Hypertension

Hypertension

1. Definition
   Hypertension is a condition in which the arterial blood pressure is persistently raised above the normal limits, usually >140 mm Hg systolic or >90 mm Hg diastolic. It is a major silent risk factor for heart disease, stroke and renal failure.

2. Synonyms (if any)
   High blood pressure – the common term used in clinical practice and health education.

3. Causes / Etiology

   Primary (essential) hypertension – accounts for 90‑95 % of cases; exact cause unknown but multifactorial: genetic predisposition, excess dietary salt, obesity, sedentary lifestyle, stress and ageing.
   Secondary hypertension – due to an identifiable disorder: chronic kidney disease, renovascular stenosis, adrenal tumours (pheochromocytoma, aldosteronoma), endocrine disorders (thyrotoxicosis, Cushing’s syndrome), co‑administered drugs (oral contraceptives, NSAIDs, steroids).

   Each cause contributes to increased peripheral resistance, volume overload or neuro‑hormonal activation, thereby raising pressure.

4. Types / Classification

   a) Primary (essential) hypertension – no specific cause found; develops insidiously over years; usually mild to moderate at presentation.
   b) Secondary hypertension – abrupt onset, often severe; linked to a specific disease or drug; may be reversible if the underlying cause is treated.

   No distinct acute‑chronic split is required beyond the above; however, a hypertensive crisis (acute severe rise) is a special emergency form.

5. Pathophysiology / Pathology – step‑by‑step

   Step 1: Increased cardiac output (due to volume expansion or sympathetic over‑activity) and/or increased systemic vascular resistance.
   Step 2: Activation of the renin‑angiotensin‑aldosterone system (RAAS) leads to vasoconstriction and sodium‑water retention.
   Step 3: Sympathetic nervous system stimulation further narrows arterioles and raises heart rate.
   Step 4: Endothelial dysfunction reduces nitric‑oxide mediated vasodilation, perpetuating the high pressure.
   Step 5: Structural changes in the arterial wall (media hypertrophy, fibrosis) develop with chronic exposure, fixing the hypertension.

6. Clinical Features

   General – most patients are asymptomatic; hypertension is often discovered on routine measurement.
   Specific – occasional headache, especially in the occipital region; dizziness, visual disturbances, epistaxis, palpitations, shortness of breath on exertion.
   Acute (hypertensive crisis) – severe headache, visual loss, chest pain, pulmonary oedema, neurological deficits.
   Chronic – left ventricular hypertrophy may produce a sustained apical impulse; renal involvement may cause nocturnal polyuria.

   Recognising these signs helps differentiate uncomplicated hypertension from end‑organ damage.

7. Complications

   Acute complications – hypertensive encephalopathy, malignant hypertension with papilledema, acute left‑ventricular failure, aortic dissection, intracerebral haemorrhage.
   Chronic complications – atherosclerotic coronary artery disease, chronic heart failure, atrial fibrillation, chronic kidney disease progressing to end‑stage renal failure, retinopathy leading to visual loss, peripheral arterial disease.

   Early control of pressure reduces the likelihood of these serious outcomes.

8. Investigations / Diagnosis

   Routine – accurate blood pressure measurement on at least two separate occasions; urine analysis for protein or micro‑albumin.
   Specific – complete blood count, serum electrolytes, renal function tests, fasting lipid profile, fasting blood glucose.
   Confirmatory – 24‑hour ambulatory blood pressure monitoring (detects white‑coat effect and nocturnal dip), echocardiography (assesses left‑ventricular mass), renal ultrasound (looks for structural renal disease), plasma renin activity when secondary causes are suspected.

   Each test clarifies the severity, identifies target‑organ damage and guides therapy.

9. Differential Diagnosis

   White‑coat hypertension – elevated readings only in clinical setting; ambulatory monitoring distinguishes it.
   Anxiety‑related tachycardia – transient rise in pressure with stress; resolves with relaxation.
   Drug‑induced hypertension – NSAIDs, oral contraceptives, decongestants; history of medication use helps separate it.

   These differentials are important to avoid unnecessary long‑term drug therapy.

10. Management / Treatment

General management – lifestyle modification is the cornerstone: weight reduction, regular aerobic exercise, smoking cessation, moderation of alcohol, stress‑management techniques.
Modern medicine treatment – first‑line agents include thiazide diuretics, ACE inhibitors, angiotensin‑II receptor blockers, calcium‑channel blockers and low‑dose beta‑blockers; choice depends on comorbidities and patient profile.
Diet and lifestyle advice – adopt a low‑sodium diet (<5 g salt/day), increase potassium‑rich fruits and vegetables, limit saturated fats, maintain a daily walking routine of at least 30 minutes, practice relaxation or yoga to lower sympathetic tone.

The combined approach achieves optimal blood‑pressure control and reduces complications.

11. Homeopathic Therapeutics – 8 remedies (each with 7‑8 points)

Rauwolfia
– Causation: stress, anxiety, over‑work.
– Characteristic symptoms: high systolic pressure, feeling of tightness in the head, insomnia with restless thoughts.
– Modalities: worse from mental strain, better after quiet sleep.
– Mental state: anxious, irritable, anticipatory fear.
– Thirst and appetite: increased thirst, normal appetite.
– Discharges: dry mouth, scanty urine.
– Physical generals: trembling hands, cold extremities.
– Suitable constitution: nervous, high‑strung individuals.
– This remedy helps by calming the sympathetic over‑activity that raises pressure.

