The document discusses hypertension, noting that its prevalence is increasing worldwide and discusses its classification, treatment options including various classes of antihypertensive drugs and their mechanisms of action, experimental models used to study hypertension, and approaches to it in Ayurveda.

1. ??
BRAIN
STROKE
HEART
FAILURE,
Coronary
Heart
Disease
RETINOPATHY RENAL
FAILURE
1

2.  One in three adults worldwide, according to
the report, has raised blood pressure – a
condition that causes around half of all
deaths from stroke and heart disease.
 Overall prevalence for hypertension in India is
29.8%.
2

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4. Presented by- Guided by-
Dr. Puneshwar Keshari Dr. Harini A.
P.G. IInd Year Associate Professor& HOD
Department of Dravya Guna
SDM College of Ayurveda & Hospital
Hassan
4

5. 1. What is blood pressure?
2. Regulation of blood pressure
3. Parameters on which blood pressure depends
4. What is Hypertension?
5. Types of Hypertension
6. Classification of Blood Pressure
7. What is Antihypertensive?
8. Classification of Antihypertensive
9. Treatment of Hypertension
10. Antihypertensive models
11. Hypertension in Ayurveda
12. Research updates
13. Discussion
14. Conclusion
15. References
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7. By definition, BP = CO X PVR
Physiologically, in both normal and hypertensive
individuals, blood pressure is maintained by
moment-to-moment regulation of cardiac
output and peripheral vascular resistance,
exerted at three anatomic sites: arterioles,
postcapillary venules (capacitance vessels), and
heart.
A fourth anatomic control site, the kidney,
contributes to maintenance of blood pressure
by regulating the volume of intravascular fluid.
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8.  Baroreceptor reflex (aortic arch and carotid sinuses)
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10. Cardiac output Total Peripheral Resistance
Stroke Volume And Heart Rate
SYSTOLIC BP DIASTOLIC BP
Preload can be defined as the initial stretching of the
cardiac myocytes prior to contraction (EDV)
Afterload is the load against which the heart has to
pump(TPR)
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12.  Hypertension can be defined as:
A sustained rise in blood pressure.
It is a condition in which the arteries have
persistently high blood pressure, making harder
for the heart to pump blood in the vessels.
Basically it has 2 main components; the
SYSTOLIC and the DIASTOLIC blood pressure.
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13. Types of
Hypertension
Essential Secondary
A disorder of unknown origin affecting the
Blood Pressure regulating mechanisms
Secondary to other disease processes
Environmental
Factors
Stress Na+ Intake Obesity Smoking
13

