Systemic hypertension and scope of homoeopathy

SYSTEMIC
HYPERTENSION AND
SCOPE OF
HOMOEOPATHY
From
Dr. Smita Brahmachari,
M.D. (Repertory) from
N.I.H., Kolkata.

M.O., Dept. of ISM &Homoeopathy,

World Health Day 2013
The focus of the World Health Day 2013 (7th April
every year) is on one of the main non-communicable
disease (NCD) risk factors, hypertension. It is currently
the leading risk resulting in considerable death and
disability worldwide and accounted for 9.4 million
deaths and 7 per cent of disability adjusted life years
(DALYs) in 2010. In India, hypertension is the leading
NCD risk and estimated to be attributable for nearly
10% of all deaths1.

World Hypertension Day 2013
The
theme
for
2013
World
Hypertension Day (17th May every
year) is “Healthy heart beat –
healthy blood pressure” emphasizing
on the importance of blood pressure
control and control of arrhythmias1.

Epidemiology of hypertension
(globally)




As per the World Health Statistics 2012, of the estimated 57
million global deaths in 2008, 36 million (63%) were due to
non-communicable diseases (NCDs). The largest proportion
of NCD deaths is caused by cardiovascular diseases (48%).
In terms of attributable deaths, raised blood pressure2 is one
of the leading behavioral and physiological risk factor to
which 13% of global deaths are attributed.
Hypertension is reported to be the fourth contributor to
premature death in developed countries and the seventh in
developing countries. Recent reports indicate that nearly 1
billion adults (more than a quarter of the world’s population)
had hypertension in 2000, and this is predicted to increase to
1.56 billion by 20252.

Epidemiology of hypertension
in India


The prevalence of hypertension in the last six decades has increased from 2% to
25% among urban residents and from 2% to 15% among the rural residents in
India2.



According to Directorate General of Health Services, Ministry of Health and
Family Welfare, Government of India, the overall prevalence of hypertension in
India by 2020 will be 159.46/1000 population2.



The number of hypertensive individuals is anticipated to nearly double from 118
million in 2000 to 213 million by 20251.



It is estimated that 16 % of ischaemic heart disease, 21 % of peripheral vascular
disease, 24 % of acute myocardial infarctions and 29 % of strokes are attributable
to hypertension underlining the huge impact effective hypertension prevention and
control can have on reducing the rising burden of cardiovascular disease 1.



This has been taken into cognizance in the newly launched National Programme
for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and
Stroke (NPCDCS) which has hypertension and diabetes as the main focus areas1.

CLINICAL APPROACH
Hypertension is easily diagnosable
and
treatable
with
lifestyle
modifications
and
effective
medicines.
Thus,
hypertension
control provides an entry point to
deal with other non-communicable
diseases (NCDs) as any intervention
will help concomitantly address
other NCDs as well.

Measurement of blood pressure (BP)
• The health related toxic effects of mercury are recognized
world over and mercury sphygmomanometers are being
replaced by aneroid and digital sphygmomanometers.
• BP should be measured with a well – calibrated
sphygmomanometer.
• The bladder width within the cuff should encircle at least 80%
of the arm circumference.
• Readings should be taken after the patient has been resting
comfortably, back supported in the sitting or supine position,
for at least 5 minutes and at least 30 minutes after smoking or
tea/ coffee ingestion.
• A video demonstrating the correct technique can be found at
http://www.abdn.ac.uk/medical/bhs/tutorial/tutorial.htm.

Measurement of blood pressure (BP)
 The first appearance of the sound (Phase I Korotkoff) is the systolic

BP. The disappearance of the sound (Phase V Korotkoff) is the
diastolic BP.
 For confirmation of diagnosis of hypertension, record at least 3 sets
of readings on different occasions.
 Measure the blood pressure in both arms at the first visit and use
higher of the two readings.
 In older persons aged 60 years and above, in diabetic subjects and
patients on antihypertensive therapy, the BP should be measured in
both, supine/sitting and in standing positions to detect postural
hypotension.
 For home measurement. blood pressure, readings of more than
135/85 mm Hg should be considered elevated.

DIAGNOSIS OF HYPERTENSION












Hypertension is diagnosed when systolic blood pressure is consistently
elevated above 140 mm Hg, or diastolic blood pressure is above 90 mm
Hg.
A single elevated BP is not sufficient to establish the diagnosis of
hypertension.
2 major exceptions to this rule are hypertensive presentations with
evidence of life threatening end-organ damage and in hypertensive
urgency where BP > 220/125 mm Hg but life threatening end-organ
damage is absent.
Hypertension is diagnosed at lower levels when based on
measurements taken outside the office environment.
BP is normally lowest at night and loss of this nocturnal dip is strongly
associated with cardiovascular risk, particularly thrombotic stroke.
An accentuation of normal morning increase in BP is associated with
likelihood of cerebral haemorrhage.

BP Classification

Systolic BP,
mm Hg

Diastolic BP,
mm Hg

Normal

< 120

< 80

Prehypertension

120 – 139

80 – 89

Stage 1 hypertension

140 – 159

90 – 99

Stage 2 hypertension

≥ 160

≥ 100

Classification of hypertension
•

•

Primary essential hypertension (95% cases)
as a result of complex interactions between
multiple genetic and environmental factors.
Secondary hypertension (5% cases) have
identifiable specific causes (should be
suspected in patients in whom HTN develops
at an early age/ who 1st exhibit HTN over
50yrs/ those previously well controlled
become refractory to treatment).

