• HYPERTENSION and Homoeopathy

    Condition is characterized by systemic arterial pressure consistently above 140 mm Hg systolic and 90 mm Hg diastolic.

     

    ETIOLOGY

    Primary (essential) hypertension

    • Idiopathic
    • Predisposing causes
    • Smoking
    • Mental stress
    • Type A personality
    • Hyperlipidemia
    • Excessive intake of salt fats
    • Obesity
    • Lack of physical activity

    Secondary hypertension

    • Renal : Chronic renal disease, Polycystic kidney disease, Hydronephrosis
    • Endocrine : Thyrotoxicosis, Acromegaly, Hyperaldosteronism, Phaeochromocytoma
    • Neurological : Brain tumor, Cerebro-vescular accident
    • Psychogenic
    • Atherosclerosis
    • Policythaemia
    • Iatrogenic
    • Pregnancy.

    CLINICAL FEATURES

    Symptoms

    • Asymptomatic during compensatory phase
    • Throbbing headache
    • Giddiness
    • Faintness
    • Sleeplessness
    • Epistaxis
    • Angina pectoris
    • Exertional fatigue
    • Decreasing exercise tolerance
    • Nocturnal cough
    • Oliguria

    Signs

    General examination

    • Age: middle age
    • Sex common in males
    • Pulse
    • High tension pulse
    • Arterial wall thick
    • Blood pressure:
    • Above 140/90 mm of Hg

    Cardiac examination

    On inspection

    • Apex more down than out
    • On palpation
    • Apical impulse heaving in charcter
    • On palpation
    • Area of cardiac dullness increased
    • On palpation
    • Si at apex booming
    • A2 at base accentuated

    COMPLICATIONS

    • Cardiovascular: Left Ventricular failure, Congestive cardiac  failure, Myocardial infarction
    • Cerebral : Cerebro vascular accidents, Hypertensive encephalopathy
    • Retinal : Hypertensive retinopathy
    • Renal : Uraemia

    INVESTIGATIONS

    Urinalysis

    • Albumin: in traces
    • Hyaline casts may be present

    Funduscopy

    Hypertensive retinopathic changes

    ECG SHOWS FEATURES OF LEFT VENTRICULAR HYPERTROPHY

    • Left axis deviation
    • Large  S waves in V1 V2
    • Large R waves in V5 V6
    • Increased duration of QRS complex (more theno.11 sec)
    • Depression  of ST segment

    Chest X-Ray

    • Left ventricular hypertrophy

    Malignant hypertension

    • It may develop as primary presentation in young subjects or as complication of essential hypertension
    • It is Characterised by
    • Very  high sustained systolic and diastolic pressure
    • Diastolic pressure disproportnately high  above 120 mm hg
    • Acute headache
    • Acute visual disturbances
    • Haematuria
    • Papilloedema
    • Rapid development of cardiac renal failure
    • High blood urea nitrogen and serum Creatinine levels
    • Lack of response to routine anti hypertensive therapy
    • Rapid course
    • Poor Prognosis

    HYPERTENSIVE ENCEPHALOPATHY

    It is a medical emergency.

    An acute and transitory disturbances of cerebra function occurring in association with rapid rise of diastolic blood pressure (more than 140 mm Hg)

    It is characterized by

    • Sever headache
    • Nausea
    • Vomiting
    • Drowsingess
    • Convulsions
    • Transient paresis with disturbances of speech and vision
    • Disorientation
    • Loss of consciousness

    PROGNOSIS

    • In  majority of cases disease follows
    • Slow benign progressive course
    • Periods of activity alternate with periods of quiescence
    • Prognosis largely depends on
    • Degree of hypertension
    • Efficiency of treatment
    • Features indicating adverse prognosis
    1. Young age
    2. Persistent diastolic pressure of more than 120 mm Hg
    3. Smoking
    4. Diabetes mellitus
    5. Hyperlipidaemia.
    6. Obesity
    7. Evidence of end organ damage

    MIASMATIC CLEAVAGE

    Mixed miasmatic disorder.

    THERAPEUTIC AIM

    • To detect, evaluate and control predisposing cause at the earliest.
    • To maintain blood pressure within acceptable range.
    • To prevent complications.

    GENERAL MANAGEMENT
    –         Treat cause.
    –         Stop smoking.
    –         Mental and physical rest.
    –         Diet:
               . Salt restricted diet (permissible up to 5g / day).
               . Low fat diet.
    –         Reduce weight, if obese.
    –         Regular, moderate exercise.

    HOMOEOPATHIC TREATMENT

    Intercurrent anti-miasmatic

    • Sulphur.
    • Syphilinum.
    • Thuja Oc.

    Constitutional

    • Arsenicum album.
    • Lycopodium.
    • Nux Vomica.
    • Natrum Muriaticum.

    Atherosclerosis

    • Baryta Carbonica.
    • Baryta Muriatica.

    Psychogenic causes

    • Argentum Nitricum.
    • Gelsemium.
    • Ignatia.
    • Staphysagria.

    Palliative

    • Allium Sativum.
    • Crataegus.
    • Passiflora.
    • Rauwolfia Serpentina.

    High blood pressure at a glance

    • Lycopus Virginicus – heart related high BP remedy
    • Argentum Nitricum – anxiety related hypertension remedy
    • Aurum Metallicum – stress related high BP remedy
    • Belladonna – sudden hypertension remedy
    • Calcarea Carbonica – frightful hypertensive remedy
    • Glonoinum – heart related high pressure remedy
    • Lachesis Mutus – psychological hypertension remedy
    • Natrum Muriaticum – high BP remedy for more responsible individuals
    • Nux Vomica – easily tempted hypertension remedy
    • Phosphorus – sensitive person high blood pressure remedy
    • Plumbum Metallicum – nerve & artery related hypertension remedy
    • Sanguinaria – high blood pressure with blood flushes

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