The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research

 

 

 

 

 

Lake Mary Clinic, Gerson Ayurvedic Spa, and Panchakarma Facility: at 635 Primera Blvd. Lake Mary, Florida 32746

Jupiter Medical Center at The Calcagnini Center for Mindfulness
1210 S. Old Dixie Highway, Jupiter, Florida 33458, Suite M-117.2

 

 

 

 Telephone: (561) 263-MIND (6463); option 2 (407) 549-2800

The Ayurvedic Approach To Hypertension

Hypertension also called high blood pressure is a chronic medical condition in which the blood pressure in the arteries is elevated. This causes the heart to work harder to pump blood through the blood vessels. Blood pressure is determined by two measurements, systolic and diastolic pressures, using a sphygmomanometer (blood pressure cuff). The systolic pressure occurs when the heart muscle is contracting (systole) and the diastolic pressure is the interval when the heart is relaxed between contractions (diastole). Normal blood pressure while a person is at rest is within the range of 100-139 mmHg systolic and 60-89 mmHg diastolic. High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

Why should we be so concerned about hypertension? Hypertension is a major risk factor for myocardial infarction (heart attacks), stroke, heart failure, aneurysms of the arteries, peripheral arterial disease and is a cause of chronic kidney disease and retinopathies. Even modest elevation of arterial blood pressure (i.e. 150/95) is associated with a shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often implemented in people for whom lifestyle changes prove ineffective or insufficient.

According to a 2005 study reported in The Lancet, nearly one billion people or approximately 26% of the adult population of the world has hypertension, predicted to increase to 1.56 billion by 2025. It is common in both developed (333 million) and undeveloped (639 million) countries.1 However rates vary greatly in different regions with rates as low as 3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in Poland.2 In Europe hypertension occurs in about 30-45% of people and in the United States about 34%.

 

1 Kearney PM, Whelton M, et.al. (2005). Global burden of hypertension: analysis of worldwide data. Lancet, 365 217–23). 2 Kearney PM, Whelton M, Reynolds K, Whelton PK, He J (January 2004). "Worldwide prevalence of hypertension: a systematic review". J. Hypertens. 22 (1): 11–9).

 

 

Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying (Western) medical cause. The remaining 5–10% of cases (secondary hypertension) is caused by other medical conditions that affect the kidneys, arteries, or endocrine system. Examples are renal artery stenosis, arteriosclerosis, pheochromocytoma, Cushings disease, hyperthyroidism, or hyperaldosteronism.

Western Understanding of the Pathophysiology of Hypertension

Although a disease whose name is recognized by most people throughout the world, the actual cause of hypertension remains an enigma wrapped in a mystery. We know that normal blood pressure depends on the equilibrium between cardiac output and peripheral vascular resistance. People with primary hypertension have normal cardiac output but elevated peripheral vascular resistance. Peripheral resistance is determined not by large arteries or the tiny capillaries but entirely by small arterioles, whose walls contain smooth muscle cells. Contraction of these smooth muscle cells occurs when sympathetic nervous input or intracellular calcium concentration increases, which may explain the vasodilatory effect of meditation, exercise, and medicines that block the calcium channels. Prolonged smooth muscle contraction is thought to induce structural changes with thickening of the arteriolar walls, facilitated by angiotensin II, leading to a sometimes irreversible rise in peripheral resistance and hence blood pressure.

It has been postulated that in very early hypertension the peripheral resistance is not raised and an elevation of the blood pressure is caused by a raised cardiac output, which is related to sympathetic over-stimulation of the heart. This is interesting from the Ayurvedic perspective because, even in the absence of hypertension, tightness, fullness, high amplitude, and exuberance of the Pitta pulse are a known purvarupa (i.e. pre-clinical) sign of raktabala (one of the many Ayurvedic names for hypertension). The subsequent rise in peripheral arteriolar resistance might subsequently develop as a protective mechanism to prevent the raised pressure being transmitted to the fragile capillary bed where it would have detrimental effects on cell homeostasis throughout the entire body.

