apprehension.

MANAGEMENT AND TREATMENT

MANAGEMENT OF HYPERTENSION 1. Quit smoking 2. Dietary managementTotal fat restricted to 30% of total calories. avoid refined sugar sweet and bakery products use complex natural carbohydrate present in vegetable whole grains and wheat products Pulse, gram, and a grade fish protein is best. FIBRE INTAKE- good amount of fibres should be consumed legumes sweet potatoes cabbage beans corn green leafy vegetables carrots dried peas.

SALT INTAKE-reduced to 2-4 gram is the maximum needs for an adult is normal intake. Moderate intake of alcohol coffee tea. Reduce the weight by regulating the diet physical exercise aerobic exercise stress adjustment modern complexity of life with too stress and strain hurry worry and curry struggle responsibility and ambition can be avoided or overcome by rest recreation and relaxation. Mental diversion include developing hobbies like photography music gardening vacation moving meditation.

Nutrition for Adults Both weight and daily nutrition can have a significant effect on blood pressure. Obesity/overweight, living a sedentary lifestyle, and eating unhealthy foods increase the risk for developing high blood pressure (hypertension). Some patients may require medication for high blood pressure and others may be able to use diet and exercise

to control itwith regular supervision from a qualified health care provider. Dietary changes can help lower blood pressure and reduce the risk for heart disease, heart attack, and stroke. Recommended dietary changes include the following:

Eat more fresh fruits and vegetables. Reduce dietary intake of saturated fat and cholesterol. Eat foods lower in sodium and added salt. Eliminate trans fats from the diet (found in foods with hydrogenated or partiallyhydrogenated oils). Fruits and vegetables provide vitamins, minerals, and important nutrients. Minerals such as magnesium, calcium, and potassium are known to help lower blood pressure. Check with a qualified health care provider before taking vitamin or mineral supplements. To reduce the amount of saturated fat and cholesterol in the diet, choose lean meats, fish, and poultry without the skin. Use the Nutrition Facts label to make healthier choices when shopping. Substitute beans, lentils, or tofu for meat 2-3 times per week. Reduce the amount of

butter, margarine, and salad dressings used and switch to low- or non-fat milk and yogurt. Other sources of saturated fat and cholesterol are cheeses, sour cream, cream cheese, ice cream, chocolate candies, and baked goods. Avoid or limit cookies, cakes, pastries, and other sweets. Based on an average 2000 calorie per day diet, saturated fat should be less than 15 grams. To reduce the amount of sodium in the diet, check the Nutrition Facts label on all foods, especially prepared foods such as frozen entrees, frozen pizzas, flavored seasoning mixes, and canned soups for sodium content. A food that is low in sodium has less than 140 mg per serving. Avoid high-sodium foods such as smoked meats and fish, pickles, condiments, and canned foods. When dining out, ask how foods are prepared and request that the food be made without added salt, soy sauce, or MSG (monosodium glutamate). Also, try seasoning with herbs, spices, citrus, vinegar, or salt-free seasoning blends instead of salt. Because trans fats raise LDL ("bad") cholesterol and lower HDL ("good") cholesterol in the blood, they should be avoided or strictly limited. Hydrogenated and

partially-hydrogenated oils contain trans fat. These oils may be found in French fries from fast food restaurants, some brands of peanut butter, microwave popcorn, cookies, chips, and crackers. Check the ingredients list for hydrogenated or partially-hydrogenated oils and avoid foods that have them. Use canola, olive, or corn oils when cooking and choose food products made with these oils. Due to potentially high levels of mercury, avoid shark, swordfish, king mackerel, and tilefish. Talk with a qualified health care provider, registered dietician, or nutritionist about the safety of fish. Patients who have high blood pressure should learn about using food labels to make healthy choices and have blood pressure checked regularly. Because high blood pressure is a risk factor for heart disease, please see Heart Disease and talk with a qualified health care provider for more information about how diet influences high blood pressure. Nutrition for Children

An increasing number of children are diagnosed with high blood pressure (hypertension). Obesity/overweight, eating an unhealthy diet, and living a sedentary lifestyle increase the risk for high blood pressure. Heart or kidney diseases can also cause hypertension in children. Under the direction of a qualified health care provider, children who have high blood pressure may benefit from regular exercise and dietary changes, including the following:

