ArticlePDF AvailableLiterature Review

Understanding hypertension in the light of Ayurveda

Authors:

Abstract

Different theories have been proposed to explain hypertension from an Ayurvedic perspective, but there is no consensus amongst the experts. A better understanding of the applied physiology and etio-pathogenesis of hypertension in the light of Ayurvedic principles is being attempted to fill this gap. A detailed review of available Ayurvedic literature was carried out to understand the physiology of blood pressure and etio-pathogenesis of hypertension from the perspective of Ayurveda. Many parallels were drawn from the concepts such as Shad Kriyakala (six stages of Dosha imbalance) and Avarana of Doshas (occlusion in the normal functioning of the Doshas) to the modern pathogenesis of hypertension to gain a deeper understanding of it. Hypertension without specific symptoms in its mild and moderate stages cannot be considered as a disease in Ayurveda. It appears to be an early stage of pathogenesis and a risk factor for development of diseases affecting the heart, brain, kidneys and eyes etc. Improper food habits and modern sedentary lifestyle with or without genetic predisposition provokes and vitiates all the Tridoshas to trigger the pathogenesis of hypertension. It is proposed that hypertension is to be understood as the Prasara-Avastha which means spread of vitiated Doshas from their specific sites, specifically of Vyana Vata, Prana Vata, Sadhaka Pitta and Avalambaka Kapha along with Rakta in their disturbed states. The Avarana (occlusion of normal functioning) of Vata Dosha by Pitta and Kapha can be seen in the Rasa-Rakta Dhathus, which in turn hampers the functioning of the respective Srotas (micro-channels) of circulation.
Review Article
Understanding hypertension in the light of Ayurveda
Maanasi Menon
a
, Akhilesh Shukla
b
,
*
a
Dept of Kayachikitsa, Amrita School of Ayurveda, Clappana P.O., Kollam Dist, Kerala, 690525, India
b
Dept of Samhita, Siddhanta, Govt. Ayurveda College, Bilaspur, Chhattisgarh, 495001, India
article info
Article history:
Received 23 May 2017
Received in revised form
18 October 2017
Accepted 22 October 2017
Available online 17 November 2017
Keywords:
Hypertension
Ayurveda
Blood pressure
Etio-pathogenesis
abstract
Different theories have been proposed to explain hypertension from an Ayurvedic perspective, but
there is no consensus amongst the experts. A better understanding of the applied physiology and
etio-pathogenesis of hypertension in the light of Ayur vedic principles is being attempted to ll this
gap. A detailed review of available Ayurvedic literature was carried out to understand the physiology
of blood pressure and etio-pathogenesis of hypertension from the perspective of Ayurveda.Many
parallels were drawn from the concepts such as Shad Kriyakala (six stages of Dosha imbalance) and
Avarana of Doshas (occlusion in the normal functioning of the Doshas) to the modern pathogenesis of
hypertension to gain a deeper understanding of it. Hypertension without specicsymptomsinits
mild and moderate stages cannot be considered as a disease in Ayurveda. It appears to be an early
stage of pathogenesis and a risk factor for development of diseases affecting the heart, brain, kidneys
and eyes etc. Improper food habits and modern sedentary lifestyle with or without genetic predis-
position provokes and vitiates all the Tridoshas to trigger the pathogenesis of hypertension. It is
proposed that hypertension is to be understood as the Prasara-Avastha which means spread of
vitiated Doshas from their specicsites,specically of Vyana Vata,Prana Vata,Sadhaka Pitta and
Avalambaka Kapha along with Rakta in their disturbed states. The Avarana (occlusion of normal
functioning) of Vata D osha by Pitta and Kapha can be seen in the Rasa-Rakta Dhathus,whichinturn
hampers the functioning of the respective Srotas (micro-channels) of circulation.
©2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services by
Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).
1. Introduction
In this modern era of specialties and super-specialties in medical
care, Ayurveda stands out by its holistic approach towards the body
as one single entity. The body with all its parts co-existing with
interdependence and mutual interaction makes it difcult to
comprehend when approached separately. In recent times, hu-
manity has begun to realize this holistic approach to health with
the multidimensional aspects of body, mind and soul [1] preached
by Ayurveda ages ago. In the present times, life has been made easy
for man with modernization every step of the way, but he has also
paid for it by becoming prey to many lifestyle diseases. The diseases
occur due to his faulty life style and stressful psychological condi-
tions. These factors affect one's mind and homeostasis of the body
by several psychosomatic mechanisms and lead to many lifestyle
diseases such as diabetes and hypertension. As per World Health
Organization report, about 40% of people aged more than 25 years
had hypertension in 2008 [2]. Hypertension is directly responsible
for 57% of all stroke deaths and 24% of all coronary heart disease
(CHD) deaths in India [3]. It is the most potent risk factor for dis-
eases of the brain, kidney, heart and peripheral arteries which may
prove fatal if not managed effectively [4]. Hypertension is a silent
killer because most sufferers (85%) are asymptomatic [5]. In 95% of
the cases of hypertension, the exact underlying causes are still
unknown [6] but is believed to be due to genetic and environmental
factors [7].
Hypertension cannot be considered as a Vyadhi (disease) as per
Ayurveda but it can be understood by assessing the involved Doshas,
Dooshyas (entity which is affected by morbid Dosha), Srotas etc.
Many Ayurvedic scholars have proposed different theories about
how hypertension can be understood in Ayurveda, but there is no
standardized and widely accepted view about the Ayurvedic path-
ogenesis of this condition. There are still many controversies
related to this disease in Ayurveda. Thus, this is an attempt to
*Corresponding author.
E-mail: an2akhilesh@gmail.com
Peer review under responsibility of Transdisciplinary University, Bangalore.
Contents lists available at ScienceDirect
Journal of Ayurveda and Integrative Medicine
journal homepage: http://elsevier.com/locate/jaim
https://doi.org/10.1016/j.jaim.2017.10.004
0975-9476/©2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Journal of Ayurveda and Integrative Medicine 9 (2018) 302e307
thoroughly understand hypertension and interpret it in terms of
Ayurvedic principles, considering all the existing views.
