It comprises of
1. Preview
2. Veda literature
3 . .Ayurveda literature
4. Modem medical literature
1. Preview:
Previous research word regarding 'Soura-SUkta' is not
available. H0wever, .Ayurvedic research work regarding Hypertension is
enlisted here:
1. Anjaneya S. - A Preliminary clinical study of the effect of
Vacha on hypertension - Dr. B.K.R.R. Government
Ayurvedic college, AP University, Vijayawada, 1979
2. Rao J.V. - A study of Jotishmati and Punamava III
hypertension Dr. B.K.R.R. Government Ayurvedic
college, AP University, Vijayawada, 1985
14
3. Bhushan K. - Effect of Sarpagandhadi Yoga on
hypertension - Dr. B.K.R.R. Government Ayurvedic
college, AP University, Vijayawada, 1989
4. Madhava Rao G. - The effect of Takra-Dhara on
hypertension - Dr. B.K.R.R. Government Ayurvedic
college, AP University, Vijayawada, 1993
5. Shrinivas K. - A clinical study of effect of the Nartia
compound in hypertension - Dr. B.K.R.R. Government
Ayurvedic college, AP University, Vijayawada, 1999
6. Sastri B.S.R.L.N. - A comparative study on the effect of
Arjuna Kshirapaka and Rasona Kshirapaka on management
of hypertension - Dr. B.K.R.R. Government Ayurvedic
college, AP University, Vijayawada, 2003
7. Ravani A.T. Hypertension - Raktachapa, Institute for post
graduate teaching and research in Ayurveda, Gujrat
Ayurveda University, Jamnagar, 1967
8. Pathania Sunilkumar k - Role of Takra-Dhara and
Sarpagandha Ghana-Vati In the management of Uccha
Rakta-Chapa (essential hypertension) Institute for post
graduate teaching and research in Ayurveda, Gujrat
Ayurveda University, Jamnagar, 2001
15
9. Bhayal Ramesh B - Role of Virechana Karma and Shamana
Chikitsa in the management of Uccha-Rakta-Chapa
(essential hypertension) Institute for post graduate teaching
and research in Ayurveda, Gujrat Ayurveda University,
Jamnagar, 2003
10.Shah (Mrs) J. R. Appraisal of Dosha in Hypertension -
Govt. Akhandananda Ayurvedic College, Gujrat Ayurveda
University, Jamnagar, 1985
l1.Vasistha A. G. - A clinical study of role ofBasti chikitsa in
the management of essential hypertension - Govt.
Akhandananda Ayurvedic College, Gujrat Ayurveda
University, Jamnagar, 1994
12.Deshbandhu R. C. - A clinical and comparative study of
Shodhana (Virechana) - Poorvakarma Shamana and
Shamana chikitsa in the management of essential
hypertension - Govt. Akhandananda Ayurvedic College,
Gujrat Ayurveda University, Jamnagar, 1998
13.Rani Yogita B. - Avasthiki Shodhana-Poorvaka Shamana
chikitsa and Shamana chikitsa in the management of
hypertension - Govt. Akhandananda Ayurvedic College,
Gujrat Ayurveda University, Jamnagar, 2001
16
14.Chaure P.S. - An experimental and clinical study on the
effect of an indigenous drug Bhringaraja (Ec1ipta alba) in
the management of arterial hypertension Faculty of
Ayurveda Institute of Medical Sciences Banaras Hindu
University 1968
IS.Pandey D. P. - A study on arterial hypertension and role of
Japapushpa (H Rosasinensis) in the management Faculty of
Ayurveda Institute of Medical Sciences Banaras Hindu
University 1977
16.Raut A. A. - Studies on the etiopathogenesis of
hypertension in Ayurveda Faculty of Ayurveda Institute of
Medical Sciences Banaras Hindu University 1986
17.Bhupendra Pai - A c1inico-pathological study of Raktagata
Vata (hypertension) and its management by Jatamansi
Chooma Faculty of Ayurveda Institute of Medical Sciences
Banaras Hindu University 1994
18.Shrivasava P. S. - Therapuetic trial of Coleus amboinicus in
systemic hypertension State Ayurvedic College,
University of Lucknow, 1979
19.Dwivedi Patanjali - Effect of Sarpagandhadi Yoga and
Shavasana in hypertension State Ayurvedic College,
University of Lucknow, 1982
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20.Shrivastava v. S. - Effect of Jatamansadi Yoga in essential
hypertension. A clinical study - State Ayurvedic College,
University of Lucknow, 1985
21.Sharma P. C. - Further observation on the effect of
alcoholic extracts of Coleus forshcollie Brims (Chhangala
Jadi) in case of hypertension - State Ayurvedic College,
University of Lucknow, 1990
22.Kumar Rajiv - Further observation of effect of alcoholic
extract of Coleus forshcolli root in cases of hypertension -
State Ayurvedic College, University of Lucknow, 1991
23.Agarwal Satish - A clinical study on the effect of
Madhupamyadi-hypothetical-Yoga In management of
hypertension M. M. M. Govt Ayurvedic College, Rajasthan
University, Jaipur, 2003
24.Asha K. K. - Clinical study to evaluate the efficacy of an
Ayurvedic coumpound w. s. r. to its action on hypertension
Govt Ayurvedic College, Kerala University,
Thruvananthapuram, 2001
2. Veda literature:
The meaning of the word 'Veda' is knowledge, true or sacred
knowledge. In fact ~gveda is the only original work. There are two
groups deciding the time of origination of ~gveda. One group considers the
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time of~gveda 4000 to 2500 B.C. after the settlement of Aryans. The other
group believes it be 1400 to 1000 B.C. after settlement of Aryans.
Each Veda has two distinct parts. Mantra or the words of
prayer and adoration often addressed to Deities like Agni, Indra, Maruta,
etc. The prayers are for health, wealth, long life, cattle offspring, victory and
even forgiveness for the sins. Another part is Brahmana consisting of
rituals (Vidhi), which are the directions for the details of ceremonies at
which the Mantras were to be used, and explanations of the legends
connected with the Mantras. Both these portions are termed as Sruti. The
revelation orally communicated by the Deity and heard but not composed by
men. Although it is certain that both Mantras and Brahmanas were
compositions spread over a considerable period, much of the later being
comparatively modem. As Manu is his law book says Vedas are actually
three.
three forms.
~ iffiIT 'f1~It1~st I ..... Sij~Rl
As the Vedaas are properly three so the Mantras are properly of
1. ~gveda, which collection of verses in context to praise
of deities and are intended for loud rec1.tation.
2. Yajurvedaa is in prose and is intended for the recitation
in the lower tone of sacrifices.
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3. Samavedaa, which is intended for chanting at Soma or
Moon-plant ceremonies
Yajur and Sarna Veda, in spite of presenting their own Mantra;
happen to borrow Mantra from Rugveda. Atharvaveda is collection of
original hymns like Rugveda; borrowing little from Rugveda. The hymns of
Atharvaveda are mixed up with incantations, having no direct relation with
sacrifices, but supposed by mere relation to produce long life, to cure
diseases, to affect the ruins of enemies.
Each of four Vedas seem to have passed through numerous
Suktas or schools giving rise to various recensions of text though Rugveda
is only preserved in the Shakala recensions, while a second recension that of
Bhashkalas is only known by name. A tradition makes Vyas the compiler
and arranger of Vedas in their present form. They each have an index or
Anukramani. Out of the Brahmana portion of the Veda grew two other
departments of sometimes included under the general name Veda viz. the
strings of aphorism rules called Sutras and mystical treatises on the nature
of God. The relation of soul and matter were Upani~adas, which were
appended to Aranyakas, which became the real Veda of thinking Hindus,
leading to Darsanas or systems of philosophy.
Rugveda is most ancient First Veda available today.
The word '?/i.~G' is a conjugated term of'~' and 'ctG',
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About '?f[q)' ,
The meaning of the word '~' is composition of rhyme made
in a typical way called 'gC;:·fiFll'.
Etymological aspect of '~' is as follows:
The definitions of the word ~ is as follows:
Means the verses where holy moieties are praised. (Sha. Ka.)
Means the mantra which follows the rules of 'Vrtta' and
contain 'Carana' and 'Ardhi'. (Jai. Nya. 2.1.12)
Means verses where the composition of the 'Carana' is based
on Anu~tupadi Chanda.
Many 'I}cha' together comprise one 'Siikta'. Siiktas in I}gveda
are mainly the prayers of holy moieties like Indra, Agni, Vauma, Marut.
Besides these prayers these verses express about the society in
those days, culture in those days, philosophy in that time, and environment
in those days and many other things.
21
Entire ~gveda-Samhita is basically composed in two ways:
1. A~taka-racana.
2. Mandala- racana.
A~taka- racana:
~gveda is divided into 64 chapters (adhyaya). Eight chapters
together comprise one A~taka. B.-gveda contains such eight A~taka. The
remaining sector of each chapter is called 'Varga'. Number of verses in one
'Varga' is five. Some of the vargas nevertheless are comprised of nine
verses also. This irregularity in the composition cannot be logically
explained. Total number of 'Varga' in ~gveda is 2006. This must be for the
sake of simplicity for the learners.
Mandal-racana:
~gveda is divided into 10 mandals. Each 'MandaI' comprises
many 'Suktas' and each 'Siikta' contains many 'ruchas'.
