Analysis of Pathological Factors of

Hypertension
&
Concept of Management

DR.K.P.YADUNANDANAN MD (AYU)

MEDICAL OFFICER

GAD, CHERUVANNOOR – NALLALAM

KOZHIKODE

Hypertension

Hypertension is one of the most common worldwide diseases afflicting humans.
 Because of the associated morbidity and mortality and the cost to society,
hypertension is an important public health challenge.

Hypertension is the most important modifiable risk factor for

Ø      Coronary heart disease

Ø      Stroke

Ø      Congestive heart failure

Ø      End-stage renal disease

Ø      Peripheral vascular disease

Normal

Systolic lower than 120, diastolic lower than 80

Prehypertension

Systolic 120-139, diastolic 80-99

Stage 1

Systolic 140-159 or diastolic 90-99

Stage 2

Systolic equal to or more than 160 or diastolic equal to or more than 100

Based on the average of 2 or more readings taken at each of 2 or more visits
after initial screening

Normal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg

Arterial blood pressure

 Arterial blood pressure is a product of

Ø      Cardiac output and

Ø      Systemic vascular resistance

Determinants of blood pressure include factors that affect both

Ø      cardiac output and

Ø      arteriolar vascular physiology 

Cardiac output

The factors affecting cardiac output include –

Ø      Sodium intake

Ø      Renal function

Ø      Mineralocorticoids- the inotropic effects occur via extracellular fluid volume augmentation and an increase in heart rate and contractility

Peripheral vascular resistance

Peripheral vascular resistance is dependent upon

Ø      sympathetic nervous system - vasoconstrictor alpha effect or the vaso
dilator beta effect

Ø      humoral factors - vasoconstrictors (angiotensin and catecholamines) or vasodilators (prostaglandins and kinins) 

Ø      local autoregulation - intravascular volume contraction and expansion & by transfer of transcapillary fluid

The pathogenesis of essential hypertension is multifactorial and highly complex.
Multiple factors modulate the blood pressure for adequate tissue perfusion and include -

Ø       humoral mediators

Ø       vascular reactivity

Ø       circulating blood volume

Ø       vascular caliber

Ø       blood viscosity

Ø       cardiac output

Ø       blood vessel elasticity and

Ø       neural stimulation

The natural history of essential hypertension evolves from occasional to established hypertension. After a long invariable asymptomatic period, persistent hypertension
develops into complicated hypertension. Organs get damaged due to persistent
hypertension include -

Target organ damage to the

Ø      Aorta and small arteries

Ø      Heart

Ø      Kidneys

Ø      Retina and

Ø      Central nervous system

Pre - Hypertension

The early stage of hypertension has been described as high-output hypertension.
High-output hypertension results from decreased peripheral vascular resistance and concomitant cardiac stimulation by adrenergic hyperactivity and altered calcium
homeostasis

Chronic - Hypertension

The chronic phase of essential hypertension characteristically has normal or reduced
cardiac output and elevated systemic vascular resistance.

Vascular Endothelium

Ø      The vascular endothelium is presently considered a vital organ, where
synthesis of various vasodilating and constricting mediators occurs.

Ø      The interaction of autocrine and paracrine factors takes place in the vascular endothelium, leading to growth and remodeling of the vessel wall and to the hemodynamic regulation of blood pressure.

Target organ damage

CVS

Cardiac involvement in hypertension manifests as

Ø      LVH

Ø      Left atrial enlargement

Ø      Aortic root dilatation

Ø      Atrial and ventricular arrhythmias

Ø      Systolic and diastolic heart failure and

Ø      Ischemic heart disease

LVH is associated with an increased risk of premature death and morbidity 

The central nervous system

Long-standing hypertension may manifest as -

Ø      hemorrhagic &

Ø      atheroembolic stroke 

Kidneys

Nephrosclerosis is one of the possible complications of long-standing hypertension

Courtesy emedicine.com

Hypertension & Ayurveda

In Ayurveda all about hypertension is often

Rx

“SARPAGANDHA”

Texts in Ayurveda didn’t explain HT.

