Ayurvedic Interventions for Type 2 Diabetes Mellitus and Hypertension: A Critical Review of Classical Foundations, Clinical Evidence and Research Gaps

Section 1. Epidemiology and Biomedical Context

Type 2 Diabetes Mellitus

“Type 2 diabetes mellitus (T2DM) and hypertension represent two of the most significant noncommunicable diseases of the twenty-first century. According to the latest International Diabetes Federation (IDF) Diabetes Atlas (2025) reports that 11.1% – or 1 in 9 – of the adult population (20-79 years) is living with diabetes, with over 4 in 10 unaware that they have the condition. By 2050, their projections show that 1 in 8 adults, approximately 853 million, will be living with diabetes, an increase of 46%.

Over 90% of people with diabetes have type 2 diabetes, which is driven by socio-economic, demographic, environmental, and genetic factors. The key contributors to the rise in type 2 diabetes include:

• Urbanisation
• An ageing population
• Decreasing levels of physical activity
• Increasing overweight and obesity prevalence

However, it is possible to reduce the impact of diabetes by taking preventive measures for type 2 diabetes and providing early diagnosis and proper care for all types of diabetes. These measures can help people living with the condition avoid or delay complications.” ¹

1. International Diabetes Federation. IDF Diabetes Atlas 2025. https://idf.org/about-diabetes/diabetes-facts-figures/

Hypertension

Hypertension affects an estimated 1.4 billion adults aged 30–79 years worldwide (2024); this represents 33% of the population in this age range. An estimated 600 million adults with hypertension (44%) are unaware that they have the condition. People with high blood pressure may not feel symptoms. The only way to know is to get your blood pressure checked. Things that increase the risk of having high blood pressure include:

• older age
• genetics
• being overweight or obese
• not being physically active
• high-salt diet
• drinking too much alcohol ²

The coexistence of these disorders is particularly concerning: a systematic review/meta-analysis of observational studies worldwide showed that most studies reported hypertension prevalence in T2DM above 50 %, and many above 75 %, supporting the 50–70 % range, and the coexistence of these conditions significantly increases the risk of cardiovascular and microvascular complications such as stroke, myocardial infarction, renal disease, and heart failure.³

“The prevalence of hypertension among individuals with diabetes is alarmingly high, ranging from 32 % to 82 % globally, with more than half of T2DM patients having hypertension…”

Yohannes Mekuria Negussie and Abel Tezera Abebe, “Hypertension and Associated Factors Among Patients with Diabetes Mellitus Attending a Follow-Up Clinic in Central Ethiopia,” Scientific Reports 15 (2025): Article 13150

People with type 2 diabetes mellitus (T2DM) and hypertension very commonly have both conditions because they share the same risk factors, underlying mechanisms, and organ damage pathways. The relationship is bidirectional — each condition makes the other more likely.

Shared risk factors

Both T2DM and hypertension are strongly linked to:

• Obesity (especially visceral/abdominal fat)
• Physical inactivity
• Unhealthy diet (high sodium, processed foods, refined carbohydrates)
• Aging
• Family history/genetics
• Chronic inflammation
• In simple terms:

“ The Cardiometabolic Disease Cycle Linking Obesity, Type 2 Diabetes, and Hypertension”- Graph 1-Ilustrates the link between obesity and diabetes. Graph 2-Ilustrates the cycles of insulin resistance increasing fluid retention which then stiff arteries creating hypertension. The hypertension then drives vascular damage which then worsens insulin resistance. ⁴

South Asia demonstrates especially rapid growth in prevalence due to urbanization, sedentary behavior, dietary shifts toward processed carbohydrates and saturated fats, and psychosocial stress. These epidemiological trends parallel classical Ayurvedic descriptions of disease arising from mithyā āhāra (improper diet), vihāra (faulty lifestyle), and manasika nidāna (psychological causative factors), suggesting a conceptual bridge between modern epidemiology and traditional pathogenesis.⁵

Section 2. Classical Ayurvedic Conceptualization

2.1 Prameha and Madhumeha

In Ayurveda, diabetes mellitus is classified under Prameha, a broad group of metabolic and urinary disorders described extensively in the Charaka Samhita, Sushruta Samhita, and Astanga Hrdaya. The Charaka Samhita (Nidāna Sthāna, Prameha Nidāna) defines the condition:

“Prabhūta avila mutratā pramehāṇām lakṣaṇam.”⁶

Excessive and turbid urination constitutes the defining feature of Prameha.

