Essential Hypertension: Homoeopathic research
Materials and Method
The material for this study comprised of patients with essential hypertension, registered for treatment in our branches of Homeocare International. Keeping the aims and objectives in mind, and to help in drawing valid conclusions from the study, the following inclusion and exclusion criteria were followed
Inclusion criteria
" Diagnosis of essential hypertension - History,
examination and routine investigations show no evidence of secondary
causes
" Age group - patients within 35 - 65 years of age
" Sex - Both sexes included
Exclusion criteria
" Diagnosis uncertain or findings from the
history, physical examination or routine investigations arouse suspicion
of a secondary cause for the hypertension
" Isolated systolic hypertension
" Cases with wide fluctuations of blood pressure
" Cases with serious illnesses or conditions affecting function
of different organs or systems - e.g. hepatic disorders, impaired
renal function, pregnancy etc.
Population under study
The study population was comprised of cases of essential hypertension registered at our clinics across all the branches during the period 2007 - 2009. They included patients who wanted treatment for their hypertension and those in whom a raised blood pressure was discovered during the examination in the various out patient departments.
Selection of sample
The hypertensive status of the study population was initially confirmed after measuring the blood pressure twice on two separate occasions. The blood pressure was measured using a mercury sphygmomanometer of standard cuff size.
The patient whose hypertensive status was confirmed was subjected to a preliminary enquiry and examination to exclude causes of secondary hypertension. They also underwent laboratory investigations, which included a blood count, urine for protein, glucose and blood, blood urea and serum creatinine, serum cholesterol, random blood glucose, chest X-ray, and an electrocardiogram.Further their blood pressure was graded and different risk factors analyzed to assess the overall cardiovascular risk in individual cases. For this purpose the criteria laid down by the WHO-ISH was followed.
The patient, who finally got through the various inclusion and exclusion criteria, formed the study sample. They were twenty in number, including - males and - females.
Study design
The study consisted of subjecting patients with
essential hypertension to homoeopathic treatment and assessing the
efficacy by comparing the systolic and diastolic blood pressures
before and after the period of study.
The feasibility of a placebo-controlled study was examined, but
was rejected because of ethical and logistical reasons. It was decided
to conduct a clinical trial without a placebo control, with the
understanding that a placebo controlled trial may be attempted in
the future if the results from the current trial are encouraging.
Period of study
The cases were followed up for six months, from
the date of the first prescription. The study period was fixed considering
the importance of assessing the efficacy of treatment within a reasonable
time frame. This is especially so in the case of essential hypertension,
with its known risks of prolonged uncontrolled blood pressure. It
also helps in comparing the results with conventional treatment,
which is known to show improvement in blood pressure within a short
period of time.
Treatment intervention
Case taking and analysis
Every patient included in this study was interrogated
in detail from a homoeopathic perspective, and the history and examination
findings were recorded in a case record book.
In all the cases, a detailed analysis and evaluation of the symptoms
were done, before reaching a totality. An examination of the miasmatic
basis of the symptoms was also carried out to understand the different
miasmatic influences in each case. Further they were repertorized
as per the principles of homeopathy.
Remedy selection
The final differentiation of the remedies were
made after reference to the different materia medicae, and a remedy
matching the totality was chosen, taking care that it also corresponded
to the predominant miasmatic influence in the case. In some cases,
especially where characteristic symptomatology was lacking, remedy
selection was influenced by factors like causation, keynotes, marked
modalities etc.
The drugs selected were given in a single dose (in sugar of milk),
along with placebo in the form of blank tablets.
Additional measures
The patients on anti-hypertensive drugs were asked
to reduce the dosage gradually and then stop, corresponding to the
pace of improvement.
All the patients were given instructions regarding diet and regimen,
keeping in mind their socioeconomic status and level of education.
The usual measures included avoiding coffee, smoking, alcohol or
other substances having a medicinal nature. They were also advised
to restrict salt and fat in their daily diet and were encouraged
to undertake more physical activity.
