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CLINICAL RESEARCH
Year : 2012  |  Volume : 33  |  Issue : 4  |  Page : 530-536  

Provocative dietary factors in geriatric hypertension: A surveillance study


1 Lecturer, Department of Kaya Chikitsa, College of Ayurveda and Research Centre, Akurdi, Pune, Maharashtra, India
2 Lecturer, Department of Kaya Chikitsa, GJ Patel Ayurveda College, New Vallabh Vidya Nagar, Anand, India
3 Professor, Department of Kaya Chikitsa, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
4 Director, Research and Development, SDM College of Ayurveda, Kuthpady, Udupi, Karnataka, India

Date of Web Publication12-Apr-2013

Correspondence Address:
Yogesh S Deole
Department of Kayachikitsa, GJ Patel Ayurveda College, New Vallabh Vidya Nagar, Anand - 388 121, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.110537

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   Abstract 

Hypertension is the most common psychosomatic disorder affecting 972 million people worldwide being more prevalent in old age. The present survey of hypertensive patients fulfilling the standard diagnostic criteria of WHO/ISH (2004) is carried out in geriatric age group from the Saurashtra region of Gujarat in India to observe the dietary pattern and provocative factors. Total 120 patients of 50 to 80 years of age having systolic blood pressure >140 mm Hg and ≤180 mm Hg and diastolic blood pressure >90 mm Hg and ≤110 mm Hg irrespective of gender and religion were selected for the present study. They were interviewed for list of provocative factors enlisted in Ayurveda. As observed, the study supported the facts described in Ayurveda that dietary etiological factors, such as excess intake of Lavana (salty), Amla (sour), Katu (pungent), Tikshna, Ushna (hot), Vidahi (producing burning sensation), Viruddha (incompatible), Snigdha (unctuous), Abhishyandi (leading to obstruction), Madhura (sweet), Guru (heavy to digest) dietary articles, Ajirnashana (taking diet before complete digestion of previous meal), Adhyashana (repeated eating at short intervals), will vitiate Rakta dhatu as well as Pitta dosha in the body leading to disorders like hypertension. Hypertension in old age is found to be a disease of Vata-Pitta dominant vitiation with the involvement of Rasa, Rakta, Meda as main Dushya (vitiated factors) and dietary factors can contribute to worsening of the disease. The etiological factors having role in the pathogenesis can also be applied for preventive guidelines for the management of hypertension.

Keywords: Ayurveda, dietary factors, geriatric age group, hypertension


How to cite this article:
Jagtap MV, Deole YS, Chandola H, Ravishankar B. Provocative dietary factors in geriatric hypertension: A surveillance study. AYU 2012;33:530-6

How to cite this URL:
Jagtap MV, Deole YS, Chandola H, Ravishankar B. Provocative dietary factors in geriatric hypertension: A surveillance study. AYU [serial online] 2012 [cited 2020 Feb 17];33:530-6. Available from: http://www.ayujournal.org/text.asp?2012/33/4/530/110537


   Introduction Top


Hypertension is an important public health challenge due to its associated morbidity, mortality, and economical burden to the society affecting about 972 million people worldwide.[1] It is opined that as not a disease entity, rather a product of several etiological processes ultimately leading to the development of hypertension. Hypertension as a disease is not described in Ayurvedic literature; however, its pathophysiology and symptomatology can be traced in many parallel conditions described in the classics. Depending on involvement of Dosha (Vata-Pitta) and Dushya (Rasa, Rakta, Meda) the spectrum of hypertension is interpreted in terms of Raktavata or Raktagata Vata and in recent years as Vyana Bala Vaishamya[2]/Vyana Bala Vriddhi in Ayurvedic parlance.[3] It is surprising that in spite of all advances in medicine field, exact cause of hypertension is less known. As a result, limited preventive measures could be undertaken.

Government of India initiated a National Campaign on Ayurveda for Geriatric Health Care in 2008 to make aware the elderly population about their health status for preventive, promotive, and curative aspects. The objectives of the campaign are to identify geriatric age-related diseases and to explore the possibilities where Ayurveda can contribute to deliver the goods for healthy dietetics, lifestyle, according to Prakriti (constitution) and to prevent the increasing incidence of geriatric hypertension. The incidence of hypertension increases as age advances irrespective of gender. There are many factors specified in relation to old age (Vardhakya). Ayurveda states Vata Dosha Pradhanata (dominancy of Vata), Parihani Kala (declining period of life), Kshiyamana Dhatu (degeneration of body tissues),[4] Paripakwa Shariratwam (aged body),[5] in old age. Whereas according to modern science thickening of vessel wall, decrease in elasticity and lumen of vessels, increased vascular resistance, favor the manifestation and exaggeration of hypertension. Human body is nourished by food. Health and disease manifestation are basically outcome of the Ahara (dietary articles). It has direct impact on Agni, which is the prime and ultimate factor responsible for the maintenance of life. Keeping all these views in mind, a survey with the objective to evaluate role of dietary factors provoking hypertension in geriatric age group was carried out in the vicinity of Jamnagar, Gujarat, India.