EXACERBATING FACTORS
1.

2.

3.
4.

5.
6.
7.

8.

Obesity esp. truncal obesity in Indians (weight reduction lowers
BP moderately).
Sleep apnea (treatment with continuous positive airway pressure
improves BP).
Increased salt intake.
Alcohol (HTN difficult to control in patients consuming >40g
ethanol i.e., 2 drinks daily).
Cigarette smoking (accentuates cardiovascular risk).
NSAIDS (increase in BP averaging 5 mm Hg)
Metabolic syndrome (associated with development of HTN and
adverse cardiovascular outcomes).
OC pills use (a significant increase of BP > 140/90 mmHg in
obesed older than 35 yrs who have been treated for more than 5
yrs).

Identifiable specific causes of hypertension
(secondary hypertension)
Chronic kidney disease
Primary aldosteronism
Renovascular disease (renal artery stenosis)
Long term corticosteroid therapy and Cushing syndrome
Pheochromocytoma
Coarctation of aorta
Hypertension associated with pregnancy (preeclampsia

and eclampsia)
Thyroid and parathyroid disease (hypo and hyper)

When to suspect secondary hypertension
clinically?


Absence of family history of hypertension.



Severe hypertension > 180/110 mm Hg with onset at age < 20 years or > 50
years.



Difficult-to-treat or resistant hypertension with significant end-organ
damage features.



Combination of pain (headache), palpitation, pallor and perspiration – 4
P’s of phaeochromocytoma.



Polyuria, nocturia, proteinuria or hematuria – indicative of renal diseases.



Absence of peripheral pulses, brachio femoral delay and abdominal or
peripheral vessel bruits.



History of polycystic renal disease or palpable enlarged kidneys.



Cushingoid features, multiple neurofibromatosis.



Significant elevation of plasma creatinine with use of ACE inhibitors.



Hypertension in children.



History of snoring, daytime somnolence, obesity, short and thick neck –
Obstructive Sleep Apnoea.

Hypertensive cardiovascular disease (left ventricular hypertrophy, CCF,
MI, ventricular arrhythmias and sudden death).
 Hypertensive cerebrovascular disease (haemorhagic and ischaemic
stroke) and dementia (vascular and Alzheimer’s types).
 Hypertensive kidney disease (nephrosclerosis). Aggressive BP control
to 130/80 mmHg or lower slows the progression of all forms of chronic
kidney disease.
 Atherosclerotic complications.
 Hypertensive encephalopathy (headache, irritability, confusion, altered
mental status due to cerebrovascular spasm).
 Hypertensive patients with diabetes are at particularly high risk for
cardiovascular events. More aggressive treatment of hypertension in these
pt.s prevents progressive nephropathy.
 Malignant hypertension (encephalopathy or nephropathy with
accompanying papilledema).


Complications of untr eated hyper tension

Systolic pressure
1. Hypertensive LVH is closely related to
degree of systolic BP reduction.
2. Hypertensive cerebro vascular
complications are closely correlated with
systolic than diastolic pressure.
 Pulse pressure (SystolicBP-DiastolicBP)


Clinical findings …symptoms
 Essential hypertension is asymptomatic for years.
 Accelerated hypertension is associated with somnolence,

confusion, nausea, vomiting and visual disturbances
(hypertensive encephalopathy).
 In pt.s with phaechromocytoma typical attack lasts from
minutes to hours with headache, anxiety, palpitations, pallor,
tremor, nausea and vomiting. BP is markedly elevated and
angina/ pulmonary edema may occur.
 In primary aldosteronism, pt.s have muscular weakness,
polyuria, nocturia due to hypokalemia.
 Chronic HTN leads to LVH and diastolic dysfunction which can
present with exertional and paroxysmal nocturnal dyspnoea.








Blood pressure: taken in both arms. Lower extremity pulses are
diminished or delayed in coarctation of aorta; an orthostatic drop is
present in phaechromocytoma; older pt.s have falsely elevated
reading because of noncompressible vessels; direct measurement of
intra-arterial pressure is done in pt.s with severe HTN who do not
tolerate therapy.
Retina: narrowing of arterial diameter to <50% of venous diameter,
copper/ silver wire appearance, exudates, haemorrhages or
papilledema are associated with a worst prognosis.
Heart: a left ventricular heave indicates severe or long standing
hypertrophy.
Pulses: radio-femoral delay in coarctation of aorta; loss of
peripheral pulses in atherosclerosis.

Evaluation
Evaluation of patients with documented hypertension
has three objectives:
 To identify known causes of high blood pressure
 To assess the presence or absence of target organ
damage
 To identify other cardiovascular risk factors or
concomitant disorders that may define prognosis and
guide treatment
Data for evaluation is acquired through medical
history, physical examination, laboratory tests, and
other special diagnostic procedures.

