Homeopathic Treatment of Essential Hypertension:
By Dr Leena Bagadia, M.D.( Hom.) India
Hypertension, described as a consistent elevation in BP above 140/90 mmHg, is the primary risk factor for stroke and heart diseases. . It brings about multiple chronic conditions in the human body (Grimsrud, Stein, Seedat, Williams, & Myer, 2009)  without apparently noticeable symptoms and hence is often called a silent killer (Barcelo, 2000)  Hypertension is one of the most frequently encountered disorders in medical practice. Worldwide, elevated blood pressure is an extraordinarily common and important risk factor for not only cardiovascular diseases (e.g. stroke, heart disease, heart failure, atherosclerosis), but also kidney disease, dementia and cognitive decline.
Hypertension is the main preventable risk factor for premature death throughout the world 3.One in four adults is hypertensive. Almost one quarter of all people past the age of fifty years die of the effects of hypertension in one or another of the vital organs. Thus hypertension has become the gravest problem of middle adult life, not even excepting cancer. It has become a major global health concern. The majority of world’s population lives in lower-income countries, and as life expectancies within these countries increased, chronic conditions such as hypertension have become central. Indeed the prevalence of hypertension is now higher in lower-income countries than in wealthy countries and the prevalence of hypertension in lower-income countries is increasing more rapidly than in wealthy countries4,5. Additionally, the rate of increase in cardiovascular disease deaths has been rising more rapidly in lower-income countries compared to higher-income countries6. Due to prohibitive costs, hypertension frequently goes untreated in lower-income countries, resulting in devastating healthcare costs for long-term treatment of complications7.
The American Society of Hypertension (ASH) Writing group1, as updated2, defines hypertension as:
Hypertension is a progressive cardiovascular syndrome arising from complex and interrelated aetiologies. Early markers of the syndrome are often present before blood pressure elevation is sustained; therefore hypertension cannot be classified solely by discrete blood pressure thresholds. Progression is strongly associated with functional and structural cardiac and vascular abnormalities that damage the heart, kidneys, brain, vasculature and other organs and lead to premature morbidity and death.
High blood pressure is ranked as the third most important risk factor that attributes to the disease burden in south Asia (2010) .
Prevalence of essential hypertension in Canada
Stroke and heart diseases are the leading cause of death in Canada http://www.phac-aspc.gc.ca/cd-mc/cvd-mcv/ hypertension_figures-eng.php. To date, over one-fifth of Canadian adults are diagnosed with hypertension and over 42% of Canadians are yet unaware of their increased blood pressures (BP) http://www.heartand stroke.com/site/c.ikIQLcMWJtE/b.3484023/. Essential hypertension (the focus of the present study) affects over 90% of hypertensive patients and refers to the increased BP without a specific medical cause http://www.phac-aspc.gc.ca/cd-mc/ cvd-mcv/hypertension_figures-eng.php. The remaining fewer than 10% of hypertensive patients suffer from secondary hypertension—usually caused by a known medical condition such as a kidney disease, a hormonal disorder or as a result of using certain medications. Despite the enhanced screening, early detection and treatment of hypertension, it is clear that the scientific community has not yet found a way to prevent hypertension. This observation is supported by the fact that new hypertensive cases are being identified. Moreover, it is estimated that 90% of people will inevitably develop hypertension over their lifetime http://www.phac-aspc.gc.ca/cd-mc/cvd-mcv/ hypertension_figures-eng.php emphasizing the unavoidable nature of hypertension. According to the 2009 Canadian Hypertension Education Program, an emphasis has been given towards dietary modifications, exercise promotion and strict adherence to the prescribed medications by the attending physician, yet a little emphasis has been given to the impact of the modifiable psychosocial factors such as anger on the initiation of hypertension.
Essential hypertension as a psychosomatic disease:
A number of prospective studies in western countries have reported the association of anger and hostility with incidence of CHD and stroke. The longitudinal findings in the circulatory risk in communities study (CIRCS)  also suggest that anger suppression increases the risk of cardiovascular disease (CVD), at least in part through the development of HTN. This is also consistent with western studies .