   Materials and Methods Top


Diagnostic criteria

The standard diagnostic guidelines of World Health Organization (WHO)/International Society of Hypertension (ISH) (2004),[6] and The Sixth Report of the Joint National Committee[7] for prevention, detection, evaluation, and treatment of high blood pressure were adopted for selection of the patients.

Inclusion criteria

  1. Patients in between 50 to 80 years of age.
  2. Patients presenting with the classical symptoms of hypertension.
  3. Those with systolic blood pressure >140 mmHg and ≤180 mmHg and diastolic blood pressure >90 mmHg and ≤110 mm Hg and who are not taking any treatment.
  4. Patients on modern antihypertensive treatment with any level of blood pressure.


Exclusion criteria

Patients with accelerated and malignant hypertension and other serious systemic illnesses, such as severe diabetes mellitus, tuberculosis, major endocrine disorders, malignancies, HIV, and renal failure, were excluded. A detailed research proforma was prepared for the survey incorporating diet and other related factors. Direct interview method was done for assessing the association of factors. The duration of study was from June 2008 to March 2010.

Total 120 patients irrespective of gender and religion attending the outpatient and inpatient department of Kayachikitsa and cases referred by other departments of the institute were selected in the present survey. In present era of stress, considering the onset of hypertension at an early age due to stress-related factors, the lower age limit for the survey was limited to 50 years.


   Observations and Results Top


The observations made on 120 patients of hypertension showed that maximum number of patients (55%) were between age group of 50-60 years; 51.67% were males; 70% were Hindu; 87.50% were married; and 35% were house wives. The 25% each had primary education and were graduates; 41.77% belonged to middle socioeconomic status; 26.67% were consuming betel leaf; 23.34% had a habit of tobacco chewing; and 17.50% were addicted to smoking. Dashavidha Pariksha (ten-point patient Ayurvedic examination) biostatistics revealed that maximum number of patients showed Vata-Pitta dominance in Prakriti (37.50%) followed by Kapha-Pitta dominance in 33.34% patients. Rajasika Manasa Prakriti (60.84%), Madhyama Sara (58.34%), Madhyama Samhanana (45.84%), Avara Sattva (69.17%), Madhyama Vyayama Shakti (50%), Mandagni (45.84%), and Krura Koshtha (50%) were also predominantly observed. Most of the patients had irregular bowel habits (66.67%) and constipated bowels (58.33%). In concern to stage wise distribution, Stage II hypertension was observed more followed by Stage I type. Stage III hypertension was less observed [Table 1].
Table 1: Stage wise distribution of hypertensive patients (n=120)


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Elaborated dietetic history showed that maximum number of patients (81.67%) were taking vegetarian diet, same number of patients were found to consume Adhika Lavana (additional intake of salt other than the salt content in diet), Ati-Tikshna Ahara (excess pungent food), and Abhishyandi Bhojana (heavy to digest and lead to obstruction), Ati-Ushna (excess hot) (78.34%), Vidahi (creating burning sensation) (61.67%), Viruddha (incompatible food) (58.33%), Ati Madhura (excess sweet items) (63.34%), Ati-Snigdha (unctuous) (58.33%), and Ati-Guru (heavy to digest) Ahara (53.34%) were observed in maximum number of patients. In majority of patients Madhura (sweet) (63.34%), Katu (pungent) (58.33%), and Amla (sour) (55%) was observed as dominant Rasa in diet. The 60.24% patients were consuming excess amount of food than needed (Atimatra Bhojana). The 56.67% and 33.33% were following Adhyashana (frequent eating) and Ajeernashana (taking diet before complete digestion of previous meal), respectively.