Follow up visits
The follow up examination of the patient were usually made at 3-4 week intervals. They were also asked to report even before the scheduled date, in the event of experiencing any troublesome symptom or serious illness. In addition, they were made aware of the necessity of being faithful to the follow up schedule.
At each follow up the patients were evaluated
in detail with special reference to changes in general well being,
change in presenting symptoms and addition of new symptoms. In addition,
the physical examination, including measurement of blood pressure,
was repeated.
During the follow up visits, the remedy was repeated only when necessary,
in the same potency or with a change in potency. Likewise a change
in remedy also was considered only when essential, after careful
evaluation of the follow up. In cases where both were not necessary,
only placebo was prescribed, in the form of sugar of milk powders
and blank tablets.
Outcome measures
The primary outcome measure is the systolic and diastolic blood pressure values after the period of the study. These were compared with the initial values, and the difference analyzed using statistical tests, to find the efficacy or otherwise of the treatment.
Secondary outcome measures include change in grade of hypertension before and after treatment, and change in other symptoms associated with hypertension.
Statistical tests
Statistical tests were used only for the main outcome measure. For the purpose of this study, the statistical analyses were conducted separately for systolic and diastolic blood pressure values, using the paired t test. The test helps to establish whether the changes observed before and after treatment were significant or not.
The same test was also used to estimate any difference in the changes observed in systolic and diastolic values, to understand specific effects if any.
Observation & Discussion
A total of twenty cases were selected for this study. Out of the many cases screened, only those, which passed all the inclusion and exclusion criteria were selected.
Characteristics of study group
Age and sex
Patients falling into the age group of 35-65 years
were selected for the study. The highest number of cases was in
the age group 60-65 years with 7 out of the 20 cases (35%). The
next highest was in the age group 55-60 with 4 cases (20%). The
rest of the cases were distributed almost evenly across the other
groups. Only one case was present in the age group 40-45 years.
The high percentage of cases in the elderly age groups (55-65 years
- 11 cases or 55%) may have a bearing on some of the results obtained,
which will be discussed later.
Sex distribution
The study group was comprised of 4 males (20%)
and 16 females (80%). Two male patients (50%) were in the 60- 65
years age group, and one each in the groups 35-40 and 45-50 years.
Out of the female patients, 5 (31.2%) were in the age group 60-65
and 4 (25%) were in the age group 55-60 years. As noted for the
overall age distribution, the highest numbers of female patients
were also in the age group of 55-65 years, with 9 patients (56.2%).
| Age group (Years) |
Male
|
FeMale
|
Total
|
||||||
|---|---|---|---|---|---|---|---|---|---|
35-40 |
|
|
|
||||||
40-45 |
|
|
|
||||||
45-50 |
|
|
|
||||||
50-55 |
|
|
|
||||||
55-60 |
|
|
|
||||||
60-65 |
|
|
|
||||||
35-65 |
|
|
|
Table. Age and sex distribution of study group
Risk factors for the development of hypertension
Several risk factors associated with the development
of hypertension were identified in the study group. Psychological
stress in varying degrees was found in 15 patients (75%), though
a direct relation between a stressful circumstance and the development
of hypertension was not found in all of them. The nature of the
psychological stress also varied, ranging from grief, anxiety, fear
etc. in different patients.
| Risk factors | No. of cases | % |
|---|---|---|
Genetic
factors |
9 |
45 |
Mental
Stress |
15 |
75 |
Obesity |
1 |
5 |
Low
socio-economic class |
11 |
55 |
High salt intake |
3 |
15 |
High
alcohol intake |
1 |
5 |
Non-vegetarian diet |
6 |
30 |
Lipid
abnormalities |
3 |
15 |
Table. Risk factors for hypertension in study group
Low socioeconomic class appears to be a significant factor in the study group, with 11 out of the 20 patients (55%) falling into this group. But this may very well be a confounder, since a good proportion of the patients approaching the study center belong to this class.