Twenty subtypes are described based on dosa predominance and qualitative urinary F characteristics. Of these, Madhumeha represents the vāta-dominant and most severe form. Charaka states:

“Madhumehaḥ kṛcchra sādhyatamaḥ pramehāṇām.”⁷

“Among all types of Prameha, Madhumeha is the most difficult to cure.”

Pathogenesis (Samprāpti)

In Ayurveda, Samprapti means the pathogenesis of a disease—that is, the complete process by which a disease develops and progresses in the body. It explains how and why a disease occurs, from the initial causative factors to the full manifestation of symptoms. The classical pathogenesis (samprapti) of Prameha as per Ayurveda involves:

• Excess intake of madhura ( foods that are sweet in taste), guru (heavy to digest) , and snigdha (oily or unctuous in nature) foods
• Sedentary habits
• Kapha and meda (fat) aggravation
• Obstruction of medovaha srotas (adipose tissue and fat metabolism system)
• Progressive involvement of multiple dhātus (meda, māmFsa/ muscles, majjā/ nervous system)
• Eventual depletion of ojas (immune system)

In early Kaphaja Prameha, pathology is characterized by excess and obstruction (srotorodha). In Ayurveda, the early stages of Kaphaja Prameha is considered curable because of the diet and lifestyle components. In advanced Vātaja Madhumeha, pathology shifts toward tissue depletion (dhātu-kṣaya) and ojas loss. This transition parallels modern understanding of progression from insulin resistance to pancreatic beta-cell exhaustion.⁸

The Astanga Hrdaya further emphasizes metabolic derangement through impaired digestive and tissue-level agni, linking Prameha to systemic metabolic collapse rather than isolated hyperglycemia.⁹

2.2 Hypertension and Raktagata Vata

Hypertension does not appear as a discrete nosological entity in classical Ayurvedic literature; however, its functional and pathophysiological features closely correspond to the conditions described as Raktagata Vāta and Sirāgata Vāta. In classical doctrine, disease classification is not strictly disease-name based but rather grounded in doṣa, duṣya, srotas, and functional disturbance. Thus, conditions characterized by abnormal vascular tension, pulsatile force, and circulatory irregularity may be understood within this framework.^10-11

In Suśruta, Suśruta Saṃhitā, Sūtra Sthāna, Vāta-Rakta Adhyāya (causes of Vāta-Rakta disease), in The Sushruta Samhita: English Translation of the Original Sanskrit, trans. Kaviraj Kunjalal Bhishagratna (Calcutta: N. L. Publishers, 1907), Chapter V, verses 1–2; the text explains:

dūṣite tu rudhire tatra vāto mārgān nirudhyate |
sa niruddho balavān vāyur vātaraktaṃ prajāyate ||

“When the blood (Rudhira/Rakta) becomes vitiated, the Vata Dosha is obstructed in its pathways. Being thus blocked, the powerful Vāyu produces the disease known as Vatarakta.” A classical description of aggravated Vāta interacting with Rakta (blood) and producing combined dosha–dhātu dysfunction in Vāta-Rakta.

This statement underscores the dynamic and destabilizing quality of aggravated Vāta within the vascular system. Among the subtypes of Vāta, Vyāna Vāyu—responsible for circulation, cardiac output, and systemic distribution of nutrients—plays a central role. When aggravated, it produces excessive force, irregular pulsation, and increased vascular tension, conceptually analogous to elevated arterial pressure.¹²

From a classical standpoint, hypertension may therefore be interpreted as a multifactorial disturbance involving:

• Vāta aggravation (particularly Vyāna Vāyu): Responsible for abnormal vascular propulsion and increased pulsatile force.
• Rakta duṣṭi: Qualitative vitiation of blood leading to altered vascular reactivity.
• Srotorodha (channel obstruction): Structural or functional impediment within rasavaha and raktavaha srotas, increasing peripheral resistance.
• Mānasika nidāna (psychological stress): Chronic anxiety, anger, and mental strain aggravate Vāta and Pitta, destabilizing circulatory regulation.
• Pitta involvement: Particularly in inflammatory states contributing to vascular irritation and heat.