Predominant chief complaints observed in the patients are presented in [Table 2]. Analysis of Doshik involvement as per signs and symptoms showed that Gadha-Varchastwam (hard stools) (51.81%) and Anaha (distension of abdomen) (66.26%) in Vata Vriddhi symptoms and Arati (non-desire) (46.10%) in Vata kshaya symptoms were the most common findings. In case of Pitta Dosha Prakopa Lakshanas (signs of vitiation), Daha (burning) (36.14%), and Sweda (excess sweating) (16.90%) were found in maximum. In Kapha Dosha Vriddhi (vitiation of Kapha) symptoms, Shwasa (dyspnoea) was found in maximum (33.73%) patients. It can be said that these are the symptoms found predominantly in geriatric hypertensive patients. In Rasa Vriddhi Lakshanas, Hridayotkleda (chest congestion) was found in 49.40%, Praseka (nausea) in 32.53%. The 19.28% of patients showed Shrama (fatigue) in Rasa kshaya symptoms. In Rakta Vriddhi Lakshanas, Raktakshi (redness in eyes) was found in 69.09%. Gurugatrata (heaviness in body) (69.09%), and Udara parshva vriddhi (excess accumulation of fats in abdominal region and flanks) (57.83%) showed Mamsa Vriddhi. Daurbalya (weakness) (69.09%) and Pipasa (excess thirst) (49.40%) indicate Oja and Mutra Kshaya symptoms. In Rasavaha Srotodushti Lakshanas, Aruchi (tastelessness) was found in 48.19%, Ashraddha (aversion to food) in 46.49% and Sada (slowness) in 31.32% of the patients. In Raktavaha Srotodushti Lakshanas, Annapanasya Vidaha (burning sensation after some time of taking food due to improper digestion) was found in 84.34%; Ati Daurbalya (weakness) in 69.09%; and Lavanasyata (salty taste sensation) in 42.17% of patients was also observed. In Annavaha Srotodushti Lakshanas, Avipaka (indigestion) was found in 6.24% of patients. In Majjavaha Srotodushti Lakshanas, Bhrama (giddiness) was found in 84.33% and Tamodarshana (black out) in 50.60%, and in Medovaha Srotodushti, Alasya (sloth) was observed in 49.40% patients. About 70% of patients were obese with majority of them (40%) exhibiting grade II (BMI >27 kg/m2) obesity [Table 3].[8]
Table 2: Chief complaints observed in hypertensive patients (n=120)


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Table 3: Geriatric signs and symptoms observed in hypertensive patients (n=120)


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   Discussion Top


Hypertension is a Vata-Pitta Pradhana Tridoshaja Vyadhi with Dushya being Rasa-Rakta-Meda Dhatu. Therefore all the etiological factors causing vitiation of Vata- Pitta Dosha, and Rasa-Rakta- Meda Dhatu can be enlisted as the etiological factors for the disease. On analysis, main etiological factors for the disease were observed to be predominant factors in diet of the patients. Constant exposure to these etiological factors augments the process of development of disease.

Agni is the most important factor, which regulates all metabolic processes at Dhatu as well as Mahabhuta level and thus maintains overall healthy status. According to Charaka, Bala (power), Swasthya (health), and Utsaha (enthusiasm) depend on status of Agni.[9] Thus if Agni is impaired, grossly the body functions are impaired. The study had supported this theory of “cause and effect” by the finding that most of the patients were having Mandagni. Ama is the pathogen resulting due to disturbance of Agni. Mandagni and Vishamagni are the prime causes of Ama.[10] This leads to Srotasavarodha (obstruction of channels) which is a prime factor in vitiating Vata Dosha, the main Dosha involved in the pathogenesis of hypertension. In normal state, Vyana Vayu performs its Rasa-Rakta Vikshepana Karma normally.[11] But if it vitiates, Dhamani Sankocha (contraction of vessels) occurs due to its Ruksha (dryness), Shita (cool), and Khara (rough) Guna, resulting in the reduction of Srotovivara (lumen of the channels). Due to this narrowed pathway, Avarodha (obstruction) occurs in Rasa-Rakta-Vikshepana Karma, causing forceful function of Vyana Vayu with increase of its Chala Guna. This makes the pressure to rise in the wall of Dhamanis. It can be stated that Mandagni[12] and hence Ama are important factors involved in the causation and exaggeration of hypertension in old age.

Koshtha determines the bowel habit of the individual. Maximum patients reported Krura Koshtha, denoting Vata dominancy.[13] Krura Koshtha individuals makes it a habit of not to pass the stools regularly. In hypertension, due to the underlying Vata-dominant pathology, Vibandha (constipation) may occur leading to obstruction and worsening of the condition. It is supported by the finding that most of the patients had irregular bowel habits (Asamyak Mala Pravritti) and constipated bowels. It is known that Apana Vikriti causes Asamyak Mala Pravritti[14] and it maintains the other four Vayus. Pakwashaya (colon) is the seat of Apana Vayu,[15] which is also a specific site of Vata Dosha.[16] The role of Apana Vayu in Aharapachana (digestion of food), is mainly due to its “Shakrit Nishkramana Kriya”(excretion of feces). Thus, the Apana Vikriti produces Samana Vikriti leading to Asamyak Pachana (improper digestion) and leading to Asamyak Dhatu Utpatti (improper formation of tissues) as Samana Vata has got predominant role in the regulation of Jatharagni[17] and its moieties. Thus, irregular Mala Pravritti (bowel habit) and constipation indirectly can aid in causing Shonita Dushti (blood impurities). In Vata Vriddhi symptoms, maximum patients had Gadha-Varchastwam (51.81%) and Anaha (66.26%). These findings also indicate towards the disturbance of Vatanulomana (proper circulation of Vata), which can lead to Udavarta. The data show that these factors have a role in precipitation and aggravation of the disease in old age. Moreover Vriddhavastha[18] is most favorable period for vitiation of Vata and hypertension is primarily a disease of Vatika disorder.

