High blood pressure in Ayurveda therapy

„You have high blood pressure. This is genetic. That's why you need lifelong antihypertensive medication.“ Many of the approximately 30 million Germans with high blood pressure hear these words. A disease that is considered the number one risk factor for cardiovascular disease, which in turn is responsible for most deaths.

How does high blood pressure develop and how is it treated in the West? What is the Ayurvedic view of high blood pressure? Are there natural alternatives to lowering blood pressure with medication? How can the development be prevented if there is a family history? Can the side effects of necessary medication be reduced?

High blood pressure from a western perspective

Facts and figures

The German Hypertension League warns:

• Every second person over the age of 65 is affected.
• Only around one in two people know about their illness.
• Only about half of those affected who know about it seek treatment.
• Only about half of those treated have good blood pressure values as a result of the therapy.

High blood pressure is treacherous - it causes no symptoms for a long time. However, this does not make it any less dangerous, on the contrary. Many sufferers play down the significance of symptoms without pain or stressful restrictions and see it more as a diagnosis for the pharmaceutical industry to market their drugs.

When do we start talking about hypertension?

Two values are determined when measuring arterial blood pressure. The maximum systolic value is generated by the ejection force of the heart. The minimum diastolic value corresponds to the permanent pressure in the arterial vascular system due to the resistance in the blood vessels.

• A blood pressure of 120-130 / 80-85 mmHg is considered normal, below that even optimal.
• Values of 130-140 / 85-90 mmHg are described as „high normal“, i.e. they are slightly higher but still normal and therefore harmless.
• If the blood pressure rises above 140 / 90 mmHg, the diagnosis is hypertension - it is categorised into three grades: mild, moderate and severe.

The diagnosis of high blood pressure

In order to make a diagnosis, at least three measurements should be taken on two different days in a practice. In addition, the values should be measured and presented independently at home - the so-called „white coat effect“ can often be observed in surgeries. This means that blood pressure rises under the observation of medical staff.

A 24-hour measurement is always recommended as a final safeguard. It also makes sense to measure both arms simultaneously in order to detect possible side differences - if the systolic values on the left and right are at least 10 mmHg apart, the risk to the heart and circulation is tripled.

Subjective symptoms are often absent for a long time - if they do occur, they usually take the form of dizziness, sleep disorders, visual disturbances, headaches, shortness of breath, light-headedness or palpitations.

What are the known causes?

A distinction is made between primary and secondary hypertension.

• Primary = essential hypertension | The cause is largely unknown. Favouring factors are a family disposition, obesity, stress, alcohol and tobacco consumption, excessive consumption of table salt and increasing age. 90% of all hypertensive patients have this primary form.

• Secondary hypertension = non-essential hypertension | In approx. 10%, other underlying diseases such as a narrowing of the renal arteries, hormonal disorders or vascular diseases are the cause of the high blood pressure. Therapeutically, the focus here is on treating the underlying disease in addition to directly lowering blood pressure.

What are the long-term consequences of high blood pressure?

If high blood pressure is not treated or not treated sufficiently, the risk of heart attacks, strokes, heart failure, circulatory disorders in the legs and kidney failure increases significantly. If high blood pressure is not adequately treated in middle age, the risk of senile dementia also increases.

How is high blood pressure treated in the West?

The therapy depends on the level and cause of the high blood pressure. For moderate and severe forms, lowering blood pressure with medication using 2-3 active ingredients is the treatment of choice. In addition, recommendations such as endurance sports, weight reduction, restriction of alcohol and nicotine consumption and salt intake are used.

The Ayurvedic perspective

Arterial hypertension as a clinical picture was unknown in classical Ayurveda. Today, this diagnosis is usually referred to in Ayurveda as Ucca Raktacapa or Raktacapa Vrddhi translated.

In the West, the treatment of a clinical picture is hardly conceivable without a reasonably certain diagnosis - in Ayurveda, however, a disease can be treated even without a name if its development (pathogenesis = Samprapti) and appearance are understood on the basis of Ayurvedic diagnostics.