The concept of Srotorodha is especially significant. Classical texts describe obstruction as leading to increased pressure proximal to the blockage, a principle that parallels modern hemodynamic understanding of elevated systemic vascular resistance.¹³ Similarly, Rakta duṣṭi—characterized by altered viscosity, reactivity, and inflammatory tendency—may be interpreted alongside contemporary descriptions of endothelial dysfunction and vascular inflammation.

In modern biomedical literature, hypertension is strongly associated with sympathetic nervous system overactivation, renin–angiotensin–aldosterone system (RAAS) dysregulation, endothelial dysfunction, arterial stiffness, and vascular remodeling.¹⁴ These mechanisms bear conceptual resemblance to Ayurvedic descriptions of aggravated Vyāna Vāyu (neurogenic drive), Srotorodha (increased resistance), and Rakta duṣṭi (vascular inflammatory change).

Thus, while classical Ayurveda does not label hypertension as an independent disease entity, its pathophysiological basis can be coherently understood within the framework of Raktagata Vāta, integrating circulatory force, vascular quality, obstruction, and psycho-physiological influences into a unified explanatory model.

2.3 Shared Pathophysiology

Both Prameha and hypertensive states share underlying pathophysiology ¹⁵

• Impaired agni
• Ama accumulation
• Meda dysregulation
• Microcirculatory disturbance
• Stress-mediated vata aggravation

Ayurveda conceptualizes these as systemic disorders requiring multimodal correction rather than single-target intervention.

Modern parallels include:

Ayurvedic Concept	Biomedical Parallel
Agnimandya	Metabolic dysfunction
Ama	Inflammatory metabolites
Meda dushti	Adiposity & dyslipidemia
Srotorodha	Endothelial dysfunction
Vyana Vata aggravation	Sympathetic overactivity

This comparative framework supports integrative exploration.

Section 3. Ayurvedic Interventions for Type 2 Diabetes (Prameha / Madhumeha)

Management of Prameha is sequential and individualized, emphasizing causative elimination, purification, palliation, and rejuvenation.

3.1 Nidāna Parivarjana

In Charaka Samhita, the first verse of the Nidāna Sthāna explains that understanding the causes of disease (Nidāna) is the foundation of diagnosis and treatment. The verse highlights the importance of removing the cause of disease to prevent progression:

“Nidānaṃ ca vyādhīnām, prahāṇaṃ kāryam īśvaraḥ”
Translation: “The removal of the cause (Nidāna) is the primary treatment for the disease, as it is the root cause of its progression.”

This aligns with the principle of Nidāna Parivarjana, where removing or avoiding the causes is emphasized as central to treatment.¹⁶

1. First Line of Treatment: Charaka considers Nidana Parivarjana the foremost step in management. If the cause is removed, the disease stops progressing, allowing the body to return to its normal state.
2. Breaking the Chain: It breaks the Samprapti (pathogenesis)—the chain of events where Nidana (cause) leads to Dosha Prakopa (vitiation of doshas).
3. Application: In Charaka Samhita (specifically Nidana Sthana), it is heavily emphasized in the management of Prameha (metabolic disorders) by avoiding Vata-vardhak (Vata-increasing) or Kapha-vardhak (Kapha-increasing) diets and habits.

In summary, this sutra highlights that treating the disease without removing its cause is ineffective; thus, eradicating the root cause is the most crucial part of Ayurvedic therapy.¹⁷

Classical nidānas include:

• Excess sweets and heavy foods
• Alcohol overuse
• Physical inactivity
• Daytime sleeping
• Psychological stress ¹⁸

