In general practice, about 11 percent of the patients who are over 50 will be found to have raised blood pressure; it should be 160mm systolic and 90mm diastolic, which is almost normal.
What kind of people develop hypertension? There are some arguments about the importance of heredity, but Platt considers it a specific inherited disorder of middle age. He points out that the parents and the siblings of patients with essential hypertension suffer in the same way, and that their younger brothers and sisters show a rise in blood pressure as they reach middle age.
When the internal secretions renin and angiotensin were first discovered, it was thought that they might be causes of raised blood pressure, but further research has demonstrated that neither renin or angiotensin nor aldosterone, occur in other than normal amounts in essential hypertension.
Draper in America employing a series of skeletal measurements tried to identify a physical type prone to essential hypertension, but the one distinguishing anatomical feature was the widely separated large orbits.
The specialists in psychosomatic medicine have summarized the characteristics of the personality developing essential hypertension. Compared with other types of patients, they have an extremely high record of previous illness. In temperament, they are predominantly introverts. Many of them have neurotic symptoms and bottle up their feelings, which if they do find expression, do so in an explosion.
They are ambitious but fear that they will fail so select an occupation below their real capacity. There is a continual conflict between active and passive roles, they would like to identify with authority figures, but on the other hand, need to be taken care of. Because of this ambivalence, they have difficulty in making decisions. When they discover or learn that they have high blood pressure, their feelings are a mixture of fear, exaggerated fear of a stroke or paralysis, and relief that they have an excuse for failing to attain their ambitions or goals. To tell these patients not to worry is absurd. Even if you ask them if they are worried about anything, they will say “No", because often they do not realize how deeply disturbed, they are, but they will, once they know about their blood pressure, project their worries onto that.
A departmental manager in a well-known firm, a bachelor living with his widowed father. He was already aware of his raised blood pressure and had been told the figures by his previous doctor. Nothing would satisfy him but he must know at each visit the figures which he entered in his diary and referred to each. Long after his systolic pressure had been stabilized, at a figure inside the normal range, he still needed to know and record these statistics. Although it should be avoided.
To come back to the psychosomatic profile here are a collection of mental symptoms. If one attempts to look them up in Kent's Repertory, one has to accept some equivalents:
٭ Timidity (for shyness)
٭ Oversensitive (sensitive to criticism)
٭Lack of self-confidence
٭Irresolution (cannot make decisions)
٭Effects of grief
When these are repertorized, the remedy which is best represented is Lycopodium, and other remedies which come through are Aurum Metallicum, Ignatia, Sulphur, and Natrum Muriaticum. But these are mental symptoms only, and in finding the similimum one has to take into consideration other symptoms and other modalities.
The evidence of hereditary factors and the well-defined pattern of psychological attitudes indicate that in essential hypertension we are dealing with a particular type of constitution. We are therefore encouraged to rely on constitutional remedies in treating this condition.
The history of the homœopathic treatment of essential hypertension does not go back as much as fifty years: but sphygmomanometers were not in use in general practice much before the mid-twenties of this century. The first reference to essential hypertension in homœopathic literature is a note by an American physician in 1924. But he had no suggestions about suitable remedies and it was not until 1931 that two French homœopaths recommended Baryta Carb. and Plumbum, not forgetting Ignatia for the temporary hypertension that they noted
tended to follow emotional shocks.
But in the seventies, in contrast to the 1940s, the problem became more complicated. As a consultant, the majority of patients referred to me have already had orthodox treatment for hypertension; and often it is because the side effects have proved so troublesome that the unfortunate patients have asked for a further opinion.
For example, one man a psychiatrist, in depression. It emerged that he had been prescribed reserpine for hypertension, and he had developed the characteristic depression, one of the reported side effects of Rauwolfia from which reserpine is derived. Depression was observed in the provings of Rauwolfia by Dr. Templeton's team some dozen years ago.
It was difficult to persuade this man to discontinue his reserpine as he had been so alarmed by the discovery of a raised blood pressure. Actually, his raised blood pressure was desirable, as he suffered from polycythaemia and his heart required more force to pump the viscous blood through the arteries. His blood pressure was contained within normal limits with spaced doses of Cobaltum 30 which was prescribed not so much for the hyperpiesia as for his raised blood count.
A more troublesome group of toxic reactions follows the use of methyldopa. Some 20-25 percent. of patients cannot tolerate this drug. Twenty percent of patients develop a positive Coombs test in three to six months and this reaction takes six months to disappear after discontinuing the drug. This positive test is the preliminary stage of a subsequent haemolytic anaemia; but not only are the red cells attacked, but there have also been reported cases of agranulocytosis. Further, the action of methyldopa is potentiated by very powerful diuretics such as hydrochlorothiazide, so much so that some authorities have considered there is a risk of cerebral and cardiac ischaemia with this combination.
A septuagenarian lady lived alone in a large country house, which she had divided up into flats; her married son lived in another part of the house. Petite, wrinkled, stumbling complained of giddiness, faintness, headaches, and lack of concentration. She had a blood pressure of 232/116, and she showed me her collection of drugs which included hydrosaluric, pentaerithytrol-tetranitrate, and dramamine.
For the immediate severe vertigo, she was given Cocculus, and after she had had time to accustom herself to the absence of the powerful drugs, spaced doses of Sulphur 30, then 200 were given.
Her blood pressure hardly varied in the six months after discontinuing the chlorothiazides, but she felt so much better in herself that she was able to resume her gardening and go out by herself which she had been afraid to do before. Nothing was heard from her for six months until she complained of an attack of shingles. Why Sulphur in this particular case? She certainly was not the Sulphur stereotype of the ragged philosopher. Her outstanding symptoms, once she was clear of side effects, were faintness on standing, and burning in the feet, which was so intense that she could not keep them still, trying to find a cool place in the sheets. Sulphur has these two symptoms strongly, and further inquiry elicited other symptoms characteristic of Sulphur.
