The major types of medication used to control high blood pressure include: § Thiazide diuretics. These medications act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. Still, diuretics are often not prescribed. If you&apos;re not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. § Beta blockers. These medications reduce the workload on your heart, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don&apos;t work as well in blacks — but they&apos;re effective when combined with a thiazide diuretic. § Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors don&apos;t work as well in blacks when prescribed alone, but they&apos;re effective when combined with a thiazide diuretic. § Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure and kidney failure. § Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Researchers have identified the substance in grapefruit juice that causes the potentially dangerous interaction, which may one day lead to commercial grapefruit juices that don&apos;t pose a risk of interaction. For now, however, talk to your doctor or pharmacist if you&apos;re concerned about interactions. § Renin inhibitors. A new drug Tekturna (aliskiren) is a renin inhibitor. Renin is an enzyme produced by your kidneys that starts a cascade of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. Tekturna acts earlier in your body&apos;s blood pressure regulation process than most other blood pressure medications. It also can be used well with the other major classes of blood pressure drugs to improve their actions. Tekturna can be used alone, but it&apos;s more effective when used in combination with existing high blood pressure medications, such as water pills (diuretics). Tekturna&apos;s effects on blood pressure last more than 24 hours, so it can be taken once daily in oral tablet form. If you&apos;re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe: § Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. § Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. § Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels. Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat. Limit the amount of sodium in diet. Although 2,400 milligrams (mg) of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 mg a day will have a more dramatic effect on blood pressure. Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too. Practice slow, deep breathing. Do it on own or try device-guided paced breathing. In various clinical trials, regular use of Resperate — an over-the-counter device approved by the Food and Drug Administration to analyze breathing patterns and help guide inhalation and exhalation — significantly lowered blood pressure.
C-reactive protein. Liver produces C-reactive protein (CRP) in response to injury or infection. CRP is also produced by muscle cells within the coronary arteries. CRP is a general sign of inflammation, which plays a central role in atherosclerosis. Homocysteine. Homocysteine is an amino acid the body uses to make protein and to build and maintain tissue. But excessive levels of homocysteine may increase the risk of coronary artery disease and other cardiovascular conditions. Fibrinogen. Fibrinogen is a protein in the blood that plays a central role in blood clotting. But too much may promote excessive clumping of platelets, the type of blood cell largely responsible for clotting. That can cause a clot to form in an artery, leading to a heart attack or stroke. Fibrinogen may also be an indicator of the inflammation that accompanies atherosclerosis. Lipoprotein (a). This substance forms when a low-density lipoprotein (LDL) particle attaches to a specific protein. Lipoprotein (a) may disrupt the body&apos;s ability to dissolve blood clots. High levels of lipoprotein (a) may be associated with an increased risk of cardiovascular disease, including coronary artery disease and heart attack.
Chest pain (angina). When the coronary arteries narrow, heart may not receive enough blood when demand is greatest — particularly during physical activity. This can cause chest pain (angina) or shortness of breath. Heart attack. If a cholesterol plaque ruptures, stimulating platelet clumping, complete blockage of the heart artery may trigger a heart attack. The lack of blood flow to the heart during a heart attack leads to irreversible damage to the heart muscle. The amount of damage depends in part on how quickly you receive treatment. Heart failure. If some areas of heart are chronically deprived of oxygen and nutrients because of reduced blood flow, or if the heart has been damaged by a heart attack, heart may become too weak to pump enough blood to meet the body&apos;s needs. This condition is known as heart failure. Abnormal heart rhythms (arrhythmia). Inadequate blood supply to the heart or damage to heart tissue can interfere with heart&apos;s electrical impulses, causing abnormal heart rhythms.
Various drugs can be used to treat coronary artery disease, including: Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL) or &quot;bad&quot; cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Boosting the high-density lipoprotein (HDL), or &quot;good&quot; cholesterol, may help, too. The doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants. Aspirin. Doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of blood to clot, which may help prevent obstruction of coronary arteries. If you&apos;ve had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn&apos;t appropriate, such as if you have a bleeding disorder of you&apos;re already taking another blood thinner, so ask doctor before starting to take aspirin. Beta blockers. These drugs slow heart rate and decrease blood pressure, which decreases heart&apos;s demand for oxygen. If you&apos;ve had a heart attack, beta blockers reduce the risk of future attacks. Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by opening up coronary arteries and reducing heart&apos;s demand for blood. Angiotensin-converting enzyme (ACE) inhibitors. These drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you&apos;ve had a heart attack, ACE inhibitors reduce the risk of future attacks. Calcium channel blockers. These medications relax the muscles that surround coronary arteries and cause the vessels to open, increasing blood flow to heart. They also control high blood pressure.