2. Previous theories eAyurvedic view
Various Ayurvedic scholars have coined different names for hy-
pertension such as: Raktagata Vata,Siragata Vata,Avrita Vata,
Dhamani Prapurana,Rakta Vikshepa,Vyana Prakopa,Raktamada,
Uchharaktachapa,Vyana Atibala etc. [8]. In each of these terms,
different points of view have been adopted, but no one has denied
the fact that in hypertension, the main pathogenesis occurs in Rakta
along with the blood vessels. This being the only factor in common,
many previous authors have given separate views on the Ayurvedic
pathogenesis of this condition. As modern science is well advanced
in understanding hypertension, we must understand all that is
known about this disease and suitably correlate it to Ayurvedic
principles for better understanding.
3. Concept of blood pressure in Ayurveda
At rst, it is essential to understand the physiological aspects of
blood pressure in Ayurveda which is fundamentally based on the
theory of Tridosha [9]. The blood rst ejected out of the heart, is
then distributed to all parts of the body, and, thereafter, is returned
back to the heart through the blood vessels termed as Sirahin
Ayurveda [10]. This return of Rasa (blood) towards heart is
controlled by the function of Samana Vata [9,11]. As it is known,
blood pressure is the lateral pressure exerted by the ow of blood
on the walls of the arteries [12]. The two components of blood
pressure are the systolic and diastolic blood pressure [13]. The heart
has its pacemaker (SA node) that generates electrical impulses on
its own, which makes the heart contract during the systole. This
self-excitatory function of the heart can be attributed to the func-
tioning of the Vata Dosha, in particular the Vyana Vata as it is seated
in the heart and is responsible for blood circulation [9,14]. Charaka
clearly describes that Vyana Vata, a component of Vata Dosha
constantly forces the blood out of the heart and distributes it [9,15].
Thus it can be said that the systolic BP attained during contraction
of the heart is controlled by Vata (Vyana Vata). Though the SA node
generates impulses on its own, the rate of its impulse generation is
controlled by the autonomic nervous system via sympathetic and
para-sympathetic nerve bers emerging from the brain. It is the
Prana Vata situated in the Moordha (Brain) [Ashtanga Hridaya, Sutra
Sthana, 12/4] that controls the Hridaya (heart) and does Dhamani
Dharana (arterial perpetuation) [16] and thus heart rate is
controlled by Prana Vata. In this context it can be understood as
Vyana Vata and Prana Vata denote the nervous control of circulation
because Vata, in general, denotes all neural mechanisms [9,17]. The
diastole is attained when the heart muscles relax. Here, diastolic
blood pressure is only due to blood owing through the narrow
structures of the chambers of the heart and arteries and there is no
active push by the heart. Thus diastolic BP can be taken under the
domain of Kapha Dosha (Kapha maintains the structural integrity of
body organs), mainly the Avalambaka Kapha [Ashtanga Hridaya,
Sutra Sthana, 12/15] because it is the resistance offered by the
structure of the heart and the blood vessels that controls the dia-
stolic blood pressure. Thus the peripheral resistance (faced by
blood in the blood vessels) determines the diastolic BP. This is
mainly inuenced by the diameter and elasticity of the blood ves-
sels which can be considered under the purview of Kapha Dosha.
The vascular tone is also controlled by the autonomic nervous
system which alters the diameter of the arteries as and when
required [18].AsDhamani Dharana is a function of Prana Vata
[Asthanga Samgraha, Sutra Sthana, 20/2], the peripheral resistance
offered by the arteries due to vasoconstriction caused by
sympathetic action of nerves can be understood as a function of
Prana Vata. The Auto-rhythmicity of the heart is due to the action
potential created by the rapid inux of Na
þ
and Ca
þþ
ions and efux
of K
þ
ions across the membrane of the SA node [19]. The involve-
ment of these chemical ions can be taken under the purview of Pitta
due to its Tikshna (rapidness) Drava (uidity) and Sara (diffusion/
dispersion) Guna, [Asthanga Samgraha, Sutra Sthana, 1/26] mainly
Sadhaka Pitta situated in the heart. The basal metabolic rate (BMR)
has a direct but imperfect positive correlation with the pulse rate
and pulse pressure of the heart [20]. This is on the basis of Read's
and Gale's formulae [21,22]. This means to say that variations in the
basal metabolic rate cause changes in blood pressure as well. Thus
the basal metabolic rate can be understood as a result of the action
of Agni or Pitta, more precisely, Pachaka Pitta [Ashtanga Hridaya,
Sutra Sthana, 12/10e12]. The blood volume and viscosity can be
determined by the quality and quantity of the Rasa and Rakta
Dhatus. These also determine the cardiac output. The heart (Hri-
daya) and the blood vessels (Rasavaha Dhamanis) form the Prana
Vaha Srotas and their Srotomulas which are mainly involved in the
blood circulation [23] along with that Medavaha Srotas,Mutarvaha
Srotas,Swedavaha srotas and Udakavaha Srotas play an important
role. Thus the Doshas,Dhatus and Srotas involved in the blood
pressure have been discussed.
4. Blood pressure regulation and the role of Tridosha
Blood Pressure in the body is regulated by multiple mechanisms.
Short-term Neural mechanisms and Long-term Renal, Hormonal
and Local vascular mechanisms [9].
Short term mechanisms include the Nervous mechanism
controlled by the vasomotor center of the brain via autonomic
stimulation through Baro-receptor and feedback of Chemorecep-
tors [24,25]. This CNS regulation of Blood pressure can be under-
stood mainly as a Vata function, typically Prana Vata (taking the
help of Kapha in case of Baro-receptors and Pitta in case of Chemo-
receptors).
Long term regulation of blood pressure is by:
1) Pressure Diuresis and Pressure Natriuresis eKidneys excrete
water and sodium through urine (Kleda nirvahanam) [Asthanga
Samgraha, Sutra Sthana, 19/20] to bring down the blood volume
to regulate the blood pressure. This mechanism can be attrib-
uted to elimination of Kapha in the form of Kleda by the function
of Apana Vata [Asthanga Samgraha, Sutra Sthana, 20/2]
2) Renin-Angiotensin Mechanism eThe Kidneys secrete Renin in
response to low blood pressure as a result of which Angiotensin
II is secreted to bring about vasoconstriction along with defec-
tive sodium and water homeostasis and thereby increasing
blood pressure [26]. This can be attributed to the function of
Pitta.
3) Hormonal regulation of Blood pressure: There are about 15
different hormones secreted which can create variations in the
blood pressure. They are Adrenalin, Nor-Adrenalin, Thyroxin,
Aldosterone, Vasopressin, Angiotensins, Serotonin, Bradykinin,
Prostaglandins, Histamine, Acetylcholine, Atrial Natriuretic
Peptide etc. [27].