These mandals are again divided into:
1. Gotra-mandal.
2. Mishra-mandal.
22
GOTRA-MANDAL
MandaI from second to eighth are called 'Gotra-madal' because
they are composed to describe the genetic tree of Rushi, their genetic
configuration 'gotra' and their heirs etc. the names of the Gotra-rushis from
second to seventh mandals respectively are Gutsamada, Vishwamitra,
Vamadeo, Atri, Bharadwaj and Vasishtha. The names of the rushis of the
eighth mandaI are Kanva and Angirasa.
Mandals from second to eighth are the core of Rugveda. The
composition of these verses is ancient most. Other Siiktas are composed in
the further era.
Suktas from the ninth mandal are prayers of single moiety
Soma. The synonym of Soma is Pawamana. So this mandaI is also called
Pawamana- mandaI. It is guessed that after the composition of second to the
eighth mandaI simple compilation of Soma-Suktas through them made the
ninth mandaI.
First and tenth mandals contain 191 Suktas each and it is
guessed that they are inserted in ~gveda afterwards. The relatively modem
language of the tenth mandaI with newly proposed holy moieties and latest
philosophical approach in those days prove that this mandaI was from
further era.
Katyayana produced the numerical data of ~gveda
composition. It is as follows:
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1. Mandals 10
2. Suktas 1017
3. Ruchas 10580.25
4. Shabdas 1,53,826
5. Aksharas 4,32,000
Beside abovementioned numerical values ~gveda-Samhita
contains 11 Suktas in eighth mandaI ranging from 49th to 59th number. These
Suktas are called Balakhilya Suktas. The number of Mantras included in
them is 80.
Due to such systematic and wonderful studies of the scholars in
those days, ~gveda-Samhita is available today as it was composed, in
unaltered form and unadulterated way.
The traditional notion is that the entire ~gveda-Samhia is
compiled and edited by a single person. About all ~~I in ten mandals,
Katyayan, in his Sarvanukramanee states as follows:
~1(1R;l""1 am1 4106cl~ 1tl~~cm4151~cml ~ ~: I
It means that the ~~Is composing hundred Ruchas from the first
mandaI are called composers of hundred ruchas. The ~Is composing the
last mandaI are named Ksudra-sukte and Maha-sukte. The ~~Is composing
middles mandaI are called Madhyama.
Commentator Shadgu~~Ishya of above-mentioned
Sarvanukramanee, composed by Katyayana stated that composer of the first
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mandaI Madhuchhanda, son of Vishwamitra wrote more than hundred
Ruchas so he is named as 'Shatarchin'. This is the reason all ~~Is by the rule
of 'Chatri-nyaya' acquired the same, i.e. 'Shatarchin' name. Similarly
Siiktas in tenth mandaI before Nasadiya Siikta are called Maha-Siikta and
Siiktas after Nasadiya Siikta are called Kshudra-Siikta. Mandals from
second to ninth are in the central portion of ~gveda-Samhita and the ~~Is
composing them are therefore called 'Madhyama'.
About '<fG'
Jf;::llillS06 0llfJiCb) ~ <fG: I
In the beginning the Veda was written in a hotchpotch way.
Vyasa~~I divided Veda into four parts and each part descended to one
student (Shishya) through him. He was crowned due to this as \~ FclClJI'('f
~ ~GClJI'('f'. It means the person who divided Vedaa. The learner of
~gveda was a student named Paila.
Paila divided the learnt ~gveda into again two parts and taught
one part to Bashkala and the other to Indrapramati. Bhagwata purana and
Bramhanda purana refer to the further descend of Indrapramati Samhita to
Mandukeya. From Mandukeya it was taught to Satyashrava, Satyahita and
Satyashriya.
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In such way various versions of ~veda were available in those
days. Patanjali in his 'Vyakarana-mahabhashya paspashanhika' refers to
twenty-one different editions of ~gveda. Amongst them Shakala, Bashkala,
Ashwalayana, Shankhayana and Mandukayana are most popular editions.
Shakala gave following editions, which are not available today.
1. Mudgala shakha.
2. Galava shakha.
3. Shaliya shakha.
4. Vatsya shakha.
5. Shoushiri shakha
The root samhita was named Shakalya or Shakalaka or
Shakaleyaka. It is very highly respected
Bashkala gave following editions, which are also not available
today.
1. Boudhya shakha.
2. Agnimathar shakha.
3. Parashara shakha.
4. Jatukamya shakha.
Eight additional Siiktas were written in Bashkalashkha.
Ashwalayana shakha avails Gruhya and Shroutasutras. No
other material is available today.
Shankhayana shakha avails the Brahmana, Aranyaka and
Kalpasutra.
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Mandukayana shakha in any form is not available today.
General grouping of the Siiktas in ~gveda are under the
headings as follows:
1. Devata-sukte.
2. Dhrupada-sukte.
3. Katha-sukte.
4. Samvada-sukte.
5. Danastuti -sukte.
6. Tatvadnyana-sukte.
7. Samskar-sukte.
8. Mantrik -sukte.
9. Laukik-sukte.
10. Apri-sukte.
~gveda contains 10,414 mantras. The division of Chandas in
~gveda is as follows:
1. Gayatri.
2. Ushnik.
3. Anushtubh.
4. Bruhati.
5. Trishtubh.
6. Pankti.
7. Jagati.
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8. Atijagati.
9. Shakvari.
10. Atishkwari.
11. Ashti.
12. Atyashti.
13. Dhruti.
14. Atidhruti.
15. Ekapadachhanda.
16. Dwipdachhanda.
17. Pragayabarhata.
18. Kakubh.
19. Mahabarhat.
It is taken that the creation of ~gveda IS not by ordinary
human. It is supposed to be created by God himself.
3i4''6~lIJt "fIffr ~ ~~)~ollq ~: ~ ~ I ~G~lftl
q'<~:tq,<~ffldJt"1 4~'6~1I("Cflq I W~ElIR~'6~~ffld("CfI'I1IGln'6~lI("Cf~Rl ~ I
'fI6t?1 ~~: I
?Jr.~.10.90.1
This dispute ultimately was dissolved to agree that the
composition is not sheer inhuman.
28
The language in ~gveda is very difficult. It is suggested that
Veda should be read after acquiring command on six tools to understand
Vedic language.
~ ~Gt'Qltd4"fqE()~ ftrefICfH:) q~""RI !'I qct1 IP! I
t ~ ~~d&Q ~ ~ ~ "lfC\ ~S15~G) qGRi "W ~qlqi(1 T.f I
d?llqi(1 ?Ii"~G) ~clG: t114"f~G)S~: ftan ~ &IICfji(uj P!'6ctti
~ GdlRlq~RlII
3T~ "W "lf~ ~~ II
j\SCf»)qp!qG 1.1.4-5
These six tools are capable of explaining the verses properly.
It is not desirable here in this dissertation to elaborate the
details of the six entities, yet the definitions of them are given below:
• q uh:<NIq:gi5iUi(UI!'ICf)lx) ~?ilqf4~d ~ ftan I
• ct>C'4ttl 3f1~q~ICIt~lqX"d~I~~I~~?I11
• ClIICf)xUI4"f~!'ICIlRI !'I~~Iq:gq4~~ ~ 'tCIXiiq ~- P!lSCI4Iqg\Jild I
• 3T~ ~amm q G\JIld ~?il (fei d P-i'6crei I
• ",,~:;fl \3lSDft"lj~iii!6<ftqRct8!~M"I<ft~dI4'l 'Htff 9GiRi I
• GiI~Rlqt'Q !'IlI)\JI;:J ~ I
'Soura-Siikta' is part and parcel of ~gveda. It is a collection of
hymns about God Sun. it is refered in 14 verses at various places in ~gveda.
Out of these 14 verses 11 verses are meant for praising God Sun, its names
29
in various contexts, time division by Sun in Samvatsara etc, its velocity,
eclipse, months, importance in science of astronomy (2.27.1; 10.72.8;
l.35.11; l.50.8; 2.36.2; l.123.8; l.164.11,12; l.117.4,5; l.16.48; 1.155.6;
5.40.5,6,7,8,9; 7.66.11; 10.156.4; 10.189.1,2,3; 1.84.15)
Since these references are not necessary for this particular
experimental project, they are only mentioned here, no given in details.
Important ~ca around which entire project is whirling is as
follows:
Two more verses related to health care together with the 11 th is
called 'Rogaghna Upani~ada' and they all together are as follows:
Si £1.5 £I flt?l Si g 3f I '() ~"jct1 if ~ I
?FL1f.1 3fjql~ 9 ~ 50 ?ft-C.IT 11
~ "4 gBSiIU} '()~O"q>I'tl ~ I
30
~J.II~R~ll) f<t~ ~ WI
ftCl;:Q ~.~ ~~~~I
?Ir:J:f.1 3i jClI <ft 9 ~ 50 ?It'f.IT 13
Experiment of this research project is designed with first out of
three 'Rogaghna Upani~ada', which is explained before.
Atharvaveda also claims that for cure of any disease medicine
is necessary and that is through God Sun without whom there could be no
herb.
at4R.!a: J:r "tffiO ~ CltidRCI I
~: &long ~ iF~SfI q)q)STSg
3T~ (6.83.1)
The speed with which the Eagle flies away from its residential
place, to eliminate diseases like indigestion and others, let God Sun prepare
medicine and destroy diseases.
This description emphasizes the need of Sunlight without
which it is impossible for any plant to prepare food. Only plants are source
of food. Human can not prepare his food, nor can he prepare medicines
without Sun.
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Rays of Sun were given utmost importance. Atharvaveda does
not fail to mention 'Varna-Cikitsa' or 'Chromotherapy' for heard diseases
and for anemia.