Procedures to restore and improve blood flow Angioplasty and stent placement (percutaneous coronary revascularization). In this procedure, doctor inserts a long, thin tube (catheter) into the narrowed part of artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against artery walls. A mesh tube (stent) is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open. Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it&apos;s most often reserved for cases of multiple narrowed coronary arteries.
Dr. Shamanthakamani Narendran
M.D. (Pead), Ph.D. (Yoga
Persistent – higher than normal blood pressure can
damage internal organs if untreated.
Normally, blood is under pressure as the heart
forces it around the circulation.
In hypertension, this pressure is above normal
There are no symptoms at first, but despite this,
over time it increases the risk of many serious
disorders, such as stroke, heart disease and
There is no obvious cause; however, lifestyle
and genetic factors may contribute, as do being
overweight, drinking excessive amounts of
alcohol, smoking and having a high-salt diet.
Most common in middle-aged and elderly
A stressful lifestyle may aggravate the condition.
A change of diet and lifestyle may be all that is
necessary, but more severe cases may be treated
with antihypertensive drugs.
High blood pressure can have for years without a
single symptom. But silence isn't golden.
Uncontrolled high blood pressure increases the
risk of serious health problems, including heart
attack and stroke.
Blood pressure is determined by the amount of
blood the heart pumps and the amount of
resistance to blood flow in the arteries.
The more blood the heart pumps and the
narrower the arteries, the higher the blood
High blood pressure typically develops without
signs or symptoms.
It affects nearly everyone eventually. If he/she
don't have high blood pressure by 55 years of
age, 90 percent chance of developing it at some
point in life, according to the National Heart,
Lung, and Blood Institute.
SYSTOLIC - 90 TO 140 mm/Hg
DIASTOLIC - 60 TO 90 mm/Hg
Pulmonary hypertension begins when tiny
arteries in the lungs, called pulmonary arteries
and capillaries, become narrowed, blocked or
This makes it harder for blood to flow through
the lungs, which raises pressure within the
As the pressure builds, the heart's lower right
chamber (right ventricle) must work harder to
pump blood through the lungs, eventually
causing the heart muscle to weaken and
sometimes fail completely.
Pulmonary hypertension is a serious illness that
becomes progressively worse and is sometimes
Although it isn't curable, treatments are available
that can help lessen symptoms and improve the
quality of life.
Most people with high blood pressure have no
signs or symptoms, even if blood pressure
readings reach dangerously high levels.
Although a few people with early-stage high
blood pressure may have fatigue, dull headaches,
dizzy spells or a few more nosebleeds than
normal, these signs and symptoms typically don't
occur until high blood pressure has reached an
advanced – possibly life-threatening – stage.
Signs and symptoms of pulmonary HTN are subtle
in the early stages and may not be noticeable for
months. As the disease progresses, it becomes
Shortness of breath (dyspnea), either while
exercising or at rest
Dizziness or fainting spells (syncope)
Chest pressure or pain
Swelling (edema) in ankles, legs and eventually in
Bluish color lips and skin (cyanosis)
Racing pulse or heart palpitations
90-95% etiology is idiopathic. This type of HBP
is essential HTN or primary HTN, tends to
develop gradually over many years.
The other 5-10% of HBP cases caused by an
underlying condition. This type of HBP, called
secondary HTN, tends to appear suddenly and
cause higher BP than does primary hypertension.
Various conditions can lead to secondary
hypertension, including kidney abnormalities,
tumors of the adrenal gland or certain congenital
Certain medications –birth control pills, cold
remedies, decongestants, OTC pain relievers and
some prescription drugs also may cause
In a 2005 study, women who took an average of
500 mg or more of acetaminophen daily over
several years were more likely to develop HBP
than were women who didn't take any
acetaminophen. It's not known if the same holds
true for men.
