Hypertension The Fundamentals
NATIONAL JOURNAL OF HOMOEOPATHY 1996 Jan / Feb Vol V No 1.
Asrani C H.
Hypertension: The Fundamentals.
Q: What is Hypertension?
For proper perfusion to occur in all tissues, Heart has to pump blood with sufficient pressure. This is called the Arterial pressure or the Blood pressure. In normal circumstances it is around 120 mm of Hg (Systolic) and 80 mm of Hg (Diastolic).Of course these are not fixed values and may vary greatly, but a reading of more than 140/90 mm of Hg, on two out of three random checks, at different times of the day, is to be taken as Abnormal Arterial Pressure or Hypertension and needs further follow-up and / or evaluation.
Q: Why does Hypertension assume such significance?
Hypertension is one of the SILENT KILLERS, others being Diabetes and IHD. In most cases, which fall into the category of Mild and Moderate Hypertension, patients have NO symptoms. In about 40 percent-10 percent of cases it is detected on a routine check, LIC or pre-employment check or as a complication like Stroke, Infarct, Loss of Vision or Renal failure. This puts a great responsibility on the treating physician to keep a close watch. Another reason for its significance is the attitude of the patient. They always have a ready explanation for an abnormally high reading like "I didnt sleep well" or "I have so much tension". Also they all feel that they can MAKE OUT what their Blood Pressure is, and since they FEEL, they have normal pressure, they neither go for regular checks nor take regular treatment., once again putting the onus on the doctor.
Q: What are the types of Hypertension?
Hypertension can be classified in two different ways. One is according to severity and second according to cause.
Mild HT-Diastolic BP> 99 mm of Hg. Moderate HT-Diastolic BP upto 110 Hg. Severe |HT-Diastolic BP> 110 mm of Hg.
According to the cause it could be Primary or Essential where no cause can be found and Blood Pressure has to be treated for life and Secondary where there is a demonstrable cause for the HT and Treatment of the same (which is mostly surgical) generally cures the patient of HT..
Q:Which class of patients are more likely to get Essential Hypertension?
People with a F/H of hypertension are more likely to get Essential HT than others. In these patients too presence of certain risk actors, like Obesity, Stress, Smoking, Overconsumption of salt etc. can precipitate hypertension (We Indians normally consume 8-10 gms of salt / day, what with our pickles, pickles, papads and farsans.).
Q: What are risk factors?
Risk factors are certain pertinent points on history, presence of which makes a person more susceptible to get Hypertension than another person of same age & constitution. Risk factors are of two types, Modifiable ie within control of patients eg Obesity, Sedentary life style, Smoking, Excess consumption of alcohol and salt, and Mental Stress. The other types of risk factors are ones which are beyond our control ie Heredity. It is of utmost importance that during history taking all of these are elicited and recorded.
Q:What are common causes of Secondary Hit?
Most common cause of Sec HT is Renal eg renal artery stenosis and Nephrosclerosis as also certain tumors of the Adrenal gland eg. Pheochromocytoma.
Q:What may be causing Essential Hypertension, even though it is said no cause can be found some changes must be occurring somewhere?
An enzyme called RENIN in the kidneys is responsible for control of BP. When there is a fall in volume of blood flowing of BP. When there is a fall of volume of blood flowing through the kidneys, kidneys secrete Renin. This Renin causes formation of a substance called Angiotension which leads to constriction of arteries thus raising the BP. Angiotension also causes excess of Aldosterone, a hormone from Adrenal glands. This Aldosterone causes sodium retention in the body, we all know that water follows sodium, hence sodium retention leads to water retention causing volume overload thereby raising blood pressure even further. A mention must be made of stress. HT is said to be a disease of urbanization and rapid Industrialization. Fast life, people always rushing against time, trying to realize their ambitions, setting up newer goals, intensely competitive nature all take their toll. This permanent stance of fight leads to increased secretion of Adrenaline, which causes HT.
Q:What are the effects of HT?
Most symptoms of HT generally start after a patient knows that he-she has HT. Vague complaints like headache, giddiness etc. are seen only with readings of at least 200 syst or 120 diast. The commonest presentation is a patient coming to you and saying that now a days I feel very angry please check my BP. Symptoms generally are of dangerous complications due to effects on target Organs. Four target organs commonly affected are Brain, Heart, Kidneys and Eye. Sudden rise in BP can cause an artery to burst in the brain causing a strike. Heart has to pump harder leading to either Ischemia (IHD) or Pump failure (Left Ventricular failure). Renal failure can occur by reduction of blood flow to the kidneys. Tiny haemorrhages occur in the retinal vessels leading to dilution of vision and finally may be total blindness. These complications form the basis of investigations of a newly detected Hypertensive or the follow -up of a hypertensive on treatment (Ref NJH CME pg 60).
Q:Non pharmacological approach to control of HT?
Most cases of mild and few cases of moderate HT can be controlled by means other that drugs. Weight reduction to desirable levels (drastic reduction not recommended). Control of salt intake to a max of 4-5 gms per day (total stoppage not recommended), avoidance of smoking, regular exercises and relaxation technique eg Yoga, Meditation etc. (stress being a most important factor).
Q:Importance of Health Education?
It is said that patients are not regular in treatment and follow-up. If we explain to a patient the silent nature of the disease and need for regular treatment and follow-up along with some idea of target organ damage, at the initiation of therapy, we will find better compliance.