All these being chemical substances causing regulation of blood
pressure, may come under the perview of Pitta Dosha.
4) Local mechanism of BP regulation at the blood vessel level-
There are local vasocontrictors like endothelins and local vaso-
dilators like CO
2
,H
þ
ions, Lactate, Adenosine and Nitric oxide
which cause change in peripheral resistance thus inuencing
the BP [28]. This again can be understood as a function of Pitta.
M. Menon, A. Shukla / Journal of Ayurveda and Integrative Medicine 9 (2018) 302e307 303
Thus, the role played by the Tridoshas in regulation of blood
pressure has been discussed.
5. Etiological risk factors related to hypertension
By denition, the causes of essential hypertension are unknown
but many genetic and environmental factors and their mutual in-
teractions act as risk factors for the development of this condition
[7]. These factors are: high salt and spicy food intake, alcohol
consumption and use of tobacco, low Calcium and Potassium
intake, psychological stress, heredity, intake of fatty food which
causes obesity and hyperlipidemia leading to atherosclerosis in
blood vessels and physical inactivity (sedentary lifestyle) [29].
Among these, high salt and spicy food, alcohol consumption, use of
tobacco, low Calcium and Potassium intake and psychological
stress may vitiate Pitta,Vata and Rakta, while physical inactivity,
dullness and habitual intake of fatty foods are Kapha and Medo-
vardhaka Nidanas (etiological factors increasing fat) [Charaka
Samhita, Sutra Sthana, 21/4]. Family history (heredity) is due to
Beeja dosha (genetic defects). Most of these Nidanas are mentioned
together as Rakta Dusti Karana by Charaka in the Vidhishonitiya
Adhyaya [Charaka Samhita, Sutra Sthana, 24/5e10] and in the
context of Pittaja Hridroga [Charaka Samhita, Sutra Sthana, 17/32].
6. Pathology of hypertension in Ayurveda based on the
modern view
Essential hypertension is dened as chronic elevation in arterial
blood pressure (BP) >140/90 mmHg with no denable causes [30].
The various genetic and environmental factors mentioned earlier
interact with each other and inuence the pathogenesis of this
condition. The main determinants of blood pressure as seen earlier
are the cardiac output and peripheral resistance. Cardiac output is
determined by the stroke volume and heart rate [31]. So, for
increase in blood pressure, there should be increase in either car-
diac output or peripheral resistance. This happens when due to the
inuence of risk factors one or more of the different regulatory
mechanisms of blood pressure gets hampered causing the blood
pressure to increase. Defects in renal Sodium homeostasis causes
decreased Na excretion leading to increased salt and water reten-
tion [32]. This increases the plasma and extra cellular uid thus
increasing the cardiac output. This is one mechanism which leads
to hypertension. This may be understood as the pathology due to
Dooshana (vitiation) of Pitta and Rakta due to Ati Katu &Lavana Rasa
sevena (excess intake of pungent and salty items) [Charaka Samhita,
Chikitsa Sthana, 4/6]. The other mechanism is increased functional
vasoconstriction due to impaired hormonal actions leading to
increased peripheral resistance [33]. This may be understood as
Pitta Dushti due to endocrinal defects. Impaired functioning of the
autonomic nervous system causing rise in blood pressure may be
seen as Dushti of Vata.Sushruta has mentioned that Vata Dooshita
Rakta (blood vitiated by Vata) is both Sheeghra gama (fast moving)
and Askandi (hemodilution) [Sushruta Samhita, Sutra Sthana, 14/
21]. Both these factors lead to changes in peripheral resistance.
Hemodilution increases cardiac output [34] and Vata being Ruksha
(dry) and Sheeta (cold) in nature may causes stiffness of vessels
which increases peripheral vascular resistance and leads to hy-
pertension [35].
The third mechanism is due to defects in the vascular smooth
muscles (atherosclerotic changes caused by factors like hyperlip-
idemia) where the blood vessels lose their normal tone and this
increases peripheral resistance, thus causing hypertension [36].
This pathology may be due to the vitiation of Kapha Dosha and
Medo Dhathu. Based on these points it can be deduced that the
pathology of hypertension involves one or all the three Doshas
which in turn affects the Rasa and Rakta Dhatus to cause this
condition [Hypothetical Samprapti (pathogenesis) of hypertension
is shown in Flow Chart 1].
Flow Chart No. 1. Hypothetical Samprapti ow chart of hypertension.
M. Menon, A. Shukla / Journal of Ayurveda and Integrative Medicine 9 (2018) 302e307304
7. Concept of Avarana in the pathogenesis of hypertension
As blood circulation is mainly the function of Vata (Vyana
vata)[9], its impairment is certain in Hypertension [37] It may be
impaired by its own Prakopa (aggravation) due to Vataja Nidanas
(etiological factors for Vata) or may get vitiated by the inuence of
other Doshas and Dhathus. This is where the concept to occlusion of
normal functioning of Vata plays a major role in the pathogenesis of
hypertension. The normal course of Vata can be occluded by Pitta,
Kapha,Rakta and or Medas [Charaka Samhita, Chikitsa Sthana; 28/
61e69]. These Anya-Dosha Avarana pathologies can be considered
under the hypertension due to increased hormonal and enzymal
action [38], decreased sodium excretion [39], change in the
chemical constituents in the blood and atherosclerotic changes in
the arteries due to lipid deposition [40]. Another type of occlusive
pathology happens when there is Anyonya Avarana of Vata (mutual
occlusion between subtypes of Vata). The subtypes of Vata such as
Prana and Vyana Vata obstruct each other and cause the
disease [Charaka Samhita, Chikitsa Sthana, 28/200e215]. This
condition can be considered as hypertension due to hampered
autonomic nervous system as it plays an important role in the
regulation of blood pressure [41,42,33].Charaka and Sushruta have
enumerated and explained many different types of mutual occlu-
sions of Dosha and occlusion of one Dosha by other Dosha or Dhatu
and in many of these conditions; symptoms of hypertension such as
giddiness, headache, and fatigue have been mentioned. These
conditions are: Pittavritavata,Vyanavrita Prana,Pittavrita Prana,
Pittavrita Vyana,Pittavrita Samana and Pittavrita Udana [Charaka
Samhita, Chikitsa Sthana, 28/221e230]. Other conditions where
these symptoms are seen together are Amashayagata Vata [Sus-
hruta Samhita, Nidana Sthana, 1/32e39]. Rakta Dushti &Pradoshaja
Vikara [Charaka Samhita, Sutra Sthana, 24/5e10] and Pittaja Hri-
droga [Charaka Samhita, Sutra Sthana; 17/32]. Vyana Vata is said to
be responsible for Sweda (sweat) and Asruk Sravana (ejection of
blood) and if it gets vitiated it produce diseases which will affect
the entire body [Charaka Samhita, Sutra Sthana, 24/11e16]. This can
be correlated to hypertension as excessive perspiration is a symp-
tom of hypertension.