Various illicit drugs, including cocaine and
amphetamines, also can increase blood pressure.
CONTRACTION OF THE HEART
Anger Fear Tension
Age - risk of HBP increases as one gets older.
Through early middle age, HBP is more
common in men. Women are more likely to
develop HBP after menopause.
Race - HBP is particularly common among
blacks, often developing at an earlier age than it
does in whites. Serious complications, such as
stroke and heart attack, also are more common in
Family history - HBP tends to run in families.
Excess weight - Greater body mass, the more
blood need to supply oxygen and nutrients to the
tissues. As the volume of blood circulated
through the blood vessels increases, so does the
pressure on artery walls.
Inactivity - People who are inactive tend to have
higher heart rates. Lack of physical activity also
increases the risk of being overweight.
Tobacco use - Chemicals in tobacco can damage
the lining of the artery walls, which promotes
narrowing of the arteries.
Sodium intake - Too much sodium in diet.
Low potassium intake – Potassium helps to balance
the amount of sodium in the cells. If doesn’t consume
or retain enough potassium, may accumulate too
much sodium in the blood.
Excessive alcohol - Over time, heavy drinking can
Stress - High levels of stress can lead to a temporary
but dramatic increase in BP. If try to relax by eating
more, using tobacco or drinking alcohol, may only
fuel problems with HBP.
Certain chronic conditions may increase risk of HBP,
including high cholesterol, diabetes, kidney disease
and sleep apnea. Pregnancy - PIH.
In a 2006 study, adults who worked more than
40-50 hours a week – particularly sedentary,
workers - were more likely to have HBP than
were those who worked 40 hours or less a week.
Researchers tied the higher risk for workers with
longer hours to unhealthy eating, less exercise,
more stress and less sleep.
Although HBP is most common in adults,
children may be at risk, too. For some children,
HBP is caused by problems with the kidneys or
heart. But for a growing number of kids, poor
lifestyle habits – such as an unhealthy diet and
lack of exercise – contribute to HBP.
STRESS AND HYPERTENSION
• Imbalance at ANS –
• Increased secretion of
catecholamines due to
HPA Axis stimulation.
TESTS AND DIAGNOSIS
BP is measured with an inflatable arm cuff and a
A BP reading, given in mm Hg, has two
The first, or upper, number measures the
pressure in the arteries when the heart beats
The second, or lower, number
measures the pressure in the
arteries between beats
Normal BP – 115/75 mmHg to 120/80 mmHg
Pre-hypertension –systolic pressure ranging
from 120-139 or a diastolic pressure from 80-89.
Stage 1 HTN – systolic pressure from 140-159
or diastolic pressure from 90-99.
Stage 2 HTN – most severe HTN, systolic
pressure of 160 or higher or a diastolic pressure
of 100 or higher.
Both numbers in a BP reading are important. But
after age 50, the systolic reading is even more
significant. Isolated systolic hypertension (ISH)
– when diastolic pressure is normal but systolic
pressure is high – is the most common type of
high blood pressure among people older than 50.
Single HBP reading usually isn't enough for a
diagnosis. Because BP normally varies
throughout the day – and sometimes specifically
during visits to the doctor – diagnosis is based
on more than one reading taken on more than
one occasion. Record BP at home and at work
will provide additional information.
If any type of HBP, the doctor may recommend
routine tests, such as urinalysis, blood tests and
an ECG – measures heart's electrical activity.
Excessive pressure on the artery walls can
damage vital organs.
The higher blood pressure and the longer it goes
uncontrolled, the greater the damage.
Damage to arteries. This can result in hardening
and thickening of the arteries (atherosclerosis),
which can lead to a heart attack or other
complications. An enlarged, bulging blood
vessel (aneurysm) also is possible.
Heart failure. To pump blood against the higher
pressure in vessels, the heart muscle thickens.
Eventually, the thickened muscle may have a
hard time pumping enough blood to meet the
body's needs, which can lead to heart failure.
A blocked or ruptured blood vessel in brain can
lead to stroke.
Weakened and narrowed blood vessels in the
kidneys can prevent these organs from
Thickened, narrowed or torn blood vessels in the
eyes can result in vision loss.