It is worth noting that at the end of six months, when she was obviously so much better, her blood pressure was still over 200. Just concentrating on lowering her blood pressure was not going to help this lady.
Indeed, it has been pointed out that despite pharmacological control of blood pressure, patients still get strokes. So atherosclerosis and damaged endothelium are also of importance, even if the blood pressure is within the normal range.
A typical example of an octogenarian, a huge man of over 6 feet, in his time a very high-powered executive indeed, had a good social relation with ministers and ambassadors. He developed giant-celled arthritis, which is not
necessarily associated with raised blood pressure. A second opinion was sought and because of the risk of blindness, steroids were recommended. After six months these were tailed off, but this patient developed sudden losses of memory lasting several hours. In these amnesias, he inquired after his wife who had been dead for some years, did not recognize his surroundings, and demanded to be taken to the country house which he had given up a decade ago.
Belladonna 200 proved to be the most effective remedy for this condition, clearing up the amnesia in an hour. But while this short-acting remedy proved efficient, it was much more difficult to treat his general condition, even six months after the steroids had been entirely discontinued. What appeared to be well-indicated remedies such as Calcarea carb, and Baryta carb, did not relieve his general discontented attitude, the slight stiffness of hemiplegic distribution, and the slight apraxia. How far the course of steroids had upset his autoimmune reactions, is hard to estimate.
Some of the most difficult problems are presented by the patient who cannot accept a diagnosis and runs from one doctor to another. A married woman had migraine and what she had been informed was cholecystitis. She already had treatment from an osteopath, a naturopath, an unqualified psychologist, and an eye specialist. She was a stout woman, very accident-prone, very sorry for herself, who wrote every month a long-winded diary of her fluctuating symptoms. Her migraine symptoms appeared to indicate Phosphorus, but after a month's treatment with little improvement, she wrote saying that she was accustomed to taking Phensic, Beecham's tablets, Fentasin, Endorosan, Andrew's Salts, Epsom Salts and would any of these clashes with my treatment.
She was very shocked when she was recommended to discontinue the lot. In view of such an accumulation of medicines, a dose of Sulphur 30 was given, to attempt to clear the picture, but her next report showed little improvement Impatient with her slow progress, she had bought herself some Metatone and fallen back on previous supplies of Senokot, Cafergol and Veracholate. The picture was still a very confusing one, and Sulphur was repeated, this time in 200. She began to fail appointments it appeared that she had lost confidence, perhaps she would do better to seek other advice. She stopped the treatment but after a couple of years repeated her desire to continue it. Previously, her systolic pressure had been under 150, but now it was 170. Her consultant had given her a regime of methyldopa, valium, and an antihistamine. On this combination, she felt worse and reverted to homoeopathic treatment. She was warned that homœopathic treatment would be a waste of time unless she was prepared to discard the allopathic treatments; once more Sulphur was given, and she was feeling better.
Sulphur was prescribed, acting on the advice that it would clear a confused picture. What is notable about this patient is her impatience and impulsiveness. In the seven years I have known her, she has moved house four times and changed her family doctor as often. Remedies characterized by impatience are Chamomilla, Ignatia, Nux vomica, Sepia, and Sulphur.
Impulsive remedies are Argentum Nit, Arsenicum, and Aurum. Perhaps Aurum will prove to be her remedy. Aurum was the remedy of another woman, also heavily built. She was a woman of enormous energy, who wrote books, edited a magazine, and worked part-time as a librarian. As is so often typical of the hypomanic, she wrote immensely lengthy letters, running to five sheets of foolscap. She was liable to depressed phases when her blood pressure tended to rise near the 200 marks. Aurum was prescribed on the combination of suicidal thoughts, her fidgety restlessness, her hot flushes, and her state of being in a hurry. She responded well to a few spaced doses and her blood pressure fell some 40 points.
When the raised blood pressure is an accompaniment of a serious heart condition, such as a history of coronary thrombosis, it is again important to take into consideration the whole person rather than to concentrate on the blood pressure alone.
A patient for forty years, who in that time has been in hospital some half dozen times because of depressive phases. Concerned about her failing sight, due to cataracts, she nevertheless was immensely independent, and after her husband's death lived by herself until well over 80, refusing help from her devoted son and daughter-in-law and critical of the social worker who did her best to make satisfactory arrangements for the partially sighted.
She would never accept any free treatment. This proud old woman was a typical Platinum. She felt herself superior to her neighbors, whom she despised. As an old woman, she became shaky, but disregarded her trembling hands; she was dark, thin, stiff, and disliked company. From time to time, she would disappear into a mental hospital or a geriatric ward but would discharge herself and ask me to visit her when she grumbled quite unjustifiably about the treatment she had experienced. Platinum usually gave her some relief. That last case was an endogenous depression, but reactive depressions also tend to develop raised blood pressure.
In contrast, a lady was a much tougher proposition. For some two years, she nursed her mother who was dying slowly from an oesophageal stricture, and soon after her death the patient's husband developed hemiplegia, and her role as a nurse continued; but added to this she took over the management of her husband's business as a building contractor and continued to do this after his death.
Twenty years ago, her blood pressure was 150, but after her husband's stroke, it rose to 184. At this time, she was obviously overworked and under great pressure; she forgot what she had to do, her sleep, often interrupted, was unrefreshing and she woke with severe headaches. She didn't like the heat and preferred fresh air. She was accustomed to keeping herself going with lots of spirits. Such physical symptoms as she had been left-sided. Lachesis 30 was of considerable assistance and a year later her systolic pressure had dropped to 142.