8. Symptomatology of hypertension and Samprapti based on
Kriyakala
Mild to moderate hypertension in most cases does not exhibit
any symptoms. But sudden or severe hypertension produces
symptoms like headache, giddiness, palpitations, excessive sweat-
ing, fatigue, exertion dyspnoea and insomnia [43].InAyurveda,a
disease should have specicLakshanas (symptoms) to be called a
Vyadhi [44], thus hypertension being asymptomatic (in its mild and
moderate forms) is not described as a disease in Ayurveda. In the
different stages of a disease, Prasarvastha is the stage where the
Doshas move out from their respective sites and along with Rakta
circulate all over the body, causing certain mild, nonspecic
symptoms [Sushruta Samhita, Sutra Sthana, 21/28]. This in turn
hampers the functions of the respective Srotas in the beginning and
later they bring about structural changes as well, leading to Kha-
Vaigunya. Then, these Doshas get lodged at susceptible sites of Kha-
Vaigunya which in this case can be: heart, brain, kidneys, eyes and
blood vessels. It is at this stage that the actual Sthana Samshraya
(vitiated Doshas getting stuck in a particular site) and Vyakta
Avastha (manifestation of specic symptoms) occur, causing dis-
eases of these vital organs. Later, in the Bheda avastha (complicated
stage), there occurs severe damage to these organs, making the
disease Asadhya (incurable) and sometimes leading to death itself.
Thus, hypertension can be taken as a sub-clinical condition where
the disease process is still in progress making it a risk factor for
more dangerous diseases of the heart, brain, kidneys, eyes etc. ac-
cording to Ayurveda (probable pathogenesis of hypertension based
on Shad Kriyakala is shown in Flow Chart 2).
Flow Chart No. 2. Samprapti (pathogenesis) of hypertension based on Kriyakala (stages of Dosha imbalance).
M. Menon, A. Shukla / Journal of Ayurveda and Integrative Medicine 9 (2018) 302e307 305
9. Principles of management
Ayurveda gives more emphasis tothe prevention and promotion
of the health. Avoiding etiological factors of disease is considered as
the rst line of management [Sushruta Samhita of Sushruta, Uttara
Tantra, 1/25]. In the management of hypertension, non-
pharmacological methods such as correction of lifestyle, diet etc.
is proven to reduce the risk of Coronary heart disease (CHD) which
is leading cause of morbidity and mortality worldwide [45]. The
role of Ayurveda is more pertinent here, many of the chapters in
classical texts such as Dinacharya Adhyaya,Ritucharya Adhyaya,
Matrashiteeya,Navegannadharniya Adhyaya etc. are particularly
dedicated to healthy lifestyle. These include the harmonious living
pattern by a deeper understanding of human life and its interaction
with nature. Adopting Ayurveda guidelines may be helpful to
reduce the increasing incidence and management of lifestyle dis-
orders which include hypertension [46,47]. This will also reduce
the risks which are associated with the drug therapy. Long-term
drug treatment can be expensive and side-effects can threaten
patients' adherence to the medicines [48]. In general, reducing
body weight, stopping smoking, healthy diet and increasing phys-
ical exercise are routinely recommended by most of the physicians
[49]. While treating this condition Prasara Avastha of all the Trido-
sha and Rasa,Rakta and Meda Dushti should be taken in to
consideration and along with lifestyle modications, appropriate
Vata Anulomana (maintaining normal course of Vata)Tridoshahara
(normalizing all Tridosha), and Rasa,Rakta Prasadakar (blood pur-
ifying), Medohara (reducing excess fat) Chikitsa may be adopted.
10. Conclusion
Improper life-style and food habits, psychological stress factors
like Atichinta (excess worry), Bhaya (fear), Krodha (anger), Alasya
(dullness) etc., with or without genetic predisposition provokes and
vitiates all the three Doshas to trigger the pathogenesis of hyper-
tension. Anya Dosha Avarana and Anyonya Avarana are the mecha-
nisms of pathogenesis. Though modern science considers
hypertension as a disease, from the Ayurveda point of view it should
be understood as the Prasaravastha of all the Doshas along with
Rakta which circulate all over the body until they get lodged at a site
of Kha-Vaigunya. This decides the organ of impact of the disease
process (whether brain, heart, kidneys, eyes or blood vessels). With
the help of recent advancements in the medical science the, diag-
nosis of this condition has been made possible at an early stage and
thus effective management can be offered at this stage itself to
avoid risk of damage to vital organs. Thus, hypertension can be
understood as a psycho-somatic hemodynamic condition where
Vata Pradhana Tridoshas are vitiated affecting the Rasa-Rakta Dhatus
as Dooshyas with both Sarva Shareera (whole body) and Manas
(mind) as its Adhisthana (site). For effective management of hy-
pertension, lifestyle modications should be given more emphasis
and if necessary appropriate drug therapy should also be given.
Sources of funding
None.
Conict of interest
None.
References
[1] Ross CL. Integral healthcare: the benets and challenges of integrating com-
plementary and alternative medicine with a conventional healthcare practice.
Integr Med Insights 2009;4:13e20.
[2] World Health Organization. Global brief on hypertension. 2013. http://apps.
who.int/iris/bitstream/10665/79059/1/WHO_DCO_WHD_2013.2_eng.pdf?
ua¼1[Accessed on 7 July 2017].
[3] Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens
2004;18:73e8.
[4] Kannel WB. Hypertension: reections on risks and Prognostication. Med Clin
North Am 2009;93(3). https://doi.org/10.1016/j.mcna.2009.02.006. 541-
Contents.
[5] Chen S. Essential hypertension: perspectives and future directions. J Hypertens
2012;30(1):42e5. https://doi.org/10.1097/HJH.0b013e32834ee23c.
