Action Of Shatavari In Hypertensive

Retinopathy(HR) :A Case Study

Presented By Dr.Panchajanya kumar Deevi,

Final year PG Scholar.Under the Guidance of

Dr.Ch.Ramadevi Devi, M.D, PhD, Asso.Prof. Dept. Of. Shalakya, DR BRKR GAC,

S.R Nagar, Hyderabad.

Contents

Introduction

HR- Urdhwagata rakta pitta of EYE.

Shatavari (Asparagus racemosus)

Case study

Conclusion

Introduction

Hypertension (HTN) is a life style disease.

Normal blood pressure (BP) is within the range of 100–140 mmHg systolic and 60–90 mmHg diastolic.

HTN is positive if the BP is persistently at or above 140/90 mmHg for most adults.

Hypertensive Retinopathy

Hypertensive retinopathy (HR) is

an ocular manifestation, due

to chronic and improper

management of the BP

Contd...

Shatavari (Asparagus racemosus)- an Ayurvedic herb frequently used as a galactagouge , uterine tonic and cardio protective.

Due to having properties like Rasayana, Netryam and Rakta pitta hara, it was given as a medicine along with HTN drugs in patient of HR.

HR –Urdhwagata Rakta pitta

HR refers to fundus changes occurring in patients

suffering from systemic HTN.

Pathogenesis of HR

Vasoconstriction

Arteriosclerotic changes

Increased vascular

permeability

3 Major factors that plays role in HR

Contd…

Vasoconstriction• Primary response of the retinal

arterioles to raised BP is narrowing and is related to severity

Arteriosclerotic changes

• Changes in arteriolar reflex and A-V nicking result from thickening of the vessel wall and are reflection of the duration of HTN

Increased vascular permeability

• Results from hypoxia and is responsible for haemorrhages, exudates and focal retinal oedema

Grading of HR: Keith and Wegner(1939)

G-1• It consists of arteriolar attenuation, with

broadening of arteriolar light reflex and vein concealment.

G-2• G-1+marked generalized narrowing and

focal attenuation of arterioles associated with deflection of veins at arterivenous crossings ( Salus’ sign)

G-3

• G-2+ copper wiring of arterioles, banking of veins distal to arteriovenous crossings (Bonnet sign) , tapering of veins on either side of the crossings (Gunn sign)and right angle deflection of veins( Salus’ sign ).Flame shaped haemorrhages, cotton wool spots and hard exudates also present

G-4 • G-3+ silver ring arterioles and papilloedema

SymptomsDecreased vision

or Headache.

Differential DiagnosisDiabetic retinopathy, Retinopathy due

to autoimmune disease, Anaemia, Radiation retinopathy, Central retinal vein

occlusion.

Contd…

According to Ayurveda HR can be correlated with Rakta pitta (Urdhwaga) of

EYE. While describing the sites of Rakta pitta of upper part of the body Acharyas said Akshi

( EYE).This urdhwaga rakta pitta can be curable in all except emaciated due to diseases, old age

and who don’t take food properly.

HabitatUp to 8,000 feet altitude throughout India,

especially Northern India .Morphology The plant is a spinous under-shrub, with

tuberous, short root stock bearing numerous succulent tuberous roots (30–100 cm long and 1–2 cm thick) that are silvery white or ash colored externally and white internally.

Shatavari(Asparagus racemosus)

Contd…

The plant flowers during February–March leaving a mild

fragrance in its surrounding and by the end of April, fruits can be seen

with attractive red berries. Part used: root and tender leaves

Contd…

Mineral contents: Ca, Mg, K, Fe, Cu, Mn, Zn, Cu in different parts as root, stems, leaves, flowers, seed, and twigs. Also contains vitamins- A, B1, B2, C, E and folic acid

Other primary chemical constituents : essential oils, asparagine, arginine, tyrosine, flavonoids ( kaempferol, quercetin, and rutin) resin, and tannin.

Intrinsic Haemorrhage, Diarrhoea, Piles, Hoarseness Of Voice, Cough, Biliary Colic, Gouty, Defects Of Vision, Poisoning, Diseases Of Female Genitalia, Rasayana, Aphrodisiac, Erysipelas, Epilepsy, Fever, Dyspepsia, Galactagouge. Among these indications present study was done on its action in intrinsic haemorrhage of Eye. Due to having properties: Sheeta Veerya, Netrya, Vata -Pitta -Asra -Shotha -Jith.