&J 'ti4jGlJcti iJ'tEl)ffi ~ :q tf I
III "<)~ct'fll ~ ~ ~ ~I
~ 1.22 qof~Fchffil
Yellow color of yours (may be due to anemia or jaundice) and
the heart diseases you are suffering from; should vanish with red rays of
Sun, which wrap you and keep healthy
everyone.
llft CQT "<)~~cfoicft~fg(cllll ~ I
<:r~ III 41 't4 I ~ 315 Rct) 1jCfC{ I
3T~ qof~Fchffil
Red shining Sun rays and milk of red cows bestow health on
In that ancient era also authors of compendia were aware of the
color therapy
Various allied branches of medicine are cropping up now like
'Naturopathy', 'Electrotherapy', 'Magneto-therapy', 'Hydrotherapy', and
32
many others. Veda is a real treasure of knowledge as all these references are
found in four Veda. One more very interesting reference is as follows:
\iEFTJI~~: rsp'i"11 ~ Pl;!h11 ~~: I
~ 3Rf: @>J1 \Q~ l"Jfct I
3J~ 2.32.1
Rising Sun by his rays kills organisms and so does rays of
setting Sun. both types of Sun rays are capable to kill insects on Earth.
fcr~ ~ ~ ttl~'IJ1~"1't I
-'q°IIRl~ tt~'<fCl 'lJl..~ 1I~'<: I
3J~ 2.32.2
And insects and worms with morphology like those having
various colors and white color, with four eyes, and so on are killed by rays
of Sun. Sun rays are able to kill the worms by breaking their vertebral
column and by severing their neck.
Mode of action of mantra:
Mantra is an invocation or a mystical formula, which aids the
person to release the self and attain bliss and ultimate fulfillment. The
sounds involved in a Mantra are themselves significant for they generate in
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the individual an unusual mystic power. Mantra produces a set of vibration
in the surrounding atmosphere & its force depends on the attitude of the
person as well as the intensity of concentration.
Mantras are performed through faith, the results of which
cannot be analyzed measured, weighed, seen but are felt. The force of
Mantra can be only felt. It should be performed with due faith and all
rituals, and then it is fruitful. One must have complete faith in Mantra he is
reciting and must know its meaning. Prescribed methods should be
followed. The performer does experience sensation and vibrations during or
at the end of Japa, this is a sufficient proof to believe. Mantra requires faith,
Japa, hard work ad per laid dictums to realize the desired objects and
vibrations. Each Mantra has a different use, The vibrations of sound create
desired reactions within the body too.
Recitation of Mantras with a prescribed number of times at different timings
to give desired results. There are three ways to perform Mantra
UPANSU JAPA: It is the method where Japa is done very slowly so that
nobody can hear it. Only lip movement should be there.
MANSIC JAPA : The Japa carried out only in the heart without any sound
or lip movements.
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V ACHNIK JAP A : In this method you can recite the mantra in a low,
medium or high tone of sound.
Sanskrit Mantras are sound formulas that echo the language of
Creation, ranging from single-syllable "seed sounds" to more extensive,
lengthy compilations of sounds designed to have specific effects. We have
been told that "In the beginning there was The Word ... " and the scriptures
from many world religions testify that sound was the originating
manifestation of the Universe as we know it. y world religions testify that
sound was the originating manifestation of the Universe as we know it. This
"Word" can be understood as Sanskrit, and delving into Sanskrit mantra is
ultimately a process of understanding Creation itself. However, the less
subtle layers of this sacred language can also serve those of us with more
practical concerns.
The word "mantra" can be translated as "that which sets free
from the ordinary mind." The regular use of Sanskrit mantra helps us to
transcend the ordinary faculty of the mind and its limited scope, helping us
access illumined intellect, the storehouse of our soul's wisdom and powerful
creative energy, and eventually awaken enlightened consciousness.
Because Sanskrit mantra is an energy-based language of light,
it works whether you fully understand it or not. Many mantras are
untranslatable, and the translations that do exist are subjectively drawn
35
sketches of a deeper meaning that supersedes our ability to convey it with
the English language.
The best way to understand a mantra is to work with it. Each
mantra has a direct, specific effect on the chakra system. (In fact, the 50
seed sounds of the Sanskrit alphabet correspond with the 50 petals of our
chakra system.) As the mantra formulae are intoned, the petals on the
chakras vibrate in sympathetic response and the bridge to healing, from the
gross physical level to the eternal cosmic consciousness, is awakened. More
simply put, the mantra creates a forcefield of such positive energy that you
cannot help but be affected positively.
There are powerful mantras that address every possible area of
personal growth, and every possible dilemma of the human condition. The
"seers" of these mantras were sages with profound understanding of human
evolution, and they set out the mantras like a trail of stars for us to follow
Home.
Each issue that humans face, whether physical, mental,
emotional, or spiritual, brings attention to something that they do not yet
understand. The learning process (aka "healing") can take days, months,
years, or lifetimes, depending on the depth of the lesson. Working with the
Sanskrit mantra for a particular issue links the awareness to its root in
cosmic consciousness, ultimately transcending space and time to access the
36
pure knowing that is inherent to our own higher nature. Through this
knowledge, we are empowered to unravel our personal knots and unleash
the dormant creative power that had been trapped inside.
Working with a personal mantra for practical or spiritual
intentions is like releasing an arrow straight to the core of the matter. It puts
the destiny of soul evolution within reach, and ones empowerment only as
far away as the tip of his tongue.
It's generally advised that one should learn mantras directly
from a teacher, rather than from a book. Since there are millions of mantras,
it's also important to choose proper mantras wisely depending on the result
one is expecting. If the mantra is desired purely for spiritual growth; one of
the great liberation mantras such as the Gayatri, "Om Mani Padme Hum," or
"Om Namah Shivaya," could resonate with you. If mantra is for practical or
medical intention, one of many more focused formulae could be better.
The science teaching the method of pronunciation of vowels,
alphabets, etc. is shiksha. Famous holy texts on this science are written by
Sages Panini, Yadnyavalkya and Vasishtha. 'The Shatpath Brahman states
that every metrical composition of Vedic mantras or every alphabet of a
word possesses some kind of strength and explains the secret of every
alphabet. The Mandukya Upanishad believes that even uttering of alphabets
from a mantra is powerful and hence describes the greatness of the alphabet
37
Om. Since the Vedas were considered to be divine in origin the order of
every word from their mantras had to be maintained while chanting, as per
the established rules. In this regard authors of the Nirukta say, Pillt1lj'{OQf
Pillt1QI'Cl)9;Ck1;: meaning a word, the order of alphabets in it and its method of
pronunciation is definite; hence the meaning of the Vedas also does not
change".' To be able to chant Vedic mantras appropriately one should know
the correct pronunciation of vowels (svar). Vowels mean sound. If
pronounced correctly the sound generated by a word makes it efficacious.
Hence if Vedic mantras are chanted correctly then the mantras become
efficacious.
Faulty pronunciation of even one word changes the entire
meamng; hence vowels decide the meaning of words. In this regard the
Panini Shiksha (52) says -
The mantra without proper pronunciation of vowels (svar) and
consonants (varna), that is the utterance of a mantra in a faulty manner
makes it faulty and does not convey the intended meaning. Instead it gets
converted into a verbal thunderbolt and harms the one chanting it, as had
occurred in the case of the word Indrashatru with faulty pronunciation of
vowels.
The compound word Indrashatru could have two meanings,
one being "Indra's enemy" (the slayer of Lord Indra) from Tatpurush Samas
38
and "the one whose enemy is Lord Indra" (the one who will be slain by
Lord Indra) from Bahuvrihi Samas. Since the first meaning was intended for
Tvashta he had to utter the note of the last letter of the entire word in a lofty
tone. He however, uttered the last letter of the first word in the Samas in a
lofty tone. Consequently, instead of a son being born to slay Lord Indra, a
son, Vrutra who would be killed by Lord Indra was born (Taittiriya Sanhita
2.5.1-2); hence in the Vedas importance is endowed to the pronunciation of
vowels.'
A. Distortion in the Vedas: 'The ancient Aryans thought of another idea to
preserve Vedic mantras in appropriate metrical compositions and hence
created distortion in the Vedas. For that poetic compositions of the Sanhitas,
which appeared in different branches of the Vedas in the mantra form, were
created. Sages Shakalya, Gargya and Atreya created poetic compositions of
the Rugveda, Samaveda and Taittiriya Sanhita respectively. Based on these
compositions distortions such as Kram, Jata, Ghan, etc. were written. These
variations were useful to chant Vedic mantras in reverse order and thus to
realise the variations of notes occurring in them.'
B. Pratishakhya: After several branches of the Vedas came into being each
branch began to chant the mantras in their own way. To bring uniformity
among them the Pratishakhya was created.
39
A couplet in the Bhagwad Gita, one of the most ancient of
Indian scriptures, clearly describes the virtues of healthy lifestyle in
prevention of infirmity and ill-health. The couplet states that those who
combine a balanced diet, regular physical activity, regular hours, maintain
equanimity, and are balanced in thoughts and action, are away from
infirmity. This couplet matches the current recommendations for CHD
prevention propounded by the World Health Organization and various
international societies. These recommendations include a balanced diet,
regular physical activity, smoking cessation and stress management.
According to Brhadaranyaka and Chhandyoga Upanishads the
ultimate aim of pranayama and yogic techniques is to control life (Prana).