[6] Nguyen Q, Dominguez J, Nguyen L, Gullapalli N. Hypertension management:
an update. Am Health Drug Benets 2010;3(1):47e56.
[7] Forjaz CLM, Bartholomeu T, Rezende JAS, Oliveira JA, Basso L, Tani G, et al.
Genetic and environmental inuences on blood pressure and physical activ-
ity: a study of nuclear families from Muzambinho, Brazil. Braz J Med Biol Res
2012;45(12):1269e75. https://doi.org/10.1590/S0100-879X2012007500141.
[8] Dhamle Madhumati. Post Graduate Thesis on ethe study of Yojana-
Chatushka of Charaka and Yojana for the management of RaktashritaVyadhi
(hypertension). Department of Basic Principles, Institute of Post Graduate
Teaching and Research in Ayurveda; 2001.
[9] Patwardhan K. The history of the discovery of blood circulation: unrecognized
contributions of Ayurveda masters. Adv Physiol Educ 2012;36:77e82. https://
doi.org/10.1152/advan.00123.2011.
[10] Joshi H, Singh G, Patwardhan K. Ayurveda education: evaluating the integrative
approaches of teaching Kriya Sharira (Ayurveda physiology). J Ayurveda Integr
Med 2013;4(3):138e46. https://doi.org/10.4103/0975-9476.118683.
[11] Shristava S, editor. Sharngadhara Samhita of Sharngadhara. Varanasi, India:
Chaukhambha Orientalia; 2013. p. 52. Purva Khanda, Chapter 6, Verse 8.
[12] Xu C, Xiong H, Gao Z, Liu X, Zhang H, Zhang Y, et al. Beat-to-Beat blood
pressure and two-dimensional (axial and radial) motion of the carotid Artery
wall: physiological evaluation of arterial stiffness. Sci Rep 2017;7:42254.
https://doi.org/10.1038/srep42254.
[13] Frank lin SS, Lopez VA, Wong ND, Mitchell G F, Larson MG , Vasan RS, et al.
Single versus combined blood pressure components and risk for cardio-
vascular disease: the Framingham heart study. Circulation 2009;119(2):
243e50. https://doi.org/10.1161/CIRCULATIONAHA.108.797936.
[14] Paradkar H, editor. Ashtanga Hridaya of Vagbhata (with the commentaries
Sarvanga Sundaraof Arunadatta and Ayurveda rasayanaof Hemadri).
Varanasi, India: Chaukhmba Surbharati Prakashana; 2002. p. 193. Sutra
Sthana; Doshabhediya Adhyaya,, Chapter12, Verse 6.
[15] Tripathy Brahmananda, editor. Caraka Samhita of Agnivesha, Charaka Chan-
drika Hindi commentary. 1st ed. Varanasi: Chaukhamba Orientalia; 1999.
p. 558. Chikitsa Sthana; Grahanidosha chikitsa, Chapter-15, Verse 36.
[16] Murthy Srikantha KR, editor. Asthanga Samgraha of Vagbhata. 9th ed. Vara-
nasi: Chowkhamba orientalia; 2012. p. 368. Sutra Sthana, Doshabhedeeya
Adhyaya, Chap 20, Verse 2.
[17] Tripathi P, Patwardhan K, Singh G. The basic cardiovascular responses to
postural changes, exercise, and cold pressor test: do they vary in accordance
with the dual constitutional types of Ayurveda? Evid Based Complement
Altern Med; doi:10.1155/2011/251850.
[18] Gordan R, Gwathmey JK, Xie L-H. Autonomic and endocrine control of car-
diovascular function. World J Cardiol 2015;7(4):204e14. https://doi.org/
10.4330/wjc.v7.i4.204.
[19] Sembulingam, Sembulingam Prema. Properties of caridiac muscle. Essentials
of medical physiology. 5th ed. New Delhi: Jaypee brothers medical publishers
(P)Ltd.; 2010. p. 509.
[20] Snodgrass JJosh, Leonard William R, Sorensen Mark V, Tarskaia Larissa A,
Mosher MJ. The inuence of basal metabolic rate on blood pressure among
indigenous Siberians. Am J Phys Anthropol 2008 Oct;137(2):145e55. https://
doi.org/10.1002/ajpa.20851.
[21] Reule S, Drawz PE. Heart rate and blood pressure: any possibl e Implica-
tions for management of hypertension? Curr Hypertens Rep 2012;14(6):
478e84.
[22] Fronczek R, Overeem S, Reijntjes R, Lammers GJ, van Dijk JG, Pijl H. Increased
heart rate variability but normal resting metabolic rate in hypocretin/orexin-
decient human narcolepsy. J Clin Sleep Med JCSM 2008;4(3):248e54.
[23] Trikamji J, Ram N, editors. Commentary Nibandha Sangraha of Dalhana on
Sushruta Samhita of Sushruta, Sharira Sthana; Dhamaneevyakaranam Share-
eram Adhyaya. 1st ed. Varanasi: Chaukhambha Sanskrit Sansthan; 2012.
p. 386. Ch. 8, Verse12.
[24] Zanutto BS, Valentinuzzi ME, Segura ET. Neural set point for the control of
arterial pressure: role of the nucleus tractus solitarius. Biomed Eng OnLine
2010;9:4. https://doi.org/10.1186/1475-925X-9-4.
[25] Timmers HJLM, Wieling W, Karemaker JM, Lenders JWM. Denervation of ca-
rotid baro- and chemoreceptors in humans. J Physiol 2003;553(Pt 1):3e11.
https://doi.org/10.1113/jphysiol.2003.052415.
M. Menon, A. Shukla / Journal of Ayurveda and Integrative Medicine 9 (2018) 302e307306
[26] Kotsis V, Stabouli S, Papakatsika S, Rizos Z, Parati G. Mechanisms of obesity-
induced hypertension. Hypertens Res 2010;33:386e93.
[27] Chopra S, Baby C, Jacob JJ. Neuro-endocrine regulation of blood pressure. In-
dian J Endocrinol Metab 2011;15(Suppl. 4):S281e8. https://doi.org/10.4103/
2230-8210.86860.
[28] Aliya S. Effects of vasodilation and arterial resistance on cardiac output. J Clin
Exp Cardiol 2011;2:170. https://doi.org/10.4172/2155-9880.1000170.
