Essential hypertension is a lethal disease that has affected nearly 15%of the Indian population. More awful is the very nature of the disease, it occurs without the development of any symptom at all. It occurs without any evident organic cause. As many as 50% of the essential hypertensive patients do not develop any symptom at all, hence it is described as silent killer.
The term hypertension is used to describe an increase in pressure in arteries. When the term hypertension is used alone, it means systemic hypertension. It means increase in pressure in the systemic circulation.

Definition: - Systemic hypertension cannot be defined precisely. But it is generally agreed that sustained elevation of systolic pressure above 140mm of Hg and/or diastolic pressure above 90mm of Hg constitutes systemic hypertension. Elevation of the diastolic component of blood pressure is particularly significant in hypertensive cases because (1) it is less affected by extraneous and other influences and (2) indicative of the constant load against which heart has to work.

Classification of blood pressure in adults:-
Category   Systolic     Diastolic
Normal       <130          <85
High normal 130-139   85-89

Hypertension
Stage (1) mild 140-159 90-99
Stage (2) moderate 160-179 100-109
Stage (3) severe 180-209 110-119
Stage (4) very severe >210 >120

Homoeopathic concepts about essential hypertension:-
Essential hypertension pertains to the class of chronic diseases described by Dr. Samuel Hahnemann, the founder of homoeopathy

Role of miasms: - Dr. Hahnemann perfected his theory on chronic diseases in the year 1828. According to this theory, chronic diseases results from chronic miasms.

Human beings are under the influence of two opposing immaterial forces: Vital force and miasms. Vital force is constructive or life preserving in action and is responsible for the harmonious functions of the whole body. Miasm, on the other hand, is destructive in action and makes man susceptible to various diseases. When the external and internal environments that encompass all spheres of human functions are favourable for thriving of man, vital force is on the upper hand and man is healthy: otherwise miasm is on upper hand and man becomes diseased

There are three known miasms namely psora, sycosis, and syphilis. Psora results from bad thinking and bad willing. It is in the mind that psora originates and it is in the mind that vitiates most. If bad thinking and willing are not checked at appropriate times, they lead to bad actions. Sycosis and syphilis result from such bad actions. Psora is considered the mother of all chronic diseases.

There are three stages of psora
1.Latent psora: - This is the first stage of miasmatic action. Miasm first make a disturbance in the vital force which is manifested as abnormal sensations and functions of the organism. These symptoms are just constitutional and do not refer any particular organ or tissues. Nosology fails to apply here, and man appears to be healthy.
2.Secondary psora:-This is characterized by the disharmony of the functions of various tissues and organs. It is a later manifestation of the disharmony of the vital force produced by the latent psora.
3.Tertiary psora:- Psoric action advances as time passes by in multilateral directions and gross structuctural changes in the tissues and organs begin to appear. This is the stage of tertiary psora. Diverse pathology is seen in this stage.

Chronic diseases are the class of disease that spring from the chronic miasms. The whole or central life is attacked and disturbed first by some morbific agent of miasmatic nature; this central disturbance leads to disturbance in the life of tissues, organs or cells. Chronic disease thus follow a definite course of evolution starting from the central to the periphery and marked by the three stages of psora, followed by sycosis and syphilis. Hahnemann explained about this in his book ‘nature of chronic diseases’ as “their beginning was promising, the continuation less favourable and outcome was hopeless, is true as far as hypertension is considered. It does not show any identifiable organic cause during most part of its course of evolution and has to be understood from the totality of symptoms.
Pathophysiology of hypertension:-

Magnitude of arterial pressure depends on the two fundamental hemodynamic variables: Cardiac output and total peripheral resistance.

Cardiac output: - It is the volume f blood pumped by the left ventricle in one minute. Normally 5 to 6 liters of blood is pumped out in healthy adult. It is depends on blood volume, which is greatly depends on body sodium.

Peripheral resistance: - The impediment of the blood flow occurring in the entire systemic circulation is called peripheral resistance. The total peripheral resistance is determined by lumen size of the arterioles, thickness of the arteriolar wall and the effects of the neural and hormonal influences that either constrict or dialate these vessels

Auto regulation:-It is a process by which increased blood flow to resistant vessel induces vasoconstriction, an adaptive mechanism that protects against hyper perfusion of tissues.

Blood pressure regulation:-
                      Humoral factors
                      Constrictors               Dialators
                      Angiotensin II         Prostaglandins
Blood volume  Thromboxane               Kinins
Sodium
                                                   Local factors
                                                  Autoregulation

Blood pressure= Cardiac output × Peripheral resistance

Cardiac Factors            Neural Factors
Heart rate            Constrictors            Dialators
Contractility       α-adrenergic             β-adrenergic

Kidney plays an important role in blood pressure regulation. Renal dysfunction is essential for the development and maintenance of both essential and secondary hypertension.

Blood pressure variation in the rennin-angiotensin system.
Angiotensinogen
Renin
AngiotensinI
ACE
AngiotensinogenII
Vasoconstriction

Kidney influences both peripheral resistance and sodium homeostasis and the rennin-angiotensin system appears to central to these influences. Renin formed from the juxtra glomerular cells of the kidney converts plasma angiotensinogen to angiotensinI, and it is again converted into angiotensin II by ACE. Angiotenin II alters blood pressure by increasing both peripheral resistance and blood volume.

Kidney produces a variety of vasodepressor that counterbalance the vasopressor effects of angiotensin.they include prostaglandins and kinins.

When blood volume is reduced, the GFR falls, this in turn leads to increased reabsorbtion of sodium by proximal tubules in an attempt to conserve sodium and expand blood volume.

ANF, a peptide secreted by heart atria inhibits sodium reabsorbtion in distal tubules and causes vasodilatation.

Arterial hypertension occurs when changes develop that alters the relationship between blood volume and total peripheral resistance.

Essential hypertension is a complex disorder that almost certainly has more than one cause. It may be initiated by environmental factors (e.g. stress, salt intake, estrogen), which affect the variables that control blood pressure in the genetically predisposed individual. Although the susceptibility genes for essential hypertension are currently unknown, they may include genes that govern responses to an increased renal sodium load, level of pressor substances, such as angiotensin II, reactivity of vascular smooth muscle to pressor agents, or smooth muscle cell growth


GENETIC INFLUENCE + ENVIRONMENTAL FACTORS
Plasma and ECF               Vascular reactivity     Vascular wall
Volume                                                               Thickness
Plasma and ECF Volume
Cardiac output
(Auto regulation)

From the pathophysiology we came to the conclusion that hypertension occurs in a predisposed individual as this miasm is inherited from parents. Hence first stage person is under the influence of psora, later the increased blood volume and increased peripheral resistance indicates its sycotic background, and finally vascular pathology and end organ damage occurs which indicate the syphilitic nature. Hence hypertension is trimiasmatic in nature.