Risk factors for hypertension in study group
Genetic factors were the next in importance, with a positive family history of hypertension present in 9 cases (45%). The siblings were affected in 7 cases, while in the other two, the parents who were hypertensive. Interestingly, another illness with a strong influence of genetic factors, Diabetes mellitus, was found in the family history of 8 patients (40%). This was in spite of patients with Diabetes mellitus being excluded from the study, and shows the tendency for aggregation of these illnesses in persons with the same genetic background
Dietary factors come in next, 6 patients (30%) having a predominantly non-vegetarian diet. High salt intake was present in 3 patients (15%) and one had history of high alcohol consumption. Lipid abnormalities, in the form of a high cholesterol level, was found in three patients
Past history
There were no notable trends in the history of past illnesses, except for the occurrence of hypertension during pregnancy in 2 out of 16 female patients.
Clinical presentation
At the time of the present study, the most frequent
chief complaint was vertigo. It was present in 8 cases, which amounts
to 40% of the cases. The next in order of frequency was recurrent
headaches (7 cases - 35%), joint pains and skin complaints (4 cases
- 20 %), chest pain breathlessness, and abdominal complaints (3
cases - 15%]
| Presenting complaint | No. of cases | % |
|---|---|---|
Vertigo |
8 |
40 |
Headache |
7 |
35 |
Joint
pain |
4 |
20 |
Skin
complaints |
4 |
20 |
Chest pain |
3 |
15 |
Breathlessness |
3 |
15 |
Abdominal complaints |
3 |
15 |
Others* |
1 |
5 |
Table: Presenting complaints of study group
Other symptoms like hot flushes, General weakness, disturbed sleep, palpitations, and dimness of vision, recurrent sneezing and numbness of the limbs were complained of in one case each. It should be noted that the presence of these complaints are not mutually exclusive, many patients have presented with more than one complaint.
Investigations
The abnormal findings in the investigations were
few, and they included the presence of high cholesterol level in
the blood examination and cardiomegaly in the chest x-ray. A blood
cholesterol level significantly increasing the risk of cardiovascular
diseases (> 250 mg/dL) was found in 3 patients (15%). Six patients
(30%) had blood cholesterol level in the range 200 - 250 mg/dL,
while 11 (55%) had levels < 200 mg/dL.
Cardiomegaly, defined by a cardio-thoracic ratio > .5, was found
in 2 cases (10%). In both the cases the enlargement was of the left
ventricular configuration.
Miasmatic analysis
The psoric miasmatic influence was very much evident in all the cases in the study. It was the dominant miasm in 19 cases (95%), and in one case it was in second position. The pseudo-psoric influence also was very marked. While it was the dominant miasm in only one case (5%), it was in the second position in 10 cases (50%).
Chronic miasm Dominant Second position
| Chronic miasm | Dominant
|
Second position
|
||||
|---|---|---|---|---|---|---|
Psora |
|
|
||||
Syphilis |
|
|
||||
Sycosis |
|
|
||||
Pseudo-psora |
|
|
Table: Miasmatic analysis of the study group
The sycotic and syphilitic miasmatic expression
was not very prominent in the study. Out of the two, syphilitic
expression was more common, being in the second position in 6 cases
(30%). The relatively weak miasmatic expression of the syphilitic
and sycotic miasms may be related to the strict exclusion criteria,
which avoided cases of essential hypertension with complications.
Distribution of blood pressure before treatment
An examination of the blood pressure values of
the study group before treatment shows that the majority have blood
pressure values in the middle range of the distribution. Seven patients
(35%) had diastolic blood pressure in the range 100-104 mm Hg, and
five (25%) had diastolic blood pressure in the range 95-99 mm Hg.
This means that 60% of the patients had a diastolic blood pressure
in the range 95-104 mm Hg.
The same trend is seen when comparing the systolic blood pressure
values. Eight patients had systolic blood pressure levels in the
range 160-169 mm Hg, while four had systolic blood pressure levels
in the 150-159 mm Hg. range. Sixty percent of the patients thus
have systolic blood pressure values in the range 150-169 mm Hg.