From an Ayurvedic point of view, the following factors are potentially involved in high blood pressure:

• Rakta Dhatu - the blood tissue
• Sira Upadhatu - the vessels
• Hrdaya - the heart
• Tridosha - the three body-pathogenic factors Vata, Pitta and Kapha
• Rajas - the psychopathogenic factor

The individual understanding

Ayurveda does not doubt the Western categorisation of blood pressure values, but calls for a more differentiated view, taking into account the individual constitution and reality of life.

There is a big difference between a Vata-dominated constitution with inadequate stress management as a flight attendant and a relaxed person with high Kapha levels and minimal exercise who has high blood pressure levels. If we do not take such differences into account, we are not treating people, but mercury columns.

From a constitutional point of view, Vata-Pitta dominated people with an additional imbalance in these two Dosha are more prone to developing hypertension. Nevertheless, all constitutions can develop this clinical picture.

Vataja, Pittaja or Kaphaja?

In Ayurveda, all diseases are differentiated according to their causal and symptomatic dosha dominance and labelled accordingly as Vataja, Pittaja and Kaphaja.

The Vataja Hypertension:

• Strong fluctuations in blood pressure within a very short time
• pronounced dependence on mental state
• Nervousness, tension, anxiety about the consequences of high blood pressure
• Sleep disorders, exhaustion, excessive demands
• Palpitations and shortness of breath

The Pittaja Hypertension:

• Reddening of the face and eyes
• Increased sensation of heat
• Headaches, light sensitivity
• Nosebleed
• Anger, aggression, irritability

The Kaphaja Hypertension:

• Often consistently high blood pressure with few fluctuations
• Overweight, water retention, tiredness, lack of exercise
• Lipometabolic disorders: elevated cholesterol levels (total cholesterol and LDL high, HDL low)
• Carbohydrate metabolism disorders: Tendency to or manifest diabetes mellitus
• Tendency to arteriosclerosis (narrowing of the channels = arteriosclerosis) Srotas)

There are also mixed types with symptoms from two of the three dosha (Dvidoshaja) or a pathological combination of all three (Tridoshaja resp. Sannipataja).

In order to diagnose the respective type of high pressure, Ayurveda has a comprehensive anamnesis (60-90 minutes) and eight examination procedures (pulse, urine, stool, tongue, voice and sounds, skin and palpation, eyes, general appearance) at its disposal. The experienced Ayurvedic physician can make an Ayurvedic diagnosis from the information gathered.

Medication is the last step - not the first!

There is no question that in the case of severe high blood pressure, immediate medical treatment with antihypertensives is absolutely essential. Any responsible Ayurveda physician will not ignore this reality.

However, it is also a fact that many people with mild hypertension are already treated with medication. Often no blood pressure values are taken over longer periods of time and the observation effect of a measurement in the practice is not taken into account. From an Ayurvedic point of view, this leads to premature therapy with side effects that could possibly be avoided.

How is high blood pressure treated ayurvedically?

In Ayurveda, treatment is always multimodal and based on eight pillars: Nutritional medicine, organising therapy, phytotherapy/mineralogy, detoxification procedures, manual therapies, surgery, psychosomatics and subtle procedures.

Ayurveda does not treat high blood pressure as a disease, but the person with his or her individual pathogenesis. This is a possible 5-fold strategy:

• Regulate Dosha
• Dilate and stabilise blood vessels
• Strengthen the heart
• Purify blood and optimise its flow behaviour
• Regulate mental tension

The most important pillars for implementing this Ayurvedic therapy for high blood pressure are described below. These are only general guidelines - detailed measures can only be initiated after an Ayurvedic diagnosis has been made. I therefore strongly advise all those affected against self-diagnosis and self-therapy. Instead, visit a medical Ayurveda practice you trust and receive individualised support there.

Therapy pillar 1: Nutritional medicine (Ahara)

A flexible vegetarian diet with plenty of fresh vegetables, fruit, salads, cereals, nuts and pulses is recommended by Ayurveda. When it comes to animals, fish is always preferable to meat and light-coloured meat (chicken, turkey) is preferable to dark meat (pork, beef, lamb, game).

Reduce your consumption of table salt and animal fats and pay particular attention to hidden salt and fat in convenience foods. Limit your alcohol consumption to a maximum of 3 glasses of wine or 3 bottles of beer per week and minimise caffeinated drinks such as coffee, black and green tea.

