EFFECTS OF ‘ALURETIC’ ON THE OEDEMATOUS STATES AND IN MILD TO
MODERATE HYPERTENSION IN THE ELDERLY
Dr. NATARAJAN V.S., M.D., F.R.C.P. (Edin.)
Professor and Head of the Department
Dr. SHANTHI RAVINDRAN Assistant Professor of Geriatric Medicine
Dr. SIVASHANMUGAM. S Research Medical Assistant,
Department of Geriatric Medicine,
Madras Medical College, Madras 600003
PAPER PRESENTED AT: FIRST NATIONAL CONFERENCE ON GERIATRICS
HELD ON 10TH & 11TH NOVEMBER, 1990, MADRAS
SUMMARY
Out of 50 subjects, 17 subjects (34%) belonging to the oedematous states showed encouraging response to Aluretic therapy. Likewise, 18 subjects (36%) with mild to moderate Hypertension showed hypotensive response. So, the overall desired effect was obtained in 35 subjects (70%) out of 50. There was no postural hypotension or any other side effects. There was no disturbance in the carbohydrate or lipid metabolism. Electrolytes were not very much disturbed by this Aluretic. So this drug can be safely given to elderly sick patients with the oedamatous states or mild to moderate Hypertension. Even though the action is slow it is smooth and gentle. The only convenience is that the elderly have to take a number of tablets per day.
INTRODUCTION:
Heart disease is the most important single cause of death in old age in both sexes worldwide. Over the age of 65 years heart disorders account for more than 70% of all cardiovascular deaths in many countries. The most important forms of heart disease are ischaemic heart disease, cardiac failure, hypertension and infective endocarditis.
Cardiac failure is the most common cause for the oedematous condition in the elderly. The other causes are hypoproteinemia and chronic renal failure. Common causes of heart failure in an elderly population are ischaemic heart disease, hypertension, anaemia, valvular heart diseases, especially calcific aortic stenosis and cardiomyopathy.
High efficacy diuretics, for example frusemide or bumetanide should be administered in the early stages of the treatment of moderate or severe heart failure, but maintenance therapy (cases of chronic heart failure with oedematous state) can be achieved with medium – efficacy diuretics like thiazide. All diuretics apart from potassium – sparing agents or spironolactone may produce hypokalaemia, and this may be associated with an increase in the cardiac sensitivity to digitalis, postural hypotension or muscle weakness.
Aluretic, an ayurvedic drug was chosen for its diuretic effect, to treat the chronic heart failure cases with oedematous state.
Hypertension is the most potent, most common and most remediable contributor to stroke, heart failure and coronary disease in the aged population1. Most elderly patients with hypertension are essential hypertensive and only a small number have secondary hypertension.
The results of an Australian trial involving more than 500 generally well persons, aged 60 to 69 showed that drug treatment of mild to moderate hypertension reduces the incidence of cardiovascular disease. The clinical benefit of antihypertensive therapy, mainly heart failure stroke prevention, has been documented for persons aged 60 to 69. The advantage of treatment is observed within several years and occurs even when BP is not lowered to normal.
The stepped care approach advocated by the Joint National Committee on Detection,
Evaluation, and Treatment o 9e|derly. commended to guide treatment does This entails initiating therapy thiazide of an antihypertensive drug, diuretic, increasing the dosage y dments, and then adding seque y or other as needed.
Diuretics have been the foundation of treatment in all the antihypertensive drug trial, have shown a reduction in cardiovascu-bidity and mortality.
Commonly a thiazide diuretic alone is used to reduce the BP (mild-moderate) in the elderly. But this can cause major adverse effects like hypokalemia, hyponatremia, postural hypotension, hyperglycemia and hyperuricemia, sometimes urinary incontinence or retention can be produced by a diuretic.
So, an ayurvedic drug Aluretic, has been chosen to treat the mild to moderate hypertension in the elderly, because of its diuretic action.
Composition of the Ingredients in the drug
Contents of Aluretic
|
Punarnava |
20.0 mg | Daruharida | 20.0 mg |
|
Guduchi |
20.0 mg | Haritaki | 20.0 mg |
| Ikshu Mul | 20.0 mg | Suntha |
20.0 mg |
|
Haldi |
20.0 mg | Jeshtimadha | 20.0 mg |
| Saunf | 20.0 mg | Anantamul |
20.0 mg |
|
Bharangi Mul |
20.0 mg | Deodar | 20.0 mg |
| Kala kadu | 10.0 mg | Gokshura |
20.0 mg |
|
Nirgundi |
10.0 mg | Patola | 10.0 mg |
| Amala | 10.0 mg | Nim Pan |
10.0 mg |
| Dusparsha | 10.0 mg | Pashanbhed |
10.0 mg |
|
Vidanga |
10.0 mg | Eranda Mul |
10.0 mg |
| Sahianjan | 10.0 mg | Apamarga |
10.0 mg |
|
Shankapushpi |
10.0 mg | Kavach Mul |
10.0 mg |
|
Guggul |
30.0 mg | Shilajit |
30.0 mg |
AIM OF THE STUDY:
1. To evaluate the effect of ALURETIC in Oedematous states.
2 .To evaluate the effect of ALURETIC in mild and moderate hypertension.
PATIENTS AND METHODS:
50 elderly subjects who were taken up this study were from the Geriatric Unit of Government General Hospital, Madras. All of them were above the age of 60 years. These subjects were divided into two groups.