This target is difficult to achieve, but mental peace and relaxation thus
achieved could be used as a therapeutic tool. Studies of yoga, transcendental
meditation and prayers have shown that it causes a decrease in blood
pressure and pulse rate. This effect is seen in normal volunteers and in
patients with hypertension. Patel and others in Britain have shown that
meditation and prayer techniques lower blood pressure on a short term and
long term basis. This factor may be important in primary prevention of
coronary atherosclerosis. On metabolic level it causes a decrease in various
biochemical inducers and aggravators of atherogenesis. Among the effects
seen are on pulse rate, respiration, blood pressure, lean body mass, basal
40
metabolic rate and biochemical parameters like glucose intolerance, lipids,
norepinephrine and epinephrine.
Bernardi et al reported the effect of prayer and yoga mantras on
autonomic cardiovascular rhythms in Italy. 23 healthy participants were
asked to recite the Ave Maria (in Latin) or a mantra. Both prayer and mantra
caused striking, powerful and synchronous Increases In existing
cardiovascular rhythms when recited six times a minute. This recitation
slowed respiration and enhanced heart rate variability and baroreflex
sensitivity and was considered a useful health practice.
Among the African Americans (blacks) that regularly pray in
church there is a significantly lower prevalence of multiple coronary risk
factors including hypertension. Oexmann et al reported results on a church
based intervention in cardiovascular risk reduction in Christian communities
in North and South Carolina in USA. Among the 381 participants in this
one-year long trial there was a significant short term reduction in weight and
systolic blood pressure which were sustained throughout the year.
Significant decline In cardiovascular risk factors- hypertension,
dyslipidemias and obesity have been reported by Patel et al in Britain using
group meditation techniques, and in India by Mahajan et al in Delhi and
Damodaran et al in Mumbai.
41
3. Ayurveda literature:
Ayurveda accepts Mantra as a supportive treatment in many
health problems. For example, as one of the means of measure on edema
C~otha)
Tf.~ 18.5
For good measure of 'life-span-increment-technique', Caraka-
Samhita has advised to follow the rules and regulations dictated through
four Vedaas.
Caraka-Samhita has advised Mantra as one of the tools to
check psychological disorders. In chapter for diagnosis for Unmada, a
psychological disorder it mentions:
am: *,1~'1IP1
Tf.~. 7.16
42
Even III treatment of poisoning, Mantra acts as supportive
measure.
T:f.~. 23.223
The vibration of sound waves of Mantra must be executing
impact on the fluid on which they fall.
~) ~ I ~ I ~\J1 ~C'!!"Rft 'N'I41 """ fa ~ II '< c!1 I
~.~34-7
Not only physician but a surgeon was no exception in having
faith in power of Mantra.
3lRtlCl41ftl 414~iI ~l/Iri'f"",,Cf)~faG:: I
"ffi g ~ fa~~ffiCf)~ 11ffi11
~.q;. 5.8
This Mantra management is not taken lightly by Ayurveda
physicians, even in emergencies execution of this treatment seems to be
authentic.
g\JilIct1~ ~ Wi ~ 41;:::i1d;:::ilfaq I
3T.la.\'f. 3.58
For babies this hannless yet strongly effective treatment was in
practice.
43
All these references point towards acceptance of Mantra as a
supportive measure in various diseases and disorders.
Blood pressure as a disease is not considered III Ayurveda
compendia yet Cardiac diseases were known. The tenns then differed from
present tenns hence all collaborations are difficult to present in the review.
Nevertheless references show that ancient Hindu physicians were executing
such treatment in era of compendia.
Kriya - Sarira of Hrdaya and circulation
Intra-uterine differentiation:
~:m. 4
_ ~: ~ClICft1~ 11Cffff I
~:m. 3
Heart is differentiated in/orth month 0/ intra-uterine life.
Beating a/heart is indication a/living baby in mother's uterus.
Modem embryology cites exact time of development of heart.
It is most logical that in ancient era it was accepted that heart beating of
viable fetus is indicative of differentiation of heart in fourth month of intra
uterine life of fetus.
44
Origin of heart:
~M{)ldCJ)4?!JItlIG\ji ~GlI't I
~:m. 4.31
Constituting tissues of heart are: 'Prasada' portion of blood
and Kapha.
In intra-uterine life all nutriments are provided to fetus by
maternal placenta. Hence tissues organized in fetus are in their purest
possible form.
Ayurveda considers non-accepted part of extra cellular
nourishing fluid or products of metabolism as 'mala' for that particular
tissue. Since Ayurveda assumes that maternal blood does not contain such
mixture of acceptable and non-acceptable portions, provision to fetus IS
pure. Therefore it is 'prasada' in nature. Ayurveda assumes heart IS
originated from such pure body entities, namely blood and Kapha.
These originating constituents are important for treatment of
cardiac diseases. Drugs acting of such constituents are seen to offer fantastic
results.
Heart as a vital organ:
Ayurveda accepts 'Marma' as body entity, which is vital for
living body. Heart is one of such vital organs.
RI x I Ii ihi Cf> Ii C'I!!Cfi C'li Cf> I ~ ~ iI g~!!cl 'tf Elh'll RI "q I
45
Heart is four anguli in measurement, appears like lotus with
face downwards principally constitutes of (Sira' and if hurt or injured, IS
responsible for immediate death.
Location of Hrdaya:
~-,
3l.{a'.W. 4
Location of Hrdaya is between midlevel of chest, breast and
'Ko~tha'.
~.W. 6
Location of heart is in the chest cavity between breasts just
above stomach, abiding satva, raja and tama.
Relation of Hrdaya:
~.W. 4.31
46
Anatomical relations of heart are; inferiorly and laterally on
right side is liver and 'Kloma', inferiorly and laterally on left side spleen
and part of lungs.
Aru~adatta mentions only right relations of heart as 'Kloma',
liver and lungs.
Hrdaya abides:
1. Oja:
T.f.~ 30
Hrdaya abides matter known as 'Oja' in Ayurveda.
2. Touch sensors:
T.f.~ 30
Whatever is necessary mechanism for sensory reception of touch IS
supported by heart.
It must be noted here that circulation is essential for sensations. If
circulation is arrested for a long time, touch sensors do not work.
47
3. Caitanya or Cetana tatva:
"q.~ 30
Hrdaya abides Cetana tatva.
4. Orientation of body organs:
All stimulations from all organs of body are reached to heart.
This is again dependent on circulatory efficiency. Experts in Caraka era
must have noticed that extreme degree of circulatory inefficiency is
responsible for non-perception of any kind of perception.
5. Functional output of sense organs:
Functions of five types of sense organs reach heart.
Any organ functions properly if oxygen and nutriment is reached to
organs and metabolic products are drained. In other words circulation is
vital for sense organs.
6. Soul:
48
Soul abides in heart.
7. Mind with its attributes:
T.f.~ 30
Mind with its three attributes namely satva, raja, tama abide in heart.
Shape and appearance of heart:
Heart has shape of a red lotus facing downwards.
Ii I~ q:tftillft XCtt1 q ,,+1 I Cf) IX+1ti'j{SlSO(I
3l~OIGct1, 3T.@.~. 3.15
~~f1c8°1 ~ ~ ~IGti~j{SlSO(I
\J11;!H1«1mCf)~R1 ~Jl..T.f Pl4")61R1II
~.~. 4.32
Heart looks like red lotus and it faces down. While sleeping
this lotus like heart appears as if it has closed petals and while activities it
appears as if it has opened all its petals.
Due to lotus shape of heart, vessels through this muscular
organ provide entire body even in particular sitting posture meant for
meditation.
49
Chief organ of two systems:
It is chief organ of two systems namely respiratory and
circulatory .
"'Cf.fct 5
Heart is chief organ for system of Rasa.
Heart is chief organ for system of Prii1}a.
Do~a-dhatu·-mala of heart:
A list of these entities is provided here. detail references are
read in chapter for 'lfrdayastha Do~a' .
a. Do~a:
Vatado~a - Udana, Vyana, PdiQ.a.
Pittado~a - Sadhaka.
Kaphado~a - A valambaka.
b. Dhatu:
Rasadhatu.
Raktadhatu.
Mamsadhatu.
Cetanadhatu.
Oja.
50
Functions of heart:
Enumeration of functions of heart is as follows:
1. To support vessels those convey Pral)a (acrr~ f6
2. Important organ of Rasavaha srotas ('{'{1Q61"1i '¢t'Id'tii
~ I 'Cf.fct 5).
3. Important organ for Pral)avaha srotas (SOIl oIQ61"1i '¢t~d'tii
~ I 'Cf.fcr. 5).
4. To support Vyanavayu (C1IT"1l ~ ~: I 3T.t2.~ 12).
5. To support Rasa (~I 'Cf.).
7. To realize sensation of touch ((IT{ ~~HiI~l;:j I 'Cf.~ 30).
8. To circulate Rasa (CZlI~"1 ~ ·Fcnil4~RldCf)4ol1 I 'Cf.
"RI". 15).
9. To express happy or unhappy condition of mind
IO.To repeatedly contract and to relax (~: "Tf: "Tf:
. 'fil . 'ffl ~ ~ '(1 Cf) I 'iI Cf) I '(11.R.'Cf Cf) '< I I "111 ~ I ) .
1 1. To abide Cetana tatva (-ad;x:j'ti~6: I 'Cf.~ 30).
1 2. Maintenance of alertness of sensory organs
51
13. Information about body condition
14. Lodgment of soul (3T"RiIT 'q ~A.~ I 'q.~ 30).
I5.All mental reactions (lFRf: ~ I 3l.ta.~ 12).
1 6. Cleaning of Rasa (W 'lJ: t<:IiUdi "lJm: "fl d~qlqRltidd I
3l'{i°IGct1, 3l.ta.~ 12).
ttl fF1 ~ ~i.J i{) ~ '<'t1 iff q ~F1) El d: I
~:~. 1.17,18
Vyana occupies entire living body. it induces circulation of
Rasa. It is responsible for sweating, various secretions, and five types of
motions like relaxations, contractions etc. it this Vata type gets vitiated, it
becomes responsible for diseases related to any location of whole body.