Metabolic syndrome – is a cluster of disorders of the
body's metabolism – including elevated waist
circumference, high triglycerides, low high-density
lipoprotein (HDL), or "good," cholesterol, HBP and
high insulin levels.
Uncontrolled HBP also may affect the ability to
think, remember and learn.
Cognitive impairment and dementia are more
common in people who have HBP.
TREATMENTS & DRUGS
Treating HBP can help prevent serious – even
life-threatening – complications.
Doctor also may suggest steps to control
conditions that can contribute to HBP, such as
diabetes and high cholesterol.
Blood pressure goals aren't the same for
everyone. Although everyone should strive for
blood pressure readings below 140/90, doctors
recommend lower readings for people with
Blood pressure treatment goals
140/90 mm Hg or lower If he/she is a healthy adult
130/80 mm Hg or lower
If presence of chronic kidney
disease, diabetes or CAD or
are at high risk of CAD
120/80 mm Hg or lower
If the heart isn't pumping as
well as it should (left
ventricular dysfunction or
heart failure) or may have
severe chronic kidney disease
Changing the lifestyle can go a long way toward
controlling HBP. But sometimes lifestyle changes
aren't enough. In addition to diet and exercise,
doctor may recommend medication to lower the
blood pressure, which category of medication
doctor prescribes depends on the stage of HBP.
Doctor may prescribe a combination of low-dose
medications rather than larger doses of one single
drug. In fact, two or more blood pressure drugs
often work better than one.
Sometimes finding the most effective medication
or combination of drugs – is a matter of trial and
Major types of medication used to control HBP
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Calcium channel blockers
LIFESTYLE & HOME REMEDIES
Eat healthy foods – DASH diet (Dietary
Approaches to Stop Hypertension)
Maintain a healthy weight.
No or limit alcohol
Practice slow, deep breathing
The heart is a powerful organ about the size of a
Located just to the left of center between the
It operates as two coordinated pumps that send
blood around the body.
HEART BLOOD SUPPLY
The muscle wall or myocardium of the heart is
constantly active and needs a generous supply of
oxygen and energy from blood.
To provide this, the heart muscle has its own
network of blood vessels known as coronary
These 2 arteries (right and left branch from the
main artery) the aorta, just after it leaves the
heart, divide over the heart’s surface and send
smaller blood vessels into the heart muscle.
The pattern of the coronary veins, which collect
wastes from the muscle tissue, is similar.
Most of the blood in these veins is collected by
the coronary sinus, a large vein at the back of the
heart that empties into the right atrium.
INCREASING RAPIDLY IN
LAST FIVE DECADES
W H MODERN LIFE STYLE
Coronary arteries are the major blood vessels
that supply the heart with blood, oxygen and
When these arteries become damaged or
diseased – usually due to a buildup of fatty
deposits called plaques –coronary artery disease.
These deposits can slowly narrow the coronary
arteries, causing the heart to receive less blood.
Eventually, diminished blood flow may cause
chest pain (angina), shortness of breath or other
symptoms. A complete blockage, caused either
by accumulated plaques or a ruptured plaque,
can cause a heart attack.
Because coronary artery disease often develops
over decades, it can go virtually unnoticed until
it produces a heart attack.
But there's plenty to prevent and treat coronary
artery disease. Start by committing to a healthy
Hardening of the arteries,
and the presence of a
thrombus, or clot, in a
blood vessel are the most
common causes of
responsible for most of the
deaths resulting from
heart attacks. Spasms of
the coronary arteries can
also result in a heart
PLAGUE AND CHOLERAPLAGUE AND CHOLERA OF
LAST CENTURY REPLACED BY
HEART ATTACK AND CANCERHEART ATTACK AND CANCER
IN THIS CENTURY
HEART ATTACK -THE SECOND
MAJOR KILLER AFTER ACCIDENTS
FAT DEPOSIT ON HEART
OVERLOAD ON HEART
DEPOSITS IN ARTERIES
LEADS TO OBESITY
LDL :HDL > 5 : 1
Sometimes coronary artery disease develops
without any classic risk factors. Researchers are
studying other possible factors,
C-reactive protein (CRP) – Liver product
Homocysteine – (amino acid) the body uses to
make protein and to build and maintain tissue.