14. The JNC 7 (2003)- 7th Report of Joint National Committee(of
USA) on prevention, detection, evaluation and treatment of
high blood pressure,
Classified HTN as follows-
BP Classification Systolic BP in mm of
Hg
Diastolic BP in mm of
Hg
Normal < 120 < 80
Prehypertension 120- 139 80- 89
Hypertension Stage I 140 -159 90 - 99
Hypertension Stage II ≥ 160 ≥ 100
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15. The drugs used in the
treatment of hypertension act
by reducing the cardiac
output and/or reducing the
total peripheral resistance,
without correcting the cause
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17. 4. Direct renin
inhibitor
Aliskiren
2.ACE inhibitors
Eg.
Captopril,
Enalapril,
Lisinopril etc.
3. Angiotensin (
AT1 receptor)
blockers
Eg. Losartan,
Candesartan etc.
1. Diuretics
Thiazides:
Hydroclorothiazide,
etc
High ceiling: Furosemide,
etc.
Potassium Sparing:
Spironolactone,
Amiloride
5. Calcium channel
blockers
Verapamil,
Diltiazem,
Nifedipine,
Lacidipine, etc.
6. Beta Adrenergic
blockers
Propranolol,
Metoprolol,
Atenolol, etc
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18.  7. Beta+ alpha
Adrenergic
blockers
 Labetalol,
Carvedilol
8. Alpha Adrenergic
blockers
Prazosin, Terazosin,
Doxazosin etc.
9. Cenral
Sympatholytics
Clonidine,
Methyldopa
10. Vasodilators
Arteriolar :
Hydralazine, Minoxidil,
Diazoxide
Arteriolar + Venous :
Sodium nitroprusside
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19.  MOA:
 1- ↑ renal excretion of Na & water
↓ plasma volume ↓ C.O.
 2- ↓ peripheral resistance ( desensitize smooth muscles
to action of catecholamine)
 Advantage: Effective in controlling blood pressure in
long term. Controls BP in Supine as well as standing
positions so postural hypotension doesn’t occur.
Disadvantage:
Of Thiazides include, hypokalemia, hyperuricemia;
Of Loop Diuretics include, Ototoxicity;
Of Potassium Sparing group include, Gastric upsets,
Gynecomastia in males, Menstrual irregularities in
females
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21. MOA:
 ↓ ang II ↓ vasocostriction
 ↓ degradation of Bradykinin ( vasodilator)
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22. Cough (dry Cough)
Angioedema
Proteinuria
Taste changes
Hypotension
Contraindicated in Pregnancy
Rashes
Increased K+ Levels
Low Ang II and Aldosterone levels
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23.  Specific angiotensin receptors have been
discovered, grouped and abbreviated as –
AT1 and AT2
 They are present on the surface of the
target cells
 Most of the physiological actions of
angiotensin are mediated via AT1 receptor
 Losartan is the specific AT1 blocker
 Available as 25 and 50 mg tablets
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24.  Upper respiratory infections
 Headache
 May cause occasional dizziness, inability to
sleep, diarrhea, dyspnea, heartburn, nasal
congestion, back pain, fatigue
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25.  Aliskiren the only available member .
 Acts by blocking catalytic activity of renin and
inhibiting production of Ang I and Ang II.
 Second line antihypertensive when
established ACE inhibitors or ARBs cannot
be used, or to supplement them.
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28. Calcium Channel Blockers
 Cardiovascular
◦ hypotension, palpitations, tachycardia
 Gastrointestinal
◦ constipation, nausea
 Other
◦ rash, flushing, peripheral edema, dermatitis
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29.  Beta blockers :
Selectives: Metoprolol, Atenolol
Adverse Effect: Dizziness, Drowsiness,
Fatigue, Diarrhea
Non-Selectives: Propranolol
Adverse Effect: Drowsiness, Sedation,
Asthma
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31. Acting on Alpha as well as on Beta receptors.
Labetolol, Carvidolol, Bucindolol
Adverse Effects: Drowsiness, Fatigue,
Insomnia, Orthostatic Hypotension
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32. Selectives: Prazosine, terazosin
Adverse Effect: Orthostatic Hypotension
Non-Selectives: Phenoxybenzamine, Phentolamine
Adverse Effect: Tachycardia, Palpitation
Advantages- improvement in carbohydrate
metabolism, lowers LDL, increases HDL
Dose- available as 0.5, 1, 2.5 and 5 mg. 1-4 mg
TDS
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34.  Directly relaxes arteriolar smooth muscle
 Result: decreased systemic vascular response,
decreased afterload, and
PERIPHERAL VASODILATION
 Eg.- Hydralazine (Hypertension in Pregnancy, Dose 25-
50 mg OD), Minoxidil, Sodium nitroprusside
 Adverse effects-
Hydralazine- Dizziness, Dyspnoea,
oedema etc.
Sodium nitroprusside- Bradycardia
34

35. ??
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37.  In the past, most studies
on experimental hypertension were carried
out on Dogs.
 Currently, rat is the preferred animal species
 Spontaneous hypertensive rat (SHR), the
genetic strain of hypertensive rat, is the
animal of choice
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38. 1.Renovascular hypertension
2. Dietary hypertension
3. Endocrine hypertension
4. Neurogenic hypertension
5. Psychogenic hypertension
6. Genetic hypertension
7. Other models
38