Compendium A~tanga-Samgraha adds more functions to Vyana
than previous references. In addition to five types of motions, movements of
eyelids he refers to yawning, enjoying flavor of food, penetrating all intra
and inter cellular spaces, sweating, bleeding, deposition of semen in vagina
after coitus. He does not stop short of saying that separation of absorbable
and not absorbable part of digested food is in jurisdiction of Vyana.
52
Chronological nourishment of Dhatavah is included in specific functions of
Vyana.
One of the chief functions of hrdaya is to circulate Rasa in
body in cyclical order.
heart.
Rasa is circulated through out the body, which is pumped by
*1ct~1 qRCIRct~ 't'Hf)qq II
'q.ftr. 15
qRCIRct~ fcllfiq Olt1i:;,<OIl~q)1 (tTcm)
t2GlIlq ~:lffqut ~ m=r ~ I ~ ~ mr mr tl5,<01SO( I
Reference from Bhelasamhita reads that Rasa is expelled
through heart and from there it is circulated everywhere in entire body.
For this expulsion, reference from Caraka-Samhitii provides
two important adjectives. One is continuous (tlctflll) and other is cyclical
Commentator explains meaning of word (qRCIRtO as (fcllfiqoD
and (*1'5'<01). Further he explains meanings of~) as process of Rasa
thrown out of heart and (*15,<01) as process of Rasa coming towards heart.
53
In this, Vyanavayu is chief executor of this function:
ClII;i"1 ~ Fcla)q1~(1ct>4ulIl
9}14q tl4dlS\iffi ~ ~ ~II
"q.~. 15
Vyana, chief amongst five types of Vatado~a, circulates
Rasadhatu. This Rasa is circulated in entire body (rrcfa) at a time (9J1Qro,
ceaselessly (rrcrT) without taking a single seconds rest ( 3lfJIWj.
Commentator wants to impress that a physician should not take
only Rasa into consideration while reading this verse. Blood and all other
fluids should be considered while reading about circulation of Rasa.
Commentator further describes the meanings of different words in the verse.
These are mentioned while reading meaning of verse. They are as follows:
Entity, which executes function of pushing and pumping in
appropriate manner, is known as 'viksepoCitakarmii '. This is function of
Vyiina. This circulation is accomplished in entire body, simultaneously
flown ceaselessly, all the time all the way.
54
This is systemic as well as pulmonary circulation. It is
described in short below. Susrta-Samhita has given examples to describe the
fashion of circulation.
~.~ 14.16
3flTIT Rt~)~OI ~lfJ1gq;l~ol I ~lqRl 't1iNRII O?r ~16G't1tll..,qt\
~t"lt;H Rl4~l~ll~tii ~ \iCft111 31"ftf: 't1t11..,qt\ ~t"lt~'" ~~II~tii,
\l1CW1t1dHqt\ ~t"lt~'" 3ThIl~II~eq~RlI ~~t\ 3RJ@U dll\@lOIl..,lIPd
~16GIR~tel""tl?l~OI dlau(+'1&1s:j(n~.fHi \l1CW1't1t11..,Qri"jG 1~4)"'I~RlI
This circulation is reached to micro capillaries. The
circulatory process is compared with sound to indicate that sound reaches
to any depth in any direction. It is compared with flames to indicate upward
direction. It is compared with water to indicate downfall means downward
direction. Different kind of velocity is also indicated here. Sound is faster
than flames and flames are faster than waterfall. Hence circulation is in all
directions in body and is maintained in different velocities.
55
This verse III this way indicates microcirculation of body,
different velocities of blood at different places and pumping in all
directions.
4. Modern medical literature:
Blood pressure in modern physiology
Definition: Blood pressure is lateral pressure exerted by blood on vessel
wall while flowing through it.
Four terms are read in this context:
A] Systolic pressure (S.P.) - maximum pressure during systole.
B] Diastolic pressure (D.P.) - minimum pressure during
diastole.
C] Pulse pressure (P.P.) - difference between systolic and
diastolic pressure.
D] Mean pressure (M.P.) - it is roughly arithmetic mean of
diastolic and systolic pressure. Approximate mean pressure may be obtained
by adding diastolic pressure with one-third of pulse pressure. In true sense it
is level of the line halving area between pulse wave contour and the
diastolic pressure level.
56
In adults relation between three pressures is as follows:
S.P. / D.P. / P.P. =3 / 2 / 1, viz., if systolic pressure is 120,
diastolic pressure should be 80 and pulse pressure should be 40 mm of Hg.
in normal conditions.
Basal blood pressure: When an individual is with the least possible amount
of strain or stress basal blood pressure is generally considered. It may be
regarded, as the lower pressure necessary in maintaining blood flow
sufficient for needs of body. When a subject is in reclining state, 5-6 hours
after last meal, in a comfortably warm room, after resting for at least 30-40
minutes and with a mind at possible ease, basal pressure is obtained.
Although it is constant in a given individual, different individuals show
variations depending on following factors:
Significance of blood pressure:
Systolic pressure undergoes considerable fluctuations.
Excitement, exercises, meals etc., increase it while sleep rest, etc.
diminishes it.
The height of systolic pressure indicates:
1. The extent of work done by heart.
2. The force with which the heart is working.
3. The degree of pressure, which the arterial walls have to
withstand.
57
Diastolic pressure undergoes much less fluctuations in health
and remains within a limited range. Increase of diastolic pressure indicates
that heart is approaching towards its failure. Variations of diastolic pressure
are of greater prognostic importance than those of systolic. Diastolic
pressure is the measure of peripheral resistance. It indicates the constant
load against which heart has to work. Pulse pressure directly varies as stroke
volume.
Function of blood pressure:
1. To maintain a sufficient pressure head to keep the blood
flowing.
2. To provide for motive force of filtration at the capillary bed,
thus assuring nutrition to the tissue cells, formation of urine
etc.
Factors controlling arterial blood pressure:
1. Pumping action of heart and Cardiac output: Effectual contraction of
heart is the main factor for controlling cardiac output, blood pressure and
flow within blood vessel. In each effectual contraction of the ventricle,
certain amount of blood is ejected out into aorta. Driving force of blood is
mainly created by the pumping action of heart. The efficiency of heart is
considered upon how much amount of blood is driven out by heart into aorta
in each beat.
58
Alteration of cardiac output will alter blood pressure. Cardiac
output depends upon venous return, force and frequency of heartbeat. Blood
volume affects blood pressure directly, by mainly modifying the cardiac
output.
2. Peripheral resistance: It is resistance which blood has to overcome while
passing through periphery. Chief seat of peripheral resistance is arterioles
and to a smaller extent the capillaries.
Muscular vascular bed offers maximum resistance due to high
extra vascular compression by skeletal muscles and skin vessels cutaneous
vascular resistance is due to sympathetic constrictor tone.
3. Elasticity of vessel wall: Decrease in elasticity increases systolic blood
pressure. Since there is an increase in peripheral resistance along with a loss
of elasticity due to involvement of peripheral vessels, diastolic blood
pressure either rises or does not change. So, in old age force, which distends
walls, now drives blood increasing blood pressure.
4. Viscosity of blood: This denotes thickness of fluid in blood. Blood is 4.5
times viscous than water. So naturally more pressure is required to push
blood in circulation. It affects both systolic and diastolic blood pressure.
Viscosity is affected by:
1. Cell count.
11. Plasma proteins.
111. Temperature.
59
IV. Chemical composition like C02, 02 etc.
v. Drugs like general anesthetics.
5. Circulating blood volume: Arterial with venous system is closed system
with elastic tubes. Any fluid in such a system can exert significant pressure
only if fluid fills the system to its capacity or more than its capacity. Normal
blood volume fills system and blood pressure is normal and maintained.
Hemorrhage - decreases blood volume - decreases blood pressure
Polycythemia - increases blood volume - increases blood pressure.
Cushing syndrome - increases blood volume - increases blood pressure.
Factors affecting peripheral resistance:
1. Velocity: A rapid flowing steam will have more frictional
effect than a slower one. Hence, pressure is high in aorta, low in capillaries.
2. Viscosity: Other factors remaining constant, a more viscid
blood will have a higher friction than a lesser one. It is for this reason that
plasma transfusion proves to be more effective to maintain blood pressure
than ordinary saline. Alteration in blood viscosity will affect the diastolic
pressure by its effect on peripheral resistance. Intermolecular friction is
greater when viscosity is high.
3. Elasticity: Due to elastic properties, arteries can dilate and
accommodate considerable amount of blood with relatively less rise of
blood pressure. In old age, arterial walls become stiff. Hence, blood pressure
60
rIses. In systolic pressure arterial wall are stretched due to presence of
elastic tissues in their walls. Blood gets accumulated while flowing through
vessels. In diastole walls of arteries recoil and maintain diastolic pressure
when no blood is actually pumped through left ventricle into systemic
circulation. Distention of aorta minimizes rise in systolic B.P. recoil acts
like an accelerator pump to heart and this facilitates diastolic blood pressure.
In arteriosclerosis where arteries undergo a narrowing of lumen and the
wall becomes relatively hard, elasticity is lost. This is usually seen in old
age.
4. Lumen of vessel: Peripheral resistance IS inversely
proportional to lumen of vessels. Smaller the vessel, higher will be the
resistance. One should expect therefore that the capillaries, having smallest
lumen, should have highest pressure. Contrary to this, due to lowest velocity
of blood in capillaries, functional effect is low. Seat of resistance is found in
arterioles mainly, where velocity is fairly high and lumen is narrow.