Anger and hostility is also associated with adverse lifestyle behaviour, such as excess alcohol consumption and smoking. Higher hostility scores were associated with higher BMI values, alcohol intake, total energy intake and proportion of current smoking .
In this study, the relation between essential hypertension (EHT), higher levels of negative emotions (trait anger, anxiety and depression) and perceived stress were studied. Frequent expression of anger affects the individual’s physical health, well-being and social functioning. (Baumeister & Exline, 2000 ; Booth-Kewley & riedman, 1987 ; Mayer & Salovey, 1995 ; Tavris, 1984 , stressing the importance in regulating negative emotions.
Homoeopathic perspective in treatment of essential hypertension:
Hahnemann was a precursor in the field of psychosomatics. He saw the human being having an integrated mind and body, in contrast to the prevailing dualism of his time. In aphorisms 210-225 , he describes mental diseases as well as psychosomatic problems. He gives detailed information of their diagnosis, treatment and also auxiliary measures like use of psychical remedies, such as display of confidence, friendly exhortations and sensible advice.
EHT is a constitutional disease affecting the person as a whole. It can be successfully treated by individualisation of the patient and application of constitutional remedy thus derived. Dr. M. L. Dhawale has mentioned in the opening chapter of Principles and Practice of homoeopathy: “The successful application of the Law of Similars depends entirely on the concepts of Individualization and Susceptible Constitutions which form the cornerstone of Homoeopathic practice. The concept of Individualization takes into consideration the total response of the organism to the unfavourable environment. This total response is seen through Signs and Symptoms on three planes: Emotional, Intellectual (Spiritual) and Physical where the Life Force manifests itself”. While assessing this total response the homoeopathic physician gives fundamental importance to the causative factors and to the peculiar characteristics of the ailment, especially the mental aspects. The concept of susceptible Constitutions is reflected in Hahnemann’s Theory of Chronic Diseases which takes into consideration the hereditary influences and predispositions that play an important role in the genesis of illness. Homoeopathic therapeutics therefore, affords unlimited possibilities of influencing favourably the mental processes and of mitigating the adverse influence of the hereditary predispositions to illness, thereby leading to a better adaptation of the patient to his environment. Thus, it represents, the Practice of Constitutional Medicine at its best and reigns supreme in the fields of psychiatry and of psycho-somatic medicine .
Objectives of the study:
This study aims to ascertain the efficacy of homoeopathic treatment used along with various psychological and relaxation techniques in the cases of essential hypertension.
1. Acknowledging essential hypertension as a psychosomatic disorder resulting due to various stresses generated by modern lifestyle.
2. To study the miasmatic aspect of essential hypertension.
3. To study the effect of the relaxation techniques like transcendental meditation and sudarshan kriya on the patients of essential hypertension.
Materials and methods:
The material for this study consists of patients diagnosed with essential hypertension, registered for treatment in the outpatient department of Mumbadevi hospital, Mumbai and at a private clinic in Mumbai. Basic routine investigations like Complete blood count, Fasting blood sugar, S. Creatinine, ECG and X-ray chest were done.
1. Diagnosis of essential hypertension: History, examination and routine investigations show no evidence of secondary causes.
2. Age group: Patients between 30-85 years of age.
3. Cases falling into low and medium risk groups after verification from various clinical tests.
1. Diagnosis not verified from history, examination or routine investigations of primary hypertension.
2. Very high risk group of patients after risk stratification.
3. Cases with other morbid illnesses affecting function of different organs or systems.
After repeated measurement of blood pressure in both arms on first and second visit a week apart, the hypertensive status of study population was confirmed. The blood pressure was measured using a mercury sphygmomanometer after calibration, of standard cuff size with the subject in sitting position, after five minutes rest as well as in recumbent position, in both arms.