The Renin-Angiotensin System

The renin-angiotensin system may be the most important of the endocrine systems that regulate blood pressure. Renin is secreted from the juxtaglomerular apparatus of the kidney in response to low glomerular perfusion or a reduced salt intake. It is also released in response to stimulation from the sympathetic nervous system.

Renin is responsible for converting angiotensinogen to angiotensin I, which is then rapidly converted to angiotensin II in the lungs by angiotensin converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor and thus causes a rise in blood pressure. In addition it stimulates the release of aldosterone from the adrenal gland, which results in a further rise in blood pressure due to sodium and water retention.

Although it regulates blood pressure quite effectively in normotensive people, the renin-angiotensin system is not thought to be directly responsible for the rise in blood pressure in essential hypertension (part of the enigma!). In fact, many hypertensive patients have low levels of renin and angiotensin II (notably African Americans and the elderly), and drugs that block the renin-angiotensin system are not particularly effective.

There is, however, increasing evidence that there are important non-circulating “local” renin-angiotensin paracrine gland systems, which also control blood pressure. Paracrine glands are located within an organ or tissue and produce chemical substances that reach neighboring cells through a process of diffusion. These local renin glands have been reported in the kidney, the heart, and the arterial tree. They probably have important roles in regulating regional blood flow.

Sympathetic Nervous System

Sympathetic nervous system activation can cause both arteriolar constriction and rapid heart rate and thus plays an important role in maintaining a normal blood pressure. It is also important in generating short term changes in blood pressure in response to stress and physical exercise.

There is, however, little evidence to suggest that epinephrine (adrenaline) and norepinephrine (noradrenaline) have any clear role in the etiology of hypertension (more enigma!). Nevertheless, their effects are important, as evidenced by drugs that block the sympathetic nervous system (i.e. beta-blockers) do lower blood pressure and have a recognized therapeutic role.

It is probable that hypertension is related to an interaction between the sympathetic nervous system, the renin-angiotensin system, serum sodium, circulating water volume, and a panoply of known and hitherto unknown hormones. In addition, vascular endothelial cells play a key role in blood pressure regulation by producing several potent local vasoactive agents, including the vasodilator molecule nitric oxide and the vasoconstrictor peptide endothelin.

Genetic Influences on Hypertension

Finally, we come to genetic factors. Although individual genes have been linked to the development of essential hypertension, multiple genes and epigenes are most likely what lead to the development of this condition in any particular individual. It is therefore extremely difficult to determine accurately the relative contributions of each of these genes. Nevertheless, hypertension is about twice as common in subjects who have one or two hypertensive parents.

Studies of genetic hypertension have shown that the inherited tendency to hypertension resides primarily in the kidney. In both animal and human studies, a transplanted kidney from a hypertensive donor raises the blood pressure in normotensive recipients coming from normotensive families.

Hypertension is rarely found in tribal areas of Africa, but it is very common in African cities and in black populations throughout the Western world. Whereas the tribal/urban differences in Africa are clearly due to lifestyle and dietary factors, the finding that hypertension is more prevalent in black people compared with white people (38.8% vs 27.2%) points to a genetic component.

The Ayurvedic Understanding of Hypertension

Although the signs and symptoms typically associated with advanced (malignant) hypertension are clearly mentioned throughout the Ayurvedic literature, there is no specific disease which was recognized as “hypertension”. This is in part because hypertension is a modern disease that was probably absent in the past.While it is clear from the earliest Ayurvedic literature that blood (shonita) was known to circulate throughout the body, the concept of pressure providing the drive for the circulation was not described. In fact, the concept of blood pressure was unknown until the early eighteenth century and was not crystallized until the invention of the sphygmomanometer in the late nineteenth century.

Ayurvedic teaching states that the wise physician will first clearly understand the root cause (hetu) of a disease, its doshic nature, whether it is curable, possible complications, and its samprapti, including clear knowledge of its affected dushyas, state of agni, presence and location of aama, srotasmi and srotodushti, marga, and sthana, before attempting treatment. Given the complexities of hypertension, it is evident that our understanding of this condition is incomplete.