Eat an abundance of fresh fruits and vegetables every day. Reduce saturated fat and cholesterol intake. Choose foods with less sodium and don't add salt. Eliminate trans fats (found in foods with hydrogenated or partially-hydrogenated oils). These dietary changes may be helpful, even if children require prescription medication for high blood pressure. Because high blood pressure is a risk factor for heart disease, please see nutrition recommendations for Heart Disease and children for more information. Changes made to accommodate high blood pressure in children can help the

whole family eat healthier. However, the amount of fat in the diet should not be restricted in children under the age of 2, unless directed to by a qualified health care provider. Their faster growth rate and developmental needs require more calories from fat. Adding more fruits and vegetables provides vitamins, minerals, and nutrients. Minerals such as magnesium, calcium and potassium are known to help lower blood pressure. Adding fresh fruits and vegetables to children's diets can help boost the intake of these nutrients. Check with a qualified health care provider before giving vitamin or mineral supplements to children. Suggestions for adding fruits and vegetables to children's diets include the following:

Allow children to help choose fruits and vegetables at the supermarket. Give children a choice between 2 or 3 healthy snacks such as: o raw vegetables with salad dressing or low-fat yogurt dip (dressing should be low in sodium and made with canola or olive oil)

apple slices with peanut butter (peanut butter should have no added salt and no hydrogenated or partially hydrogenated oil) o fresh fruit slices o low- or non-fat vanilla yogurt with fresh or frozen berries mixed in o applesauce Make children's lunches for school. o Involve them in the preparation. o Prepare lunch the night before.
o

To reduce sodium, check the Nutrition Facts labels on all food. A food that is low in sodium has less than 140 mg per serving. It is especially important to check the sodium content when choosing prepared foods such as frozen entrees, frozen pizzas, flavored seasoning mixes, and canned soups. Also, try seasoning with herbs, spices, citrus, vinegar, or salt-free seasoning blends instead of salt. The following tips can help reduce sodium in children's diets:

Let children choose from different salt-free seasoning blends. Teach children to use the Nutrition Facts label to check for sodium content in: o breakfast cereals o crunchy snack foods

condiments Help children find low sodium substitutes for favorite foods.
o

When eating out, ask how foods are prepared. Request that children's food is made without added salt, soy sauce, or MSG (monosodium glutamate). Avoid fast food restaurants and high sodium foods such as smoked meats and fish, pickles, olives, and condiments. To reduce the amount of saturated fat and cholesterol in children's diets, choose lean meats, fish and poultry (without the skin) and substitute beans, lentils, or tofu for meat 2-3 times per week. Limit children's intake of white or albacore tuna to no more than 6 ounces per week, and avoid shark, swordfish, king mackerel, and tilefish due to potentially high levels of mercury. Talk with a qualified health care provider or registered dietician about the safety of fish in children's diets. Reduce the amount of butter, margarine, and salad dressings that the child uses and switch to low- or non-fat milk and yogurt. Avoid giving children cookies, doughnuts, and other pastries as a snack.

Other sources of saturated fats are cheeses, sour cream, cream cheese, and ice cream. Low- or non-fat substitutes for these items (e.g., non-fat frozen yogurt) may be used; however, products labeled "light" may still be high in saturated fat and cholesterol. Talk with a qualified health care provider, licensed dietician, or nutritionist about how much saturated fat children should have each day. Many food products targeted to children are made with hydrogenated or partially-hydrogenated oils. These oils contain trans fats, which raise LDL ("bad") cholesterol and decrease HDL ("good") cholesterol and should be avoided. These fats may be found in French fries from fast food restaurants, some brands of peanut butter, microwave popcorn, cookies, chips, and crackers. Check the Nutrition Facts label and the ingredients lists for trans fats (hydrogenated or partially-hydrogenated oils). Lifestyle changes can be difficult for children. Be patient and discuss concerns or challenges with a qualified health care provider, registered dietician, or nutritionist. Naturopathic Treatment

"Hypertension" is the medical term for high blood pressure. High blood pressure that has no known cause is called primary, or essential, hypertension. This type of high blood pressure is the most common and responds well to lifestyle changes, such as losing weight, dietary changes, exercise, and stress reduction. Natural treatment of essential hypertension can bring blood pressure values into the normal range; however, if lifestyle changes are not maintained, hypertension will probably return. Secondary hypertension has an organic cause (i.e., kidney disease, pregnancy) and must be evaluated and monitored by a physician since the underlying cause must also be addressed. Nutrition Hypertensive people can remarkably reduce their blood pressure through nutritional changes. Increasing the amount of vegetables and fruit and reducing the amount of fat and cholesterol will not only reduce blood pressure but can help with weight loss, which also lowers blood pressure.

