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CARDIAC
CONDITIONS

Hypertension

  • 15% of the general population can be regarded as hypertensives.

  • Hypertension is defined arbitrarily at levels above generally accepted normals.


Classification                 Systolic BP9(mmHg)     Diastolic BP(mmHg)

Normal                                <120                  AND          <80

Pre-hypertension             120-139              OR            80-89

Stage 1 hypertension      140-159              OR            90-99

Stage 2 hypertension      ≥160                   OR            ≥100


  • White coat hypertension

  1. A transient increase in blood pressure in normal individuals when blood pressure is recorded in a hospital or in a physician's clinic.

  2. Consider either carefully obtained home values using an appropriately calibrated BP monitor or obtaining 24-hours ambulatory BP measurements.


  • Isolated ambulatory or masked hypertension

  1. It is reverse phenomenon of "white coat hypertension" in which individuals with normal office blood pressure (<140/90mmHg) may have elevated ambulatory or home blood pressure values.

  2. Such individuals have been slown to have greater than normal prevalence of organ damage, with an increased prevalence of metabolic risk factors compared with subjects with a truly normal blood pressure.


  • Paradoxical hypertension

  1. Patients on antihypertensive agents, paradoxically show increase in blood pressure.

  2. Paitents with diabetes and hypertension on β-blockers develop paradoxical rise in blood pressure if they develop hypoglycaemia. This occurs due to sympathetic stimulation following hypoglycaemia.

  3. Patients with bilateral renal artey stenosis who are given ACE inhibitors.

  4. Administration of pure β-blockets to patients with phaeochromocytoma.


Classification

  • Primary or essential hypertension

  1. Accounts for 85% of the cases

  2. Not possible to define specific underlying cause

  3. 70% of them have a positive family history

  • Secondary hypertension

  1. Accounts for 15% of the cases

  2. Consequence of specific disease or abnormality

Causes

  • Coarctation of aorta

  • Renal causes - Glomerulonephritis, chronic pyelonephritis, collagen vascular diseases, polycystic kidney disease, renal artery stenosis

  • Endocrine causes - Phaeochromocytoma, Cushing's syndrome, Conn's syndrome, hyperparathyroidism, acromegaly, primary hypothyroidism, hyperthyroidism, congenital adrenal hyperplasia

  • Alcohol and drugs - Oral contraceptives, anabolic steroids, corticosteroids, NSAIDs, COX-2 inhibitors, carbenoxolone, sympathomimetics, cyclosporin, sibutramine, bromocriptine, erythropoietin

  • Pre-eclamptic toxaemia

  • Miscellaneous - Obstructive sleep apnoea

  • Common causes of isolated systolic hypertension are:

  1. Atherosclerosis

  2. Aortic regurgitation

  3. Patent ductus arteriosus

  4. Thyrotoxicosis

  5. Coarctation of aorta

Symptoms

Clinical features due to hypertension per se

  • Majority are asymptomatic and hypertension is detected on routine examination.

  • Acute hypertension causes transient headache and polyuria.

  • Long-standing hypertension leads to left ventricular hypertrophy and heaving apical impulse.

  • Left atrial hypertrophy and fourth heart sound.

  • Aortic component (A2) of second heart sound is accentuated.

  • Very short early diastolic murmur.

  • Fundal changes.


Clinical features due to causes of hypertension

  • History of intake of alcohol or drugs like oral contraceptives, corticosteroids, NSAID's , carbenoxolone or sympathomimetic agents.

  • Radiofemoral delay, upper limb hypertension, collaterals aroudn scapulae and systolic murmur over spine suggest coarctation of aorta.

  • Panic attacks, paroxysmal headache and palpitations suggest phaeochromocytoma, Skin stigmata of neurofibromatosis may also suggest phaeochromocytoma.

  • Recurrent back pain, undiagnosed fever and recurrent urinary infections suggest chronic phlyeonephritis.

  • Enlarged palpable kidneys in polycystic kidney disease.

  • Bruit over the abdomen in the lumbar region suggests renal artery stenosis.

  • Characteristic facies and habitus in Cushing's syndrome.

Treatments

  • Hypertension is a lifestyle disorder. It might require long term treatment depending on patient. Homeopathy works very successfully on heart and its arteries and by doing this it helps in reducing and managing hypertension in acute and chronic cases both. 

Few homeopathic medicines which help in hypertension are sulphur, nux vomica, kali carbonica etc . 

  • Strict diet control which includes less oily and salty food and exercise is mandatory for long time to maintain this disease.

Hypertension
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