Ayurvedic Indications

Research work

The diuretic study revealed significant diuretic activity in

dose of 3 , 200 mg/kg.Shatavari has been shown to inhibit anti diuretic hormone

(ADH) (Gaitonde and Jetmalani, 1967)

Diuretic activity

The extract was found to produce hypotension in cats, which was blocked by atropine, indicating

cholinergic mechanism of action. The extract also produced congestion and complete stasis of blood flow in mesenteric vessels of mice and rat.

Cardiovascular effects

Contd…

• Slight increase in the bleeding time and no effect on clotting time was observed on i.v. administration of the extract in rabbits.

• These two research evidences show diuretic and anti hypertensive action of Shatavari in animal studies.

Case study• Details of the patient: patient XX, M ,age 45 yrs.

came to ophthalmic- OPD of GAH. Erragadda for eye check up.

• C/O: visual disturbance in both the eyes along with head ache since 15 days.

• Past History: HTN since 7 yrs, on treatment with atenolol-50mg.

• Personal History: mixed diet, non alcoholic and non smoker.

Contd…

Examination:• General examination: CVS-S1S2 +, Lungs-

BAE+, Bowels-free, Urine-free, Appetite- Good, Sleep-distrubed,pulse-80/ mint, BP -130/90mm Hg

• EYE: Patient was examined for visual acuity for both near and distant , with spectacles he can see up to 6/12.

• There after he was observed with the help of ophthalmoscope – the arteriolar narrowing with flame shaped haemorrhages are present.

Contd…

• Investigations: general lab investigations done at GAH Erragadda, for Hb, TC,DC,ESR,RBS.

• Hb-12g/dl,TC-7500 cells/cu.mm, D C Neutrophils  60% Lymphocytes 30 % Eosinophils  0 %Monocytes2% Basophils 0 % ESR-10 1st hr 15 2nd hr, RBS-136mg/dl.

• After all investigations patient was excluded from diabetic retinopathy and retinopathy due to anemia and diagnosed as patient of HR.

• Treatment: patient was advised to take Shatavari Churna (Root)-5gms.BD with Milk. along with Atenolol-50mg as per schedule.

Contd…

• The same treatment was continued for 30 days.

• Along with treatment patient was advised to take low salt diet and kept under meditation for 15 minutes/day.

• Patient was observed after 30days of treatment.

Contd…

Result:• The patient was again examined for his visual acuity and

fundus. • Visual acuity of the patient was improved from 6/12 with

spectacles to 6/6. • Fundus of the patient was also looking healthy with decreased

articular narrowing and flame shaped haemorrhages.• Patient also said some other benefits like decreased stress

levels and headache. • Patient was kept under Netra Rasayanas like Triphala Ghritam

and Saptamrita Loham etc for further maintenance.

Conclusion

Shatavari is an easily available and economical single drug. It is having good number of benefits along with disease suppression in HR. So it is advisable to use Shatavari in the management of HTN patients suffering with HR.

Further Research studies needed to know its clear pharmacology in HR.

Books

• B.P.Chi.9 cha. Raktapittadhikara

• B.P.Ni. Guduchyadivarga

• Comprehensive ophthalmology 5th edition .by AK KHURANA.

Journals• ISSN 2320-5407

International Journal of Advanced Research (2014), Volume 2, Issue 4 ,1039-1045

• World Journal of Pharmaceutical research Volume 3, Issue 1, 201-211. Review Article ISSN 2277 – 7105

e- references • https://s-media-

cache-ak0.pinimg.com/original

• https://www.google.co.in/search?q=hypertensive+retinopathy+pictures&espv

References

AKNOWLEDGEMENT

I express my deep sense of grattitude to my beloved principal , Dr.R. Vidyanath M.D,Ph.D and my mentors Prof.& HOD PG Dept.of.S.S.P:Dr. M.Guru murthy. M.D , Professor: Dr. T. Praveen kumar.M.D, Associate professor Dr. CH.Rama Devi.M.D,Ph.D., Assistant professor: Dr. B.Badrinath Benarji.M.D, for encouraging me. And I'm thankful to whole Shalakya PG unit.