5. Length of vessel: Greater the length of vessel more IS
resistance.
6. Volume of blood: Increase in blood volume will raise both
systolic and diastolic bloo<;l pressures due to increased quantity of blood in
the arterial system and greater stretching of the arterial walls.
7. Extra vascular compression: this factor is responsible for
increasing peripheral resistance.
61
Physiological variations in arterial blood pressure:
1. Diurnal: This could by idiosyncratic. It varies per person. A person may
show highest blood pressure in morning, another may show highest blood
pressure in evening. These fluctuations are rhythmic and are called circadian
chythm.
2. Age: At birth systolic BP is 40 - 60 mm Hg.
15 th day systolic BP is around 70 mm Hg.
I i h year systolic BP is around 105 mm Hg.
I t h year systolic BP is around 120 mm Hg.
60th year systolic BP is around 160 mm Hg.
3. Sex: Females have around 5 mm Hg less than males of same age. This is
due to sex hormones. After menopause values are same for both sexes.
4. Surface area: blood pressure is proportional to surface area. Hence, in
obese person blood pressure is more.
5. Digestion: Intake of food and digestion increase systolic blood pressure
by about 10 mm Hg. This is due to cardiac output, which in tum is due to a
sympathetic stimulation. Diastolic blood pressure falls slightly due to
vasodilatation in gastro-intestinal tract.
6. Sleep: During sound sleep, systolic blood pressure may fall by about 20
mm Hg. this is due to -low metabolic rate. However in disturbed sleep, blood
pressure may rise. This is due to cortical stimulation of vasomotor center.
62
7. Posture: blood pressure is variable with posture. In standing posture
systolic blood pressure is low and diastolic blood pressure is more. In lying
posture it is reverse.
When an individual stands up from a sitting posture earth's
gravitational forces start acting in long axis of body trying to minimize
venous return. This results in a fall of cardiac output and hence blood
pressure faJls. Fall in blood pressure triggers sino-aortic mechanism.
Vasomotor center is activated increasing sympathetic discharge. This
increases peripheral resistance and heart rate. Diastolic blood pressure
increases, systolic blood pressure remains low because venous return
remains low.
Thus, in standing posture systolic blood pressure is low and
diastolic blood pressure increases. In prolonged standing both systolic blood
pressure and diastolic blood pressure fall enough to cause a decreased blood
flow to brain. Subject may faint. When a person lies down from a sitting
posture, earth's gravitational forces no longer act along long axis. This is the
reason why venous return and cardiac output, increase. Sino-aortic
mechanism is inactivated. Vaso-dilation takes place causing a fall in
peripheral resistance. This results in a fall m diastolic blood pressure.
However, systolic blood pressure remams high as venous return is
increased. H~nce in lying down position systolic blood pressure is more and
diastolic blood pressure is less.
63
8. Effect of gravity: If heart is imagined at zero point, blood pressure
increases towards feet and decrease towards head. Below heart, earth's
gravitational force, acting in same direction, augments blood pressure. For
every 1 cm, rise or fall in blood pressure is by 0.77 mm Hg.
9. Emotions: Excitement, anger etc. increase blood pressure as cerebral
cortex especially limbic system through hypothalamus stimulates vasomotor
center and thereby increase activity of sympathetic nervous system.
10 Respiration: In major part of inspiration blood pressure falls and during
entire expiration it increases.
During inspiration increased negativity of intra-thoracic
pressure sucks more blood into right side. At the same time blood going to
left side of heart decreases as most of blood is trapped in lungs. Therefore
left ventricular output decreases during earlier part of inspiration causing a
fall in blood pressure. However, pulmonary circulation soon compensates
output, raising blood pressure.
11. Exercise: In strenuous exercise systolic pressure rises and might reach
even up to 180 mm of Hg. in moderate exercise there is slight rise of
systolic pressure.
Regulation of arterial blood pressure:
Whenever any fluctuation in blood pressure takes place various
short-term acting and long term acting mechanisms come into play. Putting
them in concise form:
64
a) Neural.
1. Baro receptor reflexes - Carotid SInUS reflex,
aortic arch reflex.
11. Chemoreceptor reflexes - Hypoxia, hypercapnoea,
acidosis.
111. Cushing reflex.
b) Hormonal.
1. Catecholamines - Epinephrine, nor-epinephrine.
11. Glucocorticosteroids - Cortisol, corticosterone.
111. Mineralocorticosteroids - Aldosterone, deoxy
cortico sterone.
IV. Thyroid hormone.
v. Angio tensin II
VI. Vasopressin.
VB. Histamine.
V111. Serotonin.
IX. Nitric acid
c) Chemical.
d) Renal - Renin angiotensin system, prostaglandins and
bradykinin, renal body fluid mechanism.
e) Stress relaxation phenomenon.
f) Capillary fluid shift mechanism.
65
Clinical significance:
Davidson's 'Principles and Practice of Medicine', 19th edition,
on page number 388 and onwards quotes following passages about
Hypertension.
High blood pressure is a trait as oppose d to a specific disease
and represents a quantitative rather than a qualitative deviation from the
norm. Any definition of Hypertension is therefore arbitrary. Systemic blood
pressure rises with age, and the incidence of cardiovascular disease
(particularly stroke and coronary artery disease) is closely related to average
blood pressure at all ages, even when blood pressure readings are within the
so-called 'normal range'. Moreover, a series of randomized control trials
have demonstrated that antihypertensive therapy can reduce the incidence of
stroke and to a lesser extent, coronary artery disease (EBM panel, page
393).
The cardiovascular risks associated with a given blood pressure
are dependent upon the combination of risk factors in the specific
individual. These include age, gender, weight, physical activity, smoking,
family history, blood cholesterol, diabetes mellitus, and pre-existing
vascular diseases. Effective management of Hypertension therefore requires
a holistic approach that is based on the identification of those at higher
66
cardiovascular risk and the adoption of multi factor intervention, targeting
not only at blood pressure but all modifiable cardiovascular risk factors. In
light of these observations a useful and practical definition of Hypertension
is 'the level of blood pressure at which the benefits of treatment overweigh
the costs and hazards' .
The relation between blood pressure (BP) and the risk of
cardiovascular disease is direct, graded, and continuous over a wide range,
apparently beginning at 115 mm Hg systolic and 75 mm Hg diastolic.
Despite such a continuous relation, some working definitions, or subtypes,
of Hypertension have gained wide clinical acceptance. Experimental and
clinical data support the notion that the Hypertension subtypes defined by
isolated or combined elevations of systolic and diastolic BP reflect distinct
patho-physiological mechanisms, have different prognostic implications,
and may require a different therapeutic approach.
There are two broad categories of Hypertension - Primary (or
Essential) and Secondary Hypertension. Approximately 90-95% of
patients diagnosed with Hypertension have primary Hypertension. Unlike
secondary Hypertension, there is no known cause of primary
Hypertension. Therefore, the diagnosis of primary Hypertension is made
after excluding known causes that comprise what is called secondary
Hypertension.
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Despite many years of active research, there is no unifying
hypothesis to account for the pathogenesis of primary Hypertension. There
is a natural progression of this disease that suggests early elevations in
blood volume and cardiac output might initiate subsequent changes in the
systemic vasculature (increased resistance). This has suggested to some
researchers that a basic underlying defect in many hypertensive patients is
an inability of the kidneys to adequately handle sodium. Increased sodium
retention could then account for the increase in blood volume. In chronic,
long-standing Hypertension, blood volume and cardiac output are often
normal; therefore the Hypertension is sustained by an elevation in
systemic vascular resistance rather than by an increase in cardiac output.
This increased resistance is caused by a thickening of the walls of
resistance vessels and by a reduction in lumen diameters. There is also
evidence for increased vascular tone. This could be mediated by enhanced
sympathetic activity or by increased circulating levels of angiotensin II. In
recent years, considerable evidence has suggested that changes in vascular
endothelial function may cause the increase in vascular tone. For
example, in hypertensive patients, the vascular endothelium produces less
nitric oxide and the vascular smooth muscle is less sensitive to the actions
of this powerful vasodilator. There is also an increase in endothelin
production, which can enhance vasoconstrictor tone. There is compelling
evidence that hyper insulinemia and hyperglycemia in type 2 diabetes
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(non-insulin dependent diabetes) causes endothelial dysfunction by
enhanced oxygen free radical mediated damage and decreased nitric oxide
bioavailability.
Many mechanisms may operate to initiate and sustain
Hypertension. Treatment of patients with primary Hypertension is in
reality a pharmacologic intervention to modify factors (e.g., angiotensin II,
sympathetic activity, calcium entry into cells) in a way that leads to a
reduction in arterial pressure. However, these treatments do not target the
cause(s) of the underlying disease. Nevertheless, treatment of
Hypertension with antihypertensive drugs is vitally important because
Hypertension increases the risk for coronary artery disease, stroke, renal
disease and other disorders. The three broad classes of drugs used to treat
primary Hypertension are diuretics (to reduce blood volume), vasodilators
(to decrease systemic vascular resistance), and cardioinhibitory drugs (to
decrease cardiac output).
Secondary Hypertension accounts for approximately 5-10%
of all cases of Hypertension, remaining being primary Hypertension.
Secondary Hypertension has an identifiable cause whereas primary
Hypertension has no known cause (i.e., idiopathic).