The dietary habits of a person are based on the choice, availability, and religious customs. Diet is more important than the medicine itself, which is quite evident from the famous statement that if one follows or practices the Pathyasevana (following suitable regimen), does not require any medication.[19] Diet depends on various factors, such as taste, mood, presentation of food, place of eating, and hunger as well. Different dietary articles due to their specific Rasas, properties (Vishishta Shaktitwat Dravyanam),[20] if consumed without following the rules of proper dietary intake (Ahara Vidhi Visheshayatanani), can lead to manifestation of disease by vitiating Doshas and deteriorating the healthy status of Dhatus. The Rasas according to the Samanya-Vishesha Siddhanta lead to the vitiation and pacification of corresponding Doshas by their Prabhava.[21]

Adhika Lavana Sevana (excessive intake of salt), had received a greatest attention among all. It is mentioned that, the Bahlika, Saurashtric, Saindhava, and Sauvarika people, take more intake of Lavana (and even consume it along with milk), which is the main etiological factor in pathogenesis of hypertension.[22] The data of study also supports this as maximum indulged in consuming Adhik Lavana. Lavana Rasa is having dominancy of Teja and Jala Mahabhuta. In small doses, salt can be used continuously in the preparations of dietary articles but continuous use in large doses is harmful. All Lavana are mentioned as Ushna, Tikshna, Anatisnigdha, Anatiguru, Upakledi (deliquescent), Sara, Vikasi, Adha Sranshi, Avakashakara, Vishyandi, Sukshma, Saraka, and Mrudu in nature.[23] Ati-lavana intake leads to increase of Abhishyandi, Sukshma, Ushna, and Vyavayi Guna in the body.[24] This in turn results into vitiation of Pitta Dosha in terms of Ushna, Ttikshna Guna due to Samanagunabhuyishtata.[25] Further aggravation of Rakta (Raktam Vardhayati) develops due to Rakta-Pitta-Ashryashrayi Bhava.[26] This effect is due to Sukshma Guna (penetrating power in microchannels), and Vyavayi Guna (spreading of the Dravya all over the body).[27] On the other hand, it liquefies Kapha Dosha (Kapham Vishyandayati) due to Samanagunata. The Abhishyandi Guna leads to obstruction in the Rasavahi Siras[28] causing Vata obstruction and hypertension. The Vishyandana effect (Sravayati) increases osmolarity and increased extracellular fluid volume with increase in calculated osmolarity. This increases blood pressure showing the way to volume-loaded hypertension. The Vata dosha due to Viparita Gunata is unable to pacify efficiently with the changes (Vata-Sneha-Gaurava-Alpatwat).[29]

Excessive use of Lavana is described as the cause of Shonitaja Roga[30] and it causes increase the blood.[31] Likewise in Uccharaktachapa (raised blood pressure), Rakta is also vitiated. It is also perceptible that Lavana Rasa is mentioned under the articles, which are specially indicated for not to be consumed in excess and for longer duration.[32] When excessively used, it produces fatigue, lassitude, and weakness of the body,[33] which are the symptoms observed in the patients of hypertension. People who are accustomed to excessive use of salt, suffer from premature baldness, greying of hairs, and wrinkles in the skin. Excessive use of Lavana Rasa thus can hasten the aging process aggravating the course of hypertension in geriatric people.

Even a small increase in extracellular fluid and blood volume, can often increase arterial pressure greatly. It ultimately leads to increase in cardiac output, which in turn increases arterial pressure through its direct as well as indirect effect. This leads to secondary increase in total peripheral resistance resulting from the autoregulation mechanism. It greatly elevates the arterial pressure than it is expected. The amount of salt that accumulates in the body is the main determinant of the extracellular fluid volume. Even a small amount of extra salt in the body can lead to considerable elevation of arterial pressure. As the salt is not excreted so easily like water, it accumulates in the body. Excess salt in the body produces increased osmolarity thereby stimulates the thirst centre, making the person to drink more amount of water to dilute extracellular salt to a normal concentration, thus indirectly leading to increase in extracellular volume. This is also achieved by another mechanism through stimulation of hypothalamic-posterior pituitary gland secretary mechanism in response to the increased osmolarity in the extracellular fluid. This leads to secrete increased quantities of antidiuretic hormone, which causes the kidneys to reabsorb greatly increased quantities of water, thereby diminishing the volume of urine while increasing the extracellular volume.[34]

Excessive Katu (pungent) Rasa intake leads to fainting (Murchha), vertigo (Bhrama), thirst, tremor,[35] and contraction of blood vessels.[36] The Mahabhautik composition of Katu rasa is Vayu and Agni Bhuta dominant. Katu Rasa dominant Dravyas are usually having Katu Vipaka and Ushna Virya and thus leading to Pitta Prakopa. As we know the Pitta and Rakta live symbiotically, the Pitta vitiation thus leads to Rakta Dushti. Thus, it can be inferred that the Katu Rasa and Ushna Virya are one of the causes of Shonita Dushti. Also due to its Laghu and Ruksha Gunas excessive consumption of Katu Rasa can cause the vitiation of Vata Dosha. This Vita-Pitta vitiation and Rakta Dushti is the basic pathology involved in the causation of hypertension.