Therefore, when high blood pressure found its way to India in the early twentieth century, in order to find an Ayurvedic cure Ayurveda physicians used the following approach.

They first identified the root cause in each individual and the other important features of hypertension mentioned above (i.e. doshic nature, curability, samprapti, etc). Next they correlated these factors with diseases already described in the Ayurveda texts, thus helping them to construct a logical preliminary treatment protocol. Finally, they carefully observed the effects of their treatment and modified them as indicated.

In classical literature of Ayurveda there is no mention of Raktasammaradanam (friction, resistance in blood vessels), Raktabala (forceful flow) or any other descriptions suggesting increased blood pressure. However several conditions involving rakta ((blood) as well as rakta vaha srota (channels of circulation) have been described. In contemporary Ayurveda, many terms have been proposed to represent hypertension. Here are a few of the more common terms in current use: rakta vriddhi (vriddhi=increase), vata rakta, rakta bala (bala strength, force), Rakta Bhāra (bhāra=large quantity; load) Rasabhāra, Vyanabala, Pratichaya (prati, increasing; chaya, heap, pile), and Raktapitta.

Ayurveda regards hypertension as a state of vitiation of all three doshas, viz. vata, pitta and kapha. More specifically, regulation of blood pressure is achieved through the functions of Prana Vata, Vyana Vata, Sadhaka Pitta, Avalambaka Kapha, and Rakta Dhatu.

Prana Vata is said to be located in the head and heart and is related to hridaya dharana (support of the heart), indriya dharana (support of the five senses), respiration, and cetana (consciousness). All of these functions elucidated over 2000 years ago precisely correspond to the functions of a region of the brain we know today as the medulla oblongata. In addition, the medulla is also responsible for the neural regulation of blood pressure.

Located between the upper end of the spinal column and the brain, like Prana Vata, it regulates the most basic aspects of life: breathing, heart rate, blood pressure, and consciousness itself.

The medulla oblongata regulates blood pressure in the body through the use of what are called baroreceptors. These receptors detect changes in pressure throughout the circulatory system and then translate those changes into electro-chemical signals which are conveyed to the medulla. They do this by automatically responding to the dilation or contraction that occurs to the arterial wall.

Because the saptadhatus require proper blood flow within a relatively narrow range blood pressure, upon receiving pressure information from the arteries, the medulla can then stimulate the contraction or expansion of blood vessels through the sympathetic or parasympathetic nervous system in order to increase or decrease blood pressure and blood flow.

The medulla also either increases or decreases the heart rate, also through the sympathetic or parasympathetic nervous system, respectively. The combination of these changes regulated by the medulla contributes to blood pressure control. In Ayurvedic terms this represents the coordinated functions of Vyana Vata and Prana Vata.

Vyana Vata is located in the heart, the vascular system, and the peripheral nerves. Its principal function are rasa-rakta samvahana (blood circulation), prasarana (diffusion or spread), gati (forceful movement), and kujchana (contraction). Thus Vyana Vata regulates the contraction and relaxtion cycles of the heart, propels blood through the circlatory system and, by diffusion, into the minute spaces of the body, and conducts nervous energies throughout the peripheral nervous system. With aggravated Vyana Vata there is internal pressure due to excessive internal movements; this can manifest is anxiety, dizziness, vertigo, circling thoughts, and excessive dryness and hardening of the arteries—contributing to hypertension.

Sadhaka Pitta has its locus in the subtle heart---also known in Ayurveda as “mother substance of the mind”. Its function is to maintain healthy mental function by preventing accumulation of rajas and tamas gunas. It helps create and sustain medha (intelligence), fulfill desires, and utsaha (mental strength, perserverence). Sadhaka Pitta connects the heart and rational mind. Unlike the loud voice of the stomach or liver, the hear speaks in truthful whispers which often are unheard when life and mind is noisy. When Sadhaka Pitta is disturbed raja guna vitiates both Prana and Vyana Vata resulting in abnormal cardiovascular function leading to excessively forceful propulsion of blood and hypertension.