39.  GOLDBlAtT HYPERTENSION
Ischemia of kidney Blood pressure
RENIN ANGIOTENSIN MECHANISM
Clamping of Renal artery for 4 hours and reopening
Accumulated Renin is released
ACUTEHYPERTENSION
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40.  Sprague – Dawley Rats (300gm) are anesthetized ĉ
Hexobarbital sodium (100mg/kg) Intra peritonially.
 Cannulate the trachea for respiration and the Jugular vein
for test compound administration.
 A transducer is connected to the carotid artery for
recording the pressure.
 A PVC coated clip is placed in the left hilum of the kidney
by fixing with the back muscle for 3.5 - 4hr.
 Pentolinium is administered for ganglionic block.
 Relaese the clip and record the rise in B.P.
 Administer the test drug through I.V. and monitor the
pressure continuously.
 Increase in B.P after releasing the clip and reduction after
the drug administration is determined.
 Compare using percentage values
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41.  -Sprague – Dawley Rats (200 - 300gm) are anesthetized ĉ -
Phenobarbitone sodium (100mg/kg) Intra peritonially.
 -A flank parallel incision is made in the left lumbar area.
 -Renal artery is dissected, cleaned and ‘U’ shaped silver clip is
slipped around near the aorta.
 -The internal gap b/w the clip is adjusted to 0.25 – 0.38 nm.
 -The right kidney is removed after tying off the renal pedicel.
 -After 4-5 weeks the B.P is measured and the animals are
divided into groups of different doses.
 -Test drug is administered for 3 days
 -Pressure before and after drug administration(3min) are
recorded.
 -Percent reduction in pressure is calculated and compare to
the Std.
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43. Hypertension in Ayurveda may fall under
Pittavruta udana(Su.S.Ni.1/35) Raktagata
vata(Ch.Chi. 28/31), Pittavruta vata,
Raktavruta vata, Pranavruta
udana, Rakta vega vridhi, Rasa bhara, Rakta
Samvardhana, Vyanabala,
Uccharaktachapa, Siragata vata,
Bhrama(Ch.su.20/10.Ma.Ni.17/1),
Raktamada(Ch.su. 24/34), Moorcha(Ma.Ni.17),
Sanyasa , Dhamanipratichaya,
Raktabhara Vridhi etc
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45. Name of the Journal-
Pharmacogn.Rev. 2011Jan-June; 5(9): 30-40
Name of the Authors-
Nahida Tabassum and Feroz Ahmad
 Total 49 plants are reviewed for
Antihypertensive effect by experimental,
Clinical and Phytochemical evaluations
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46. Agathosma betulina Cassia occidentalis Hibiscus sabdariffa Pueraria lobata
Allium sativum Castanospermum
australe
Lavandula stoechas Punica granatum
Annona muricata Coleus forskohlii Lepidium latifolium Raphanus sativus
Apium graveolens Commelina virginica Linum usitatissimum Rauwolfia serpentina
Aristolochia
manshuriensis
Crataegus pinnatifida Lumnitzera racemosa Rhaptopetalum
coriaceum oliver
Artocarpus altilis Crinum glaucum Lycopersicon
esculentum
Sesamum indicum
Avena sativa Cuscuta reflexa Moringa oleifera Solanum sisymbriifolium
Blond psyllium Daucus carota Musanga cecropiodes Theobroma cacao
Camellia sinensis Desmodium
styracifolium
Ocimum basilicum Triticum aestivum
Capparis cartilaginea Fuchsia magellanica Peganum harmala Uncaria rhynchophylla
Carum copticum Glycine max Phyllanthus amarus Viscum album
Cassia absus Gossypium
barbadense
Pinus pinaster Vitex doniana
Zingiber officinale46