Medical History
•
•
•

•
•
•
•
•

•
•

Duration and level of elevated blood pressure, if known.
History of previous antihypertensive therapy, including adverse effects experienced, if any.
Past history or current symptoms of coronary artery disease (CAD), heart failure,
cerebrovascular disease, peripheral vascular disease, CKD, diabetes mellitus, dyslipidaemia,
obesity, gout, sexual dysfunction and other co-morbid conditions.
Family history of hypertension, obesity, premature CAD and stroke, renal diseases,
dyslipidaemia and diabetes.
Symptoms suggesting secondary causes of hypertension.
History of smoking or tobacco use, physical activity, dietary assessment including intake of
sodium, alcohol, saturated fat and caffeine.
Socioeconomic status, professional and educational levels.
History of use / intake of all prescribed and over-the-counter medications, herbal remedies,
liquorice (Yashtimadhu/ Jestamadha), illicit drugs, corticosteroids, NSAIDs, nasal drops.
These may raise blood pressure or interfere with the effectiveness of antihypertensive drugs.
History of oral contraceptive use and hypertension during pregnancy.
Psychosocial and environmental factors.

PHYSICAL EXAMINATION
 Record three blood pressure readings separated by 2 minutes, with the
patient either supine or sitting position and after standing for at least 2
minutes.
 Record height, weight and waist circumference.
 Examine the pulse and the extremities for delayed or absent femoral and
peripheral arterial pulsations, bruits and pedal oedema.
 Look for arcus senilis, acanthosis nigricans, xanthelasma and xanthomas.
 Examine the neck for carotid bruits, raised JVP or an enlarged thyroid
gland.
 Examine the heart for abnormalities in rate and rhythm, location of apex
beat, fourth heart sound and murmurs.
 Examine the lungs for crepitations and rhonchi.
 Examine the abdomen for bruits, enlarged kidneys, masses and abnormal
aortic pulsation.
 Examine the optic fundus and do a neurological assessment.

LAbOrATOrY fINdINgS
•
•
•
•
•
•
•
•
•

Haemoglobin, urinalysis and kidney function study to detect haematuria,
proteinuria, casts (primary kidney disease/ nephrosclerosis).
Fasting blood sugar level (diabetes and hyperglycemia is a feature of
pheochromocytoma).
Lipid profile (atherosclerosis).
Serum uric acid (if elevated then contraindication for diuretic therapy).
Serum electrolytes.
Echocardiography (cardiac disease as ECG is not sensitive for LVH).
Specific tests like 24-hour urine free cortisol, plasma metanephrines and
plasma aldosterone/ renin ratio for endocrine causes of HTN.
Renal USG (polycystic kidney, obstructive uropathy).
Renal arteriography (renal artery stenosis).

Lifestyle modifications to manage hypertension
Modification

Recommendation

Approx. systolic BP
reduction, range

Weight reduction

Maintain normal body weight
(BMI,18.5-24.9)

5-20 mm Hg/10 kg weight loss

Adopt DASH eating plan

Consume a diet rich in fruits,
vegetables and low fat dairy
products with a reduced content of
saturated fat and total fat

8 – 14 mm Hg.

Dietary sodium reduction

Reduce to 2g sodium or 6g sodium
chloride

2 – 8 mm Hg.

Physical activity

Engage in regular aerobic physical
activity such as brisk walking at
least 30 minutes/day. Also
relaxation techniques like yoga
and meditation.

4 – 9 mm Hg.

Moderation of alcohol
consumption

Not more than two drinks per day
(30 ml ethanol).

2 – 4 mm Hg.

(Dietary approaches to stop
hypertension)

Stop smoking

Lifestyle modifications to manage hypertension
(contd.)
•
•

•

•

Initial management of hypertension uses a two-pronged approach, with
emphasis on lifestyle measures and add – on medicinal management.
Lifestyle management has an important role in both non-hypertensive and
hypertensive individuals. Whilst these modifications shows modest reduction in
BP, all too often these treatments are not adopted and, even if they are, but not
sustained.
In non-hypertensive individuals, including those with pre-hypertension,
lifestyle modifications have the potential to prevent hypertension and more
importantly to reduce BP and lower the risk of BP-related clinical
complications.
In hypertensive individuals, lifestyle modifications can serve as initial
treatment before the start of medicinal treatment and as an adjunct to medicinal
treatment in persons already on medication. In hypertensive individuals with
medication – controlled BP these modifications can facilitate medicinal stepdown in individuals who can sustain lifestyle changes.

Food items to be avoided in
hypertensives
• Table salt
• Mono sodium glutamate
(Ajinomoto)
• Baking powder
• Sodium bicarbonate
• Fried foods
• Alcohol
• Sugar, mithais, candies

Salt preserved foods
• Pickles and canned foods
• Ketchup and sauces
• Prepared mixes
• Ready to eat foods (soups)
Highly salted foods
• Potato chips, cheese, peanut
• Butter, salted butter, papads
Bakery products
• Biscuits, cakes,
• Breads and pastries

gOALS Of TrEATMENT
• Early treatment initiation reduces overall cardiovascular risk.
• The BP target for hypertensive pt.s at the greatest risk for
cardiovascular events, particularly pt.s with diabetes and with
chronic kidney disease should be lower (<130/80 mm Hg).
• Over-enthusiastic treatment has adverse effects: there is an
association between lower BP and cognitive decline in elderly.
• Excessive lowering of diastolic pressure below 70 mm Hg
should be avoided in pt.s with coronary disease.
• Antihypertensive therapy prevents fatal myocardial infarction
and cardiovascular mortality and recent advances have placed
focus on control of systolic BP.

