Hypertension

Dr. Shamanthakamani Narendran

M.D. (Pead), Ph.D. (Yoga Science)

Hypertension 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

limits. 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 kidney failure.

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 people.

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 pressure.

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

NORMAL BP Adult males (20-50 yrs)

NORMAL BP Adult males (20-50 yrs)

Pulmonary hypertension begins when tiny arteries in the lungs, called pulmonary arteries and capillaries, become narrowed, blocked or destroyed.

This makes it harder for blood to flow through the lungs, which raises pressure within the pulmonary arteries.

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 fatal.

Although it isn't curable, treatments are available that can help lessen symptoms and improve the quality of life.

SYMPTOMS

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 worse.  

Shortness of breath (dyspnea), either while exercising or at rest

Fatigue Dizziness or fainting spells (syncope) Chest pressure or pain Swelling (edema) in ankles, legs and eventually in

abdomen (ascites) Bluish color lips and skin (cyanosis) Racing pulse or heart palpitations

PATHOPHYSIOLOGY

CAUSES

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 heart defects.

Certain medications –birth control pills, cold remedies, decongestants, OTC pain relievers and some prescription drugs also may cause secondary hypertension.

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.

EMOTIONAL CORTEX

HYPOTHALAMUS

SYMPATHETIC NERVES

CONSTRICTSBLOOD VESSELSFORCEFUL

CONTRACTION OF THE HEART

Anger Fear Tension

RISK FACTORS

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 blacks.

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 damage heart.

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 – Sympathetic dominance.

• Increased secretion of catecholamines due to HPA Axis stimulation.

TESTS AND DIAGNOSIS BP is measured with an inflatable arm cuff and a

pressure-measuring gauge. A BP reading, given in mm Hg, has two

numbers. The first, or upper, number measures the

pressure in the arteries when the heart beats (systolic pressure).

The second, or lower, number

measures the pressure in the

arteries between beats

(diastolic pressure).

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.

COMPLICATIONS

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 functioning normally.

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 certain conditions.

Blood pressure treatment goals

140/90 mm Hg or lower If he/she is a healthy adult

130/80 mm Hg or lowerIf 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 error.

Major types of medication used to control HBP Thiazide diuretics Beta blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers Calcium channel blockers Renin inhibitors Alpha blockers Alpha-beta blockers Central-acting agents Vasodilators

LIFESTYLE & HOME REMEDIES

Eat healthy foods – DASH diet (Dietary Approaches to Stop Hypertension)

Maintain a healthy weight. No or limit alcohol Don't smoke Manage stress Practice slow, deep breathing

The heart is a powerful organ about the size of a clenched fist.

Located just to the left of center between the lungs.

It operates as two coordinated pumps that send blood around the body.

INTERNAL VIEW OF THE HEART

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 arteries.

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.

HEART ATTACK

AND ANGINA

INCREASING RAPIDLY IN LAST FIVE DECADES

W H Y ???

MODERN LIFE STYLE

Coronary arteries are the major blood vessels that supply the heart with blood, oxygen and nutrients.

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 lifestyle.

Myocardial Infarction / Heart Attack

Angina Pectoris Hardening of the arteries, and the presence of a thrombus, or clot, in a blood vessel are the most common causes of obstruction. Arteriosclerosis is responsible for most of the deaths resulting from heart attacks. Spasms of the coronary arteries can also result in a heart attack.

PLAGUE AND CHOLERAPLAGUE AND CHOLERA OF LAST CENTURY REPLACED BY HEART ATTACK AND CANCERHEART ATTACK AND CANCER IN THIS CENTURY

HEART ATTACK -THE SECONDMAJOR KILLER AFTER ACCIDENTS

NICOTINEARTERIAL SPASM

OVERLOAD ON CIRCULATIONFAT DEPOSIT ON HEART

OVERLOAD ON HEART

DEPOSITS IN ARTERIESNARROWING

EARLY AGINGATHEROSCLEROSIS

LEADS TO OBESITY

CHOLESTEROL &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.

COMPLICATIONS

Chest pain – coronary arteries narrow Heart attack – cholesterol plaque ruptures,

stimulating platelet clumping, complete blockage of heart artery may trigger a heart attack.

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 supply to the heart or damage to heart tissue

STRESS MANAGEMENT

ANGER MANAGEMENT SCHOOLS

• Headache• Sleep disturbances• Difficulty in concentrating• Short temper• Upset stomach• Job dissatisfaction• Low morale

In atherosclerosis, arteries are clogged by an accumulation of plaques – which are made up of cholesterol particles, fat, calcium, cellular waste and other substances.

NORMAL 20YRS

FATTY STREAKS

40YRS

STAGES OF HARDENING & BLOCKAGE

60YRS

80YRS

FIBROUS

PATCHES

COMPLICATED

PATCH

ATHERECTOMY

Rotational Athrectomy

Directional Coronary

Athrectomy

Extraction Athrectomy

NORMALLY VERY SLOW

PROBLEM SEEN ONLY IN VITAL ORGANS LIKE HEART AND BRAIN

MODERN LIFESTYLE RAPID AGING - 35 - 50 YEARS

STRESS FREE LIFESTYLEHEART ATTACK AT 90TH YEAR,

NON PHARMACOLOGICAL INTERVENTIONS

• BIOFEEDBACK.