Ø      HT is a modern disease and is not explained as it is in Ayurveda

Ø      To understand a modern disease in Ayurvedic perspective we have to follow
these steps

Identify Factors (pathological)

First by studying the symptoms and progression of the disease, identify the functional
and structural factors that get imbalanced in the disease like -

Ø      Agni Vaishamya

Ø      Vayu Vaigunya

Ø      Ama, Kleda

Ø      Srotorodha Etc.

Correlation

Ø      Second correlate these factors with disease processes already explained in Ayurveda like Jwara, Sopha, Pandu etc

Ø      This helps us apply the treatment & medicines of above diseases in a new unexplained condition

Analysis of Factors in HT

Prana Vaigunya

Ø       Prana seated in Siras (head) initiates breathing and sustains Hridaya
(heart), Budhi (intelligence) and Manas (mind).

Ø       Prana stimulates functions of brain and heart

In HT imbalance of Prana is often responsible for life threatening conditions like stroke & cardiac arrest

Vyana Vaigunya

Ø       Vyana seated in Hridaya (heart) is responsible for circulation and functional integrity of Sira (vessels)

Ø       Functions of Vyana depends on quality of the Rasa & Raktha that it circulates all over the body

Vyana Vaigunaya results from

Ø      Srotorodha &

Ø      Apana Vaigunya

Srotorodha due to Ama, Kapha Vridhi & Medo Vridhi imbalances Vyana Vayu. Imbalanced Apana Vayu in diseases like Arsas and Gulma also causes Vyana Vaigunaya. Imabalace of Vyana affects normal functioning of Hridaya and Sira.

Rasa & Raktha Dushti

Ø       Rasa and Raktha flowing through the Sira (vessels) maintain structural integrity of vessels.

Ø       Sudhi (purity) of Rasa & Raktha is maintained by Agni

Impurity (Dushti) of Rasa & Raktha has important role in imbalancing Vyana Vayu and also affects structural contsitution of Sira (vessels)

Medo Dushti & Srotorodha

Ø       Resulting from Dhatawgni Agni Vaishamya, Medo Dushti imbalances Vayu by producing Avarana (block)

Medo Dushti leads to Vatha Vyadhi by producing Avarana of Srotases & could be fatal when vital Sira, Dhamani & Srotas are involved

Ojakshaya & Rajo Guna Vridhi

Ø       Rajo Guna destabilizes mind and throws it into an extreme emotional
state resulting in Ojaksaya and stress

Mental Stress is an important factor causing HT

Correlation with Diseases

Prana & Vyana Vaigunya

Disease condition with this imbalance -

Ø      Vata Vyadhi

Often HT is an indicator of Vata Vyadhi and Vata Kopa signs can be noted in HT
 patients. Here Vata Vyadhi is caused in majority by Avarana and less frequently - Dhathukshaya.

Vyana Vaigunya & Rasa Dushti

Disease condition with this imbalance -

Ø      Hridroga

Hridroga, its causes similar to Gulma, is a disease with Srotorodha and Vayu Kopa. Symptoms of Hridroga like Swasarodha (dyspnoea), Brama (dizziness), Moha
(syncope) etc can be noted in HT patients also.

Vyana Vaigunya & Raktha Dushti

Disease condition with this imbalance -

Ø      Rakthapitha

Ø      Sopha

Raktha is Anushna (balance of heat & cold) & Asamhatham (balance of fluidity & density). VathaPitha increases fluidity and causes RakthaPitha while KaphaPitha
increases density and causes Sopha.

Internal bleeding and swelling, especially of extremities are symptoms of HT.

Medo Dushti

Disease condition with this imbalance -

Ø       Medo Roga

Ø       Prameha

Increase of Medas causes Srotorodha and results in Vayu Kopa.

Silent stage of HT is mostly caused by Medo Vridhi

Ojakshaya & Rajo Guna Vridhi

Disease conditions with this imbalance are –

            Manasa Rogas

Ø      Moorcha

Ø      Mada

Rajo Guna increases Vatha & Pitha causing dizziness, altered consciousness & loss of consciousness.