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There are many known conditions that can cause secondary
Hypertension. Regardless of the cause, arterial pressure becomes elevated
either due to an increase in cardiac output, an increase in systemic
vascular resistance, or both. When cardiac output is elevated, it is
generally due to either increased neurohumoral activation of the heart or
increased blood volume.
Patients with secondary Hypertension are best treated by
controlling or removing the underlying disease or pathology, although
they may still require antihypertensive drugs.
Target organ damage:
The adverse effects of Hypertension principally involve the
blood vessels, the central nervous system, the retina, the heart and the
kidneys and can often be detected by simple clinical means.
Blood vessels
In target arteries (over 1 mm in diameter) the internal elastic
lamina is thickened, smooth muscle is hypertrophied and fibrous tissue is
deposited. The vessels dilate and become tortuous and their walls become
less compliant. In smaller arteries (less than 1 mm in diameter) hyaline
arteriosclerosis occurs in the wall, the lumen narrows and aneurysms may
develop. Widespread atheroma develops and may lead to coronary and/or
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cerebro-vascular disease, particularly if other risk factors (e.g. smoking,
hyper-lipidaemia, diabetes) are present.
These structural changes in the vasculature often perpetuate
and aggregate Hypertension by increasing peripheral vascular resistance and
reducing renal function.
Hypertension is also implicated in the pathogenesis of aortic
aneurysm and aortic dissection.
Central nervous system
Stroke is common complication of Hypertension and may be
due to cerebral hemorrhage or due to cerebral infarction. Carotid atheroma
and transient cerebral ischemic attacks are more common in Hypertensive
patient. Subarachnoid hemorrhage is also associated with Hypertension.
Hypertensive encephalopathy is a rare condition characterized
by high blood pressure and neurological symptoms, including transient
disturbance of speech or vision, parasthesia, disorientation, fits, dizziness
and loss of consciousness. Papilloedema is common. A CT scan of the brain
often shows hemorrhage in and around the basal ganglia; however the
neurological deficit is usually reversible if the Hypertension is properly
managed.
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Retina
The optic fundi reveal a gradation of changes linked to the
severity of Hypertension. Fundoscopy can therefore provide an indication of
the arteriolar damage occurring elsewhere.
Heart
The excess cardiac mortality and morbidity associated with
Hypertension is largely due to higher incidence of coronary artery disease.
High blood pressure places a pressure load on the heart and
may lead to left ventricular hypertrophy with a forceful apex beat and fourth
heart sound. ECG or echocardiography evidence of left ventricular
hypertrophy is highly predictive of cardiovascular complications and these
tests are therefore particularly useful in risk assessment.
Atrial fibrillation is common and may be due to diastolic
dysfunction caused by left ventricular hypertrophy or the effects of coronary
artery disease.
Severe Hypertension can cause left ventricuIar failure in the
absence of coronary artery disease, particularly when renal function and
therefore sodium retention is impaired.
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Kidneys
Long standing Hypertension may cause proteinuria and
progressive renal failure by damaging the renal vasculature.
Malignant or (accelerated' phase Hypertension
This rare condition may complicate Hypertension of any
etiology and is characterized by accelerated micro vascular damage with
necrosis in the walls of the small arteries and arterioles and intravascular
thrombosis. The diagnosis is based on evidence of high blood pressure and
rapidly progressive end organ damage such as retinopathy of grade three or
four, renal dysfunction, hypertensive encephalopathy. Left ventricular
failure may occur and if this is untreated, death occurs within months.
Approach to newly diagnosed Hypertension:
Hypertension occasionally causes headache but, provided there
are no complications, most patients remain asymptomatic. Accordingly, the
diagnosis is usually made at routine examination or when a complication
arises. A blood pressure check is adisable every 5 years in adults.
The objectives of the initial evaluation of a patient with high
blood pressure readings are:
• To obtain accurate and non representative measurements
of blood pressure
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• To identify contributory factors and any underlying
cause (Secondary Hypertension)
• To assess other risk factors and quantify cardiovascular
risks
• To direct any complications regarding target organs that
are already present
• To identify co-morbidity that may influence the choice
of Antihypertensive therapy
These goals can be usually attained by a careful history,
clinical examination and some simple investigations.
Clinical assessment and investigations:
History
Family history, lifestyle (exercises, diet, smoking habits) and
other risk factors should be recorded. A careful history will also identify
these patients with drugs or alcohol induced Hypertension and may elicit
symptoms of other causes of Hypertension such as pheochromocytoma
(paroxysmal headaches, palpitation and sweating) and/or complications
such as coronary artery disease (e.g. angina, breathlessness).
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Examinatil'n
Radio-femoral delay (coarctation of aorta), enlarged kidneys
(polycystic kidney disease), abdominal bruits (renal artery stenosis), and the
characteristic facies and habitus of Cushing's syndrome are all examples of
physical signs that may help to identifY one of the causes of Secondary
Hypertension. Examination may also reveal features of important risk
factors such as central obesity, hyperlipidemia. Nevertheless the majority of
abn~rmal signs are due to the complications of Hypertension.
Non-specific findings may include left ventricular hypertrophy
(apical heave), accentuation of aortic component of the second heart sound,
and a fourth heart sound. The optic fundi are often abnormal and there may
be the evidence of generalized atheroma or specific complications such as
aortic aneUlysm or peripheral vascular disease.
Investigations
All hypertensive patients should undergo a limited number of
investigations. Additional investigations are appropriate in selected patients,
the list is given below.
Hypertension - investigations for all patients
• Urinanalysis for blood, proteins and glucose
• Blood urea, electrolytes and creatinine
• Blood sugar
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• Serum total and high density lipoproteins, cholesterol
• 12 lead ECG
Hypertension - investigations for specific patients
• Chest X-Ray (for detection of cardiomegaly, heart
failure, coarctation of aorta)
• Ambulatory BP recording to assess borderline or 'white
coat' Hypertension
• Electrocardiogram to detect or quantify left ventricular
hypertrophy
• Renal ultrasound to detect possible renal disease
• Urinary catecholamine to detect possible
pheochromocytoma
• Urinary cortisol and dexamethasone suppression test to
detect Cushing's syndrome
• Plasma rennin activity and aldosterone to detect possible
primary aldosteronism
High Blood Pressure Symptoms:
High blood pressure usually causes no symptoms.
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Even if high blood pressure does cause symptoms, the
symptoms are usually mild and nonspecific (vague or suggesting many
different disorders).
Thus, high blood pressure often is labeled "the silent killer."
People who have high blood pressure typically don't know it
until their blood pressure is measured.
Sometimes people with high blood pressure have the following
symptoms:
• Headache
• Dizziness
• Blurred vision
• Nausea
People often do not seek medical care until they have
symptoms arising from the organ damage caused by chronic (ongoing, long
term) high blood pressure. The following types of organ damage are
commonly seen in chronic high blood pressure:
• Heart attack
• Heart failure
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• Stroke or "mini stroke" (transient ischemic attack,
TIA)
• Kidney failure
• Eye damage with loss of vision
• Peripheral arterial disease
• aneurysms
About 1 % of people with high blood pressure do not seek
medical care until the high blood pressure is very severe, a condition known
as malignant Hypertension.
• In malignant Hypertension, the diastolic blood pressure (the
lower number) often exceeds 140 mm Hg.
• Malignant Hypertension may be associated with headache,
light-headedness, or nausea.
• This degree of high blood pressure reqUIres emergency
hospitalization and lowering of blood pressure to prevent
brain hemorrhage or stroke.
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It is of utmost importance to realize that high blood pressure
can be unrecognized for years, causing no symptoms but causmg
progressive damage to the heart, other organs, and blood vessels.
Factors that can't be changed:
Age: The older one gets, the greater is the likelihood of developing high
blood pressure, especially systolic, as your arteries get stiffer. This is largely
due to arteriosclerosis, or "hardening of the arteries."
Race: African Americans have high blood pressure more often than whites.
They develop high blood pressure at a younger age and develop more severe
complications sooner.
Socioeconomic status: High blood pressure is also more common among
the less educated and lower socioeconomic groups. Residents of the
southeastern United States, both whites and blacks, are more likely to have
high blood pressure than Americans from other regions.
Family history (heredity): The tendency to have high blood pressure
appears to run in families.
Gender: Generally men have a greater likelihood of developing high blood
pressure than women. This likelihood varies according to age and among
various ethnic groups.
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Factors that can be changed :Overweight (obesity): Obesity is defined
as having a body mass index (BMI) greater than 30 kg/m2. It is very closely
related to high blood pressure. Medical professionals strongly recommend
that all obese people with high blood pressure lose weight until they are
within 15% of their healthy body weight. Your health care provider can help
you calculate your BMI and healthy range of body weight.
Sodium (salt) sensitivity: Some people have high sensitivity to sodium
(salt), and their blood pressure goes up if they use salt. Reducing sodium
intake tends to lower their blood pressure. Americans consume 10-15 times
more sodium than they need. Fast foods and processed foods contain
particularly high amounts of sodium. Many over-the-counter medicines,
such as painkillers, also contain large amounts of sodium. Read labels to
find out how much sodium is contained in food items. Avoid those with
high sodium levels.
Alcohol use: Drinking more than one to two drinks of alcohol per day tends
to raise blood pressure in those who are sensitive to alcohol.
Birth control pills (oral contraceptive use): Some women who take birth
control pills develop high blood pressure.
Lack of exercise (physical inactivity): A sedentary lifestyle contributes to
the development of obesity and high blood pressure.
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Drugs: Certain drugs, such as amphetamines (stimulants), diet pills, and
some pills used for cold and allergy symptoms, tend to raise blood pressure.