Eat whole, fresh, unrefined, and unprocessed foods. Include fruits, vegetables, garlic, onion, whole grains, soy, beans, seeds, nuts,

olive oil, and cold-water fish (salmon, tuna, sardines, halibut, and mackerel). Low sodium-high potassium diet. Most people are aware that reducing sodium (salt) intake can help reduce blood pressure. However, that may not be the whole picture. Restricting sodium intake to lower blood pressure appears to work better if accompanied by increasing potassium intake. Keep in mind that reducing sodium intake involves more than not using a salt shaker, but also reading processed and prepared food labels for the sodium content. ? Avoid salt, sugar, dairy products, refined foods, fried foods, junk foods, and caffeine. Eliminate food sensitivities. Use an elimination and challenge diet to determine food sensitivities. Drink ? of your body weight in ounces of water daily (e.g., if you weigh 150 lbs, drink 75 oz of water daily). Supplements Supplements are intended to provide nutritional support. Because a supplement or a recommended dose may not be appropriate for all persons, a physician (i.e., a licensed naturopathic physician or holistic MD or DO) should be consulted before using any product. Recommended doses follow:

Calcium-Take 800-1500 mg daily. Vitamin C-Take 1000 mg daily. Coenzyme Q10-Take 50 mg two times daily. Flaxseed meal-Grind 2-4 tablespoons daily. Flaxseed meal is a better choice due to its fiber, lignan, and vitamin content, but flaxseed oil (1 tbsp daily) can be substituted.

Herbal Medicine Herbal medicines rarely have significant side effects when used appropriately and at suggested doses. Occasionally, an herb at the prescribed dose causes stomach upset or a headache. This may reflect the purity of the preparation or added ingredients, such as synthetic binders or fillers. For this reason, it is recommended that only high-quality products be used. As with all medications, more is not better and overdosing can lead to serious illness and death.

These herbs are often used to treat hypertension; however, they have serious side effects if taken in large doses. It is recommended that these herbs be used only with a physician?s supervision.

Coleus forskohlii-Lowers blood pressure and improves heart function.

Hawthorne (Crataegus oxycantha)-Has the ability to dilate coronary blood vessels, which helps lower blood pressure.

Mistletoe (Viscum album)-Not as potent as Rauwolfia but well tolerated and nontoxic in normal doses. Rauwolfia (Rauwolfia serpentina)-This is considered the most powerful hypotensive botanical. Only a small dose is required to achieve results and to avoid side effects. Nasal congestion is the most common side effect Prevention Lifestyle changes may help control high blood pressure:

Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed. Exercise to help your heart.

Adjust your diet as needed. Decrease fat and sodium -- salt, MSG, and baking soda all contain sodium. Increase fruits, vegetables, and fiber. Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.

GRAPHS Percent people affected in different age group

Age group(years) Blood Mot pressure her 0-4 Hypertensi ------5-9 on Hypertensi -----10-14 on Hypertensi + 15-24 on Hypertensi + 25-34 on 35-44 45-54 55+
70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00%

Affected % Fat Child her 0.0 ------ 2-5% .20 + 20% .50 ----- 20% 15 + 47.3 50% 54.8 60.7 62.1

55 +, 62.10% 45-54 yrs, 60.70% 35-44 yrs, 54.80% 25-34yrs, 47.30% 15-24 yrs, 31.90%

10-14 yrs, 15.40% 5-9 yrs, 6.40% 0-4 yrs, 1.00% 0.00% 0-4 yrs 5-9 yrs 10-14 15-24 yrs yrs

