Accelerated Hypertension – Accurate Prescription Yields Rich Dividends

Introduction – Systemic hypertension has nearly become the order of the day sparing no age group or sex. WHO has predicted that the prevalence in adults is highest in the age group of 40-55 years. Blood Pressure levels were highest in Indian men as compared to 20 developed countries.

As one moves more and more towards modern life-styles, one becomes more susceptible to be hypertensive. In the real sense, raised blood pressure is just a signal of the prevailing overall tensive state. Probable risk factors in Indians – Truncal obesity (hyperinsulinemia), tobacco (without chuna), smoking, post- alcohol snacks, dietary excess of sodium and fat, deficiency of potassium and fiber, psychosocial stress, low birth weight, etc.

The economic impact is adverse too – Direct costs (screening, diagnosis, clinic visits, laboratory tests, drugs, adverse reactions, transport cost, time lost from work, etc.), Indirect Costs (income lost due to absence, cost of therapy for co-existing conditions).

Primary or essential hypertension is a miasmatic disorder and should be treated as such. But sometimes particularly in hypertensive urgencies or accelerated hypertension, rapid prescriptions with so-called specifics like Rauwolfia serpintina, Digitalis, Nux vomica, Nat muraticum, Spigelia or Veratrum vir, etc. may be needed.

Regular blood pressure monitoring with relevant investigations can help to streamline therapy. Auxiliary measures like Yoga have also to be resorted. Shavasan which is a mental relaxant, is a boon for rehabilitation following myocardial infarction apart from hypertension.

Pranayam helps in better diabetic control and improves lipid profile. Isotonic exercises as walking, jogging, swimming, racket games are preferable whereas isometric exercises as weight lifting, etc should be avoided. One must cultivate a hobby (music, painting, etc.) and must try to relax on weekends.

Non-Smoking should be practiced as a social behavior. The physician needs to find alternatives if the hypertensive female on treatment is using contraceptive pills as these deep acting drugs act as barriers in the successful removal of the miasmatic block.

In this context, I present a case of Accelerated Hypertension, where the knowledge of materia medica of certain rare drugs helps immensely in managing such cases.

Mr. F., a 22-year-old college boy pursuing his business management course reported on 12/1/21 with complaints of palpitation and anxiety in chest since 2 hours. No history of chest pain, perspiration, choking or suffocation or headache. He had tobacco addiction since a 1year. Smoked about 10-11 cigarettes a day but had stopped since 1 week. There was an altercation with his classmate about an hour ago and he still seemed very angry.

Chilly, appetite – average, preferred salty food, cold drinks. Urine / Stool – normal

He had such episodes in the past 9 months but the palpitation was erratic in nature (as regards the modalities) with changing sensations in the chest.  He had taken Digitalis off and on (prescribed by another homeopath). But there was only partial relief.

Later he was diagnosed to have high systolic BP levels on 2 occasions and was started with tablet Olmesartan 40mg + Atenolol 50mg. But the systolic BP remained steady at 160-180 mm Hg and the symptoms continued.  Basically, he was a social person with a friendly and helping nature. Presently he was worried about getting a heart attack.

On Exam – Lean built, Afebrile,

Pulse – 110/min good volume, non-collapsing. No carotid or aortic bruit.

BP = 190/112mm Hg. No Pallor/ Icterus. JVP Not raised.

No edema. Skin / Spine / Joints Normal.  ENT Normal.

Heart Sounds pure. No gallop or murmurs.

Respiration normal.

Per Abdomen- soft. No organomegaly. 

CNS – NAD

ECG – LVH with Strain pattern.

Urine – albumin +

Symptoms for Presenting Totality:

1. Chest, Palpitations
2. Chest, Angina
3. Chest Anxiety in
4. Mind, fear disease of impending
5. Albuminuria

The following drugs were thought of – Spigelia, Aconite Nap, Aconite Ferox, Digitalis and Spartein S.

Management –

1:30 pm: hospitalized. Rx- Digitalis 0/1, 1 hourly

3 pm: palpitations less but anxiety in chest same. BP – 182/110    Rx – Digitalis 0/2 1 hourly

4 pm: No significant change. Rx: Spartein S 0/1 every 1 hour

6.10 pm: BP 160/90 mm. Had slept for 30 mins. Had Coconut water. Continued Spartein 0/1

7:30 pm – Patient much better. BP150/90. Spart 0/1 TDS

9.30 pm – Had dinner. Passed Urine & stool.

13/1: 8am – slept well.

7 pm – Much better. No complaints. Had a late lunch. BP 160/96.   

Sudden craving for smoking developed at 1.30am. Mild Palpitation & anxiety.

BP 156/100.

Blood Counts, Kidney & Thyroid profile Normal; Urine routine – Normal

2D ECHO – Diastolic Dysfunction present. No RWMA. EF 60%. Rx: Spartein S 0/2 BD

14/1 – Patient was better. He was counseled about his addiction and discharged. BP 150/90.           Phosphorus 200 stat. Asked to continue his previous allopathic medicines.

Discussion –

1. Since the patient was taking Digitalis in potencies off and on for his complaints, hence we administered it first. But it did not work.
2. The restlessness and anguish of Aconite was absent and neither there were any characteristics to prescribe Spigelia
3. Spartein Sulp is a short acting rare remedy that helps to manage accelerated hypertension. Clinically it works better in patients who have taken Digitalis previously and those who are addicted to tobacco. We have additionally found in other patients that it acts well when Spigelia and Aconite fail to show results.
4. Phosphorus was the constitutional drug.