Gelsemium
– Causation: mental over‑exertion, prolonged study or work.
– Characteristic symptoms: pulsating headache, feeling of heaviness in the limbs, mild hypertension.
– Modalities: worse from mental effort, better in fresh air.
– Mental state: timid, indecisive, anticipatory anxiety.
– Thirst and appetite: decreased appetite, slight thirst.
– Discharges: dry skin, scanty sweat.
– Physical generals: weak pulse, slight tremor.
– Suitable constitution: students, clerks, people with mental fatigue.
– It reduces nervous tension and thereby lowers peripheral resistance.

Glonoinum
– Causation: exposure to heat, sun, or hot drinks.
– Characteristic symptoms: throbbing frontal headache, flushing, rapid pulse, raised pressure.
– Modalities: worse from warmth, better in cool environment.
– Mental state: irritable, impatient, feeling of impending doom.
– Thirst and appetite: great thirst for cold water, normal appetite.
– Discharges: profuse sweating, especially on the forehead.
– Physical generals: dilated pupils, hot skin.
– Suitable constitution: people living in hot climates, those who over‑use stimulants.
– It counteracts heat‑induced vasoconstriction and stabilises pressure.

Sarsaparilla
– Causation: chronic kidney irritation, long‑standing salt excess.
– Characteristic symptoms: high diastolic pressure, swelling of ankles, dull headache.
– Modalities: worse from cold, better from warmth.
– Mental state: melancholy, feeling of heaviness.
– Thirst and appetite: decreased thirst, reduced appetite.
– Discharges: scanty urine, occasional proteinuria.
– Physical generals: oedematous lower limbs, sluggish pulse.
– Suitable constitution: individuals with renal predisposition, middle‑aged men.
– It supports renal elimination of excess fluid, lowering volume‑related pressure.

Lycopus
– Causation: emotional upset, grief, over‑thinking.
– Characteristic symptoms: pounding headache, high pressure, palpitations.
– Modalities: worse from mental stress, better after rest.
– Mental state: anxious, fearful, constantly worrying.
– Thirst and appetite: increased appetite, occasional thirst.
– Discharges: dry tongue, scanty urine.
– Physical generals: tremulous hands, cold feet.
– Suitable constitution: people prone to nervous tension, especially women.
– It balances the autonomic nervous system, reducing sympathetic drive.

Digitalis
– Causation: underlying heart disease, especially atrial fibrillation.
– Characteristic symptoms: high pressure with irregular pulse, visual disturbances (yellow‑green halos).
– Modalities: worse after exertion, better when lying down.
– Mental state: depressed, feeling of heaviness in the chest.
– Thirst and appetite: decreased appetite, occasional thirst.
– Discharges: slow, weak urine flow.
– Physical generals: bradycardia, cold clammy skin.
– Suitable constitution: elderly patients with known cardiac insufficiency.
– It improves cardiac contractility and helps regulate the heart rate, indirectly lowering pressure.

Cactus
– Causation: dehydration, excessive diuretic use.
– Characteristic symptoms: sharp headache, high pressure, dry mouth.
– Modalities: worse from lack of fluids, better after drinking water.
– Mental state: irritable, impatient, feeling of thirst.
– Thirst and appetite: intense thirst for cold water, reduced appetite.
– Discharges: scanty urine, dry skin.
– Physical generals: rapid pulse, dry mucous membranes.
– Suitable constitution: people living in arid regions, those on strict low‑fluid diets.
– It restores fluid balance and eases vascular constriction caused by dehydration.

Natrum muriaticum
– Causation: excessive intake of salty foods, emotional suppression.
– Characteristic symptoms: persistent high pressure, feeling of fluid retention, occasional headaches.
– Modalities: worse after salty meals, better after fresh air.
– Mental state: reserved, grieving, tendency to hold emotions.
– Thirst and appetite: normal thirst, craving for salty foods.
– Discharges: clear urine, occasional nasal discharge.
– Physical generals: dry skin, cold extremities.
– Suitable constitution: individuals with a habit of over‑salting food, introverted personality.
– It helps the body eliminate excess sodium, reducing volume‑related hypertension.

12. Prognosis
    If blood pressure is controlled early and complications are prevented, most patients lead a normal lifespan; uncontrolled hypertension leads to progressive organ damage and increased mortality. Prognosis is better in younger patients, those without diabetes or renal disease, and those who adhere to therapy.

13. Prevention
    Adopt a heart‑healthy lifestyle: maintain ideal body weight, limit dietary salt to <5 g/day, eat plenty of fruits and vegetables, exercise regularly, avoid tobacco and limit alcohol. These measures lower the incidence of primary hypertension and reduce the risk of secondary forms.

14. Diet

Recommended foods – fresh fruits (especially bananas, oranges), leafy green vegetables, whole grains, low‑fat dairy, legumes, nuts, and unsalted nuts; these provide potassium, fibre and antioxidants that counteract sodium‑induced pressure rise.

Foods to avoid – processed foods, canned soups, pickles, salty snacks, fast food, excessive red meat, and foods high in saturated fat; they increase sodium load, promote atheroma formation and worsen hypertension.

These notes cover all required headings, provide detailed explanations, and follow the handwritten‑style format suitable for a MUHS BHMS examination.