Diagnosis of essential hypertension :-Usually the diagnosis of essential hypertension is not difficult.
Diagnosis : An elderly patient complaining of symptoms already noted is found to have high blood pressure; then the diagnosis is obvious. Sometimes one comes across a border line case. Then the only thing is to wait and observe the patient for some months before the diagnosis can be established. The following conditions offer some difficulties in diagnosis :.
(1) In elderly women at the time of menopause the blood pressure fluctuates from time to time, so that at one time one may find the blood pressure increased, at other times within normal limits. These cases need further observation before one can say that the patient is suffering from essential hyper- tension. It may be remarked here that when one comes across a case which at one time shows elevated blood pressure and at other times normal pressure, it should be taken as a potential case of hypertension because it has been observed that such cases ultimately go to essential hypertension.
(2) Another condition that is difficult to diagnose, is a case of hypertension which is due to previous nephritis. It becomes particularly difficult to diagnose such a case from that stage of essential hypertension where the kidneys have been affected. The following point may help. A history of a previous attack of nephritis is of course in favour of chronic nephritis; but such history is quite often absent. Much elevation of blood pressure, say above 250 systolic and 150 diastolic, is more common in essential hypertension than in chronic nephritis. Age may sometimes help. If the patients is in twenties the probability of nephritis is more. If after fifty it is in favour of essential hypertension. But at thirties or forties it is very difficult to differentiate the two conditions.
(3) The third condition which presents diagnostic difficulties is when one sees the patient after an attack of coronary thrombosis. As already stated, under such a condition the blood pressure falls and it may be difficult to say whether the case is of essential hypertension. In these cases presence of retinal arteriosclerosis is of help. Sometimes in these cases as the heart improves the blood pressure begins to rise revealing the true nature of the disease.
TREATMENT :-
Treatment of essential hypertension is a very difficult problem. Patient should be asked to take rest for one to two hours after lunch and at least eight hours in the night. Patient should take frequent holidays from work. Exercise may be allowed within the limits of the heart. Unusual excitement etc. should be avoided. The diet should be light and if any change is to be made in the diet it should be more quantitative than qualitative.
So far as the allopathic treatment of essential hypertension is concerned there is very little to be said. Vaso dilators, particularly the nitrites, are very extensively used but are only of temporary use. One of the latest addition is the use of Serpina tablets. They also seem to be of temporary use. The blood pressure falls for a few days and then again rises even when the tablets are continued. Personally I think Homoeopathic treatment offers a better chance to these patients. I will here describe to you one case of essential hypertension from my practice treated homoeopathically.
This was a case of a school teacher, aged 38 years. He came to me on the 21st march 1940, with the following complaints: Cough, in the morning, almost immediately after waking, which lasted for about half an hour, accompanied with slight yellow expectoration; dyspnoea, on slight exertion, of 6 months duration; periodic attacks of headache either in the occipital or in the temporal region. The periodicity of these attacks was generally monthly; but he also got these attacks at any time if the strain of work at school was more. Usually the attack of headache lasted for two to three days and then disappeared spontaneously.
Origin, duration and progress:-The patient had been getting these periodic attacks of headache almost for about three years. In the beginning they used to be insignificant and were usually ascribed to the strain of work. Latterly for about one year the attacks came not only when there was strain of work but also otherwise. The dyspnoea on exertion started about 6 months previous to the date he saw me and had been steadily increasing so that the patient then found it difficult to climb two staircases. He got an attack of Pneumonia, left base, in the month of January 1940.
The attack of pneumonia ran its usual course and the temp. came down by crisis on the ninth day. It was during this attack of Pneumonia that his blood pressure was noted by a practitioner to be high. After the attack was over although the patient was feeling better, crepitations persisted at the left base. He had been under the care of one prominent physician of Bombay for the presence of these adventitious sounds and high blood pressure.
Sputum was repeatedly found to be negative for Tubercle Bacillus. X Ray showed a small area of consolidation at the left base. The patient was given extensive treatment with injections and mixtures but neither did the sounds disappear, nor did the blood pressure come down. It was after trying all possible allopathic treatment that the patient came to me for Homoeopathic treatment.
The family history of this patient was very significant in that his father died of a sudden attack of paralysis. His mother is living and healthy. He has four brothers, who are in good health excepting one who is also habituated to get periodic attacks of headache.
On physical examination I found the patient to be well built and well nourished. Examination of the respiratory system revealed nothing abnormal on inspection or palpitation. There was a slight impairment of note at the left base just near the anterior axillary line. On auscultation at this area very distinct crepitations at the end of inspiration were heard. The patch seemed to be about an inch in diameter as could be made out from auscultation. There were no foreign sounds in other parts of the lung.
The examination of circulatory system revealed that the apex beat was in the 5th intercostal space, 42″ away from the middle line and distinctly heaving. First sound at the apex was prolonged and booming and second sound at the base was accentuated. The blood pressure was 150/110. The rest of the physical examination was essentially negative. I examined the sputum once myself and found it to be negative for T.B. The urine examination revealed nothing abnormal. My diagnosis was essential hypertension with unresolved pneumonia at the left base.
The case was taken up for Homoeopathic treatment and was repertorised from Kents repertory. The following rubrics were selected for repertorisation.
(1) Neglected Pneumonia p.836-1.
(2) Periodicity, Headache p.145-1.
(3) Cough, on waking p.778-2.
(4) Expectoration yellow p.821-1.
(5) Respiration difficult on exertion p.769-1.
(6) Hypertrophied heart p.835-1.
On combining the first three rubrics the following drugs come up highest. Phos 7; Silicea 9 and Sulphur 6. On combining the other three rubrics Phos was 12, Silicea 14 and Sulphur 10. Phosphorus was the drug which covered all the rubrics. Silicea was also quite a prominent remedy and was high throughout excepting that it did not cover up hypertrophied heart. I decided to try Silicea first. So I gave Sil. 30 in three doses on 16th March 1940. The headache was slightly less the next day, but a day after that it increased in severity.
I had given him sac.lac. for two days. So far as the headache was concerned he gave two more symptoms this time, namely that the headache was aggravated by motion and also by lying down. On referring to the repertory for “headache; aggravated by motion,” the rubric was found to be covered both by Phos. and Sil. but aggravation by lying down is covered only by Phos. By that time the attack of headache had spontaneously subsided after lasting for three days. On giving second thought to the whole case I decided to give him Phos. for the next attack.
In the meantime I continued him on sac.lac. He got the next attack of headache on 5.4.40, I had already provided him with Phos 30, for the contingency. He took these powders at the interval of one hour and within four to five hours the attack completely subsided. That was the first time in so many months that the attack subsided so quickly. I continued him on sac.lacs. On 8.4.40 his blood pressure was 140/105 Patient used to see me twice a week. The morning cough was gradually becoming less.
On 26.4.40 the respiratory sounds had practically disappeared. The blood pressure was varying between 130/100 to 120/95, On 24.7.40 practically after three months the sounds at the left base reappeared. I repeated Phos 30 on 27.7.40 and the sounds disappeared again. On 8.8.40 the patient got an attack of headache again. The blood pressure, which was previously 120/95, became 130/100. There were no sounds in the lungs. I repeated Phos 30 and again he was relieved of the attack of headache. He continued taking sac. lac. till 28.9.40 and had no more attack of headache. I then advised him to discontinue the treatment.