[29] Buttar HS, Li T, Ravi N. Prevention of cardiovascular diseases: role of exercise,
dietary interventions, obesity and smoking cessation. Exp Clin Cardiol
2005;10(4):229e49.
[30] Messerli FH, Williams B, Ritz E. Essential hypertension. Lancet 2007 Aug
18;370(9587):591e603. PMID: 17707755.
[31] Vincent J-L. Understanding cardiac output. Crit Care 2008;12(4):174. https://
doi.org/10.1186/cc6975.
[32] Wang D, Wang Y, Liu F-Q, Yuan Z-Y, Mu J-J. High salt diet affects renal sodium
excretion and ERR
a
expression. Mihailidou AS, ed Int J Mol Sci 2016;17(4):
480. https://doi.org/10.3390/ijms17040480.
[33] Charkoudian N, Rabbitts JA. Sympathetic neural mechanisms in human car-
diovascular health and disease. Mayo Clin Proc 2009;84(9):822e30.
[34] V
azquez BYS, Martini J, Tsai AG, Johnson PC, Cabrales P, Intaglietta M. The vari-
ability of blood pressure due t o small changes of hematocrit. Am J Physiol Heart
Circ Physiol 2010;299(3):H863e7. https://doi.org/10.1152/ajpheart.00496.2010.
[35] Mayet J, Hughes A. Cardiac and vascular pathophysiology in hypertension.
Heart 2003;89(9):1104e9.
[36] Leitschuh M, Chobanian A. Vascular changes in hypertension 1987 Sep;71(5):
827e41. PMID: 3306205.
[37] Agrawal S, Pol H, From 5th World Ayurveda Congress 2012 Bhopal, Madhya
Pradesh, India. 7e10 Dec 2012. PA01.17. A clinical study to evaluate the effect
of extract based herbal formulation on hypertension ea single blinded
standard controlled randomized study. Anc Sci Life 2012;32(Suppl. 1):S66e7.
[38] Freel EM, Connell JMC. Mechanisms of hypertension: the expanding role of
aldosterone. J Am Soc Nephrol JASN 2004;15(8):1993e2001. https://doi.org/
10.1097/01.ASN.0000132473.50966.14.
[39] Ha SK. Dietary salt intake and hypertension. Electrolytes Blood Press
2014;12(1):7e18. https://doi.org/10.5049/EBP.2014.12.1.7.
[40] Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease.
JRSM Cardiovasc Dis 2012;1(4). https://doi.org/10.1258/cvd.2012.012016.
cvd.2012.012016.
[41] Joyner MJ, Charkoudian N, Wallin BG. A sympathetic view of the sympathetic
nervous system and human blood pressure regulation. Exp Physiol 2008;93:
715e24.
[42] Wallin BG, Charkoudian N. Sympathetic neural control of integrated cardio-
vascular function: insights from measurement of human sympathetic nerve
activity. Muscle Nerve 2007;36:595e614.
[43] Katz JN, Gore JM, Amin A, Anderson FA, Dasta JF, Ferguson JJ, et al. Practice
patterns, outcomes, and end-organ dysfunction for patients with acute severe
hypertension: the Studying the Treatment of Acute hyperTension (STAT)
registry. Am Heart J 2009;158(4):599e606.
[44] Trikamji J, editor. Commentary Ayurveda Dipika of Chakrapanidatta, Charaka
Samhita by Agnivesha, Sootra Sthana, Dirghamjivitiyam Adhyaya. 1st ed.
Varanasi: Chaukhambha Orientalia; 2007. p. 7. Chap 1, Verse 24.
[45] Mannu G, Zaman M, Gupta A, Hu R, Myint P. Evidence of lifestyle modication
in the management of hypercholesterolemia. Curr Cardiol Rev 2013;9(1):
2e14. https://doi.org/10.2174/157340313805076313.
[46] Patwardhan B. Public perception of AYUSH. J Ayurveda Integr Med 2015;6(3):
147e9. https://doi.org/10.4103/0975-9476.166389.
[47] Chandola HM. Lifestyle disorders: Ayurveda with lots of potential for pre-
vention. Ayu 2012;33(3):327. https://doi.org/10.4103/0974-8520.108814.
[48] Kawachi I, Malcolm LA. The cost-effectiveness of treating mild-to-moderate
hypertension: a reappraisal. J Hypertens 1991;9:199e208.
[49] Elhani S, Cleophas TJ, Atiqi R. Lifestyle interventions in the management of
hypertension: a survey based on the opinion of 105 practitioners. Netherlands
Heart J 2009;17(1):9e12.
M. Menon, A. Shukla / Journal of Ayurveda and Integrative Medicine 9 (2018) 302e307 307
... When we look at Samprapti, Hridroga is considered as Tri dosha imbalance (4). Excess avalambaka kapha (the diameter and elasticity of the blood vessels) (5) induces exaggerated contractility of the heart, while aggravated vyana vayu (the forces that expel the blood out of the heart) (5) leads increased speed of blood flow and increases the force of ejection of blood from heart. These events result in forceful expulsion of blood through blood vessels and increase resistance in vessels causing high blood pressure and symptoms of CAD (5). ...
... Excess avalambaka kapha (the diameter and elasticity of the blood vessels) (5) induces exaggerated contractility of the heart, while aggravated vyana vayu (the forces that expel the blood out of the heart) (5) leads increased speed of blood flow and increases the force of ejection of blood from heart. These events result in forceful expulsion of blood through blood vessels and increase resistance in vessels causing high blood pressure and symptoms of CAD (5). Ayurveda therapy has a five-step procedure called Panchakarma, and it has been used to treat various diseases including CAD. ...
... As the patient gave consent, an integration of yoga and ayurveda approach to balance doshas for her overall health was executed. Hrudaydhara is beneficial for decreasing avalambaka kapha, removing ama from rasa vaha slotas, rakta vaha srotas and prana vaha slotas for decreasing excess vyana vayu (5). In order to monitor patient's response to various therapies, Visual analogue scales (VAS) was used. ...
Article
Full-text available
Today, cardiovascular disease has become a global health issue owing to high-stress in personal and professional environments and adverse lifestyle changes with neglected diet and decreased physical activity. Ayurveda and Yoga aim not only to treat diseases but to also reinforce measures to promote health and well-being. Holistic approaches in these two sciences can be used in an effective way to improve cardiovascular health. A blend of Yoga practices and Ayurveda therapy is quintessentially useful for both the mind and body. Sun Salutation and Mind Sound Resonance Technique (MSRT) meditation work on calming the mind and allow the body to transition into a high energy state for moderate exercise. This is followed ultimately by Hrudaydhara of Ayurveda which focuses on relaxing the intercostal and cardiac muscle which in turn reduces chest discomfort of the patient and eventually improves the ejection fraction of the heart. This shows evidence that integrating yoga and ayurvedic practices with conventional medicine can be a collaborative approach while managing cardiovascular ailments.