The patients whose hypertensive status was confirmed were subjected to a preliminary enquiry and examination to rule out secondary hypertension.
The blood pressure was graded and different risk factors analysed to assess the overall cardiovascular risk in individual cases. For this, the criteria laid down by the WHO-ISH was followed.
After this, the study sample was identified with thirty cases of both sexes.
The patients were subjected to thorough homoeopathic case taking and remedy was administered along with psycho-relaxation techniques and changes in life style. The blood pressure values were compared before and after the study.
Period of Study:
The cases were followed up for three to nine months, starting from the date of first prescription.
Case Taking and Analysis
Every patient included in this study was asked history in detail from a homoeopathic perspective and the history and examination findings were recorded in a case record book based on Organon. A detailed evolution and analysis was carried out to construct a totality. Symptoms were also analysed on miasmatic basis to confirm the underlying miasm. Thereafter the cases were repertorised with complete repertory (2007-2008 edition) using homoeopathic software ISIS by Miccant (London).
The final differentiation was made after referring Materia Medicas, and a similimum was decided taking into consideration the predominant miasm. In a few cases especially where characteristic symptoms could not be ascertained, remedy was selected on factors like causation, keynotes, marked modalities etc.
The potency was decided as per the individual case. Factors like degree of similarity, reversibility of pathological changes, picture of sickness, constitution of patient etc were considered.
Patients were advised to reduce their antihypertensive medications gradually and stop corresponding to the reduction in blood pressure values. (Cases with reduction in BP of more than 10mm of Hg then the BP on admission in study with symptomatic relief were considered for tapering the dosage of antihypertensive medication.)
All the patients were given instructions regarding diet and regimen, keeping in view their socio-economical status and level of education. The usual measures included avoidance of extra salt, fatty food, coffee, smoking, alcohol intake or other substances of medicinal nature. They were encouraged to undertake more physical activities like yoga, aerobic exercises, long walks minimum for half an hour daily and keeping a daily log.
They were also taught various relaxation techniques like meditation and Sudarshan kriya.
They were called at every 2-3 weeks interval for follow ups. They were also instructed to report even before the scheduled date, in the event of appearance of any troublesome new symptom or any serious illness. They were also made aware of need of regular follow ups.
At each follow up, the patients were evaluated in detail with special reference to changes in general wellbeing, Presenting symptoms or appearance of new symptoms. The blood pressure was examined in both arms after five minutes interval. During the follow up visits, the remedy was repeated only when required, in same potency or with a change in potency. When needed, a change in remedy was also considered after thorough evaluation. Placebo was administered when no remedy was required in the form of sugar of milk powder or pills.
The primary outcome measure is the systolic and diastolic blood pressure values after the period of study. The change in their reaction to the stressors was also assessed.
Observation and Analysis:
Total thirty cases were selected for this study. Out of the many cases screened only those which passed all the inclusion and exclusion criteria were selected. Some were rejected after analysis of the risk factors showed that they fall in the very high-risk category due to very high blood pressure, complications like coronary artery disease or other concomitant serious illness.
Characteristics of the Study Group
Age and Sex
Patients falling into the age group of 32-85 years were selected for the study. The highest number of cases was in the age group 40-45 years with 16 out of the 30 cases (55%). The next highest was in the age group 55-60 with 7 cases (23%). The rest of the cases were distributed almost evenly across the other groups. The highest percentage of cases in the elderly age groups (40-54 years:!6 cases or 53%) may have bearing on some of the results obtained, which has been discussed later.
The study group was comprised of 16 males (53%) and 14 females (46%). Among the 14 female patients, the highest number of female patients is seen in the age group of 50-55 years i.e. 7 patients; while the highest number of male patients were in the age group of 55-65 years, with 4 patients (13%).