Avalambaka Kapha is located in the upper back, chest, spine, and shoulders. The Sanskrit word avalambaka literally means “dependent upon” or “supporter”. It provides protection for the heart and lungs and creates the caretaker instinct. Healthy Avalambaka Kapha maintains regular and lifelong cardiac function as summarized by the sloka “avalambaka hridaya samarthya karoti” (avalambaka gives strength to the heart). But the true function of the heart is to transcend the illusion of opposites and unify all of creation into Oneness. A protected and supported heart allow for the emergence of the ancient Vedic realization, “Tat tvam asi”: Thou art That.

Samprapti Ghatakas (Stages of Pathogenesis)

Doshas: Prana Vata, Vyana Vata, Sadhaka Pitta, Avalambaka Kapha

Dushyas: Rakta, Rasa, Meda

Agni: Jatharagni-Dhatwagnimandya

Aama: Rasagata, Raktagata

Srotas: Raktavaha, Rasavaha, Manovaha

Srotodushti: Sanga form of srotorodha

Udbhava sthana: Hridaya, Dhamani

Adhisthana: Sira, Dhamani, Srotas

Sanchara sthana: Sarva sharira

Rogamarga: Bahya and Madyama rogamarga

Nidana (Etiological Factors)

Despite generations of study by both Western and Eastern pundits, the precise etiology of hypertension is not always clear for many individuals. Nevertheless most Ayurvedic clinical experts agree that there is a strong association between high blood pressure and the following several factors.: ati lavana sevena (excessive salt use), ati snigdha ahara (excessively oily food), vishamashana (irregular eating habits), shoka (sorrow), chinta (anxiety), madya (intoxication), surapana (alcohol consumption), jirna (age), and bhaya (fear). It is noteworthy that all of these features are also signs and symptoms of a disease known as shonita dushti (“vitiated blood”), which some authorities equate with the modern disease called “hypertension”.

Ati lavana sevena (excessive salt use)

Current U.S. recommendations call for a maximum of one teaspoon of salt (2,300 milligrams of sodium) a day, and two-thirds of a teaspoon (1,500 milligrams of sodium) for people who have high blood pressure or are at high risk of developing it. The latter group includes people who are over the age of 40, are African American, or have somewhat elevated blood pressure (pre-hypertension)—which encompasses almost 70 percent of adults in the United States! People with diabetes, kidney disease, heart failure and other conditions should cut back, too. The average American gets 3,400 milligrams (about 1½ teaspoons of salt).

The human body requires only a very small amount of sodium (about 500 md/day) since it is exquisitely effective in conserving whatever is in our body. The transmission of nerve impulses and the contraction of muscle fibers depend on sodium. Along with potassium, it is essential for maintaining proper fluid balance in and around cells. It takes very little sodium to accomplish these tasks.

When ati lavana sevana persists, Pitta dosha and Shonita are both vitiated and jala mahabhuta, rasa dhatu and rakta dhatu increase. Besides ushna, tikta, and vishyandi (cause to flow) qualities the salty taste also has the property of kledana (moistening), which in modern terms is owing to sodium and water retension.

The kidneys have trouble keeping up with the excess sodium in the bloodstream. As it begins to accumulate, the body responds by retaining water to dilute the sodium. This increases the volume of blood in the bloodstream. That means more work for the heart and more pressure within the blood vessels. Over time, the extra work and pressure can stiffen blood vessels, leading to high blood pressure, heart attack, or stroke.

Ati Snigdha Ahara

The quantity of fat is less significant than the type of fat consumed and the general sattvic quality of the diet. Trans-fats (“partially hydrogenated oils”) and heated polyunsaturated fatty acids (i.e.cooking at high temperatures with sunflower, safflower, soy, corn, or canola oil).The relationship between saturated fat and heart disease is complex and debatable. Although high levels of saturated fat consumption are associated with higher incidence of cardiovascular disease, they do not need to be eliminated completely.