Diastolic blood
pressure (mm/Hg)
|
Systolic blood pressure (mm/Hg)
|
||||||
|---|---|---|---|---|---|---|---|
|
|
||||||
|
|
||||||
|
|
||||||
|
|
||||||
|
|
||||||
|
|
Figure: Distribution of diastolic blood pressure in study group
On examining the rest of the values, we can see that most of the values are clustered around the upper part of the distribution for both diastolic and systolic blood pressure levels. Seven patients (35%) have diastolic blood pressure levels more than 104 mm Hg, while only one patient (5%) has a value less than 95 mm Hg. In the case of systolic blood pressure levels, six patients (30%) have a value more than 169, and only two (10%) have values less than 150 mm Hg.
Classification of blood pressure
The blood pressure values of the study group were classified according
to the World Health Organization - International Society of Hypertension
guidelines for the management of hypertension. According to this
classification, eleven patients (55%) have grade II hypertension.
Seven patients (35%) have grade III, while two (10%) have grade
I hypertension.
| Grade of hypertension | Grade I | Grade II | Grade III |
|---|---|---|---|
No. of cases |
2 |
11 |
7 |
Percentage |
10 |
55 |
35 |
Table: Classification of blood pressure before treatment
Assessment of cardiovascular risk profile before treatment
Assessment of risk of cardiovascular complications was carried out according to the guidelines mentioned earlier. Here apart from the grade of hypertension, presence of other risk factors is also considered to assess overall risk.
After risk stratification, it can be seen that half the patients’ fall into the medium risk group. Only one patient falls into the low risk group, while there are nine patients in the high-risk group. The presence of a good number of patients in the high-risk group is partly due to the stringent criteria laid down by the WHO-ISH for assessing risk in cases of hypertension.
| Grade of risk | Low risk | Medium risk | High risk | Very high risk |
|---|---|---|---|---|
No. of cases |
1 |
10 |
9 |
- |
Percentage |
5 |
50 |
45 |
- |
Table: Stratification of cardiovascular risk before treatment
The risk of a major cardiovascular event in the next 10 years is estimated to be less than 15% in the low risk group, 15 - 20 % in the medium risk group, 20 - 30 % in the high risk group, and > 30 % in the very high risk group. The patient in the very high-risk group requires the most intense and rapidly instituted treatment measures.
Assessment of efficacy of treatment
Distribution of blood pressure after period of study
An examination of the blood pressure distribution after the period of study shows a definite change from the previous distribution, with the majority of the values now clustered towards the lower end of the distribution. The same pattern is observed for both diastolic and systolic blood pressure values.
Nine patients now have diastolic blood pressure values less than 90 mm Hg. This means that 45% of the patients have diastolic blood pressure in the normal or high normal range. Six patients (30%) have diastolic values in the range 90-94 mm Hg, making a total of fifteen cases or 75% of patients with values less than 95 mm Hg after the period of study.
The systolic blood pressure levels also show a downward trend, with nine patients (45%) having blood pressure values less than 140 mm Hg. Four patients (20%) have systolic values in the range 140-149 mm Hg, and thus thirteen patients or 65% have values less than 150 mm Hg. after the treatment period.
On examining the rest of the distribution, we now see that four patients (20%) have diastolic blood pressure levels more than 100 mm Hg, with one (5%) of those having a blood pressure above 110 mm Hg. The corresponding figures before the period of study were fourteen (80%) and five (25%) respectively. Similarly in the case of systolic blood pressure levels, the number of patients with values more than 160 mm Hg was fourteen (80%), with four (20%) of them having values more than 180 mm Hg. After the treatment period, these numbers were reduced to six (30%) and two (10%) respectively.
Overall, it is clear that the treatment intervention has had an effect in reducing the blood pressure levels.
Change in grade of hypertension
Observation of the change in grade of hypertension before and after treatment is another measure of efficacy. After treatment five patients (25%) have blood pressure levels falling below the hypertensive range, with four (20%) in the high normal and one (5%) in the normal range. The relatively less number of cases in the normal range despite nine cases having diastolic blood pressure < 90 mm Hg shows that the effect on the corresponding systolic blood pressure level has not been the same. One of the reasons could be the higher proportion of patients in the elderly age groups, where atherosclerotic changes are more widespread.
| Grade of blood pressure | Normal | Upper end of normal limits | Hypertension
|
|||
|---|---|---|---|---|---|---|
No. of cases |
1 |
4 |
|
|||
Percentage |
5 |
20 |
|
Table: Classification of blood pressure after treatment
A positive effect was observed on the patients remaining in the hypertensive range also. Seven patients (35%) now have grade I hypertension, compared to two (10%) before treatment. The number of patients in the higher grades have correspondingly decreased, with only five patients (25%) having grade II and three patients (15%) having grade III hypertension. These figures were eleven (55%) and seven (35%) respectively before treatment.