Diagnosis of HT in Ayurvedic Perspective

Rogee Pareeksha

Using Darsana, Sparsana & Prasna closely examine the patient – physical, mental & emotional aspects and diagnose HT as any of the following conditions -

Ø                  Vatha Vyadhi

Ø                  Hridroga

Ø                  Rakthapitha

Ø                  Sopha

Ø                  Medo Roga

Ø                  Manasa Roga – Mada & Moorcha

Management of HT

Management of HT has two Phases -

Ø       Emergency treatment &

Ø       Long Term treatment

Emergency treatment

Ø      Prana Anulomana & Srotosodhana

Ø      Pitha Samana, Ojo Prasadana, & Mana Prasadana

Prana Anulomana & Srotosodhana

Nasya

Sirodhara

Rookshasweda

Medicines with Prabhava – Eg.

            Dasamoolarishtam

            Dhanwnthara Gulika

            Nayopayam Kashayam

            Rasonadi Kashayam

            Kasthooryadi Gulika

Pitha Samana Pitha Samana, Ojo Prasadana, & Mana Prasadana

Ksheeradhara

Nasya

Thalam

Virechana

Medicines – Eg.

            Drakshadi Kashayam

            Aswagandharishtam

            Gorochanadi Gulika

            Suvarnamukthadi Gulika

            Manasamitram

Long Term Management

Vatha Vyadhi Chikitsa

Vatha Vyadhi associated with HT is usually caused by Avarana. Treatment should be Amapachana, Srotosodhana & Anulomana

Eg. Shaddharanam, Ashthavargam Dhanadanayanadi etc

This should be followed by Snehana, Swedana & Sodhana (Vasthi)

Hridroga Chikitsa

Hridroga Chikitsa involves -

Ø      Correction of Rasa Dushti

Ama Pachana medicines like Dasamoolam, Vaiswanaram, Hinguvachadi etc

Ø      Vyana Anulomana & Hridya

Medicines like Rasonadi, Partharishtam, Hridayarnava Rasa, Sthira Sidham paya, Silajathu Rasayana etc

Raktha pitha Chikitsa

Ø      Virechanam

Ø      Kashaya pana

            Drakshadi

            Shathavaryadi

            Guloochyadi etc

Sopha Chikitsa

Ø      Mootrala

Ø      Raktha Sodhana

Ø      Virechanam

Ø      Kashaya pana

                        Punarnavadi

                        Punarnavasam

                        Dasamoolahareethaki etc

Medo Roga Chikitsa

Ø      Ama Pachana

Ø      Medohara

Ø      Rookshana

Ø      Vyayama

Ø      Udwarthana

                        Guggulu

                        Silajathu

                        Loha Prayoga

Mano Roga Chikitsa

Ø      Sodhana – Vamana, Virechana, Vasthi

Ø      Manaprasadhana – Sirodhara, Sirolepa

Ø      Oja Vardhana - Rasayana

Ø      Yoga

Ø      Meditation

Ø      Medicines

                        Mridweekadi

                        Kalyanakam

                        Manasamitravatakam etc                     

Thrimarma

In HT all three Maha Marmas Siras, Hridaya & Vasthi are affected. Marmas are
the seats of Prana vayu. So balancing Vayu is the most important step in managing HT. This imbalance of Vayu is caused by Avarana in most cases. The Avaraka factors that
produce Srotorodha are –

Ø      Ama

Ø      Kapha & Medas

Ø      Raktha

Agitation of mind and body also results in Vayu Kopa. This also involves
Oja Kshaya and imbalance of Pitha.

So after properly managing these Avaraka factors balancing Vayu should be done.
Vasthi is the best treatment for balancing Vayu. Rasayana therapy also balances
 functions of Vayu. For example Vathanulomyam is explained as an effect of Chyavanaprasa. Importance of Rasayanas also should be acertained in maintaining
 normal blood pressure.

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