HYPERTENSION AND ITS UNANI MANAGEMENT Introduction Hypertension is

HYPERTENSION AND ITS UNANI MANAGEMENT

Introduction �Hypertension is defined as the presence of a blood pressure elevation to a level that places patients at increased risk for target organ damage in several vascular beds including the retina, brain, heart, kidneys and large arteries.

WHO/ISH grading of HTN

JNC 8 grading of HTN Classification SBP (mm Hg) DBP (mm Hg) Normal < 120 AND < 80 Prehypertension 120 - 139 OR 80 - 89 Stage 1 HTN 140 - 159 OR 90 - 99 Stage 2 HTN ≥ 160 OR ≥ 100

Classification of HTN 1) Primary / Essential / Idiopathic HTN: When BP is elevated without an evident cause it is known as essential hypertension, 80 - 95% of HTN is Idiopathic. 2)Secondary hypertension: it is the arterial hypertension of known cause. It accounts 5 - 20% of all cases of systemic hypertension.

Causes of secondary hypertension Renal : Ø renal vascular disease Ø parenchymal renal disease(glomerulonephritis) Ø Polycystic kidney disease q Endocrine : Ø Adrenal- primary aldosteronism, cushing’s syndrome, phaeochromocytoma, Congenital adrenal hyperplasia Ø Hyperthyroidism Ø Hypothyroidism Ø Acromegaly q

Cont…. q Drugs Ø High dose estrogen Ø Adrenal steroids Ø Decongestants Ø Appetite suppresants Ø Tricyclic antidepressants Ø Erythropoietin Ø NSAIDs q Coarctation of aorta q Obstructive sleep apnoea q Preeclampsia / eclampsia

Diagnosis �BP elevation is usually discovered in asymptomatic individuals during routine health visits. �Secondary hypertension should be considered in the following situations: �Age below 35 and above 65 years of age �First time presenting with severe hypertension > 180/110 mm hg. �Difficult to control on 2 or more drugs. �First time presenting with hypertension with deranged kidney functions. �Patient’s renal function starts to derange on ACE inhibitors and ARBs.

Investigations q. First line: �Complete blood count �Urine – routine & microscopic �RFT �Blood sugar level �Lipid profile �ECG �Serum electrolytes �Thyroid profile �Fundus examination

q. Second line : �USG abdomen for kidney size, cortical thickness and corticomedullary differentiation �Renal artery colour doppler for stenosis �Renal angiogram �MRI angiography �PAC / PRA ratio �Urinary cortisol level � 24 hrs urinary catecholamines �CT scan abdomen and thorax �Echocardiography

Unani concept Ø In ancient unani literature, hypertension has not been described as separate entity but unani physicians were all aware of zaghtuddam(B. P). They regarded zaghta-e-qawi as Systolic & zaghta-e–inbesati as diastolic blood pressure. Ø Most of the unani physicians like Rhaze, Majoosi, Ibn sina , Ibn rushd , Al jirjani has given the concept of hypertension as imtila ba hasbul auiya and said that this occurs due to su-e-mizaj damwi and comes under the heading of imtela. Ø Unani physicians were familiar to manifestations of hypertension.

Cont… Ø Some of them described that increased vascular pressure is due to increased blood volume & decreased in lumen of blood vessels. Ø Som e scholars believed that hypertension is a manifestation of yaboosat-e-mizaj (dryness in arteries)which is the main cause of atherosclerosis (tasallub –e-sharaeen).

Cont… Ø Clinical features of imtela in classical unani literature correspond with clinical features as encountered in the patient of hypertension. Therefore we can correlate both these terms imtela & hypertension to the same content. Later on unani physicians translated hypertension as zaghtuddam qawi. Ø As per unani literature , imtela is of two types • Imtela ba hasbul auiya (repletion in regard to vessels) • Imtela ba hasbul quwa (repletion in regard to vitality)

Sign and symptoms of imtela �Heaviness of body / lethargy �Headache �Redness of complexion �Engorgement of vessels �Fullness of pulse �Epistaxis �Hematuria �Palpitation �Blurring of vision

Management q. Ilaj bil ghiza q. Ilaj bil tadbeer q. Ilaj bil dawa Ø Ilaj bil ghiza / dietotherapy taqleel ghiza and mulattif ghiza are used. Dietary salt reduction to < 6 g Na. Cl / day. Adapt DASH diet, increased potassium intake and overall healthy dietary pattern.

Ø Ilaj bil tadbeer / regimental therapy �Regular aerobic activity e. g brisk walking for 30 min/day 6 -7 days a week. �The regimental therapies mentioned in unani system of medicine are basically applied for istefragh. These include – �Fasd ( venesection) �Hijama bil shurt – Razi and Al Zohrawi described the application of cupping in intra scapular region for imtela dam with khafqan. �Tareeq ( diaphoresis) �Ishaal ( purgation)

Ø Ilaj bil dawa / pharmacotherapy �Mudirrat bol e. g tukhm khayarain, kharpaza, khurfa etc are used. �Musakkinat and munawwimat e. g tukhm khash, kahu, kishneez khushk, gul e neelofer, asrol etc are used. �Mufarreh wa muqawwi qalb e. g abresham, sandal safed, zafran, mushk, gaozaban, badranjboya etc are used. �Mufatteh urooq e. g chhaal arjun, sumbul teeb, parsyaosha, lehsun etc are used. �Several compound formulations e. g qurs dawaul shifa, khamira abresham sada, safoof musakkin are also used.