When to Seek Medical Care :
One should call for health care provider if a routine blood
pressure measurement (during health screening) reveals systolic blood
pressure higher than 140 mm Hg, diastolic blood pressure higher than 90
mm Hg, or both.
Also care should be taken III case of any of the following
symptoms:
• Unexplained severe headache
• Sudden or gradual changes in vision
• Light-headedness or dizziness
• Nausea associated with severe headache
• Chest pain or shortness of breath upon exertion
It is needed to tell the health care provider if any family
member has or has had high blood pressure, heart attack, stroke, or kidney
failure.
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It is needed to go to a hospital emergency department if your
blood pressure is high when measured (for example, if your diastolic
pressure is greater than 100 mm Hg).
It is also needed to go to a hospital emergency department if
you have any of the following symptoms:
• Severe headache
• Unexplained dizziness of faintness
• Unexplained blurred vision or loss of vision (partial or
complete)
• Chest pain or breathlessness that is severe or occurs at
rest
• Unexplained sudden weakness or other symptoms of
stroke
Medical Treatment:
In about half of people with high blood pressure, limiting
sodium intake by eliminating table salt, cooking salt, and salty and
processed foods can reduce blood pressure by 5 mm Hg. Losing weight and
doing regular physical activity can reduce the blood pressure further.
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If these lifestyle changes and choices don't work, medications
should be added. The medications have been proven to reduce the risk of
stroke, heart disease, and kidney problems. Do not stop taking your
medications without talking to your health care provider.
Medications :
Medications most often prescribed for high blood pressure
include the following:
Water pills (diuretics):
Diuretics are used very widely to control mildly high blood
pressure, and are often used in combination with other medications.
They increase sodium excretion and urine output and decrease
blood volume. The sensitivity to the effect of other hormones in your body
is decreased.
Example - Hydrochlorothiazide (HydroDIURIL)
Beta-blockers:
Beta-blockers reduce heart rate and decrease the force of heart
contraction, thereby reducing the pressure generated by the heart.
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They are preferred for people who have associated coronary
heart disease, angina, or history of a heart attack, since they also prevent
recurrent heart attacks and sudden death.
Examples - Carvedailol (Coreg), metoprolol (Lopressor),
atenolol (Tenormin)
Side effects - Fatigue, depression, impotence, nightmares
Calcium channel blockers :
Calcium channel blocking agents work by relaxing the muscle
in the walls of the arteries.
They also reduce the force of contraction of the heart.
Examples - Nifedipine (Procardia), diltiazem (Cardizem),
. verapamil (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc),
felodipine (Plendil)
Side effects - Ankle swelling, fatigue, headache, constipation,
flushing
Angiotensin-converting enzyme (ACE) inhibitors:
ACE inhibitors stop the production of a chemical called
angiotensin II, a very potent chemical that causes blood vessels to contract,
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a cause of high blood pressure. Blockage of this chemical causes the blood
vessels to relax.
Examples - Captopril (Capoten), enalapril (Vasotec), lisinopril
(Zestril, Prinivil), quinapril (Accupril), fosinopril (Monopril)
Side effects are infrequent but sometimes they can worsen
kidney function and raise blood potassium levels, especially in patients with
damaged kidneys. ACE inhibitors sometimes cause dry cough and rarely
angioedema (severe swelling around the trachea/windpipe).
Angiotensin receptor blockers or ARBs :
ARBs work on receptors in tissues all over the body to prevent
uptake of angiotensin II, and therefore inhibit the vasoconstrictor effect of
angiotensin II.
Examples - Losartan (Cozaar), valsartan (Diovan), candesartan
(Atacand), and irbesartan (Avapro)
Side effects tend to be less with ARBs than ACEls with much
less cough.
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Alpha-blockers :
Alpha-blockers relax blood vessels by blocking messages from
the nervous system that cause muscular contraction.
Examples - Terazosin (Hytrin), doxazosin (Cardura)
Since publication of a study known as the ALLHA T
(Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial) in 42,000 patients, and premature termination of the alpha-blocker
arm (discontinuation of treatment in the group receiving alpha-blockers)
because of excessive incidence of congestive heart failure, alpha-blockers
are no longer frequently prescribed and are primarily used in men with
associated prostatism (benign prostatic hyperplasia, or enlargement of the
prostate) symptoms.
Blockers of central sympathetic (autonomic nervous) system:
These agents block messages out of the brain from the
autonomic nervous system that contract blood vessels. The autonomic
nervous system is the part of the nervous system that is automatic and
controls heart rate, breathing rate, and other basic functions.
The effect of these drugs is to relax blood vessels, thus
lowering blood pressure. These agents are not as popular because of
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exceSSIve side effects, and no randomized trials demonstrate their
effectiveness in lowering heart attacks, strokes, etc.
Example - Clonidine (Catapres)
Direct vasodilators:
Direct vasodilators dilate the blood vessels to allow blood to
flow under lower pressure.
These medications are often given through an IV line in an
emergency (that is, in malignant Hypertension).
Examples - Nitroprusside (Nitropress), diazoxide (Hyperstat).
Oral medications are hydralazine and minoxidil.
Surgery :
Rarely, surgery is needed to remove benign, hormone
producing tumors of the adrenal gland. If a narrowing of a renal artery is
discovered, sometimes a balloon dilatation, followed by placement of a
metal stent, is done in the invasive vascular laboratory.
Other Therapy:
Alternative therapies may be helpful to people trying to control
their blood pressure.
87
Acupuncture and biofeedback are well-accepted alternative
techniques that may help some people with high blood pressure.
Techniques that induce relaxation and reduce stress are
recommended. These include meditation, yoga, and relaxation training.
These techniques alone will not keep the blood pressure in the
healthy range for many people. They are not used as a substitute for medical
therapy.
Dietary supplements and alternative medications and therapies
are sometimes recommended for high blood pressure.
Examples are vitamins, garlic, fish oil, L-arginine, soy,
coenzyme QI0, herbs, phytosterols~ and chelation therapy.
While these substances may be beneficial, the exact nature of
their benefits is not known.
Scientific studies have produced no evidence that these
therapies lower blood pressure or prevent the complications of high blood
pressure.
Most of these substances are harmless if taken in moderate
doses. Most people can take them without problems.
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Apparatus:
1. Cuff - it consists of an empty rubber bag, rectangle in shape, measuring
about 18 x 12 cm. It beats two tubes. It is wrapped in silk or linen covering
bag.
2. Tubes of cuff - one of the tubes is connected to mercury manometer and
other to hand pump.
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3. Mercury manometer - it is U-shaped glass tube with one long calibrated
arm and other short well-shaped thick arm filled with mercury. One tube
from cuff is connected to calibrated arm of mercury manometer so pressure
of inflation of rubber bag is recorded directly on manometer.
4. Hand pump - it bears valve for pushing air when desired. It is directly
connected to cuff. Hence pushed air enters bag and inflates it pressing
brachial artery around which it is wound.
Methods:
1. Palpatory method.
2. Auscultatory method.
J. Oscillatory method.
1. Palpatory method:
1. Cuff ofB.P. apparatus is wound around brachial artery four fingers above
cubital crease so as to expose cubital fossa.
2. Cuff is connected to mercury manometer of shygmomanometer.
3. Radial pulse of same upper extremity to which cuff is tied is palpated
with three fingers.
4. With the help of hand pump, closing valve of pump, air is pushed into
cuff inflating it against brachial artery. B.P. cuff is inflated to around 200
mm Hg. While deflating the cuff, mercury manometer is constantly
observed.
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5. Pressure at which radial pulse IS no more palpable IS recorded as
'approximate systolic pressure' .
Diastolic pressure is not measured by this method. This is
because once radial pulse is re-established at systole and continues being
palpable throughout deflation.
1. Auscultatory method:
1. Cuff is inflated to 20 mm Hg. above approximate systolic pressure
decided by palpatory method.
2. Chest piece of stethoscope is kept on brachial artery and valve of
hand pump is released.
3. While cuff is deflated, sounds over brachial artery are heard carefully.
First sound heard is clear tap sound of systolic pressure. This IS
because of gush of forcing blood, hitting wall of empty vessel.
4. Due to occlusion in flow of blood, Eddie currents produce sounds
like murmur, which last for sometime while deflation is continued,
get muffled, and stop. These are called Korotcoff s sounds. Pressure
at which these stop is diastolic pressure. This is because normal
laminar flow of blood is established in artery, which is soundless.
5. In patients where systolic pressure is high sometimes while
deflating the cuff, the blood hits walls of empty vessel and gives first
systolic tap, as usual. A few sounds may be heard following this tap,
which are not strong. At lower pressure than the first systolic tap,
91
strong sounds start becoming audible through stethoscope. For a
beginner, this lower tap is many times approximate systolic pressue.
The gap between real systolic tap and reappearance of strong sounds
is called 'auscultatory gap'.
ntlatabltl-·~"~' cuff
How to overcome 'auscultatory gap'?
No sQunds (artery is closed)
sound$, are ooafd with $t~osoopt\
Palpation of radial artery after deflation of cuff helps in
estimating real systolic blood pressure. Whenever one feels auscultatory
gap, one should go for palpation of radial artery to overcome misjudgment
of systolic blood pressure.
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2. Oscillatory method:
Cuff of apparatus is wound over brachial artery on upper arm.
Cuff is inflated to around 200 mm Hg. then it is deflated slowly. Mercury
column of manometer is observed while this deflation takes place. At a
certain pressure, oscillations are noticed to appear, in the mercury column.
This pressure is recorded as systolic pressure. After sometime, these
oscillations disappear. At this time, pressure recorded is diastolic pressure.
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