... Although none of these names were universally accepted. In each of these terms, the main pathogenesis occurs in Rakta along with Dhamani (blood vessels) 19 . ...
Article
Full-text available
Background:Hypertension is termed as a silent killer as a result of it doesn't exhibit any of the cardinal features. The number of adults with hypertension in 2025 was anticipated to ascend by about 60% and is certainly guilty for 57% of all stroke deaths in India. As per Ayurvedic parlance, Hypertension can be visualized asVataPradhanaTridoshajaVikara. MriduVirechana is the choice of management of VataVyadhi.Objective:This clinical trial was done to contemplate the efficacy of Nitya VirechanausingTrivrita and AragvadhaChurna on Essential Hypertension.Settings: Outdoor and indoor patient, Maharashtra.Design:Randomized Open Comparative Clinical Trial. Materials and Methods:Newly diagnosed thirty patients of Stage 1 Essential Hypertension were randomly divided into two groups and were administered Nitya Virechanawith Trivirtaand AragvadhaChurnarespectively for sequential 15 days. Statistical Test:Paired and unpaired t test were done to find out whether the changes observed was statistically significant or not.Results:Results were drawn based on alteration in blood pressure (Systolic, Diastolic blood pressure, Pulse pressure) and serum electrolyte (Serum Sodium, Potassium and Creatinine) observed in both groups showed statistically highly significant improvement (p<0.0001).Conclusion:Overall effect of NityaVirechanausing both drugs had marked reduction and prolonged impact inEssential Hypertension.
Article
Full-text available
The physiological relationship between local arterial displacement and blood pressure (BP) plays an integral role in assess- ment of the mechanical properties of arteries. In this study, we used more advanced methods to obtain reliable continuous BP and the displacement of the common carotid artery (CCA) simultaneously. We propose a novel evaluation method for arterial stiffness that relies on determining the physiological relationship between the axial and radial displacements of the CCA wall and beat-to-beat BP. Patients (total of 138) were divided into groups according to the following three criteria: essential hyper- tension (EH) and normotension, male and female, elderly and younger. The Pearson correlation test and canonical correlation analysis showed that the CCA indices were significantly correlated with BP indices (r = 0:787; p < 0:05). The slope of the CCA displacement/pressure curve showed a progressive reduction with increasing age and EH disease occurrence (EH: 0.496 vs. normotension: 0.822; age <= 60:0.585 vs. age > 60:0.783). Our method provides an explicit reference value and relationship for the manner in which the CCA wall responds to changes in BP. Short-term and continuous BP were significantly correlated with CCA displacement and exhibited a close inverse relationship with each subject’s BP and EH, age, and systolic blood pressure.
Article
Full-text available
Kidneys regulate the balance of water and sodium and therefore are related to blood pressure. It is unclear whether estrogen-related receptor α (ERRα), an orphan nuclear receptor and transcription factor highly expressed in kidneys, affects the reabsorption of water and sodium. The aim of this study was to determine whether changes in the expressions of ERRα, Na⁺/K⁺-ATPase and epithelial sodium channel (ENaC) proteins affected the reabsorption of water and sodium in kidneys of Dahl salt-sensitive (DS) rats. SS.13BN rats, 98% homologous to the DS rats, were used as a normotensive control group. The 24 h urinary sodium excretion of the DS and SS.13BN rats increased after the 6-week high salt diet intervention, while sodium excretion was increased in DS rats with daidzein (agonist of ERRα) treatment. ERRα expression was decreased, while β- and γ-ENaC mRNA expressions were increased upon high sodium diet treatment in the DS rats. In the chromatin immunoprecipitation (CHIP) assay, positive PCR signals were obtained in samples treated with anti-ERRα antibody. The transcriptional activity of ERRα was decreased upon high salt diet intervention. ERRα reduced the expressions of β- and γ-ENaC by binding to the ENaC promoter, thereby increased Na+ reabsorption. Therefore, ERRα might be one of the factors causing salt-sensitive hypertension.
Article
Full-text available
The function of the heart is to contract and pump oxygenated blood to the body and deoxygenated blood to the lungs. To achieve this goal, a normal human heart must beat regularly and continuously for one's entire life. Heartbeats originate from the rhythmic pacing discharge from the sinoatrial (SA) node within the heart itself. In the absence of extrinsic neural or hormonal influences, the SA node pacing rate would be about 100 beats per minute. Heart rate and cardiac output, however, must vary in response to the needs of the body's cells for oxygen and nutrients under varying conditions. In order to respond rapidly to the changing requirements of the body's tissues, the heart rate and contractility are regulated by the nervous system, hormones, and other factors. Here we review how the cardiovascular system is controlled and influenced by not only a unique intrinsic system, but is also heavily influenced by the autonomic nervous system as well as the endocrine system.
Article
Full-text available
Over the past century, salt has been the subject of intense scientific research related to blood pressure elevation and cardiovascular mortalities. Moderate reduction of dietary salt intake is generally an effective measure to reduce blood pressure. However, recently some in the academic society and lay media dispute the benefits of salt restriction, pointing to inconsistent outcomes noted in some observational studies. A reduction in dietary salt from the current intake of 9-12 g/day to the recommended level of less than 5-6 g/day will have major beneficial effects on cardiovascular health along with major healthcare cost savings around the world. The World Health Organization (WHO) strongly recommended to reduce dietary salt intake as one of the top priority actions to tackle the global non-communicable disease crisis and has urged member nations to take action to reduce population wide dietary salt intake to decrease the number of deaths from hypertension, cardiovascular disease and stroke. However, some scientists still advocate the possibility of increased risk of CVD morbidity and mortality at extremes of low salt intake. Future research may inform the optimal sodium reduction strategies and intake targets for general populations. Until then, we have to continue to build consensus around the greatest benefits of salt reduction for CVD prevention, and dietary salt intake reduction strategies must remain at the top of the public health agenda.