Drug therapy in
conventional medicine
1.
2.
3.
4.

5.
6.

Current antihypertensive agents include:
Diuretics (useful for isolated or systolic HTN)
β –adrenergic blockers (useful in individuals with angina, MI, CCF,
migraine headaches and somatic manifestations of anxiety).
Renin inhibitors (Aliskiren was recently approved by FDA)
Angiotensin-Converting Enzyme inhibitors (useful in type 1 diabetes
with frank proteinuria or evidence of kidney dysfunction; drug of choice in
pt. c CCF when given in conjunction with a diuretic and a β –blockers)
Calcium channel blockers (useful for in angina, arrhythmias, in
prevention of CAD, stroke, cardiovascular death and total mortality)
Angiotensin II Receptor Blockers (useful in related conditions like heart
failure and type2 DM with nephropathy; given in combination with ACE
inhibitor).

Follow-up of pt.s receiving
hypertensive therapy
• Once BP is controlled on a well tolerated regimen, follow-up
visits can be infrequent and laboratory testing limited to tests
appropriate for the pt.
• Yearly monitoring of blood lipids is recommended and an
ECG should be repeated at 2- to 4-year intervals depending on
whether initial abnormalities are present, the presence of
coronary risk factors and age.
• Pt.s who have excellent BP control for several years,
especially if they have lost weight and initiated favorable
lifestyle modifications should be considered for step-down of
therapy to determine whether lower doses or discontinuation
of medications are feasible.

HYPERTENSION: HOMOEOPATHIC CONCEPT




Homoeopathy considers health as a state indicating
harmonious functioning of the life force. Disease is a
deviation from health, which develops when the life force is
unable to overcome obstructions to its smooth functioning. It
can be seen as the total response of the organism to adverse
environmental factors, internal or external, conditioned by
constitutional factors, inherited or acquired. This stands true
for all diseases, including hypertension11.
Thus in the case of hypertension, homoeopathy focuses on the
patient with the hypertension, rather than on the hypertension
itself. The totality of various characteristic signs and
symptoms exhibited by this patient leads the homoeopath to
the similar remedy. The similar remedy relieves the totality of
symptoms, and with it the symptom of an elevated blood
pressure.

Exacerbating factors
High salt intake - desire for salt is a pseudo psoric
trait.
Obesity - tendency for obesity is sycotic.
High fat intake - desire for fat is pseudo psoric.
Alcohol consumption - desire for alcohol is pseudo
psoric.
Psychological factors – tendency to be affected by
suppressed emotions, grief, sorrow is psoric.

Hypertension…miasmatic influences (contd.)
Pathogenesis and pathology :
 The initial phase in the development of hypertension is
though to be due to the hyper reactivity of the
vasculature or due to a hyperactive sympathetic nervous
system. Hyperactivity is a psoric trait.
 Later on hypertrophic changes occur in the walls of the
arteries and arterioles. Sclerotic changes also occur as
age advances. These represent the sycotic and
tubercular influences.
 In malignant hypertension, the predominant pathology
is necrosis of the arterioles, showing a clear influence
of the syphilitic miasm.

Clinical presentation :
1. The asymptomatic presentation in many cases, in spite of sustained hypertension
with pathological changes, clearly indicate that psora is not the only miasmatic
influence.
2. The purely psoric patient is usually the victim of many unpleasant sensations. It is
the syphilitic or sycotic stigmata which usually present with only a few or no
symptoms at all.
3. On examination of the more common symptoms, we find that occipital headache is
syphilitic in origin. Vertigo is the other symptom more frequently complained of,
and the psoric miasm is known to produce many kinds of vertigo. But it is the
union of syphilis and psora which stresses it to a marked degree
4. From the miasmatic analysis given above, it is clear that hypertension is a
disorder with multi-miasmatic influences, with strong psoric and pseudopsoric influences. Many authors10 have classified hypertension under the pseudopsoric miasm.
5. But it is quite possible that the individual presentation and course of the disease
depends on the relative predominance of different miasmatic influences.

A. Psoric predominance


Patients with psoric predominance13 typically have labile hypertension or hypertension
caused by emotional disturbances like anger, anxieties worry, grief etc.



They are prone to be more symptomatic, complaining of dizziness, dyspnea,
palpitations etc. which are better by lying down and keeping quiet and worse after
eating.



Neuralgic and stitching pains in the chest > rest, and band sensations around the heart
may also be complained of.



Sensations like rush of blood to the chest, weakness, fullness about the chest are
common.



The psoric element makes sure that there are many sensations, concomitants and
modalities, giving a true picture of the suffering10.