2534yrs

35-44 yrs

45-54 yrs

55 +

Percentage (%) of child affected on the basis of heredity

AFFECTED PERCENTAGE OF CHILD

HYPERTENS ION 20%

+ ---

Hypertension ------ + Hypertension + ----Hypertension

+ + HYPERTE
NSIO-N 50 %

HYPERTENS ION 20 %

---+

SYNOPSIS OF THE CASES

Case 1 Mr. Ramnarayan, 36y/m/h, complaining of violent palpitation, with laboured breath , skin flushed and hot, throbbing all over the body.. The patient also complained of pain in chest. On the basis of local symptoms Bell 30/tds was prescribed. After proper follow up and diet management patient has cured. Case 2 Mr.Ratan Singh, 67y/m/h, retired professor, complaining of irritable and excitement by opposition end in congestive headache, pulsating pain, fluutering heart, rush of blood to head and heart. blood pressured measured 140/100 mmhg.Glonoine 30/tds was prescribed.After proper follow up patient has cured. Case 3 Mrs. Savitri Sharma 46y/f/h, house wife complaining of pain in chest with history of blood pressure fluctuate near 154/98 mmhg,Chilly patient, desire company ,fatty & salty food. A constitutional remedy, Nitric Acid 200/3 doses, one hourly were prescribed. After proper follow

up and guidance in life style patient has cured. Case 4 Mrs. kamal jayant, 49y/m/h, businessman, complaining of violent palpitation with anxiety , with lying on left side. heart dialated, feeling of warmth in heart.pulse are rapid , small and soft.blood pressure 170/104 mmhg. very social, fearful, desire salty food& cold water; Chilly pt., constitutional remedy, Phosphorus-1m/3 doses were prescribed.After proper follow up patient has cured. Case 5 Mrs. Shahnaaz Bano 55y/f/m, housewife complaining of pain wanders from joint to joint and is finally located in the heart . sensation as heart stop beating.self condemnation and great fear of death . thought of suicide, oversensitive to noise, constitutional remedy, Aurum met 1m/3 doses were prescribed. After proper follow up patient has cured. Case 6 Mr. Ram naresh 75y/m/h, farmer complaining of recurrent chest pain, palpitation , dysnoea, faintness,< night especially at 2 A.M.anxiety and restlessness , with pain in neck and occiput. thirst for small quantity of water in short interval of time. feeling of irritability in heart .On the basis of

local complaints Arsenicum album 30/tds was prescribed. After proper follow up patient has cured. Case 7 Mr.Raj kishan kumar 52y/m/h, shopkeeper complaining of violent palpitation with foul order from mouth. dysnoea and wishes to lie on right side and want to head high. patient with violent , audible visible and roaring heart with systolic blowing at the apex. needle like pain in chest.blood pressure measured 154/ 98 mmhg.on local symptoms Spigelia 200/ 3 doses were prescribed. After proper follow up patient has cured. Case 8 Mrs. manoj Khosla 49y/f/h Teacher complaining of irregular beating of heart, on examination mitral regurgitation was found. There was clutching at heart and palpitation. There was feeling of constriction in chest. On the basis of local symptoms, Laurocerasus 30/ tds were prescribed.After proper follow up patient has cured.

Case 9 Mr. .premnath 58y/m/m, sweeper complaining of pain especially severe n elbow of left arm, stitching pain in heart,

feeble and irregular pulse and has a distressing dyspnoea. There was bruised and sore feeling .on examination there was cardiac dropsy. Blood pressure was 164/102 mmhg. Arnica 200/3doses were prescribed on the basis of local and general symptoms. After proper follow up patient has cured. Case 10 Mr. Vivek chaturvedi 63y/m/h watchman, complaining of chest pain since 3 month with violent palpitation pain radiating towards left arm .standing is the worst position .craving for sweets .aversion to washing cat nap sleep <standing rest bathing morning dry warm weather lying on the right side, desire for open air. Constitutional remedy, Sulphur-1m/3 doses were prescribed.After proper follow up patient has cured. Case- 11 Mr.Awadhesh kumar 38/m/h serviceman ,complaining of constant , dull , burning pain in region of heart since 1 month, beating of pulses throughout the body, especially in right thigh. pain from nape of neck , can not hold head up, headache aggravated by suns heat, flushed face , convulsive twitching of facial muscle. Blood pressure measured is 144/96 mm hg.On the basis of local symptoms,