If you are overweight, your diet should contain fewer calories than your daily consumption - this „negative energy balance“ allows excess pounds to tumble off. Losing 10kg reduces systolic blood pressure by 15mmHg and distolic blood pressure by 8 to 10mmHg.

Therapy pillar 2: Lifestyle change (Vihara)

In Ayurveda, a healthy lifestyle begins with the rhythmisation of the day-night cycle. Regular sleep, work and leisure times are a guarantee for hormonal and mental balance and therefore also for healthy blood pressure regulation.

An important measure is to increase daily exercise and targeted exercise therapy. In everyday life, you can leave the car at home more often and walk or cycle instead, preferring the stairs to the lift. Targeted endurance training such as running, cycling, rowing or swimming should be organised and regularly monitored by a training therapist.

Yoga and breathing therapy are excellent ways of directly influencing blood pressure. Daily practice is recommended.

Therapy pillar 3: Supplementation (Aushadha)

Ayurvedic food supplements can support blood pressure regulation.

Important individual plants include

• Terminalia arjuna - Arjuna
• Allium sativum - Lashuna (garlic)
• Zingiber officinale - Shunthi (ginger)
• Boerhaavia diffusa - Punarnava
• Tribulus terrestris - Gokshura
• Eclipta alba - Bhringaraja
• Bacopa monnieri - Brahmi
• Centella asiatica - Mandukaparni
• Convolvulus pluricaulis - Shankhapushpi
• Nardostachys jatamamsi - Jatamamsi
• Withania somnifera - Ashwagandha
• Asparagus racemosus - Shatavari
• Rauwolfia serpentina - Sarpagandha

Important combinations include

• Triphala Guggulu
• Arjunarishta
• Punarnavasava
• Sarasvatarishta

The recommendation and composition of your supplements should only be carried out by an experienced Ayurveda therapist!

Therapy pillar 4: Drainage procedures (Antahparimarjana)

The five most important purging procedures are summarised under the generic term Panchakarma: Emesis (gastric lavage), purgation (laxative treatment), enemata (intestinal enemas), intranasal therapy (nasopharyngeal cleansing) and blood purification through phlebotomy or leech therapy.

In the treatment of high blood pressure, laxative treatment (Virecana), intestinal enemas (Basti) and bloodletting (Raktamokshana) have been used successfully. The treatment should be carried out in qualified inpatient treatment centres.

Therapy pillar 5: External therapies (Bahihparimarjana)

Ayurvedic massages (Abhyanga) have a balancing effect, especially on forms of high pressure caused by Vata. It is used as a full-body or partial body treatment (e.g. as a Padabhyanga foot massage). The forehead oil massage (Shirodhara) with the classic herbal oil Kshirabala Taila to regulate blood pressure in series. Daily application is recommended in the first week, every two days in the second week and twice a week thereafter.

Therapy pillar 6: Psychosomatics (Sattvavajaya)

Effective blood pressure regulation without the involvement of the mind, its thoughts and feelings, is unthinkable from an Ayurvedic point of view. The first priority here is to analyse and promote individual stress management - what stressors exist, how are these stressors evaluated, what responses to stress reactions are shown?

Changing habits, developing emotional intelligence, realising values and guiding principles and targeted training of the mind through mindfulness training and meditation are essential pillars of Ayurvedic psychosomatics. From my own practical experience, I can also warmly recommend the use of biofeedback methods.

To summarise, we can say that

• High blood pressure cannot always be cured, but it can almost always be controlled.
• If recognised early, high blood pressure can be optimally treated Ayurvedically.
• Drug therapy with western antihypertensives is the last step in mild and moderate forms when all naturopathic measures have been ineffective.
• Severe forms of hypertension must always be treated with medication without delay - every hour means an unnecessarily high risk.
• The key to a constitutionally balanced blood pressure lies not in the right medication, but in a healthy lifestyle and mental balance.
• Ayurveda therapy is always multimodal - the more pillars are considered in the treatment, the faster and more successful the results are.

With best wishes for your health,

Ralph Steuernagel

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