Article
Full-text available
'What is the ideal way of teaching Ayurveda?' - has been a debated question since long. The present graduate level curriculum lists out the topics from 'contemporary medical science' and 'Ayurveda' discretely, placing no emphasis on integration. Most of the textbooks, too, follow the same pattern. This makes learning not only difficult, but also leads to cognitive dissonance. To develop and evaluate the effectiveness of a few integrative teaching methods. We introduced three different interventions in the subject Kriya Sharira with special reference to 'cardiovascular physiology'. The instructional methods that we evaluated were: 1. Integrative module on cardiovascular physiology (IMCP), 2. case-stimulated learning (CSL), and 3. classroom small group discussion (CSGD). In the first two experiments, we subjected the experimental group of graduate students to the integrative instructional methods. The control group of students received the instructions in a conventional, didactic, teacher-centric way. After the experiments were over, the learning outcome was assessed and compared on the basis of the test scores. The groups were crossed over thereafter and the instructional methods were interchanged. Finally, feedback was obtained on different questionnaires. In the third experiment, only student feedback was taken as we could not have a control group. The test results in the first experiment showed that the integrative method is comparable with the conventional method. In the second experiment, the test results showed that the integrative method is better than the conventional method. The student feedback showed that all the three methods were perceived to be more interesting than the conventional one. The study shows that the development of testable integrative teaching methods is possible in the context of Ayurveda education. It also shows that students find integrative approaches more interesting than the conventional method.
Article
Full-text available
Propagation of the pressure wave along the arterial tree (pulse wave velocity [PWV]) is related to the intrinsic elasticity of the arterial wall. PWV is increased in stiffer arteries and, when measured over the aorta, is an independent predictor of cardiovascular morbidity and mortality. Given the predictive power of PWV, identifying strategies that prevent or reduce stiffening may be important in prevention of cardiovascular events. One view is that aortic stiffness occurs as a result of atherosclerosis along the aorta. However, there is little or no association between PWV and classical risk factors for atherosclerosis, other than age and blood pressure. Furthermore, PWV does not increase during early stages of atherosclerosis, as measured by intima-media thickness and non-calcified atheroma, but it does increase in the presence of aortic calcification that occurs within advanced atherosclerotic plaque. Age-related widening of pulse pressure is the major cause of age-related increase in prevalence of hypertension and has been attributed to arterial stiffening. This review summarizes the methods of measuring aortic stiffness in humans, the pathophysiological mechanisms leading to aortic stiffness, including its association with atherosclerosis, and the haemodynamic consequences of increased aortic stiffness.
Article
Purpose: In Ayurveda although there is no such terminology like hypertension but still this work is an approach to establish relationship between Hypertension & vitiated functioning of three governing forces of our body i.e. Tridosha and to treat Hypertension on Ayurvedic principles. The logic behind such correlation is based on the fact that, like other physiological processes, B.P. too is normal phenomenon of our body which is governed by Tridosha. After going through modern pathogenesis of primary hypertension and its symptomology, in present study it has been correlated with Vata Kaphaja Vikara with Rasavaha, Raktavaha and Manovahi Srotas as the seat of disease. Looking at its pathogenesis, the term Uccha Vyan Bala (exaggerated physiological functioning of Vyan Vayu leading to increase contractility of heart & blood vessels) can be coined for hypertension. Method: Subjective criteria Headache, Palpitation, Vertigo, Dyspnoea on walks and Fatigue. Objective criteria BP value recorded by sphygmomanometer in supine position. Final assessment of results; Subjective assessment 75 to 100% disappearance of symptoms effectively cured. 50 to 74% disappearance of symptoms well cured. 25 to 49% disappearance of symptoms fairly cured. 0 to 24% disappearance of symptoms poorly cured. Objective assessment Patient showing reduction in BP by 10mmHg Poorly cured; Patient showing reduction in BP between 11 to 20mmHg Fairly cured; Patient showing reduction in BP between 21 to 30 mmHg Well cured; Patient showing reduction in BP by more than 30 mmHg Effectively cured. Research methodology Type of study-Single blinded comparative study. Study site IPD and OPD department of Shubhdeep ayurved medical college, Indore (MP). Sample size 50 patients divided randomly into two equal groups. Group A given trial drug whereas Group B given control drug. Drug dosage and vehicle 1 capsule twice daily with lukewarm water after meals. Duration of treatment one month (examined at weekly intervals.) Dietary advice to strictly restrict the daily intake of Amla, Lavana, Guru & Vidahi diet. Result: 70% Patients found to be hypertensive were above 40 years of age. 60% Patients were fond of salty & spicy diet. Out of 50 patients 30 patients (60%) belongs to service class. Out of 50 patients 35 patients (70%) were male. Regarding prevalence of symptoms, Dyspnoea on routine work was found in 82%, Headache & palpitation in 80%, Vertigo in 78% & Fatigue in 66% patients. Conclusion: As per classical texts, Vata predominant diseases are caused due to vitiation of Vata due to emaciation (Dhatu Kshaya) & obstruction (Marg avarodha). Hypertension seems to be Vata predominant disease due to obstruction. Reason being that, Lavana is Vata Shamak, & should therefore decrease Blood pressure but on contrary it increases B.P. Similarly increase in weight leads to greater chances of High Blood pressure. Above discussion favours that Hypertension can be considered Vata predominant disease due to Marg avarodha by Kapha Dosha and Pitta Dosha in Anubandh. Finally it can be concluded that the drug under study has shown enthusiastic results in reducing the overall value of blood pressure. 64% patients got effectively cured, 24% got well cured and 12% got fairly cured. Regarding symptomatic relief, out of 25 patients 8 showed more than 75% relief, 9 showed more than 50% relief, 7 showed more than 25% relief and only 1 patient showed less than 25% relief in overall symptoms. No significant side effects have been reported in any subject.
Article
Hypertension is a significant and costly public health problem. It is a major, but modifiable contributor for the development of cardiovascular disease. Randomized controlled trials have shown that controlling hypertension reduces the risk of stroke, coronary artery disease, congestive heart failure, end-stage renal disease, peripheral vascular disease, as well as overall mortality. The risk of developing these hypertension-related complications is continuous, starting at a blood pressure level as low as 115/75 mm Hg. Despite the inherent health risks associated with uncontrolled hypertension, elevated blood pressure remains inadequately treated in the majority of patients. This article reviews guidelines for optimal evaluation of hypertension and current therapeutic options available to combat this common yet pervasive disease.