veratrum viride 30/ tds were prescribed. After proper follow up patient has cured. Case-12 Mr.Anoop agarwal 45/m/h clerk, complaining of pain in back of neck and neck since 2 month. Painful sensation of pressure in left side of chest below clavicle.dyspnoea on least exertion. pulse irregular, feeble,valvular murmurs.cold extremeties with dropsy.anaemia and chilliness is present. On the basis of local symptoms, crategus 30/ tds were prescribed. After proper follow up and changing life style patient has cured. Case-13 Reeta sethi 35/f/h, house wife complaining of heaviness and bursting sensation in head from last 2 days.vertigo and shaking head, great anxiety and restlessness,profused sweat and increased thirst , she was very tense and worrying very much.on examination pulse was full and hard, violent pain in chest.on examination blood pressure was 174/100 mmhg. On the basis of local symptom Aconite 30/ qid were prescribed. After proper follow up patient has cured. Case-14 vipin chaudhary 44/m/h businessman complaining of pain in the chest since 5 month.palpitation of heart with faint feeling, oppressed breathing.pain in

region of heart extends down left arm.alternate with rheumatic complain, anguish about the heart.on examination slow pulse, blood pressure was 160/100 mmhg. On the basis of local symptom kalmia 30/ tds were prescribed. After proper follow up patient has cured. Case 15 Vindu seth, 54/f/h housewife complaining of violent palpitation of heart,stching pain in the heart since 2 year. Vertigo feeling on looking down or upward, dragging down sensation especially in pelvic region, mentally she was indifferent , aversion company, irritable. General relief from motion, food, sleep. Aversion to milk, Chilly patient. A constitutional remedy, Sepia 1 m/3 doses, one hourly were prescribed. After proper follow up modification in diet patient has cured. Case -16 Mr. Mustafa ali, 64/m/m, complaining of chest pain, constriction and tenderness feeling in the chest, since 3 month. Profuse flow of urine when heart is most irritable. Cough with haemoptysis, frontol headache. On the basis of local symptom lycopus 30/ tds were prescribed. After proper follow up patient has cured.

Case 17 Mr. Abhinav 48/M/h, Difficulty of breathing because of oppression of chest, since 3 year. Fluttering about heart and throbbing pain in the heart; acute quick dull sharp pain at apex, worse on movement. Burning in heart extending to back and left arm.desire salt, ice cream, sleep postion lying on abdomen,dreams of dead bodies. Blood pressure measured was 154/96 mm hg. A constitutional remedy, Medorhinum 1m/3 doses, one hourly were prescribed. After proper follow up patient has cured. Case 18 Mr. yogesh singh, 34/ m/h ,complaining of high blood pressure , with anxiety and persistant headache, since1 year.Family history positive for high blood pressure, with craving for alcohol <night .patient is afraid to go sleep offensive discharges profuse perspiration in night and excessive salivation during day morning about slowly. A constitutional remedy, syphilinum 1m/3 doses, one hourly were prescribe ed. After proper follow up patient has cured. Case 19 MR.Abhay srivastav 36/M/H, complaining of chest pain with hypertension since 1 year. excessive nervous excitement. <Lying down, on its side least motion ,>rest. . On the basis of local symptoms,

iberis amara 30/ tds were prescribed. After proper follow up patient has cured. Case-20 Mr. Ramesh 55/M/H a service man emotional and psychological person complaining of chest pain since5 year. There is an impulse to jump down when looping down from height or out of the window. Anticipatory anxiety ,examination going to a function ,meting.the subject becomes apprehensive and palpitation dizziness and diarrhea may accompany.craving for sweets ,intolerance of heat < mental exertion and better on tight bandaging and pressure. A constitutional remedy,Argentum nitricum 1m/3 doses, one hourly were prescribed. After proper follow up and diet management patient has cured.

Bibliography
Snells clinical anatomy Tortora GrabowskiPrincipals of Anatomy & Physiology Harrisons Practice of Internal medicine Kents Repertory of the homoeopathic materia medica

William boerickes Materia Medica

J.Compton BurnettThe New Cure for Consumption W.A Dewey Practical Homoeopathic Therapeutics

Dr.H.L. ChitkaraBest of Burnett Clarkes Materia Medica Robinsons Pathology Allens Key Notes