Overall, thirteen cases (65%) have shown a change to a lower grade of hypertension, while six (30%) have not shown any change in grade. Only one case has worsened to a higher grade, from grade I to grade II. On examining the improvement in individual grades, the maximum improvement was observed in grade II. Off the eleven patients in grade II before the period of study, a change was observed in eight (72.7%), with six falling into grade I and two into the high normal range.
Grade of hypertension |
No. of cases* |
Cases with improvement |
Cases without improvement |
% Change |
|---|---|---|---|---|
Grade I |
2 |
1 |
1 |
50 |
Grade II |
11 |
8 |
3 |
72.7 |
Grade III |
7 |
4 |
3 |
72.7 |
Grade III hypertensives have shown a change in four out of seven cases (57.1%), with two showing a reduction to high normal range and one each reducing to grade I and grade II respectively. In the case of the two patients with patients with grade I hypertension, one has reduced to normal range, while the other has not shown any change
Change in cardiovascular risk profile
The major factor affecting cardiovascular risk profile in this study is the grade of hypertension. Apart from this the other risk factors identified were age in the case of two patients, cholesterol levels in three, and ventricular hypertrophy in two patients.
Before the onset of treatment, three patients had cholesterol levels adversely affecting the cardiovascular risk profile (> 250 mg/dL). After the period of study, one had the cholesterol level lowered below the risk level, while the other two did not show a significant change.
On risk stratification after the treatment period, a trend towards reduction in the risk for cardiovascular diseases is observed. Now there are ten patients (50%) in the low risk group, while there was only one (5%) before treatment. This is associated with a corresponding decrease in the higher risk groups, with only five (25%) patients falling into high-risk group, compared to nine (45%) before treatment. Similarly the number of patients in the medium risk group is reduced to five (25%) from ten (50%).
Risk group |
Before treatment
|
After treatment
|
||||
|---|---|---|---|---|---|---|
Low risk |
|
|
||||
Medium risk |
|
|
||||
High risk |
|
|
Statistical analysis
Statistical analysis was conducted separately for diastolic and systolic blood pressure levels. Different scores were given to the various blood pressure levels, for the purpose of comparison. The scores obtained before and after three months of homoeopathic treatment were analyzed using the paired `t` test.
Diastolic BP |
Score |
Systolic BP |
Score |
|---|---|---|---|
< 90 |
1 |
< 140 |
1 |
90-94 |
2 |
140-149 |
2 |
95-99 |
3 |
150-159 |
3 |
100-104 |
4 |
160-169 |
4 |
105-109 |
5 |
170-179 |
5 |
>(or)=110 |
6 |
>(or)=180 |
6 |
Table: Scores assigned to range of blood pressure levels
The following are the steps in the analysis:
A. Purpose of analyses:
To know if the observed difference between scores before and after three months homoeopathic treatment is significant or not.
B. Null hypotheses:
There is no significant difference in the scores before and after treatment.
C. Find the difference in scores before (x) and after (y) treatment = z
D. Calculate the mean of the difference
ž = S z/n where `n` is the sample size
E. Calculate the standard deviation - SD = v S (z- ž )2/n-1
F. Calculate the standard error of mean
S.E. = SD/vn where SD is the standard deviation of differences and `n` is the sample size.
G. Determine the t value at n-1 degrees of freedom
t19 = ž /SE where ž is the mean of differences and SE is the standard error of mean of difference.
H. Comparison with table value
If `t` value obtained is more than table value at n-1 degrees of freedom, null hypothesis is rejected.