The heart symptoms are always associated with great anxiety and fear, always fear that
they will die from heart trouble. The symptomatology is strongly influenced by
emotions like joy, grief, anxiety etc

B. Syphilitic predominance
 The predominantly syphilitic patient is usually asymptomatic. They
may have for many years a slight dyspnea or pain or perhaps no
symptoms at all. They have few subjective symptoms, desires.
Typically, they have little mental disturbance accompanying the
heart conditions, even when they are critical.
 But it is these patients who are prone to die suddenly and without
warning.
 The syphilitic influence13 leads to widespread destructive changes in
the vital organs like heart, kidney, retina and brain. Many of the life
threatening complications of hypertension, like cerebral and
myocardial infarction, malignant phase etc. shows the influence of
this miasm

C. Pseudo-psoric predominance
 The pseudo psoric10 or tubercular miasm reflect many of the subjective symptoms.
 Hypertensives13 with the tubercular dimension are likely to have wide fluctuations
in blood pressure to very high levels of systolic and diastolic pressures.
 They are prone to haemorrhagic manifestations like epistaxis, retinal haemorrhage,
cerebral haemorrhage etc.
 In the tubercular10 as in the psoric heart conditions, the patient wants to keep still.
They are much aggravated by higher altitude, climbing stairs or ascending.
 Vertigo and palpitation are greater than that of psora and are accompanied by rush
of blood to heart and chest.
 The pains are worse sitting, better lying, and are so severe that they are associated
with dimness of vision, ringing in the ears and great weakness.
 The heart complaints may be associated with a greater falling away of flesh.

D. Sycotic predominance
 In the predominantly sycotic patient, the subjective symptoms are less, like the
syphilitic. We find none of the fears and apprehensions of the psoric patients, but
these are the conditions that have a fatal outcome10.
 In hypertension, the sycotic element may be responsible for marked ventricular
hypertrophy12. The combination of psora with sycosis may also cause marked
changes of structure of the heart, as well as dropsical conditions10.
 As a rule the sycotic patients are fleshy and puffy, their obesity contributing to
their dyspnea. The dyspnea is seldom painful, as opposed to the psoric or
tubercular miasms12.
 There may be soreness and tenderness and pains radiating from heart to scapula or
from shoulder to heart. These pains are ameliorated by motion, walking, riding or
gentle exercise.
 The heart complaints may be accompanied by or there may be a past history of
suppressed rheumatic symptoms13.

HOMOEOPATHIC MANAGEMENT OF
HYPERTENSION









Based on the principle of similia. The totality of symptoms guides the
physician to the indicated remedy.
Being a chronic disease, it requires constitutional, antimiasmatic treatment.
Smaller or lesser known remedies may be required to control high blood
pressure or to manage the complications.
Agrees with the conventional school on the necessity for lifestyle
modifications along with medications for proper management.
Any medicine in the materia medica may be potentially capable of bringing
down the elevated blood pressure. In the search for the similar remedy,
homoeopathy lays emphasis on the individuality of the patient. In §153 of
the Organon of medicine5, Hahnemann makes it clear that it is the
peculiar, characteristic and individualizing symptoms, and not the common
symptoms that denote the similimum.

HYPERTENSION (CONTD.)








“In all corporeal diseases, the condition of the disposition and mind is
always altered”…. § 210, Organon of Medicine5.
“In all cases of disease to be cured, the patient’s emotional state should
be noted as one of the most preeminent symptoms, along with the
symptom complex, if one wants to record a true image of the disease in
order to be able to successfully cure it homoeopathically”…. § 210,
Organon of the Medical Art7.
Hahnemann stressed the prime importance of the mental symptoms in all
physical disorders.
He said that the mental disposition and emotional reactions are too be
particularly noted, as they often determine the remedy selection. This
will apply quite naturally to cases of hypertension, where psychological
factors play a significant part in the causation of illness.

HYPERTENSION (CONTD.)

While treating diseases with multimiasmatic influenced
diseases like hypertension, it is also important that the
remedy selected correspond to the dominant miasm10. This is
very often found to be the psoric miasm… §80, Organon of
medicine5. Afterwards, the dormant syphilitic or sycotic
miasm, as the case may be, manifests itself and may call for
appropriate changes in remedy. Even in predominantly psoric
cases, several antipsoric remedies may be required, each one
homoeopathically chosen in consonance with the group of
symptoms remaining after completion of action of the
previous remedy….. §171, Organon of medicine5.

•
•

•
•

•

ONE SIDED EXPRESSION
Paucity of symptoms or the
absence of peculiar symptoms
1st selected medicine is partially
suitable due to lack of
symptoms.
This medicine will produce
accessory symptoms (disease).
2nd medicine selected on basis of
present picture of disease (old
existing symptoms + accessory
symptoms).
Subsequent prescriptions are to
be made depending on the
symptoms
remaining,
until
recovery is complete.

PATIENTS
UNDER
CONVENTIONAL TREATMENT
• Majority
of patients approach
homoeopaths after taking allopathic
medicines.
• Cases
which have undergone
prolonged
treatment
for
hypertension and other illnesses are
very difficult to treat, as the original
symptomatology is often not
available14.
• Prolonged drugging also weakens
the vital force, and develop their
own chronic symptoms. Such cases
require a much longer time for their
recovery, often indeed are they
incurable5.