In Ayurvedic literature the samprapti of a disease known as shonita dushti, similar in many ways to hypertension, is described. In this disease the excessive consumption of snigdha (oily) and guru (heavy) ahara combined with daytime sleep causes jatharagni and vaigunya and medodhatuvagni mandya leading to vitiated rasa dhatu and increased fat accumulation. The abnormal rasa and meda eventually are deposited in rasa and rakta vaha srotas leading to dhamani pratichaya and dhamani kathinya (thickening and narrowing of blood vessels). This may be a contributing factor in the development of hypertension as well as shonita dushti.

Ati Madyapana (Excessive Alcohol Consumption)

The link between alcohol and disease dates back to the samhita period and its modern-day association with hypertension is well established, yet the mechanism through which alcohol raises blood pressure remains ambiguous. Possible mechanisms include an imbalance of the central nervous system, impairment of the baroreceptors, an increase of sympathetic activity, stimulation of the renin-angiotensin-aldosterone system, an increase in cortisol levels, an increase of intracellular calcium levels, increased secretion of endothelin or reduction of endothelium-dependent nitric oxide production.

Alcoholic beverages are characterized by ten guna (properties): hot, light, sharp, sour, subtle, quick acting, easily absorbed, non-slippery, depression, and rough. These ten properties of alcohol are precisely opposite to the ten properties of ojas 3,4.

3 Charaka Samhita, Chikitsa sthana, 24/37-38. 4 Sushruta Samhita, Sutra sthana,15/24-27.

When alcohol enters the heart it neutralizes ojas, which has its seat in the heart. Thus, the coldness of ojas is subdued by the heat of alcohol; heaviness by lightness; smooth by sharp; sweet by sour; gross by subtle, viscosity by absorbability, and so on. And as ojas is progressively destroyed by even moderate chronic alcoholism, the mind and body deteriorate.

Mano Vighatas (Mental Impediments)

The ability of stress to transiently increase blood pressure is well established and probably is mediated through increased adrenal hormones (epinephrine, norepinephrine) and sympathetic nervous activity. It is likely that prolonged, unmitigated stress will also contribute to persistent high blood pressure (hypertension). In Ayurveda, chinta (anxiety), shoka (sorrow), bhaya (fear), krodha (anger) are manasika bhavas (mental states) known to promote disease. These states all initiate Prana Vata and Vyana Vata prakopa leading to hridaya dysfunction manifesting in hypertension.

Vayas (Age)

The observation that hypertension occurs mainly in middle age (40-65) and old age (>65) indicates the importance of age in this condition. The younger a person is when hypertension is initially diagnosed, the lower is life expectancy if not treated. As Pitta Dosha and Vata Dosha are dominant in middle age and old age, respectively, these are the periods when hypertension with Pitta and Vata dominancy can most easily manifest and be difficult to treat. This is because the doshic nature of the disease gets additional momentum in the direction of imbalance from the prevailing dosha associated with one’s age. Conversely, if the doshic nature of hypertension is different from the dosha dominance of one’s age, (i.e. Vata dominant hypertension occurring in the Pitta dominant stage of life) treatment is significantly easier.

Most modern Ayurvedic authorities do not recognize (or at least do not generally describe) aama as a pathogenic factor in hypertension. However in my clinical experience and observation it is almost always a prominent factor. Logical evidence includes the fact that many patients experience difficulty in curing the condition (Kruchchhasadhya) and recurrences almost always occur when treatment stops (Yapya). Generally, although not categorically, these two classes of disease indicate the presence of aama.

Like Kapha, aama is heavy (guru), moist (snigdha),sticky (shleshmana) and cold (shita) in nature.  For this reason, ama typically associates with Kapha before the other two doshas. Ama initially forms and accumulates in the digestive tract but then can enter other srotas (channels) of the body such as the blood vessels, capillaries, and lymphatics where it can cause obstruction, functional and structural abnormalities. According to the Madhava Nidanam, when ama is allowed to accumulate in the dhamanis (circulatory channels) they become congested and hardened. Dhamani Praticaya (thickening) and Dhamani Kathinya (narrowing) with atherosclerosis and arteriosclerosis which are the known pathological associates of hypertension. Soon the (dhamanis) throughout the body become dysfunctional as well. Eventually this abnormal function affects the heart (hrdaya), which then becomes the seat of this disease. Once Kapha has become vitiated by aama the other doshas eventually become involved.  To restore homeostasis the body will initiate local inflammatory processes (i.e. Pitta) in the blood and involved srotas (rasa and rakta vaha) in order to ‘cook’ the accumulated ama.  Despite the inflammatory component of this condition however, the hallmark of hypertension is the progressive pathological influence of Vata in the blood and heart, and the resulting tissue degeneration.