• PROGRESSIVE MUSCLE RELAXATION.

• YOGA.

• TAICHI.

• AEROBICS

• MEDITATION.

• EXERCISE.

• HERBAL FORMULATIONS

PHARMACOLOGICAL INTERVENTIONS

Cholesterol-modifying medications Beta blockers Nitroglycerin ACE inhibitors Calcium channel blockers

PROCEDURES Angioplasty and stent placement (percutaneous

coronary revascularization) Coronary artery bypass surgery (CABG)

Tests Digital subtraction angiography (DSA)

Doppler ultrasound

Echocardiography (ECHO)

Nuclear cardiology:

Positron emission tomography (PET scan)

Thallium 201 scintigraphy

Technetium 99 ventriculography

Magnetic resonance imaging (MRI)

ELECTROCARDIOGRAM

Angiography

Electrocardiography (EKG / ECG)

Detects heart abnormalities, disease and damage by measuring the heart's rhythms and electrical impulses.

EchocardiographyThe 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 cardioversion.

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.

Defibrillator

Cardiac Arrest: Sudden stoppage of heart.

Palpitation: Uncomfortable sensation in the chest associated with arrhythmia. This causes

1. Premature atrial contraction (PAC)

2. Premature ventricular contraction (PVC).

HYPERTENSION&

CAD

ÁDHIJA VYÁDHIS

IS EXCESSIVE SPEEDIN

MANOMAYA KOSA

• CM - DEEP REST CALMNESS

• CM - DEEP REST CALMNESS

- MEDITATION DIVINE MOOD - CALM - REST- MEDITATION DIVINE MOOD - CALM - REST

PURE LOVE

SURRENDER TO DIVINE

ANGER & IRRITABILITY

TENSION AND FEAR

JEALOUSY AND HATRED

DEPRESSION

PARDON

FAITH IN DIVINE

ACCEPTANCE

CONFIDENCE

THE EXCESSIVE SPEEDPERCOLATES AS IMBALANCES

IN

THE EXCESSIVE SPEEDMANIFESTS AS HYPER REACTIVE HABIT OF

PERSISTANT HIGH BLOOD PRESSURE

AT (CONSTRICTION OF BLOOD VESSELS)(CONSTRICTION OF BLOOD VESSELS)

DEEP RESTDEEP REST TO MIND BODY COMPLEX

IRT QRT DRT

CMCM

QRTIRTDRT

QRT

CMCM

INTEGRATED YOGA MODULE FOR HYPERTENSION

Suksma Vyayama (strengthening the joints) Loosening of wrists Shoulder rotation Padasancalana Drill walkingBreathing exercise Hands stretch breathing Ankle stretch breathing Trikonasana breathing Tiger breathing Straight leg raising Setubandhasana breathing Quick relaxation technique (QRT)

Yogasanas Ardhakaticakrasana Vrksasana Garudasana Vakrasana/ Ardha-Matsyendrasana Gomukhasana Bhujangasana Deep relaxation technique (DRT)

Pranayama Vibhaga pranayama Candra Anuloma pranayama Nadi suddhi Ujjayi pranayama Sitali/ Sitkari/ SadantaMeditation (Dhyana Dharana) Nadanusandhana OM meditationKriyas Jala Neti Vamana Dhouti Kapalabhati (20-40 strokes/minute)

INTEGRATED YOGA MODULE FOR HEART DISEASES

Loosening Exercises Loosening of fingers Shoulder rotation Drill walking Instant relaxation

technique (IRT)

Breathing practices Hands stretch breathing Ankle stretch breathing Rabbit breathing Straight leg raise breathing

(alternating) Side bending, each Quick relaxation

technique (QRT)

Yogasanas

Standing Ardhakati cakrasana Garudasana Bhujangasana Vakrasana Gomukhasana Deep relaxation

technique (DRT)

Pranayama Nadisuddi pranayama Sitali pranayama Bhramari pranayama

Meditation Nadanusandhana OM-Dhyana (meditation)

Acute attack - chair breathing

Vamanadhouti + DRT – Once a week Laghu Sankapraksalana + DRT - Daily

SPECIFIC PRACTICE 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 the arteries.

Yoga helps to cope with this stress so that do not need to depend on smoking or eating unhealthy food.

It also helps to find a contentment from within.

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 very high.

Nadi Shodak Pranayama - It can be done 10 times.

Heart disease 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 fairly good.

Recommendations: Patients shortly after myocardial infarction are advised to practice Savasana, full yoga breath and later some easy Pavanmuktasanasa, in prone position.

Hypertension General considerations: Severe hypertension

should be medically treated on a long-term basis.

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.

Hypotension General considerations: Hypotension, if it is

not caused by some acute condition, such as internal bleeding, is usually not a serious medical problem.

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

whole body. Pavanmuktasana (Relieving the flatus) - wind

reliever, corrects malfunctioning of the abdomen. Make 4-6 rounds.

Uttanpadasana (Raising the legs) - Helps reduce fat.

Santulanasana - normalizes blood circulation. Savasana (Corpse pose) - should be done twice

or thrice daily as it normalizes the blood pressure.

THANK YOU