Excessive Madhura Rasa (sweet taste) intake leads to diseases related to Medasa, Shleshma, obesity, loss of appetite, coma, diabetes,[37] heaviness, and weakness.[38] Obesity was observed as major concomitant factor in 70% patients among whom 40% were having grade II obesity with body mass index between 27 and 40 kg/m2. This finding is suggestive of probable friendship of hypertension and obesity. Madhura (sweet), Guru (heavy), and Snigdha (unctuous) articles of the food are predominant in the qualities of Prithvi and Apa Mahabhuta. Thus these articles, being suppressors of appetite by nature impair, the digestive power, and are extremely harmful, if taken in excess. There is a need of strong digestive power and metabolism achieved by physical exercise.[39] Thus excessive intake of such articles can aid in provocation of hypertension in senile people.

Excessive Amla (sour) rasa intake leads to Kapha, Pitta, and Asra Prakopa, Shaithilya (loss of function), Vertigo,[40] Raktadushti.[41] It is also having Ushna virya, which again causes Pitta vitiation and ultimately Rakta dushti. The Mahabhautik composition of Rakta dosha is predominantly Jala and Agni Mahabhuta. Guru, Snigdha, and Ushna Virya Dravyas are mentioned as to cause Shonita Dushti.

The Abhishyandi dietary articles, such as Dadhi, produce Gaurava and Karshya[42] in the body by obstructing the channels of circulation of rasa (Rudhwa Rasavaha Siraha) due to their Picchila and Guru Gunas (properties). The continuous and at a time (Ekakala/Yugapat) circulation of Rasa Dhatu is carried out by the normal functioning of Vyana Vayu all over the body.[43] Hence nourishment of all Dhatus (tissues) take place continuously and in circulatory fashion (Parivruttistu Chakravat). By obstructing the channels of circulation (Srotorodha), these articles cause vitiation of Vata leading to improper circulation of Rasa (Ahara Rasa) resulting in emaciation (Dhatukshayam/Karshyam Karoti), which again hastens the process of aging and degeneration. This again leads to Vata Prakopa. In this way, the vicious cycle develops and all the factors again ultimately precipitate hypertension in Vata pradhana life span, that is, old age.

Faulty dietary habits, such as Adhyashana, Ajirnashana, Vishamashana (taking compatible and incompatible food at wrong time), Anashana (not taking food when needed) were found in maximum. The dietary habit is regulated mostly by behaviour and life style pattern. Diet has got direct impact in causing Mandagni, thereby Ama production. All of the above habits lead to improper digestion of food, vitiation of Agni[44] itself leading to Grahani Dosha resulting into Ama, which is the most important causative factor in the pathogenesis of disease. This formation of Ama, impairment of Agni, also creates the obstruction in the normal circulation of Vyana Vayu. Improper quantity food is again of two types Hinamatram (deficient in quantity) and Atimatram (excessive in quantity).[45] The Anashana habit also leads to Mandagni, as long waiting for food increases gastric secretions more, resulting in the increased quantity of Drava Rupa Pitta, which is ineffective to digest the food, directing Mandagni and consequently Amotpatti.[46]

Ati-Ahara Sevana leads to Yugapata Tridosha Prakopa.[47] Gastric juice varies in both amount and composition with the food taken. The duration of secretion and the time during which food remains in the stomach also becomes longer as the quantity of the food increases (Adhyashana).[46] Adhyashana, Ajirnashana, and so on are mentioned in Rakta dushtikara nidana.[48] It is always customary that one should take the food only when the previous food is digested. If the person indulges in Ajirnashana, that is, taking food before the digestion of previous meal, the digestive product of previous meal (undigested Rasa) gets mixed up with the product of food taken afterward, resulting in the provocation of all the doshas instantaneously, which can aggravate the manifestation of the disease.[49] Vishamashana, that is, irregular timings and quantity of the food leads to indigestion. Thus due to the impaired digestion, the Ardhapakva, Apakva, and Pakva Aahara Rasa produce Vidagdhavastha (Shuktata).[50] This Shuktata produces Pitta Kopa and consequently Shonita Dushti. Viruddhashana is being directly accepted as a cause of Shonita dushti.[48] Thus the data shows that these improper habits and dietary articles can aid to cause Shonita Dushti and hence precipitating the occurrence of the disease.