Group A consisted of 25 patients with oedematous state due to cardiac failure. Cases with acute left heart failure were not included in this study.
Patient’s pulse rate. B.P. jugular venous pressure, cardiac added sounds, lungs signs and dependent oedema were documented. Weight was also recorded. Above assessment was carried out once in a week for 4 weeks. Along with the diuretic and digoxin the primary cause for the oedemations state was treated.
Group B consisted of 25 patients with mild to moderate hypertension (mild hypertension, diastolic B.P. – 95 mg – 100 mg Hg. moderate hypertension diastolic B.P. 100 – 105 mg Hg)
B.P.was recorded both in lying and sitting postures for two occasions. After the initiation of therapy B.P was recorded once in a week for 4 weeks.
The selected patients were taken up for complete clinical assessment. Routine investigations like X-ray chest. E.C.G. haemoglobin, RBC. lipid profile, sugar, urea, creatinine, uric acid, and electrolytes were done. Height and weight were also recorded.
The clinically assessed cases were started with Aluretic tablets, two tablets three times a day. The last dose was given late in the evening itself to avoid nocturnal diuresis. No other anti-hypertensive drug was used in this study.
Before starting diuretic therapy the blood was drawn for the above blood tests.
RESULTS AND DISCUSSIONS GROUP A.
This includes those patients wiith oedematous states in cardiac failure. A total of such 25 patients were analyzed, for the same. Out of 25 cases, 18 cases were males and 7 cases were females. With a ratio of 2.4 : 1. Minimum age was 60 years and the maximum 74 years with the average being 66 years.
|
Causes for cardiac failure |
Subjects | Percentage |
|
I.H.D |
12 |
48% |
|
Hypertension |
7 |
28% |
|
Anaemia |
3 |
12% |
|
Vascular Heart Disease |
2 |
8% |
|
Idiopathic |
1 |
4% |
| 25 |
100% |
Out of 25 subjects with congestive cardiac failure, 12 (48%) were secondary to IHD, 7 cases (28%) secondary to hypertension, 3 cases (12%) secondary to anaemia and 2 cases (8%) secondary to valvular heart disease. Only in one case of congestive cardiac failure cause could not be determined.
The response was very good in patients with cardiac failure due to I.H.D. Out of 12 subjects with oedematous states due to IHD, 9 subjects showed very good response to the Aluretic therapy. Out of 7 subjects who had hypertension with oedema, 6 subjects showed satisfactory result with this diuretic therapy. The diuretic response was not satisfactory in oedematous states due to anaemia and valvular heart disease, in 1 patient with oedematous state where cause could not be detected no diuretic response was achieved.
The diuretic response was evident only after 48 hours in 15 cases (60%) and the maximum effect of diuresis was observed after 7 days of therapy. The diuretic response was maximum in the evening. There was no incidence of urinary retention or incontinence in this diuretic therapy. There was no symptom suggestive of electrolytes imbalance.
GROUP B
Patients with mild to moderate hypertension were started on Aluretic tablets. General advise like reduction of weight, wherever indicated. avoiding of smoking and regular walking were also advised. No anti-hypertensive drugs were given along with Aluretic tablets.
Out of 25 subjects, 14 subjects (56%) had mild hypertension (Diastolic B.P. 95 to 100) and the rest 11 subjects (44%) had moderate hypertension (Diastolic B.P. 100 to 105)
Out of 26 subjects 17 were males and 8 were females with a ratio of 2.1:1. The minimum age was 60 years and the maximum age 68 years with the average age being 62 years. The response was good in patients with mild hypertension. Out of 14 cases, 10 cases showed good response with the diastolic B.P. dropping lo below 90 mm Hg
In 11 cases with moderate hypertension, 8 cases showed satisfactory response with the diastolic dropping to below 95 mm Hg.
The hypotensive effect was delayed in our study. The effect was seen only after 10th day of treatment in 70% of cases the response in 30% of cases was seen only after 2 weeks only. Postural hypotension was not reported in our study.
BIOCHEMICAL ANALYSIS
Out of 50 subjects with oedematous states and mild to moderate hypertension, lipids are not disturbed by the Aluretic tablets. Likewise, blood glucose, renal functions, liver functions and uric acid are all within normal limits. Potassium and bi-carbonate levels were also not altered. In the oedematous subjects 3 developed hyponatremia. This may be due to too much of diet restrictions for the above subjects.
SIDE EFFECTS
No side effects have been reported in our study. This drug was absolutely safe to the elderly patients. The drug compliance is the disadvantage to the elderly patients i.e. they have to take minimum 4 to 6 tablets per day for a longer period to have the desired effect.
ACKNOWLEDGEMENT
We thank the Dean. Government General Hospital Madras for permitting us to do the work.
REFERENCES
- 1. Kannel WB: Some lessons in Cardio Vascular epidemiology from Framingham, Am, J. Cardrol 1976. 37 : 269-282.
- The Australian Therapeutic Trial in Mild Hypertension Lancet 1980 1 :1261-1267.
- Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure: A cooperative study, JAMA 1977. 237 : 255-261.
- The 1980 Report of the Joint National Committee in Detection. Evaluation and Treatment of High Blood Pressure, Arch. Int. Med. 1980; 140 : 1280-1285.