Ayurvedic Treatment

The Ayurvedic line of treatment of hypertension consists of all or some of the following approaches:

Nidana parivarjana (removal and avoidance of the cause) Niramkarana (removal of ama) Dosha pratyanika (antagonististic to the vitiated doshas) Vyadhi pratyanika (antagonistic to the vitiated dhatu) Shodhana (purification) including: --Virechana (purgative therapy) --Shirovirecana (purification through nasal root)  --Niruha Basti (herbalized enema decoction) --Raktamokshana (bloodletting)  Pizicchil (special massage technique utilizing large quantities of herbalized oil) Shirodhara (using takra medicated with brahmi, amalaki, and musta) Shamana medications (includes diet and herbal medicines) Satvavajaya (psychotherapeutic approach) Rasayana Chikitsa (rejuvenative medicines)

It is beyond the scope of this brief monograph to treat each of these approaches in detail. Also bear in mind that treatment of any condition must always be precisely individualized for each patient and thus it is not possible to list a standard therapeutic protocol for hypertension or any disease. Any treatment undertaken without the full knowledge of the disease and the patient usually fails or is successful only by chance. This section will highlight only a small glimpse of traditional treatments currently in clinical use in the treatment of hypertension. In reality,all or most of the above approaches are utilized for each patient. Dosages of medicinal preparations have intentionally not been included to discourage self-treatment, which is contraindicated in hypertension.

Pathya (Diet and Behaviors to Follow)

Diet and lifestyle modification have been the pivotal features of Ayurvedic Medicine since its inception more than 2000 years ago. It appears that we are coming full circle with regards to the treatment of hypertension because the conventional Western medical establishment is finally beginning to re-cognize the essential role of diet in treating hypertension. The National Heart, Lung, and Blood Institute has developed dietary guidelines for hypertensive patients which are remarkable similar to those promoted by Ayurveda. The NHLBI protocol is called the DASH-Low Sodium diet (Dietary Approaches to Stop Hypertension) and it recommends a diet rich in fruits, vegetables, low-fat dairy products, high in potassium, magnesium, calcium, and fiber, moderate in protein, and low in red meat and sodium (< 1500 mg/day).

The Ayurvedic diet to treat and prevent hypertension is similar yet differs in some important fundamental concepts as described below.

The diet should be of a rukshana nature (one which reduces corpulence) and should also be vatanulomana (moving Vata in a healthy direction), avidahi (not spicy), pittashamaka (Pitta pacifying) and alavana (not salty). Food should always be fresh and one should never eat in excess. If the individual exhibits dominant kapha prakriti or vikriti, the diet is initially of a Kaphashamak nature. A low-fat milk lactovegetarian diet, which favors sweet, bitter and astringent tastes is an ideal diet for hypertension. No specific food articles are of particular benefit except one which is to be taken in the diet as much as possible: fresh garlic. Otherwise, one should follow a vatapittashamak diet, reduce salt, and pay strict attention to the quantity of food intake.

Other helpful aspects of pathya include: frequent self-massage using narayana taila or til taila, performanance of Chandra bhedana pranayama followed by suryanamaskar and shivasana, ghrita nasya one hour before sleep, and continuous sipping of warm water throughout the day. Light to moderate exercise most days of the week, primarily of the aerobic type is recommended (walking, slow jogging, bicycle, yogasana practice, etc). Studies have shown that laughter reduces blood pressure.