Analysis of change in diastolic blood pressure
Case No. |
X |
Y |
Z=X-Y |
z - ž |
(z - ž )2 |
|---|---|---|---|---|---|
1 |
6 |
1 |
5 |
2.9 |
8.41 |
2 |
5 |
4 |
1 |
-1.1 |
1.21 |
3 |
4 |
5 |
-1 |
-3.1 |
9.61 |
4 |
5 |
4 |
-1 |
-1.1 |
1.21 |
5 |
4 |
1 |
3 |
.9 |
.81 |
6 |
6 |
6 |
0 |
-2.1 |
4.41 |
7 |
4 |
1 |
3 |
.9 |
.81 |
8 |
6 |
2 |
4 |
1.9 |
3.61 |
9 |
3 |
1 |
2 |
-0.1 |
.01 |
10 |
2 |
1 |
1 |
-1.1 |
1.21 |
11 |
6 |
2 |
4 |
1.9 |
3.61 |
12 |
6 |
3 |
3 |
.9 |
.81 |
13 |
3 |
1 |
2 |
-.1 |
.01 |
14 |
4 |
2 |
2 |
-.1 |
.01 |
15 |
4 |
9 |
3 |
.9 |
.81 |
16 |
4 |
2 |
2 |
-.1 |
.01 |
17 |
3 |
1 |
2 |
-.1 |
.01 |
18 |
4 |
1 |
3 |
.9 |
.81 |
19 |
3 |
2 |
1 |
-1.1 |
1.21 |
20 |
3 |
2 |
1 |
-1.1 |
1.21 |
x - Score before treatment y - Score after treatment
z - Difference in scores ž Mean of difference
Table 19. Difference in scores of diastolic blood pressure levels
Mean of difference - ž = 2.1
Standard deviation - SD = v39.8/19 = 1.45
Standard error of mean - SE = 1.45/v20 = .32
`t` value - t19 = 2.1/.32 = 6.56
Comparison with table value:
The table shows that the value of `t` at 19 degrees of freedom at 5%, 1% and .1% levels are 2.09, 2.86 and 3.88 respectively. The calculated value of 6.56 is greater than 5%, 1% and .1% levels, with P < .001. Hence the null hypothesis of no difference is rejected and the alternate hypothesis of significant difference is accepted.
Analysis of change in systolic blood pressure
Case No. |
X |
Y |
Z=X-Y |
z - ž |
(z - ž )2 |
|---|---|---|---|---|---|
1 |
4 |
1 |
3 |
1.45 |
2.10 |
2 |
3 |
1 |
2 |
.45 |
.20 |
3 |
4 |
4 |
0 |
-1.55 |
2.40 |
4 |
2 |
1 |
1 |
-.55 |
.30 |
5 |
4 |
1 |
3 |
1.45 |
2.10 |
6 |
4 |
5 |
-1 |
-2.55 |
6.50 |
7 |
6 |
1 |
5 |
3.45 |
11.90 |
8 |
3 |
1 |
2 |
.45 |
.20 |
9 |
3 |
1 |
2 |
.45 |
.20 |
10 |
3 |
4 |
-1 |
-2.55 |
6.50 |
11 |
6 |
6 |
0 |
-1.55 |
2.40 |
12 |
6 |
6 |
0 |
-1.55 |
2.40 |
13 |
5 |
2 |
3 |
1.45 |
2.10 |
14 |
1 |
1 |
0 |
-1.55 |
2.40 |
15 |
4 |
3 |
1 |
.55 |
.30 |
16 |
5 |
2 |
3 |
1.45 |
2.10 |
17 |
6 |
5 |
1 |
.55 |
.30 |
18 |
4 |
1 |
3 |
1.45 |
2.10 |
19 |
4 |
2 |
2 |
.45 |
.20 |
20 |
4 |
2 |
2 |
.45 |
.20 |
x - Score before treatment y - Score after treatment
z - Difference in scores ž - Mean of difference
Table 20. Difference in scores of systolic blood pressure levels
Mean of difference- ž = 1.55
Standard deviation - SD = v 46.9/19 = 1.57
Standard error of mean - SE = 1.57/v20 = .35
`t` value - t19 = 1.55/.35 = 4.43
Comparison with table value:
The table shows that the value of t at 19 degrees of freedom at 5%, 1% and .1% levels are 2.09, 2.86 and 3.88 respectively. The calculated value of 4.43 is greater than 5%, 1% and .1% levels, with P < .001. Hence the null hypothesis of no difference is rejected and the alternate hypothesis of significant difference is accepted.