Fibrinogen – protein in the blood that plays a
central role in blood clotting.
Lipoprotein (a) – substance forms when a LDL
particle attaches to a specific protein.
Chest pain – coronary arteries narrow
Heart attack – cholesterol plaque ruptures,
stimulating platelet clumping, complete
blockage of heart artery may trigger a heart
Heart failure – some areas of heart are
chronically deprived of oxygen and nutrients
because of reduced blood flow, or damaged by a
heart attack, heart may become too weak to
pump enough blood to meet body's needs
Abnormal heart rhythm – Inadequate blood
Electrocardiography (EKG / ECG)
Detects heart abnormalities, disease and
damage by measuring the heart's rhythms and
The image shows the motion pattern and
structure of the four heart valves, revealing
any potential leakage (regurgitation) or
narrowing (stenosis). During this test, a
Doppler ultrasound may be done to
evaluate cardiac blood flow.
Stress Test/ Exercise tolerance test (ETT) / treadmill test
It can assess the heart’s reaction
under physical stress.
Flutter: Rapid, regular contraction of atria or
ventricle reaching upto 250/300 beats per minute.
Fibrillation: Rapid, random, irregular contraction
reaching upto 350-400 beats per minute.
Defibrillator is applied to the chest wall to help in
Defibrillation is a technique used to counter the onset
of ventricular fibrillation, a common cause of cardiac
arrest. Defibrillation is part of an advanced cardiac life
support. It applies a controlled electric shock.
Millions of people in the world suffer from the
diseases of the heart and blood vessels.
The heart, which is muscular pump, keeps the blood
circulation of blood going.
But when there is a break down of this complicated
mechanism, blood supply to a part of the body may be
affected leading to what is known as heart attack.
But with yoga the cardiovascular diseases can be
cured. Diseases that can be cured are:
Arteriosclerosis - hardening of arteries
Coronary Thrombosis - sudden blocking of one of
Yoga helps to cope with this stress so that do
not need to depend on smoking or eating
It also helps to find a contentment from
Smoking should be completely stopped as it
constricts the arteries.
For daily practice :
Keep yourself relaxed and free from anxiety ,
nervousness, tension and restlessness.
Meditation – has been scientifically proven to
be beneficial for hypertensive people.
Ujjayi Pranayama - can be done while lying for
about 3-4 minutes, if the blood pressure rises
Nadi Shodak Pranayama - It can be done 10
General considerations: Consultation with
patient’s doctor is advisable because the
limitation may differ substantially according to
various heart diseases and their stages. Some
heart abnormalities require no or little restraint.
Contraindications: No practices with internal
breath retention. No physically demanding
physical exercises exceeding trainee’s
tolerance. Practices like Agnisara Dhauti or
Shankha Prakshalana may be too risky even in
persons with heart problems whose condition is
Recommendations: Patients shortly after
myocardial infarction are advised to practice
Savasana, full yoga breath and later some easy
Pavanmuktasanasa, in prone position.
General considerations: Severe hypertension
should be medically treated on a long-term
Contraindications: Long internal breath
retention and inverted asanas, especially in
older people, are usually not suitable. Shankha
Prakshalana with drinking too much of salty
water and too physically demanding exercise
may be risky.
Recommendations: Relaxation, Ujjayi,
Bhramari, and other practices.
General considerations: Hypotension, if it is
not caused by some acute condition, such as
internal bleeding, is usually not a serious
Contraindications: People with hypotension
should raise up very slowly after practising
inverted asanas or after asanas in lying position
to prevent dizziness.
Recommendations: Most vigorous Yoga
practices such as Surya Namaskara,
Dhanurasana, Bhunjangasana and activating
pranayamas which increase blood pressure.
Recommended Asana :
Suryanamaskara (Sun salutation) - activates the
Pavanmuktasana (Relieving the flatus) - wind
reliever, corrects malfunctioning of the
abdomen. Make 4-6 rounds.
Uttanpadasana (Raising the legs) - Helps reduce
Santulanasana - normalizes blood circulation.
Savasana (Corpse pose) - should be done twice
or thrice daily as it normalizes the blood