These dietary factors hasten the progressive changes of aging observed through signs and symptoms enlisted in the [Table 2] and [Table 3]. These ultimately worsen the degenerative pathologic changes in hypertensive patients. Hypothetically it can be stated that the aggravated Vata and Pitta in case of hypertension hastens aging process, but the relationship between hypertension as provoking factor to enhance aging is essential to be supported by robust clinical data.

The triad of chief complaints, that is, Shirah shoola (headache), Bhrama and Klama (fatigue/easy fatigability), which are found most prevalently are supportive to the underlying pathologic status of Vata-Pitta dominancy and thus also proves the theory of cause and effect (Karya-Karanavada) of Ayurveda as most of the etiologic factors are found to be causing the vitiation of Vata and Pitta. These symptoms can be considered as the cardinal signs and symptoms of hypertension. Aruchi and Udgarabahulya are indicative of Ama dominant obstruction and disturbances in Vatanulomana in underlying pathology.

Thus the present article establishes the fact that the faulty dietary habits, such as Ajirnashana, Adhyashana, and certain dietary qualities, such as excess intake of salt, pungent items can vitiate the Rasa, Rakta owing to disturbance in Agni and formation of Ama. This obstructs the channels and leads to vitiation of Vata-Pitta Dosha. Thus it disturbs the normal circulatory functioning of Vata particularly Vyana Vata resulting into hypertension. The pathogenesis of hypertension in Ayurveda and above relevant discussion is presented in [Figure 1].
Figure 1: Pathogenesis of hypertension in Ayurveda

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   Conclusion Top


The present survey study supported the facts described in Ayurveda that the dietary etiologic factors, such as much intake of Lavana, Amla, Katu, Tikshna, Ushna, Vidahi, Viruddha, Snigdha, Abhishyandi, Madhura, Guru dietary substances can lead to vitiation of Rakta Dhatu as well as Pitta Dosha in the body leading to disorders, such as hypertension. Hypertension in old age is found to be a disease of Vata-Pitta Pradhana Doshik vitiation, Rasa, Rakta, Meda being main Dushyas involved. Various dietary factors and habits enlisted can contribute to hypertension specifically in old age. The etiologic factors observed in the present study can have the role in the pathogenesis of hypertension and can be used as guidelines for deciding the Ayurvedic principles of management for hypertension accordingly. Healthy dietetics and healthy life style as per the Prakriti of an individual along with the possible use of medications will certainly bestow the tangible results because both are complementary and supplementary to each other. The study conveys the message that Ayurvedic dietary guidelines are to be followed and adopted in order to prevent hypertension in geriatric population. Also in known hypertensive patients, this will be helpful to control the blood pressure within range and to minimize the medication. This article substantiates the Ayurvedic references with data.

 
   References Top

1.Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet 2005;365:217-23. Available from: http://www.sld.cu/galerias/pdf/servicios/hta/global_burden_of_hypertension.pdf. [Last accessed on 2010 Apr 23].  Back to cited text no. 1
    
2.Bharati, Adarsha Kumar, Bhikshapati T. Evaluation of Arjunavachadi yoga in Vyana bala vaishamya (HTN) - A clinical study. JRAS 2006;27:57.56.  Back to cited text no. 2
    
3.Baghel MS. Researches in Ayurveda (A classified directory of all India P.G. and Ph.D. theses of Ayurveda). 2 nd ed. Jamnagar - 361 002, Gujarat (India): Mridu Ayurvedic Publication and Sales; 2005.  Back to cited text no. 3
    
4.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Vimana Sthana, Roga Bhishajitiya Vimanadhyaya, 8/122, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000. p. 280.  Back to cited text no. 4
    
5.Sushruta, Sushruta Samhita, Sutra Sthana, Shonitavarnaniya Adhyaya, 14/19, edited by Vaidya Jadavaji Trikamaji Acharya and Narayana Rama Aachrya, Reprint. Chaukhambha Surbharati Prakashana, Varanasi, 2003. p. 64.  Back to cited text no. 5
    
6.The Updated World Health Organization (WHO)/International Society of Hypertension (ISH) Hypertension Guidelines. 2004. Available from: http://www.medscape.com/viewarticle/471863. [Last accessed on 2008 Jan 31].  Back to cited text no. 6
    
7.The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413-42. Available from: http://archinte.ama-assn.org/cgi/reprint/157/21/2413. [Last accessed on 2010 Mar 28].  Back to cited text no. 7
    
8.Jagtap Madhavi. M.D. (Ayu.) Thesis, A survey of hypertension in geriatric population and its management with Makandi (Coleus forskohlii (Willd.) Briq.), I.P.G.T. and R.A., G.A.U., Jamnagar, India. 2010.  Back to cited text no. 8
    