Difficulties in Homoeopathic treatment

•

•

•
•

An attempt should be made to trace the symptoms
before the onset of treatment, to get an idea about the
original form of the disease.
One should not discontinue the allopathic treatment
abruptly; sudden withdrawal may do more harm than
good.
When the homoeopathic remedies seem to have an
effect, the drugs may be reduced very cautiously.
These cases also requires knowledge of the allopathic
drugs on the part of the homoeopathic physician

PATIENTS UNDER CONVENTIONAL
TREATMENT 5,14

Hypertension as described in repertory
 Many authors have grouped remedies under the heading of the related

pathological process of “arteriosclerosis”, and these may be useful in
cases of hypertension.
 Another related term, that is described in the materia medica and
repertory is “threatened apoplexy”. The remedies grouped under this
heading also may be useful in high rise of blood pressure, especially
when symptoms of cerebral congestion are present.
 In recent times repertories have separate rubric for “hypertension’’ like
Murphy’s Repertory (Blood, Hypertension, high blood pressure);
Complete Repertory (Generalities - Hypertension).
 Under Phatak Repertory, HTN c low diastolic: Bar-mur and For
sudden rise of B.P. medicine is Coffea (single medicine).
 In Synthesis Repertory (9.1 version) following medicines for
hypertension (HTN) are discussed under chapter Generalities in the
subrubric hypertension.

Hypertension as described in
repertory (contd.)
Here I have mostly discussed rubrics with single medicine [Synthesis 9.1version]
 HTN c apoplexy : Glon. and Op.
 HTN c DM : Sec cor.
 HTN c albuminous urine : Viscum alb.
 HTN c headache : Loxosceles laeta; if <morning : Fumaric acid.
 HTN c hypertrophy of heart : Crataegus oxyacantha.
 HTN c kidney complaints : Cupr met., Picric ac., Plb met.
 Renal hypertension : Melilotus.
 HTN from dialysis : Acon-ferox, Adren., Eel serum.
 Excessive HTN : Toxoplasma – gondii.
 HTN after lung complaints : Nat-ox-act.
 HTN due to disturbed nervous mechanism : Aur-mur-natonatrum.
 Pulmonary hypertension : Brassica napus oleifera.
 Sudden HTN : Adren., Coff., Lactrodectus mactans

Control of high rise of blood pressure
•

•

•
•

•

Even though constitutional treatment is the mainstay of
homoeopathic management, it may be very much necessary in some
cases to bring down the high blood pressure without delay.
These may be cases where the blood pressure elevation is very
high, or there are already some damage to the vital organs, making
the occurrence of a cardiovascular complication very likely.
In such situations, the initial prescription should be one capable of
bringing the blood pressure down to reasonable limits.
Here the knowledge of drugs known to be effective in such
conditions, especially smaller or partially proved drugs, may be
useful. They may also be required in cases when there is a paucity
of characteristic symptoms, especially the ones dependent on
allopathic drugs.
As mentioned earlier, the rubric for “threatened apoplexy” may be
helpful in some cases, especially when symptoms of cerebral
congestion are present.

Frequently used anti – miasmatic
homoeopathic medicines
Anti

– psoric medicines : Baryta mur.,
Con., Lach., Lyco., Nat mur., Sepia.,
Sulphur.
Anti – syphillitic medicines : Aur met.,
Con., Crotalus hor., Fluoric acid., Lach.,
Phos.
Anti – sycotic medicines : Calc carb.,
Lach., Lyco., Medo., Nat sulph., Nit
acid., Sepia, Staphy.,Thuja.

Therapeutic hints in Hypertension

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
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






From sudden shock due to bad news15 - Gelsemium sempervirens
Hypertension because of some insult16 - Staphysagria
With personal or parental history of coronary thrombosis 15 - Thuja occ.
As an intercurrent remedy, in persons wasting in health 17 - Tuberculinum.
In fleshy persons who eat a great deal, especially non-vegetarians 15 Allium sat
Hypertension in those engaged in mental work, teachers and professionals
who are exhausted from worry18 - Avena sativa
Nervous hypertension, levels go up and down - Ignatia, Nux vom.
With high difference between systolic and diastolic pressures 17-Baryta
mur.
With cracks on fingers - Baryta carbonica
With roaring in ears15 - Adrenalinum
HTN c hyperthyroidism and valvular heart disease6 – Lycopus virginicus.

Therapeutic hints in hypertension (contd.)











With acute nasal obstruction6 - Iodum
With insomnia18 - Passiflora incarnata, Crataegus oxyacantha.
With redness of face19 – Bell., Adrenalin, Asterias rub, Strontium carb
With throbbing headache, flushed face, tachycardia, hot body and cold
extremities19 - Bell. and Adrenalin.
With red face, feeling of hot air around the head, and fear of
apoplexy6,19Asteria rub
With profuse nose bleed ameliorating the headache 6 - Hammamelis,
Melilotus alba.
With full hard, bounding pulse, and congestive symptoms 6,20 - Verat vir.
With obstinate occipital headache15 – Carbo animalis
With suppurative conditions in warm blooded persons – Calcarea sulph.
Hypertension with pulmonary lesions17 – Phosphorus.

Therapeutic hints in Hypertension (contd.)











Hypertension with hyperthyroid phenomena21 - Thallium metallicum
Hypertension with diabetes mellitus - Lac vaccinum defloratum
Hypertension with albuminuria6 – Mer cor and Viscum album
In pregnant women with pre-eclampsia, hypertension, oedema -Apis
mel.
Hypertension at climacteric17 – Glon., Sang can, Lach., Sepia, Cactus g.,
Amyl nit., Sulphuric acid, Con mac.
Hypertension with arteriosclerosis17 - Adrenalin, Baryta carb, Baryta
mur, Aurums, Plb met, Strophanthus hisp., Viscum alb., Sumbul
mosch.
Hypertension with cardiac hypertrophy22- Crataegus oxyacantha
Hypertension with nephrosis22 - Fumaricum acidum
Insufficiency of the left ventricle due to hypertension - Baryta carb,
Sulphur, Lachesis, Aurum met., Glonoine.