3.2 Āhāra and Vihāra in the Management of Prameha

In Ayurveda, Āhāra refers to dietary intake and nutritional regulation, encompassing not only the type and quality of food consumed but also its preparation, quantity, timing, and compatibility, all of which influence agni (digestive and metabolic fire). Proper āhāra is essential in restoring metabolic balance, particularly in disorders such as Prameha, where impaired agni and kapha–meda accumulation are central to pathogenesis. Dietary therapy therefore aims to rekindle agni, reduce kapha and excess meda (adipose tissue), and prevent srotorodha (obstruction of bodily channels). Classical texts recommend foods that are light (laghu), drying (rukṣa), and kapha-reducing, including barley (yava), green gram (mudga), bitter vegetables, and light preparations.¹⁹

Vihāra refers to lifestyle and behavioral regimens, including physical activity, sleep patterns, and daily routines. Regulation of vihāra plays a crucial role in correcting metabolic dysfunction. Vyāyāma (exercise) is strongly emphasized in the management of Prameha, as it reduces kapha and meda accumulation and enhances metabolic efficiency. The Ashtanga Hridaya specifically notes that regular exercise alleviates kapha and excess fat, thereby helping to prevent the progression of Prameha.²⁰

3.3 Śodhana Chikitsā

In suitable patients, purification therapies such as Virechana and Basti are recommended to remove aggravated doṣas and clear srotas.

Virechana is the process of therapeutic purgation of Pitta and aggravated doshas, mainly to remove toxins from the liver, gastrointestinal tract, and circulatory channels. In Madhumeha (T2DM), Virechana is indicated when there is Pitta-Kapha imbalance, especially in the digestive and metabolic tissues, to correct agni (metabolic fire), reduce excessive Kapha, and improve glucose metabolism. The goal: Reduce blood sugar load, detoxify dhatus, and restore metabolic balance, often as a preparatory step before Basti therapy.

Clinical Context: Used in early to moderate Madhumeha with constipation, heaviness, or metabolic stagnation, and in patients with Kapha-Pitta aggravation.

Basti (Medicated Enema / Colonic Therapy) is the therapeutic administration of medicated decoctions, oils, or ghee through the rectum to pacify Vata dosha. In Madhumeha (T2DM), Vata aggravation is often the chronic stage of disease, manifesting as tissue depletion, polyuria, and neuropathic changes. The goal: Restore Vata balance, nourish tissues (dhatus), and improve metabolic regulation. Considered a primary therapy for chronic Madhumeha because it targets systemic Vata, which governs elimination, nerve function, and glucose regulation.

Clinical Context: Particularly useful in Vata-predominant chronic T2DM, for polyuria, weight loss, and neuropathy associated with long-standing diabetes.²¹

Summary Table:

Therapy	Target Dosha	Stage of T2DM / Madhumeha	Primary Effect
Virechana	Pitta-Kapha	Early to moderate	Detoxifies, reduces Kapha/Pitta, improves metabolism
Basti	Vata	Chronic/advanced	Nourishes dhatus, balances Vata, improves systemic metabolic regulation

However, modern clinical research evaluating Panchakarma in T2DM remains limited in methodological rigor. Existing observational studies suggest improvements in metabolic parameters but lack adequate controls and long-term follow-up.

3.4 Śamana Chikitsā (Herbal Therapy)

Classical Ayurvedic literature describes numerous herbal therapies for Prameha, including Madhumeha. Therapeutic discussions appear in the Cikitsāsthāna of the Charaka Samhita and the Sushruta Samhita, and were later systematized in Dravyaguṇa literature and lexicons such as the Bhavaprakasha Nighantu. Modern compilations, including K. M. Nadkarni’s Indian Materia Medica, further document these plants.

Key antidiabetic herbs include:

• Gymnema sylvestre (Mesaśṛṅgī / Gurmar)
• Momordica charantia (Karela)
• Pterocarpus marsupium (Vijayasāra)
• Tinospora cordifolia (Guḍūcī)
• Curcuma longa (Haridrā)
• Emblica officinalis (Āmalakī)
• Shilajit (Asphaltum)
• Gumar (Gum Arabic, Acacia)
• Saptaranga (Salacia reticulata)

These herbs are traditionally indicated for Kapha-dominant metabolic disorders characterized by excess medas and impaired carbohydrate metabolism.^22-23-24-25