Inference:
The study shows that there is a significant difference between the scores representing blood pressure levels before and after 3 months of homoeopathic treatment. This difference is more than that due to chance, and therefore the treatment is effective.
Medicines administered
Majority of the medicines prescribed during the course of the study were based on the chronic totality. On a few occasions, the medicines were prescribed based on the acute totality, when there was an acute flare up of complaints. In a couple of cases, nosodes were also used
The following are the various remedies prescribed during the course of the study.
Remedy |
No. of cases |
% |
First prescriptions |
% |
|---|---|---|---|---|
Natrium muriaticum |
4 |
20 |
3 |
15 |
Lachesis mutus |
3 |
15 |
2 |
10 |
Kalium carbonicum |
3 |
15 |
3 |
15 |
Nux vomica |
2 |
10 |
2 |
10 |
Calcarea carbonica |
2 |
10 |
1 |
5 |
Sepia officinalis |
2 |
10 |
2 |
10 |
Pulsatilla pratensis |
1 |
5 |
1* |
5 |
Sulphur |
1 |
5 |
1 |
5 |
China officinalis |
1 |
5 |
1 |
5 |
Arsenicum album |
1 |
5 |
1 |
5 |
Rhus toxicodendron |
1 |
5 |
1 |
5 |
Opium |
1 |
5 |
1 |
5 |
Conium maculatum |
1 |
5 |
- |
- |
Syphilinum |
1 |
5 |
- |
- |
Carcinosinum |
1 |
5 |
- |
- |
Constitutional remedies:
Frequency of prescriptions:
Natrum mur was the most frequently prescribed remedy, with four cases (20%). In three cases (15%) it was made as the first prescription, and in one it was made as the follow up remedy Lachesis and Kali carb were the next in order of frequency, both being prescribed in three cases (15%). Lachesis was the first prescription in two of the cases (10%) where it was prescribed, while Kali carb was prescribed first in all the three (15%)of its cases.
Nux vomica, Calcarea carb and Sepia were prescribed in two cases each (10%). Out of these, Nux vomica and Sepia were the first prescriptions in their respective cases, while Calcarea carb was prescribed first in only one case. However, it should be pointed out that even in the second case Calcarea carb was the chronic remedy selected, but Pulsatilla was prescribed first since the patient was in an acute exacerbation. Calcarea carb was prescribed once the acute symptomatology subsided.
Rest of the medicines prescribed in this study were needed only in one case each (5%). They include Pulsatilla, Sulphur, China, Arsenic alb, Opium, Rhus tox, Conium, Syphilinum and Carcinosinum. Out of these Pulsatilla, Sulphur, China, Arsenic alb, Opium, and Rhus tox were the first prescriptions in their respective cases, while the rest were made during the follow up.
Frequency of first prescriptions:
Overall, Natrum mur and Kali carb were the most frequently made first prescriptions, with three cases (15%) each. The next in order of frequency are Lachesis, Nux vomica and Sepia, with two cases each (10%). The rest of the medicines were prescribed first only in one case each.
Nosodes:
The nosodes, Syphilinum and Carcinosinum, were prescribed in one case each. Both were prescribed during one of the follow up visits. Syphilinum was prescribed in a case with paucity of symptoms, when none of the remedy images were clear. Carcinosinum was prescribed as an intercurrent remedy, in a case where the indicated remedy was not giving the desired result
Potencies used
Various potencies, ranging from 30th to 10M were used during the period of the study. The potency most often used to begin the treatment was the 200th, with eight cases (42.1%). The 30th potency also was frequently used, in seven or 36.8% of the cases. The use of the higher potencies in the first prescription was less frequent, with the 1M potency prescribed only in four cases (21.1%).