9.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Grahani Chikitsa Adhyaya, 15/3, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000. p. 512.  Back to cited text no. 9
    
10.Srinivasulu M, Suresh Babu S. 'Concept of Ama in Ayurveda', Chapter 3, 1 st ed. Varanasi: Chowkhambha Press; 2005. p. 27.  Back to cited text no. 10
    
11.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Grahani Chikitsa Adhyaya, 15/36, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000. p. 516.  Back to cited text no. 11
    
12.Vagbhata, Ashtanga Hridayam, Nidana Sthana, Udara Nidanadhyaya, 12/1, edited by Pt. Harishastri Paradakar Bhishgacharya, Reprint. Chaukhamba Surbharati Prakashana, Varanasi, 2002. p. 513.  Back to cited text no. 12
    
13.Ibidem, Commentary by Hemadri on Ashtanga Hridaya, Sutra Sthana, Ayurvdotpati, 1/9; 8.  Back to cited text no. 13
    
14.Ibidem, Ashtanga Hridaya, Sutra Sthana, Doshabhediya Adhyaya, 12/9; 193.  Back to cited text no. 14
    
15.Sushruta, Sushruta Samhita, Nidana Sthana, Vatavyadhi Nidana, 1/19, edited by Vaidya Jadavaji Trikamaji Acharya and Narayana Rama Aachrya, Reprint. Chaukhambha Surbharati Prakashana, Varanasi, 2003. p. 261.  Back to cited text no. 15
    
16.Vagbhata, Ashtanga Hridayam, Sutra Sthana, Doshabhediya Adhyaya, 12/1, edited by Pt. Harishastri Paradakar Bhishgacharya, Reprint. Chaukhamba Surbharati Prakashana, Varanasi, 2002. p. 192.  Back to cited text no. 16
    
17.Srinivasulu M, Suresh Babu S. 'Concept of Ama in Ayurveda', Chapter 3, 1 st ed. Varanasi: Chowkhambha Press; 2005. p. 18.  Back to cited text no. 17
    
18.Vagbhata, Ashtanga Hridayam, Sutra Sthana, Ayurvdotpati, 1/7, edited by Pt. Harishastri Paradakar Bhishgacharya, Reprint. Chaukhamba Surbharati Prakashana, Varanasi, 2002. p. 7.  Back to cited text no. 18
    
19.Satpute LP, Ranade S. Vaidyakiya subhashita sahitya, Pune: Anamol Prakashana. p. 8.  Back to cited text no. 19
    
20.Dalhana, Commentator, Sushruta Samhita, Sutra Sthana, Hitahitam Adhyaya, 20/20, Reprint. Chaukhambha Surbharati Prakashana, Varanasi, 2003. p. 97.  Back to cited text no. 20
    
21.Charakopaskara, Commentary, Charaka Samhita, Vimana Sthana, Rasa-Viman Adhyaya, 1/7, edited by Pandita Jogindranatha sen, Vidyabhushana, Vol. 2. Calcutta: Published by J.N. Sen; 1922. p. 915.  Back to cited text no. 21
    
22.Agnivsha, Charaka, Charaka Samhita, Vimana Sthana, Rasa-Viman Adhyaya, 1/18, text with English translation and Critical exposition based on Chakrapanidatta's Ayurveda Dipika by Sharma R.K. and Bhagwan Dash, Vol. 2. Chaukhambha Sanskrit Series Office, Varanasi, 2002. p. 121-2.  Back to cited text no. 22
    
23.Vagbhata, Ashtanga Hridayam, Sutra Sthana, Annaswarup Vijnaniya Adhyaya, 6/143, edited by Pt. Harishastri Paradakar Bhishgacharya, Reprint. Chaukhamba Surbharati Prakashana, Varanasi, 2002.  Back to cited text no. 23
    
24.Charaka Samhita, Sutra Sthana 13/98, pg-87.   Back to cited text no. 24
    
25.Charakopaskara, Commentary, Charaka Samhita, Vimana Sthana, Rasa-Viman Adhyaya, 1/7, edited by Pandita Jogindranatha sen, Vidyabhushana, Vol. 2. Calcutta: Published by J.N. Sen; 1922. p. 917.  Back to cited text no. 25
    
26.Vagbhata, Ashtanga Hridayam, Sutra Sthana, Doshadi Vijnanaiya Adhyaya, 11/26, edited by Pt. Harishastri Paradakar Bhishgacharya, Reprint. Chaukhamba Surbharati Prakashana, Varanasi, 2002. p. 186.  Back to cited text no. 26
    
27.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Sneha Adhyaya, 13/98, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000. p. 87.  Back to cited text no. 27
    
28.Sharangdhara, Sharangdhara Samhita, Purva Khanda 4/24.  Back to cited text no. 28
    
