Abstract: Hypertension is one of the leading causes of the global disease burden. The prevalence of hypertension increases with age. Both environmental and genetic factors may contribute to variations in hypertension prevalence. This article includes mechanisms of hypertension, homoeopathic management of Hypertension, remedies with indications and various rubrics of Hypertension corresponding to the symptoms.
Keywords: Hypertension, Clinical Features, Mechanism, Therapeutics.
Introduction:
The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines define hypertension in adults as a blood pressure of ≥ 130/80 mm Hg and the Eisghth Joint National Committee (JNC 8) criteria specify ≥ 140/90 mm Hg.
Blood Pressure Classification in Adults
| Blood Pressure Category | Systolic(mmHg) | Diastolic(mmHg) | |
| Normal | <120 | and | <80 |
| Elevated | 120 – 129 | and | <80 |
| Hypertension | |||
| Stage 1 | 130 – 139 | or | 80 – 89 |
| Stage 2 | >=140 | or | >90 |
Mechanisms of Hypertension:
Intravascular Volume: The kidney plays a dual role in hypertension, being both a cause and target. Primary renal disease is the leading cause of secondary hypertension. Kidney-related hypertension arises from impaired sodium excretion, excessive renin secretion, and increased sympathetic activity. High sodium intake can expand vascular volume, raise cardiac output initially, and increase peripheral resistance. This sodium-induced blood pressure rise is related to sodium chloride, not other sodium salts. It is balanced by pressure-natriuresis, requiring higher blood pressure in individuals with reduced sodium excretion capacity.
Autonomic Nervous System: The autonomic nervous system regulates blood pressure through adrenergic reflexes and receptors, with α1 receptors causing vasoconstriction and sodium reabsorption, while β1 receptors increase cardiac output and renin release. Sympathetic overactivity, influenced by catecholamines like norepinephrine and epinephrine, is linked to hypertension. Drugs targeting these receptors manage hypertension by inhibiting α1 and β1 receptors or stimulating α2 receptors to reduce sympathetic outflow.
Renin-Angiotensin-Aldosterone Mechanism: The renin-angiotensin-aldosterone system regulates arterial pressure via the vasoconstrictor angiotensin II and sodium-retaining aldosterone. Renin, produced mainly in the renal afferent arteriole, converts angiotensinogen to angiotensin I, which is then converted to active angiotensin II. Angiotensin II raises blood pressure and promotes aldosterone secretion, leading to sodium retention. Renin secretion is stimulated by decreased NaCl in the loop of Henle, decreased renal arteriole pressure, and sympathetic stimulation. Aldosterone increases sodium reabsorption in the kidneys, which can lead to hypertension, hypokalemia, and alkalosis. High aldosterone levels also contribute to cardiovascular and renal damage, exacerbated by high salt intake.
Vascular Mechanisms: Vascular radius and compliance of resistance arteries are key determinants of arterial pressure. Resistance varies inversely with the fourth power of the radius, so a small lumen decreases significantly to increase resistance. Hypertensive patients often experience vascular remodeling, reducing lumen size and increasing peripheral resistance. Arterial stiffness, measured by pulse wave velocity, correlates with hypertension and predicts cardiovascular disease. Ion transport in vascular smooth muscle cells, particularly Na+-H+ exchange, may increase vascular tone and growth, contributing to hypertension. Endothelial function also impacts vascular tone, with impaired endothelium-dependent vasodilation common in hypertension, and endothelin antagonists can lower blood pressure in resistant hypertension.
Clinical Features:
- Mild to Moderate Hypertension:
- Often asymptomatic, with headache being the most frequent but nonspecific symptom.
- Accelerated Hypertension:
- Symptoms include somnolence, confusion, visual disturbances, and nausea/vomiting.
- Pheochromocytoma-Related Hypertension:
- Symptoms include episodic blood pressure spikes, headache, anxiety, palpitations, perspiration, pallor, tremor, nausea, and vomiting.
- Primary Aldosteronism and Chronic Hypertension:
- Symptoms include muscular weakness, polyuria, nocturia (due to hypokalemia), exertional/paroxysmal nocturnal dyspnea, stroke, and hypertensive encephalopathy (headache, visual disturbances, altered mental state, seizures).
Homoeopathic Rubrics for corresponding to the symptoms:
- Mild to Moderate Hypertension:
- Headache: [Head] Pain, headache in general.
- Accelerated Hypertension:
- Somnolence: [Sleep] Sleepiness: During the day, in general.
- Confusion: [Mind] Confusion of mind.
- Visual Disturbances: [Vision]Dim, cloudy, foggy, weak.
- Nausea and Vomiting: [Stomach] Nausea
- [Stomach] vomiting.
- Pheochromocytoma-Related Hypertension:
- Headache: [Head] Pain, headache in general.
- Anxiety: [Mind] Anxiety.
- Palpitations: [Chest] Palpitation, heart.
- Perspiration: [Perspiration] Profuse.
- Pallor: [Face]Discoloration: pale.
- Tremor: [Extremities] Trembling.
- Nausea and Vomiting: [Stomach] Nausea
- [Stomach] vomiting.
- Primary Aldosteronism and Chronic Hypertension:
- Muscular Weakness: [Sensation and Complaints in general]Weakness: Muscular
- Polyuria: [Urine] Copious.
- Nocturia: [Urine] Micturition: Urination: Frequent, too: Night
- Exertional Dyspnea: [Respiration] Difficult: Exertion: After.
- Stroke: [Generalities] Apoplexy
- Hypertensive Encephalopathy (Headache, Visual Disturbances, Altered Mental State, Seizures):
- Headache: [Head] Pain, headache in general.
- Visual Disturbances: [Vision] Dim, cloudy, foggy, weak.
- Altered Mental State: [Mind] Confusion of mind
- Seizures: [Generalities] Convulsions
Homoeopathic Remedies for Hypertension:
Baryta Mur: Hypertension and Vascular degeneration. Increased tension of Pulse. Arteriosclerosis where a high systolic pressure with a comparatively low diastolic tension is attended by cerebral and cardiac symptoms. Convulsions. Icy coldness of body, with Paralysis. A general feeling of lassitude in the morning, especially weakness of the legs, with muscular stiffness.
Plumbum metallicum: Hypertension and arteriosclerosis. Progressive muscular atrophy. Excessive and rapid emaciation. Sudden loss of sight. Constant vomiting. Worse at night and by motion.
Arnica montana: Essential hypertension and a history of myocardial strain due to over-exertion or work. Homoeopathic Aspirin. Respiration hoarseness after exertion.
Conium maculatum: Hypertension, Urinary troubles, Heavy nausea. Vomiting coffee ground-like. Dyspnea. Pulse intermittent, unequal in strength and irregular in rhythm.
Crotalus horridus :Varicose veins in hypertension. Fluttering, quick, soft pulse. Sleeplessness due to mental agitation. Violent vomiting with anxiety and palpitations.
Crataegus: Hypertension with high diastolic and low systolic. Arteriosclerosis of the aged. Insomnia with aortic sufferers. Attacks of dyspnea on least exertion. Mind confused feeling
Conclusion:
In summary, hypertension is a complex condition influenced by various factors like genetics and lifestyle. This article highlights the mechanisms of hypertension, and how homoeopathy can complement conventional treatments by addressing symptoms such as headaches, confusion, palpitations and other manifestations through specific remedies. By considering both the physical and emotional aspects of patients, homoeopathy can also offer a holistic approach in managing hypertension effectively.
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