Systemic Hypertension

##Systemic Hypertension

1. Definition
   Systemic hypertension (high blood pressure) is a condition in which the arterial pressure is persistently raised above normal limits, predisposing to damage of heart, brain, kidneys and vessels.

2. Causes / Etiology

• Family history (genetic predisposition)
• Advancing age (risk rises after 40 years)
• Obesity and central fat distribution
• Sedentary lifestyle
• Smoking and excessive alcohol intake
• High dietary salt intake
• Chronic stress
• Underlying diseases such as renal parenchymal disease, endocrine disorders (e.g., pheochromocytoma, hyperaldosteronism)

3. Types or Classification
   Essential (primary) hypertension – the common form (≈95 % of cases) with no single identifiable cause.
   Secondary hypertension – high pressure that results from a specific disease or drug (e.g., renal disease, endocrine tumour, certain medications).

4. Pathology (step‑wise)
   step 1 → increased peripheral resistance: arterioles constrict, raising resistance to flow.
   step 2 → increased cardiac output: heart pumps more blood to overcome resistance, further elevating pressure.
   step 3 → renal‑angiotensin‑aldosterone system activation: kidneys release renin, forming angiotensin II which causes vasoconstriction and sodium‑water retention.
   step 4 → sustained vasoconstriction and volume expansion maintain the high pressure.

5. Clinical Features

General (often silent) – many patients feel no symptoms; may notice occasional headache, dizziness or epistaxis (nose‑bleed).

Specific – chest discomfort or angina, shortness of breath on exertion, palpitations, visual disturbances, fatigue, confusion in severe cases.

6. Complications

Acute – hypertensive crisis (malignant hypertension), acute heart failure, intracerebral hemorrhage, aortic dissection.

Chronic – left‑ventricular hypertrophy and heart failure, coronary artery disease, chronic kidney disease, retinopathy, peripheral arterial disease, stroke.

7. Diagnosis / Investigations

Routine – accurate blood pressure measurement (sitting, after 5 min rest, two readings), complete blood count, serum electrolytes, renal function tests, fasting lipid profile, urine for protein.

Special – 12‑lead ECG (look for LVH, strain), echocardiography (assess cardiac size and function), ambulatory blood pressure monitoring (to confirm diagnosis), renal ultrasound (structure), plasma renin activity or aldosterone levels when secondary cause is suspected.

8. Management

General – lifestyle modification: regular aerobic exercise (30 min most days), weight reduction to BMI < 25, low‑salt diet (≤5 g NaCl/day), limit alcohol, stop smoking, stress‑reduction techniques (yoga, meditation).

Modern pharmacotherapy – first‑line agents may include thiazide diuretics, ACE inhibitors, angiotensin‑II receptor blockers, calcium‑channel blockers, beta‑blockers; choice guided by age, comorbidities and tolerance.

Dietary advice – DASH diet (fruits, vegetables, low‑fat dairy, whole grains), increase potassium‑rich foods (banana, orange), reduce saturated fats, maintain adequate hydration.

9. Homeopathic Therapeutics

Glonoinum

• Sudden rise in pressure, pulse hard and full
• Face flushed, throbbing headache
• Dizziness, sensation of blood rushing to head
• Palpitations, feeling of heat in the body

Natrum Muriaticum

• High pressure with cardiac strain, palpitations
• Headache pressing on the vertex
• Shortness of breath, feeling of weakness
• Thirst for small sips, tendency to retain fluids

Nux Vomica

• Hypertension associated with stress, irritability
• Occipital headache, nausea, occasional vomiting
• Constipation, feeling of fullness in the stomach
• Restlessness, insomnia, sensitivity to noise

Rauwolfia

• Elevated pressure with anxiety, fear of death
• Tremors, palpitations, sweating at night
• Insomnia, mental agitation, desire for solitude

Calcarea Carbonica

• Hypertension with renal involvement (proteinuria, edema)
• Fatigue, coldness of limbs, desire for warm drinks
• Anxiety about health, feeling of heaviness in the head