Risk Factors for Development of Hypertension
Several risk factors associated with the development of hypertension were identified in the study group. Psychological stress in varying degrees were found in 15 patients (50%), though a direct relation between a stressful circumstance and the development of hypertension was not found in all of them. The nature of the psychological stress also varied: ranging from grief, anxiety, fear etc. in different patients.
|Risk factors||No. of cases||%|
|Low socio-economic class||11||36|
|High salt intake||3||10|
|High alcohol intake||1||3|
|Excessive non-veg consumption||6||20|
Table 1 : Risk factors for hypertension in study group
Low socioeconomic class appears to be a significant risk factor in the study group, with 11 out of the 30 patients (36%) falling into this group. But this may very well be a confounder, since a good proportion of the patients approaching the study centre belong to this class.
As noted earlier, high-risk behaviour commonly seen in this class like smoking and alcohol consumption is relatively less in the group due to peculiarity of the sex distribution, and hence it is difficult to estimate the adverse effect of social class. On the other hand, there might even be a positive effect in the form of decreased levels of physical inactivity. This is also reflected in the presence of only a single case, where obesity was a predominant factor.
Genetic factors were next in the importance, with a positive family history of hypertension present in 9 cases (30%). The siblings were affected in 7 cases, while in the other 2, the parents were hypertensive. Interestingly, another illness with a strong influence of genetic factors, diabetes mellitus, was found in the family history of 8 patients (26%). This was in spite of patients with Diabetes Mellitus being excluded from the study, and shows the tendency for aggregation of these illnesses in persons with the same genetic background.
Dietary factors came in next, 6 patients (20%) having a predominantly non-vegetarian diet. High salt intake was present in 3 patients (10%) and 1 patient had history of high alcohol consumption. Lipid abnormalities in the form of high cholesterol level, was found in 3 patients.
There were no notable trends in the history of past illnesses, except for the occurrence of hypertension during pregnancy in 2 out of 16 female patients.
Symptoms attributable to hypertension, like vertigo, occipital headache etc. were absent at the time of diagnosis in more than half of the patients. In 12 out of the 30 patients (40%), the hypertensive status was discovered when the patient was examined in connection with other illnesses.
Four patients had recurrent headaches, but they were felt mostly in the frontal or temporal regions rather than in the occiput. It was only in 8 cases that the patients sought the help of the doctor for symptoms known to be associated with hypertension. At the time of the present study, the most frequent chief complaint was vertigo. It was present in 8 cases. The next in order of frequency was recurrent headaches (7 casa), joint pains and skin complaints (4 cases), chest pain, breathlessness and abdominal complaints (3 cases).
Other symptoms like hot flushes, disturbed sleep, palpitations, dimness of vision, recurrent sneezing and numbness of the limbs were complained of in 1 case each. It should be noted that the presence of these complaints are not mutually exclusive, many patients have presented with more than one complaint.
The dominance of psora was very much evident in all cases in the study. It was dominant miasm in 19 cases (63%), and in one case it was in second position. The pseudo-psoric influence also was very marked. While it was the dominant miasm in only 1 case (3%), it was in the second position in 10 cases (33%).
|Chronic miasm||Dominant||Second position|
|No. of cases||%||No. of cases||%|
Table 2 Miasmatic analysis of the study
The sycotic and syphilitic miasmatic expression was not very prominent in the study. Out of the two, syphilitic expression was more common, being in the second position in 6 cases (20%). The relatively weak miasmatic expression of the syphilitic and sycotic miasms may be related to the exclusion criteria, which avoided cases of essential hypertension with complications.
The study shows that there is a significant difference between blood pressure levels before and after 3 to 9 months of homoeopathic treatment. The difference is more than that due to chance, and therefore the treatment is effective.
Majority of the medicines prescribed during the course of the study were based on the totality. On a few occasions, the medicines were prescribed on the acute totality, when there was an acute flare up of complaints.