29.Charakopaskara, Commentary, Charaka Samhita, Vimana Sthana, Rasa-Viman Adhyaya, 1/22, edited by Pandita Jogindranatha sen, Vidyabhushana, Vol. 2. Calcutta: Published by J.N. Sen; 1922. p. 923.  Back to cited text no. 29
    
30.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Vidhishonitiya Adhyaya, 24/5, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000.  Back to cited text no. 30
    
31.Ibidem, Charaka Samhita, Sutra Sthana, Atreya-Bhadrakapiya Adhyaya, 26/44/3; 144.  Back to cited text no. 31
    
32.Ibidem, Charaka Samhita, Vimana Sthana, Rasa-Vimana Adhyaya; 1/15.  Back to cited text no. 32
    
33.Ibidem, Charaka Samhita, Vimana Sthana Rasa-Vimana Adhyaya; 1/18.  Back to cited text no. 33
    
34.Guyton AC, Hall JE. Textbook of Medical Physiology, 11 th ed., chapter 19. Philadelphia, Pennsylvania: Elsevier Inc.; p. 224-5.  Back to cited text no. 34
    
35.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Sutra Sthana, Atreya-Bhadrakapiya Adhyaya, 26/4, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000.  Back to cited text no. 35
    
36.Vagbhata, Ashtanga Hridayam, Sutra Sthana, Rasabhediya Adhyaya, 10/19, edited by Pt. Harishastri Paradakar Bhishgacharya, Reprint. Chaukhamba Surbharati Prakashana, Varanasi, 2002.  Back to cited text no. 36
    
37.Ibidem, Ashtanga Hridaya, Sutra Sthana, Rasabhediya Adhyaya, 10/9.  Back to cited text no. 37
    
38.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Trimarmiya Chikitsa Adhyaya, 26/1, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000.  Back to cited text no. 38
    
39.Agnivsha, Charaka, Charaka Samhita, Sutra Sthana, Matrashitiya Adhyaya, 5/6, text with English translation and Critical exposition based on Chakrapanidatta's Ayurveda Dipika by Sharma R.K. and Bhagwan Dash, Vol-1. Chaukhambha Sanskrit Series Office, Varanasi, 2002; 107.  Back to cited text no. 39
    
40.Vagbhata, Ashtanga Hridayam, Sutra Sthana, Rasabhediya Adhyaya, 10/11, edited by Pt. Harishastri Paradakar Bhishgacharya, Reprint. Chaukhamba Surbharati Prakashana, Varanasi, 2002.  Back to cited text no. 40
    
41.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Trimarmiya Chikitsa Adhyaya, 26/2, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000.  Back to cited text no. 41
    
42.Vaidya G. A. Fadke, Dravya-Guna-Shastram, edited by Vaidya N. H. Joshi, First part (Prathamam Pushpam)., Mumbapuri, India: Published by Vaidya Vamanrav Dinanatha; 1881. p. 38.  Back to cited text no. 42
    
43.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Grahani Chikitsa Adhyaya, 15/21,36, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000. p. 515-6.  Back to cited text no. 43
    
44.Ibidem, Charaka Samhita, Chikitsa Sthana, Grahani Chikitsa Adhyaya, 15/42-4; 517.  Back to cited text no. 44
    
45.Agnivsha, Charaka, Charaka Samhita, Vimana Sthana, Trividhakukshiya Vimana Adhyaya, 2/7, text with English translation and Critical exposition based on Chakrapanidatta's Ayurveda Dipika by Sharma R.K. and Bhagwan Dash, Vol-2. Chaukhambha Sanskrit Series Office, Varanasi, 2002. p. 135.  Back to cited text no. 45
    
46.Srinivasulu M, Suresh Babu S. 'Concept of Ama in Ayurveda', Chapter 3, 1 st ed. Varanasi: Chowkhambha Press; 2005. p. 29.  Back to cited text no. 46
    
47.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Jwara Chikitsa Adhyaya, 3/7, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000.  Back to cited text no. 47
    
48.Ibidem, Charaka Samhita, Sutra Sthana, Madatyaya Chikitsa Adhyaya, 24/10; 124.  Back to cited text no. 48
    
49.Agnivsha, Charaka, Charaka Samhita, Vimana Sthana, Rasa Vimana Adhyaya, 1/4, text with English translation and Critical exposition based on Chakrapanidatta's Ayurveda Dipika by Sharma R.K. and Bhagwan Dash, Vol-2. Chaukhambha Sanskrit Series Office, Varanasi, 2002. p. 129.  Back to cited text no. 49
    
50.Agnivesha, Charaka, Dridhabala, Charaka Samhita, Chikitsa Sthana, Grahani Chikitsa Adhyaya, 15/44, edited by Vaidya Jadavaji Trikamaji Acharya, Reprint. Chaukhmbha Surbharati Prakashana, Varanasi, 2000. p. 517.  Back to cited text no. 50
    


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