Apathya (Diet and Behaviors to Avoid)

Avoid excessive alcohol, excessive salt, and excessively acidic and pungent food. Avoid meats of animals living in water, marshes, or in holes in the earth; avoid eggs, curd, vinegar; avoid unctuous and heavy foods, reduce the sour, salty, and pungent tastes. Avoid meals consisting of foods with contradictory qualities (i.e. astringent and moistening, e.g. dal and okra). Do not eat until the food from the previous meal has been completely digested (4-6 hours). Completely eliminate coffee, tobacco, and pan; reduce the amount of black tea.

Daytime sleep especially following a meal is prohibited. Anger, jealousy, arguments, frustration, loud speech, and exposure to fire and strong mid-day sunshine should be avoided as much as possible. Never exercise more than 50% of one’s capacity and never in the heat.

Herbal Medications

Western hypertensive drugs act by decreasing the cardiac output, peripheral vascular resistance, or both. The classes of drugs most commonly used include the thiazide diuretics, β-blockers, ACE inhibitors, angiotensin II receptors antagonists, calcium channel blockers, α-adrenoceptor blockers, combined α- and β-blockers, direct vasodilators, and some centrally acting drugs such as α2-adrenoceptor agonists and imidazoline I receptor agonists. While Ayurvedic preparations have actually been shown to possess some of these actions, their use is dictated by a fundamentally different concept of the disease. A very abridged list of some of the individual herbs and formulae used in hypertension are listed below.

Individual Herbal Medications

Sarpagandha, Jatamansi, Arjuna, Brahmi, Shankhapushpi, Gokshura, Punarnava, Haritaki, Rasona

Some Common Herbal Combinations

Guduchi + Gokshura + Raktachandana + Patola + Shunthi

Aragvadha + Dhanyaka + Shankhpushpi + Pippalimula + Rasna

Punarnava + Guggulu + Sarpagandha + Gokshura +Jatamansi

Ashwagandha + Sarpagandha + Gokshura + Haritaki + Bibhitaka

Ashwagandha + Pippalimula + Brahmi + Shankhpushpi + Sarpagandha

Arishtas and Asavas

Ashokarishta

Kumarasava

Ashwagandharista

Saraswatasava

Rasonasava

Chandanasava

Mahamanjisthadi Kwath

Bhasmas / Rasaushadis (contain metals and/or gemstones)*

Brihat Rasa Chintamani

Abhrak Bhasma

Suarna Makshik Bhasma

Arogyavardhini

Yogendra Rasa

*References: Bhaishajya Ratnawali or Yoga Ratnakar

Conclusion

Human hypertension is probably caused by environmental influences such as excessive salt intake, alcohol consumption, obesity, lack of exercise and mental disturbances acting on a genetic predisposition. The specific genes responsible for hypertension have not been identified but family and twin studies support the concept that blood pressure is partially genetically determined. Untreated hypertensives are often asymptomatic for years or decades and then suddenly present acutely with stroke, coronary artery disease, myocardial infarction or acute renal failure. Most patients have essential hypertension, where no specific cause can be determined, but who have a constellation of physiological abnormalities including neurotransmitter and humoral factors with defects of the cardiac and vascular smooth muscle and endothelium. Excessive vasoconstriction, commonly involving the endogenous peptides, angiotensin II and endothelin, or deficient vasodilatation, possibly involving nitric oxide (NO) and hydrogen sulfate (H2S) are proposed mechanisms in hypertension.

In Ayurvedic literature there is no mention of raktasammaradanam (friction, resistance in blood vessels), or raktabala (forceful flow) or any other descriptions suggesting increased blood pressure. However modern Ayurveda understands quite clearly that hypertension is caused by an excess of all three doshas in the rasa and rakta dhatus as well as shonita (blood), compromised digestion, the presence of aama, sroto varodha, central and autonomic nervous dysregulation, and mental stress. Ayurveda treats this condition with a sequence of detoxification protocols, dietary and behavioral modifications, herbal treatments, lifestyle changes, and pranayama/asana/meditation to restore equilibrium throughout the body and mind. All treatments are according to the individual’s prakriti, vikriti, and other idiosyncratic factors.