Modern pharmacologic findings

Modern pharmacologic findings support the traditional Ayurvedic use of herbs for managing Madhumeha (diabetes), with research validating their efficacy in improving insulin sensitivity, controlling blood sugar levels, and reducing inflammation and oxidative stress. Studies have shown that Gymnema sylvestre promotes beta-cell regeneration, while Momordica charantia (Karela) activates AMPK to improve glucose metabolism. Pterocarpus marsupium (Vijayasāra) inhibits alpha-glucosidase, reducing postprandial blood sugar spikes. Curcumin (from Curcuma longa) exhibits potent antioxidant and anti-inflammatory effects, crucial for managing the complications of diabetes. Finally, Tinospora cordifolia (Guduchi) has been shown to enhance insulin sensitivity, making it an important herb for metabolic regulation in diabetes. These findings not only corroborate Ayurvedic practices but also demonstrate the growing integration of traditional knowledge with modern pharmacological insights.^{26-27-28-29-30}

Yet, variability in extract standardization, dosage, and study design limits definitive conclusions.

3.5 Rasāyana Therapy

Rasāyana, in Ayurveda, is a specialized therapeutic approach aimed at rejuvenation, metabolic balance, and the strengthening of tissue vitality, particularly relevant in the management of madhumeha (a subtype of prameha correlated with diabetes mellitus).³¹ Within this context, rasāyana therapy supports the restoration of impaired dhātus, enhances agni (metabolic function), and promotes systemic resilience against the progressive depletion associated with chronic metabolic disorders. Rasāyana aims to preserve dhātu integrity and ojas. Herbs such as Āmalakī and Guḍūcī are described as rejuvenative in the Charaka Samhita.³² In madhumeha, where ojas is considered diminished or qualitatively altered, rasāyana measures are employed to stabilize tissues, improve vitality, and prevent complications. In modern terms, rasāyana may correspond to antioxidant, anti-inflammatory, and immunomodulatory actions, which are relevant in addressing oxidative stress and chronic inflammation observed in diabetes.³³

Section 4. Ayurvedic Interventions for Hypertension: Classical Framework and Biomedical Correlates

Although classical Ayurvedic texts do not describe hypertension as a discrete diagnostic entity, symptom clusters and pathophysiological mechanisms correspond closely to Raktagata Vāta, Sirāgata Vāta, and certain forms of Pittaja and Vātaja disorders described in the Sushruta Samhita and Charaka Samhita.^34-35

4.1 Classical Pathogenesis of Vascular Disorders

The Sushruta Samhita explains, in the chapter on Vāta-Rakta (often in Sutra Sthāna or Chikitsā Sthāna depending on the edition), the classical pathogenesis:

“The Vāyu, thus enraged and agitated, enters into the blood-carrying channels of the body and, being obstructed in its passage, becomes mixed with the vitiated blood. The deranged Vāyu and the blood thus combine to give rise to a disease characterized by Vāta-Rakta.”

– Kaviraj Kunjalal Bhishagratna, trans., The Sushruta Samhita: With English Translation of the Original Text, and Notes Based on Original Commentaries, vol. 3 (Calcutta: Bharatiya Kala Prakashan, 1968 reprint), chap. V, Medical Treatment of Mahā-Vāta-Vyādhi

In Ayurvedic physiology, Vyāna Vāyu governs circulation and cardiac output. When aggravated through stress, irregular lifestyle, excessive salt, or psychological strain, it disrupts vascular tone. Contributing factors include:

• Rakta duṣṭi (impure or overheated blood)
• Srotorodha (microchannel obstruction)
• Pitta aggravation (inflammatory component)
• Meda accumulation (metabolic component)

The Astanga Hrdaya further describes the interplay between Vāta and Rakta in systemic disorders, noting that improper diet and stress destabilize vascular regulation.³⁶

4.2 Biomedical Correlation

Modern hypertension pathophysiology involves multiple mechanisms, including sympathetic nervous system overactivity, renin–angiotensin–aldosterone system (RAAS) dysregulation, endothelial dysfunction, arterial stiffness, and chronic low-grade inflammation.1–4 The conceptual parallel between Vyāna Vāyu dysregulation in Ayurvedic physiology and sympathetic overactivation is compelling, as both relate to the regulation of blood flow, vascular tone, and systemic circulation. ³⁷