Therapeutic hints in Hypertension (contd.)
Tissue remedies23
 Arteriosclerosis – Nat phos., Silicea, Nat sulph.
 High blood pressure due to arteriosclerosis – Calc flour, Fer phos.
Nosodes6
 Streptococcinum : HTN c hypercholestrolemia.
 Toxoplasma gondii : HTN c LVH and hypertensive emergencies
Drainage remedies24
Drainage of arteries in arterial hypertension – Sulphur, Cereus bonplandii
Indian drugs6
 Boerhaavia diffusa : marked diuretic properties, HTN with dropsy in feet, ringing in ears and
heat in the vertex.
 Rauwolfia serpentina : HTN without marked atheromatous changes in the vessels.
 Terminalia arjuna : HTN c functional and organic changes in heart with angina pectoris.
Bowel nosodes6
 Bacillus morgan : keynote is congestion, HTN with venous congestion resulting in varices,
venous stasis of legs and feet, congestive headache, vertigo and intense nervous excitement.

Potency selection
The selection of the potency in
hypertension is not different from
that for other disease conditions.
Various factors like susceptibility,
degree of similarity, presence or
absence of structural changes,
general vitality of the patient etc.
are taken into account before
selecting the appropriate potency in
each case.

Potencies suggested by various authors
However, various authors have mentioned the potencies they have found most
useful in cases of hypertension. These represent only the individual experience
of the authors. The potencies suggested for the different remedies and their
authors are given in next few slides. `X` denotes decimal potencies, all the
others are in the centesimal scale.
References of author as superscript :
 M – Dr. Farokh. J. Master22
 T – Dr. T.P. Chatterjee25
 P – Dr. S.G. Palsule18
 C – Dr. J. H. Clarke20
 G – Dr. R.L.Gupta26
 B – Dr. William Boericke6
 W – Dr. W. A. Dewey27
 D – Dr. Bishamber Das15
 F – Dr. Francoise Cartier28

Potencies suggested by various authors(contd.)

 Aconitum nap: 1C,6T,F, 30T,F

 Baryta carbonica: 30G

 Adrenalinum: 3W, 6W, 12W

 Baryta mur: 200P, 6G, 30G

 Allium sativum: QD

 Belladonna: 6G, 30G

 Amylenum nitrosum: 30P

 Crataegus oxyacantha: QM

 Aurum metallicum: 200M, 6G

 Diphtherinum: 200M

and 30B,G
 Aurum muriaticum: 30G
 Avena sativa: QP, 200P

 Fumaricum acidum: 200M
 Gelsemium: 1MD
 Glonoinum: 3F,6G,200P, 30G

Potencies suggested by various authors (contd.)

 Hypophysis posterior: 200M
 Ignatia amara: 200D, 30G
 Lachesis: 200M, 1MD, 30G

 Serum anguillae: 200M
 Spartium scoparium: QM

 Morgan pure: 200M

 Syphilinum: 200M

 Natrum iodatum: 1XW, 3XW, 6XW

 Toxoplasma nosode: 200M

 Natrum muriaticum: 200D

 Tuberculinum bovinum: 200

 Passiflora incarnata: 200P, 1MP

 Viscum album: 200M, QC

 Plumbum metallicum: 6G, 30G
 Psorinum: 200M

 Veratrum vir.: 30P,6XG ,30G

A prospective, double-blind, randomized, placebo-controlled,
parallel-arm clinical trial was conducted at the Outpatient Clinic
of the Mahesh Bhattacharyya Homoeopathy Medical College and
Hospital, West Bengal, between April 2011 and Feb 2012 to
evaluate whether individualized homoeopathy can produce any
significant effect different from placebo in essential hypertension
by comparing the lowering of blood pressure between groups.
Natrum muriaticum, Calcarea carbonica, Sulphur, Thuja
occidentalis, Nitric acid and Medorrhinum were frequently
prescribed. The result showed individualized homoeopathic
treatment produced statistically significantly result than placebo.
Reference :
Saha S, Koley M, Hossain SI, Mundle M, Ghosh S, Nag G, Datta
AK, Rath P. Individualized homoeopathy versus placebo in
essential hypertension: A double-blind randomized controlled
trial. Indian J Res Homoeopathy 2013;7:62-71

CONCLUSION
 The increasing hypertension and NCD burden presents a formidable challenge to the

Indian health care system. The gap between what is known and actually done for
hypertension prevention, detection and management is disconcerting and requires to
be addressed as a public health priority.
 Given the high prevalence of hypertension in India, blood pressure assessment in all
adults at every opportunity is both prudent and justified. In addition, simple nonlaboratory based risk scores based on simple assessment of age, waist
circumference, physical activity, and family history could be used to assess total
cardiovascular risk as well as co-morbidities and refer those requiring further
detailed evaluation to the secondary and tertiary health care system.
 What we can see in above slides that hypertension is easily diagnosable and
treatable with lifestyle modifications and cost - effective homoeopathic medicines.
 It is important for all of us to work more meticulously, on modern scientific
parameters, creating enough documentary proofs as per the need of the hour,
without jeopardizing the tenets of Homoeopathy, so that our studies leave no gaps
when such analyses are repeated.