Potency* |
30 |
200 |
1M |
10M |
|---|---|---|---|---|
| No.of Cases: | ||||
8 |
4 |
- |
* - Centesimal scale Table: Potencies used in first
prescriptions
When all the prescriptions are considered together also, the potency most often used is the 30th and 200th potency. The higher potencies were used less often, with the 10 M potency prescribed only thrice.
Remedy |
Potencies |
Remedy |
Potencies |
|---|---|---|---|
Natrium muriaticum |
30, 200, 1M, 10M |
Pulsatilla pratensis |
30, 200 |
Lachesis mutus |
30, 1M, 10M |
Sulphur |
200, 1M |
Kalium carbonicum |
30, 200 |
China officinalis |
30, 200 |
Nux vomica |
200, 1M, 10M |
Arsenicum album |
200 |
Calcarea carbonica |
30 |
Rhus toxicodendron |
30 |
Sepia officinalis |
200, 1M |
Opium |
200, 1M |
Conium maculatum |
30 |
Carcinosinum |
200 |
Syphilinum |
200 |
- |
- |
Table: Remedies and potencies used
Natrum mur, Lachesis and Nux vomica were the only remedies which were prescribed in the 10M potency. The remedies prescribed in the 1M potency include the three mentioned above, as well as Sulphur, Sepia and Opium. The rest of the remedies were prescribed in the 30th and 200th , with Calcarea carb, Conium and Rhus tox being prescribed only in the 30th potency. The nosodes were prescribed in the 200th potency
Summary & Conclusion
Essential Hypertension is a major health problem, especially in the developing countries. It is a key risk factor for important cardiovascular diseases like coronary heart disease and stroke, both of which account for a good proportion of the deaths worldwide. Conventional anti-hypertensive treatment, while effective in reducing the blood pressure, has its own draw backs. Non compliance with the treatment regimen is a major problem. The asymptomatic nature of the illness, adverse effects of drugs and high cost of treatment has resulted in the "rule of halves", where less than half the hypertensive population is adequately treated. In this scenario, Homoeopathy has a lot of potential to help in reducing the proportion of the hypertensive population in the community, and thereby make a contribution in reducing overall cardiovascular mortality levels. The holistic nature of homoeopathy is ideally suited for this, as even the practitioners of allopathic medicine are realizing the fallacy in treating the blood pressure or other risk factors in isolation. The cheaper cost of treatment also makes it a more attractive option at the community level.
The study has shown that homoeopathic medicines have a positive effect on the hypertensive status of the patients in the study sample. The efficacy is demonstrated by the results of the statistical analyses (p < .001for both diastolic and systolic levels), which show that the pretreatment and post treatment levels of blood pressure are indeed, different. An analysis of the change in grade of hypertension before and after treatment has also shown that thirteen cases or 65% have changed from a higher to a lower grade of hypertension. The group which responded the most to treatment was patients in grade II hypertension with 72.7 % showing change to a lower grade. Finally, an analysis of the cardiovascular risk profile before and after treatment has also demonstrated a reduction in the percentage of cases in the higher risk groups.
The remedies used in this study were essentially prescribed based on the totality. Remedies like Natrum mur, Calcarea carb, Kali carb and Sepia were found to be effective in more cases than others. China and Carcinosinum were found to be effective in one case each, though both are not mentioned in the general repertories under the rubric for hypertension.
Further to the "in house" clinical research done at Homeocare International, the vast experience of our team of doctors has come to a better understanding of the diseases and their effective treatments. We have reached a stage wherein precision of prescription is achieved in all the cases with "in-depth" study of vast number of cases with the support of dedicated team of doctors who does clinical research.
We are Pleased to inform you that our team of doctors has found success formulae to various illnesses to add much value to the patients' quality of life through genome therapy / CT therapy that had enhanced our success rate in almost all the diseases. This feat is not achieved by any body so far in the field of homeopathy except Homeocare International. To feel the blend of ultimate quality of homeopathic treatment and technology, please contact / visit our nearest clinic. Homeocare International, the Leaders in world class Homeopathy… we care always……all ways.