4.3 Ayurvedic Management of Hypertension

4.3.1 Nidāna Parivarjana

Classical Ayurvedic texts emphasize Nidāna Parivarjana (avoidance of causative factors) for the prevention and management of elevated blood pressure, recommending the restriction of excessive salt and alcohol intake, avoidance of emotional agitation, maintenance of regular sleep, and engagement in physical activity.³⁸ These measures align closely with modern lifestyle modification guidelines for hypertension, which advocate sodium reduction, alcohol limitation, stress management, sufficient sleep, and regular exercise.³⁹

4.3.2 Āhāra and Vihāra

Classical Ayurvedic dietary and lifestyle principles (Āhāra and Vihāra) for cardiovascular health emphasize light, cooling foods, reduced salt intake, and bitter or astringent tastes, alongside practices that reduce stress.⁴⁰ Complementing this, the Hatha Yoga Pradipika describes pranayama techniques as regulating prāṇa and calming Vāta, which modern interpretations suggest may correlate with enhanced parasympathetic activity and improved heart rate variability.⁴¹

4.3.3 Śamana Herbal Therapies

Classical texts classify several herbs as hridya (cardiotonic) or Vāta-calming, highlighting their stabilizing, antioxidant, and adaptogenic properties. Modern studies support these traditional claims, showing improvements in cardiac function, vascular health, and modulation of stress-related sympathetic activity.

Cardioprotective Herbs

• Hawthorn berries – Traditionally cardiotonic; support heart function and circulation.⁴²
• Garlic – Antioxidant, mild antihypertensive, supports vascular health.⁴²
• Terminalia arjuna (Arjuna) – Hridya herb; astringent and stabilizing; improves left ventricular function.⁴²
• Rauwolfia serpentina (Sarpagandha) – Calms Vāta; reserpine historically used for hypertension.⁴³
• Withania somnifera (Aśvagandhā) – Adaptogen; reduces stress-mediated sympathetic activation.⁴⁴

Section 5. Methodological Strengths and Weaknesses in Current Research

Strengths

• Growing number of randomized trials.
• Integration into national health programs.
• Biochemical endpoints used (HbA1c, BP).
• Better safety monitoring in newer studies.

Weaknesses

• Small sample sizes (<100 participants).
• Short follow-up (<6 months for chronic conditions).
• Herbal standardization issues (active compounds, preparation, plant source).
• Diagnostic discordance (Ayurvedic subtypes rarely stratified).
• Publication bias (positive results overrepresented).
• Safety & herb–drug interactions:
  
  Hypoglycemia with metformin/insulin.
  Hypotension with antihypertensives.
  Heavy metal contamination in some formulations.
  Heavy metal contamination in some formulations.

Note: Robust pharmacovigilance and long-term safety data remain limited. 45-46

Section 6.Toward an Integrative Clinical Model for T2DM and Hypertension

Given the shared metabolic and vascular pathophysiology of type 2 diabetes mellitus (T2DM) and hypertension, an integrative framework combining Ayurvedic principles with biomedical care may offer a multidimensional therapeutic strategy. While such a model is not yet formally tested or validated, its components draw on existing evidence for lifestyle, dietary, herbal, and mind–body interventions that have shown promise in managing each condition individually.

Section 7.Conclusion

Type 2 diabetes mellitus and hypertension are interrelated chronic diseases with overlapping metabolic, vascular, and inflammatory mechanisms. Classical Ayurvedic literature—particularly the Charaka Samhita and Sushruta Samhita—provides a sophisticated systemic framework describing metabolic dysregulation, vascular disturbance, and progressive tissue depletion.

Modern clinical studies suggest that selected Ayurvedic herbs and integrative lifestyle interventions may improve glycemic control and reduce blood pressure. However, methodological limitations—including short duration, heterogeneity, lack of diagnostic stratification, and limited long-term safety data—prevent definitive conclusions regarding replacement of conventional pharmacotherapy.

The strongest current evidence supports Ayurveda as an adjunctive, lifestyle-centered, and preventive model rather than a standalone substitute for standard care in moderate-to-severe disease.

If the research gaps mentioned in section 5 are addressed, Ayurveda may contribute meaningfully to global chronic disease management through a model that emphasizes root-cause correction, individualized care, and systemic balance.