References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Mohan S et al. Time to effectively address hypertension in India. Indian J Med Res April 2013; 137: 627-31
Epidemiology of HTN, Supplement to Journal Of The Association Of Physicians Of India, Feb 2013; 61
Mcphee J.Stephen and Papadakis A.Maxine. Systemic hypertension. Current Medical Diagnosis and Treatment 2012, 51 st ed.
McGraw Hill Publication, 2012. p. 420 – 49.
Mathew and Aggarwal. Diseases of the cardiovascular system : Hypertension. Medicine: Prep manual for undergraduates, 3 rd
ed. Elsevier Publication, 2009.p. 442 – 49.
Hahnemann S. Organon of Medicine, 5th ed. New Delhi: Pratap Medical Publishers (P) Ltd, Indian edition; 1994.
Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica with Repertory, 3rd revised and augmented edition
based on 9th ed. New Delhi : B.Jain Publishers (P) Ltd; 2008.
Hahnemann S. Organon of the Medical Art, edited and annotated by Wenda Brewster O’Reilly. New Delhi: B.Jain Publishers
(P) Ltd, Indian edition; 2010.
Phatak S.R. A Concise Repertory of Homoeopathic medicines, 4th ed. New Delhi : B.Jain Publishers (P) Ltd; 2010.
Schroyens Frederik. Synthesis, 9.1 ed. New Delhi : B.Jain Publishers (P) Ltd; May 2007.
Roberts H.A. The Principles and Art of Cure by Homoeopathy. 2nd ed. Reprint. New Delhi : B Jain Publishers (P) Ltd.; 1990,
p. 191-193, 206, 213, 217-220, 233
Dhawale M.L. Principles and Practice of Homoeopathy. 2nd ed. Bombay : Institute of Clinical Research; 1985, p. 1011,38,450-454,281,447
Allen J.H. The Chronic Miasms - Psora, Pseudo Psora and Sycosis Vol I & II. 1st ed. Reprint. New Delhi : B Jain Publishers
(P) Ltd; 1996.
Muzumdar KP. Lectures on Homoeopathic Therapeutics. 1st ed., Bombay: Paramanand Prakashan; 1995
Vithoulkas G. The Science of Homoeopathy. Indian ed.. New Delhi : B Jain Publishers (P) Ltd., 1998
Das B. Select Your Remedy. 17th ed.. Bishamber Free Homoeopathic Dispensary, 1996

References (contd.)
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.

Rastogi D.P. Homoeopathic Gems. 2nd ed. New Delhi: B Jain Publishers (P) Ltd., 1997.
Banerjee N.K. Blood Pressure - Its Aetiology and Treatment. Revised ed., Reprint. New Delhi: B Jain Publishers (P) Ltd.,
1998.
Palsule S.G. Homoeopathic Treatment for Asthma and Blood pressure 3rd ed. Reprint. New Delhi: B Jain Publishers (P)
Ltd., 1999.
Vithoulkas G. Materia Medica Viva (vols.1-6) Accessed from Encyclopaedia Homoeopathica, RADAR, by Archibel,
Belgium.
Clarke J.H. The Prescriber. Indian ed. Reprint. New Delhi: B Jain Publishers (P) Ltd., 1998
Julian O.A. Dictionary of Homoeopathic Materia Medica. Translated by Dr. Rajkumar Mukerji. English ed. Reprint. New
Delhi: B Jain Publishers (P) Ltd., 1999.
Master F.J. Bedside Clinical Tips.1st ed. New Delhi:B Jain Publishers (P) Ltd., 1999 .
Boericke & Dewey. The Twelve Tissue Remedies of Schussler. 6th ed. Reprint. New Delhi: B Jain Publishers (P) Ltd.,
1990.
Bernoville F. Remedies of the Circulatory and Respiratory system. 2nd ed. Reprint. New Delhi: B Jain Publishers (P) Ltd.,
1999.
Chatterjee TP. My Random Notes on Some Homoeo-Remedies. Accessed from Encyclopaedia Homoeopathica, RADAR,
by Archibel, Belgium.
Gupta RL. Directory of Diseases and Cures in Homoeopathy. Accessed from Encyclopaedia Homoeopathica, RADAR, by
Archibel, Belgium.
Dewey WA. Practical Homoeopathic Therapeutics. 3rd ed. Reprint. New Delhi: B Jain Publishers (P) Ltd., 1996
Cartier F. Arterial hypertension. The Homoeopathic Herald 1947; Vol VII, No. 10. Accessed from Encyclopaedia
Homoeopathica, RADAR, by Archibel, Belgium.
Arun Prasad K.P . Efficacy Of Homeopathic Medicines In the Management Of essential hypertension : a clinical study.
Accessed from www.similima.com

I HEREBY ACKNOWLEDGE DR. VINITA GOEL,
DR. PARAMJEET KAUR AND DR. JITHESH T.K.
FOR THEIR CONTRIBUTIONS .

THANK
YOU

Systemic hypertension and scope of homoeopathy

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