Natrum Muriaticum was the most frequently prescribed remedy, with 4 cases. In three cases, it was the first prescription and in one it was the follow up remedy. Lycopodium and Kali Carbonicum were the next in order of frequency, both being prescribed in 2 cases as the first prescription. Sulphur was used in 2 cases. Rest of the medicines prescribed in this study were needed only in one case each. They included Pulsatilla, Silicea, Veratrum Album, Arsenicum Album, Apis mellifica, Granite, Natrum Carbonicum, Phosphorus, Phosphoric acid, Medorrhinum, Bellis parennis, Platina, Aurum metalicum, Ignatia, all were the first prescriptions in their respective cases.
Nosodes were not used in any cases except for one in which Osteoarthritis Nosode was prescribed when the joint pain caused marked discomfort that could be contributing to the elevation of BP in that case.
Acute remedies had to be prescribed in 3 cases, even though there were no acute flare ups relating to the entity of essential hypertension itself. In one case Arnica had to be prescribed due to a syncopal episode in a case of age related dementia, while in another case Arsenic album was given on the basis of acute totality for repeated attacks of breathlessness. In third case, Pulsatilla was prescribed for the acute exacerbation of headache, which was the chief complaint. Once he acute flare up was subsided, the chronic remedy was prescribed. In the cases where Arnica and Pulsatilla were prescribed as the acute remedy, it was followed by remedies which follow them well, Kali carbonicum and Belladonna respectively.
Various potencies ranging from 30th to 1M were used during the period of the study. The potency most often used to begin the treatment was the 200th with 28 case. The 30th potency also was frequently used, in 2 of the cases. The use of the higher potencies in the first prescription was less frequent, with the 1M potency prescribed only in follow up of 4 cases.
Natrum Muriaticum, Lycopodium, Nux vomica and Sepia were the only remedies which were prescribed in the 1M potency. The remedies prescribed in the 200th potency include all the rest of the remedies used in the study.
Relative Efficacy of Various Remedies
The relative efficacy of various remedies was assessed by noting the change in the grade of hypertension before and after treatment. From the analysis, no single remedy was found to be clearly more effective than others in the study.
No particular potency was found to be clearly more effective than others.
Limitations of the Study
1. Small sample size: Due to the small sample size, it would be difficult to generalise the results from this study.
2. Duration of the study: The study duration was 3-9 months, and hence the study does not reflect the efficacy of homoeopathic treatment in the long term.
3. Lack of placebo control: The role of the placebo effect of treatment if any, cannot be assessed in the absence of placebo control.
4. Age and sex distribution: Although a wide age group was selected for the study, most of the cases are in the 45-65 years age group. In the sex distribution also there is predominance of the male sex. Both of these factors may possibly confound the results obtained.
5. Selection criteria: Most of the hypertensive complications and concomitant illnesses are excluded from this study, and one cannot assume the efficacy of homoeopathic treatment in such cases. Such cases may also arrant the use of many partially proved or smaller remedies, and the efficacy of such remedies has not been assessed in this study.
The homoeopathic treatment being gentle, without any adverse effects and cheaper is very useful in combating with essential hypertension. Along with the medication, patients were also taught various relaxation techniques and their life situation problems were also addressed.
The observations made by this study clearly underline the necessity to develop, evaluate and apply non-pharmacological treatment modes also as adjuncts to homoeopathic treatment. As indicated above, there is a considerable body of literature attempting to provide evidence for the utility of psychological modes of high blood pressure treatment, and many approaches have plausible rationales in addition to promising initial findings.
It also shows that constitutional homoeopathic treatment is very effective in treating this malady. The results of combining these two i.e. homoeopathic treatment along with different relaxation techniques proved to be very efficacious.
|Natrum Muriaticum||200, 1M|
|Kalium carbonicum||30, 200|
|Nux vomica||200, 1M|
At present Dr Leena Bagadia is doing PHd in Hypertension from India.
 Note that, although this definition paper was prepared by the American Society of Hypertension Writing Group, the Society has not accepted the paper as official Society policy. Therefore it is not a position statement of the American Society of Hypertension