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Endnotes:

1. International Diabetes Federation. IDF Diabetes Atlas 2025. https://idf.org/about-diabetes/diabetes-facts-figures/
2. World Health Organization. “Hypertension Fact Sheet.” https://www.who.int/news-room/fact-sheets/detail/hypertension
3. Colosia I, Ann D, et al. “Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review”, https://pubmed.ncbi.nlm.nih.gov/24082791/
4. Petrie, J. R., Guzik, T. J., & Touyz, R. M. (2018). Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Canadian Journal of Cardiology, 34(5), 575–584, https://onlinecjc.ca/article/S0828-282X(17)31214-X/fulltext
5. Mohan, Viswanathan, et al., “Slowing the diabetes epidemic in the World Health Organization South-East Asia Region: the role of diet and physical activity” https://pubmed.ncbi.nlm.nih.gov/28604391/
6. Agniveśa, Charaka Saṃhitā, Nidāna Sthāna, Chapter 4, Prameha Nidāna, verse 3, trans. P. V. Sharma, 4th ed. (Varanasi: Chaukhambha Visvabharati, 2010)
7. Agniveśa, Charaka Saṃhitā, Nidāna Sthāna, Chapter 4, Prameha Nidāna, verse 6, trans. P. V. Sharma, 4th ed. (Varanasi: Chaukhambha Visvabharati, 2010)

