Sir Osler may be indeed right, as arterial pressure is essential for sustaining life, the most important factor which ensures that the circulation of blood reaches all the tissues in our body. At the same time, an elevated blood pressure can be most inimical to life, if persisting over a period of time.

Classification of Hypertension: 

It is classified as either primary (essential) or secondary. About 90–95% of cases are termed "primary hypertension", which refers to high blood pressure for which no medical cause can be found .The remaining 5–10% of cases (Secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart, or endocrine system(diabetes).

Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure. Moderate elevation of arterial blood pressure leads to shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove ineffective or insufficient

 Normal blood pressure less than 120/80

 Pre-hypertension 120-139/ 80-89

 High blood pressure (stage 1) 140-159/90-99

 High blood pressure (stage 2) higher than 160/100

 Usually this requires three separate sphygmomanometer  measurements at least one week apart. The heart pumps blood into the arteries with enough force to push blood to the far reaches of each organ from the top of the head to the bottom of the feet. Blood pressure can be defined as the pressure of blood on the walls of the arteries as it circulates through the body. Blood pressure is highest as its leaves the heart through the aorta and gradually decreases as it enters smaller and smaller blood vessels (arteries, arterioles, and capillaries). Blood returns in the veins leading to the heart, aided by gravity and muscle contraction.

 Hypertension is the medical term for high blood pressure. It is known as the "silent killer" since it has no initial symptoms but can lead to long-term disease and complications..

Many people have high blood pressure and don't know it. 
Sometimes people with markedly elevated blood pressure may develop:

·         headache, 

·         dizziness, 

·         blurred vision, 

·         nausea and vomiting, and

·         Chest pain and shortness of breath.

People often do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure. The following types of organ damage are commonly seen in chronic high blood pressure:

·         Heart attack 

·         Heart failure 

·         Stroke or transient ischemic attack (TIA) 

About 1% of people with high blood pressure do not seek medical care until the high blood pressure is very severe, a condition known as malignant hypertension.

·         In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg. 

·         Malignant hypertension may be associated with headache, lightheadedness, nausea, vomiting, and stroke like symptoms

·         Malignant hypertension requires emergency intervention and lowering of blood pressure to prevent brain hemorrhage or stroke.

·         Important complications of uncontrolled or poorly treated high blood pressure include heart attack, congestive heart failure, stroke, kidney failure, peripheral artery disease, and aortic aneurysms (weakening of the wall of the aorta, leading to widening or ballooning of the aorta). 

Causes of Hypertension:

Traditionally, hypertension has been classified into essential2 or primary, where there is no evident cause, and secondary, where there is an evident anatomical, pathological or biochemical abnormality. But this view of essential hypertension is increasingly being challenged with the recognition of constitutional, dietary and environmental factors in its pathogenesis.
Essential5 hypertension is the commonest among the causes of hypertension, constituting up to 95% of the cases. Among the secondary causes, renal diseases account for the majority of cases. A useful classification is given below

·         1) Systolic hypertension with increased pulse pressure
a) With decreased compliance of aorta (arteriosclerosis)
b) With increased stroke volume
i) Aortic regurgitation
ii) Thyrotoxicosis
iii) Fever
iv) A-V fistula
v) Patent ductus arteriosus

·         2) Systolic and diastolic hypertension (increased peripheral vascular resistance)
a) Unknown aetiology
i) Essential hypertension
ii) Toxemia's of pregnancy
iii) Acute intermittent porphyria
b) Renal causes
i) Chronic pyelonephritis
ii) Acute or chronic glomerulonephritis
iii) Polycystic disease
iv) Renovascular stenosis or renal infarction
v) Severe renal diseases e.g. Diabetic nephropathy
vi) Renin producing tumors
c) Endocrine causes
i) Cushing's syndrome / Cushing's disease
ii) Conn's syndrome
iii) Pheochromocytoma
iv) Hypothyroidism
v) Acromegaly
d) Iatrogenic causes
i) Oral contraceptive pills
ii) ACTH & Corticosteroids
iii) Non-steroidal anti-inflammatory drugs
e) Miscellaneous causes
i) Coarctation of aorta
ii) Poisoning - lead, thallium etc
iii) Polyarteritis nodosa
iv) Increased intravascular- volume - blood transfusion, Polycythemia vera etc.

Unfortunately there is little information regarding the management of hypertension in homoeopathic literature. Many of the classical therapeutic text books and materia medicae do not mention the condition at all. This is possibly due to the lack of awareness about hypertension during the earlier days of homoeopathy. Clinical studies on the effectiveness of homoeopathic medicines in hypertension also has been few. Off the studies published, most have tried to evaluate the action of "specific" drugs rather than use an individualized approach.Most of practitioner use Rauwolfia only because of there own comfort zone .

Prevalence: India

Hypertension affects up to a quarter of the adult population. The prevalence depends on the age, racial composition and the criteria used to define the condition. In a white population, 20% of the adults in the age group 35 - 65 years have a diastolic blood pressure in the range 90 - 109 mm Hg, 4 - 5% have a range of 110 - 129 mm Hg, and 0.5% have blood pressure levels > 130 mm Hg. The prevalence is even higher in the non white population.

Prevalence: India
Epedemiological  studies show a rising trend in the prevalence of hypertension in India in the last three decades. This is in contrast to with the findings reported in developed countries, which show a decrease in prevalence. Studies10 show overall prevalence in the age group 25 - 64 years as 25.6 %. This11 figure is close to 33% in the age group 45 - 65 years.

Lifestyle Modifications to Manage High Blood Pressure Weight Control

·         Aim for a healthy weight range for your height and body type. Your health care practitioner can help you calculate a healthy target weight. 

·         Even a small amount of weight loss can make a major difference in lowering or preventing high blood pressure. 

·         You must burn more calories than you take in to lose weight. 

·         Crash or fad diets are not helpful and may be dangerous. 

·         Some weight loss medications also carry major risks and may even elevate blood pressure, and great caution is advised in using these drugs. Please ask your health care practitioner or pharmacist for help in deciding if a weight loss medication is appropriate for your situation.

Exercise or Increase Physical Activity

·         Physical activity reduces total cholesterol and bad cholesterol (low density lipoprotein or LDL) and raises the good cholesterol (high density lipoprotein or HDL).

·         Both the American Heart Association (AHA) and the U.S. Surgeon General recommend 30 minutes of physical activity on most days of the week. 

·         Physical activity includes many daily activities such as cleaning the house, raking the lawn, and walking. Other possible sources of activity can include using the stairs instead of an elevator or escalator, walking for errands instead of driving a car, and participating in a sport or social activity such dancing