47. 1. Annona muricata
Hindi name – Lakshman phala
Family- Annonaceae
Parts used – fruit, leaves, bark
The leaf extract of the plant has been reported to lower an
elevated BP by decreasing the peripheral vascular resistance.
2. Apium graveolens
Family: Apiaceae
Sanskrit name- Ajmoda
Parts used - Fruit
The juice was mixed with equal amount of honey and about 8 ounces
were taken orally three times each day for up to one week. It has
also been reported to reduce systolic and diastolic BP.
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48. 3. Cassia occidentalis
Family- Caesalpiniaceae
Sanskrit name- Kasmarda
Parts used- Seeds, Panchanga
In vitro studies of the leaf extract have shown a relaxant effect on the
aortic rings. The studies revealed that cassia extract may be relaxing
smooth muscle and reducing BP by inhibiting Ca2+ influx through
receptor-operated channel and voltage-sensitive channel, showing
its nonselectivity on these Ca2+ channels.
4. Cuscuta reflexa
Family- Cuscutaceae
Sanskrit name- Amarvela
Parts used- whole plant
Crude extract of C. reflexa has been reported to cause a decrease in
systolic and diastolic BP as well as HR in anesthetized rats.
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49. 5. Moringa oleifera
Family- Moringaceae
Sanskrit name- Shigru
Parts used- Leaves, Fruit, Root
 In anesthetized rats, the crude extract of the leaves of
M. oleifera caused a fall in systolic, diastolic, and mean BP in a dose-
dependent manner.
6. Phyllanthus amarus
Family- Euphorbiaceae
Sanskrit name- Bhoomi Aamalki
Parts used- whole plant
intravenous administration of the aqueous extract of the leaves of this
plant (5-80 mg/kg) to anesthetized NMT male rabbits produced a
significant fall in mean diastolic, systolic, and mean arterial
pressures in a graded dose-response manner.
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50.  Name of the Journal-
World journal of Pharmaceutical research, Vol.3(8): 769- 777
Name of Authors- V.Velpandian*, N.Anbu, S.Elangovan, M. Mohamed
Musthafa
Conclusion- Drug- Sadamanjil Chooranam (Nardostachys jatamansi)
Dose - 500mg and 1000mg/kg body weight
Route- Oral
Method of screening- 2 kidney 1 clipped, Gold Blatt
occlusion method
Result- statistically significant decrease in systolic and
diastolic blood pressure in renovascular hypertensive rat through
the action on renin angiotensin system.
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51.  -The prevalence of Hypertension(HTN) is growing
on day by day.
 -Both Primary and Secondary HTNs are directly or
indirectly related with food habit, sedentary life
styles and consumption of various drugs.
 -The antihypertensive drugs are classified
according to their site of action, their target
receptors and their mode of actions.
 -Older drugs for Hypertension are outdated due
to their various adverse effects and newer are
going on to be incorporating in treatment
schedule.
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52.  -All types of antihypertensive drugs are only
able to do symptomatic decrease in blood
pressure. They are not able to treat the real
cause of Hypertension.
 -Hypertension can be correlated with various
Vata and Raktagata vyadhi but the exact
terminology is not dealt in classical Ayurvedic
texts.
 -There are various herbs which are proven as
safe and better antihypertensive and search for
new one should be done on the basis of
scientifically proven and widely accepted
Screening models of Antihypertensive.
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53.  Hypertension is becoming a global burden
and the world is looking towards natural
remedies system like Ayurveda, even though
there are various antihypertensive drugs in
contemporary system of medicine. So it is a
high time to adopt proper screening model of
antihypertensive and search for best solution
from herbs for HTN.
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54. 1. Tripathi. KD, Essential of Medical Pharmacology
2. Nahida Tabassum and Feroz Ahmad, Pharmacogn.Rev.
2011Jan-June; 5(9): 30-40
3. Dr.G.H.ANANTHASAYANA, MANAGEMENT OF ESSENTIAL
HYPERTENSION IN AYURVEDIC PERSPECTIVES, ( Desertation work
submitted to RGUHS)
4. D.K. BADYAL, H. LATA*, A.P. DADHICH, Indian Journal of Pharmacology
2003; 35: 349-362
5. V.Velpandian*, N.Anbu, S.Elangovan, M. Mohamed Musthafa, wjpr,
Vol.3(8): 769- 777
6. www.google searh.net.
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