8. Dr. Sonia and Dr. Sharma, Priya. “A Review Article on Etiopathogenesis of Prameha,” International Journal of AYUSH 14, no. 06 (June 2025): https://internationaljournal.org.in/journal/index.php/ijayush/article/view/1426
9. Vāgbhaṭa, Aṣṭāṅga Hṛdaya, Nidāna Sthāna, Chapter 10, Prameha Nidāna, trans. P. V. Sharma, 4th ed. (Varanasi: Chaukhambha Visvabharati, 2010)
10. Pooja K. Sharma et al., “Lifestyle Disorders and Ayurveda with Special Reference to Raktagata Vata (Hypertension),” Journal of Ayurveda and Integrated Medical Sciences 9, no. 1 (2024): 22, https://jaims.in/jaims/article/view/2905
11. Dr. Manish Singh and Dr. Anish Kumar, “Conceptual Understanding of Raktagata Vata in Ayurvedic Classic and Its Modern Correlation with Hypertension,” International Journal of AYUSH 14, no. 8 (2025): 149–59, https://internationaljournal.org.in/journal/index.php/ijayush/article/view/1469
12. Dr. Swati Bhandari et al., Article “Preventive and curative aspect of Nidana Parivarjan,” World Journal of Pharmaceutical and Medical Journal, 30/04/2021, https://www.wjpmr.com
13. Abhirami Babu and Anjali Sivaram, “Understanding Vyana Vayu: Bridging Ayurveda and Modern Physiology,” International Journal of Ayurveda and Pharma Research 12, no. 2 (March 5, 2024): 122–26, https://ijapr.in/index.php/ijapr/article/view/3126
14. Maanasi Menon and Akhilesh Shukla, “Understanding Hypertension in the Light of Ayurveda,” Journal of Ayurveda and Integrative Medicine 9, no. 4 (2018): 302–307, https://pmc.ncbi.nlm.nih.gov/articles/PMC6314241/
15. Maanasi Menon and Akhilesh Shukla, “Understanding Hypertension in the Light of Ayurveda,” Journal of Ayurveda and Integrative Medicine 9, no. 4 (2018): 302–307, https://pmc.ncbi.nlm.nih.gov/articles/PMC6314241/
16. Charaka Saṃhitā, Nidāna Sthāna, with Vidyotini commentary by Kashi Nath Shastri and Gorakh Nath Chaturvedi, ed. Yadavji Trikamji Acharya (Varanasi: Chaukhambha Bharati Academy, 2018), verse 1.1
17. Dr. Swati Bhandari et al., Article “Preventive and curative aspect of Nidana Parivarjan,” World Journal of Pharmaceutical and Medical Journal, 30/04/2021, https://www.wjpmr.com
18. Agnivesha, Charaka Samhita, Nidāna Sthāna 4 (Prameha Nidāna), trans. R. K. Sharma and Bhagwan Dash (Varanasi: Chaukhambha Sanskrit Series Office, 2009)
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20. Vāgbhaṭa, Ashtanga Hridaya, Sutra Sthāna 2, trans. K. R. Srikantha Murthy (Varanasi: Krishnadas Academy, 2001)
21. Agnivesha, Charaka Samhita, Chikitsā Sthāna 6 (Prameha Chikitsā), trans. R. K. Sharma and Bhagwan Dash (Varanasi: Chaukhambha Sanskrit Series Office, 2009).
22. Nadkarni, K. M. Indian Materia Medica. 3rd ed. Vol. 1. Mumbai: Popular Prakashan, 2002: 590-592, 815-818, 1021-1023.
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29. Patel, A., S. M. Soni, and A. R. Patel. “Curcumin: Antioxidant and Anti-Inflammatory Effects in Diabetes and Cardiovascular Disease.” Biofactors 40, no. 6 (2014): 618-630.
30. Gupta, N., A. R. Khatri, and V. K. Singh. “Tinospora cordifolia as an Insulin Sensitizer in Diabetic Management.” Journal of Ayurveda and Integrative Medicine 2, no. 3 (2011): 145-150.
31. P. V. Sharma, Ayurveda: The Science of Life (New Delhi: Chaukhambha Orientalia, 1996), 158–165.
32. B. S. Dash and R. K. Sharma, Charaka Samhita, vol. 1 (Varanasi: Chaukhambha Sanskrit Series Office, 2001), introduction to Rasayana chapter.
33. Charaka, The Charaka Samhita, trans. P. V. Sharma (Varanasi: Chaukhambha Orientalia, 1994), Sutrasthana 1:7–8.
34. P. V. Sharma, trans., Caraka-Samhita, vol. 4 (Varanasi: Chaukhambha Orientalia, 1981), Chikitsa Sthana 28:35–37.
35. Ibid., Chikitsa Sthana 28:221–230.
36. Dr. Bhagya Shree Potter et al., “An Ayurvedic Perspective on Blood Circulation: Role of Vyana Vayu and Prana Vayu,” International Journal of Health Sciences and Research 15, no. 4 (April 2025): 246–250, describing Vyana Vāyu’s role in circulation and cardiovascular regulation, https://www.ijhsr.org/IJHSR_Vol.15_Issue.4_April2025/IJHSR-Abstract35.html
37. Guido Grassi and Luciano F. Drager, “Sympathetic Overactivity, Hypertension and Cardiovascular Disease: State of the Art,” Current Medical Research and Opinion 40, suppl. 1 (2024): 5–13, https://pubmed.ncbi.nlm.nih.gov/38597067/
38. “Nidāna Parivarjana – Preventive Care for Blood Pressure,” in Ayur360: Ayurveda Treatment for Blood Pressure and Hypertension – Causes & Symptoms, https://www.ayur360.in/high-blood-pressure-Ayurveda-Treatment-Causes-Symptoms.php
39. Pooja Kumari Sharma et al., “Lifestyle Disorders and Ayurveda with special reference to Raktagata Vata (Hypertension),” Journal of Ayurveda and Integrated Medical Sciences 9, no. 1 (2024), https://jaims.in/index.php/jaims/article/view/2905
40. Ibid.
41. Swami Svatmarama, Hatha Yoga Pradipika, trans. Hans N. Kugler (Delhi: Yoga Publications Trust, 2018), chap. 2, verses 28–30.
42. P. K. Sharma, Dravyaguna Vijnana, 3rd ed. (Varanasi: Chaukhambha Sanskrit Pratisthan, 2019), 212–215.
43. J. S. Raju, Rauwolfia serpentina: Pharmacology and Historical Use in Hypertension (New Delhi: Springer, 2020), 45–52.
44. A. K. Singh et al., “Withania somnifera (Ashwagandha) and Cardiovascular Health: Adaptogenic Modulation of Sympathetic Activity,” Phytomedicine 102 (2023): 154–162, https://doi.org/10.1016/j.phymed.2023.154162
45. Pushya A. Gautama and Ram Manohar, “RCTs and Other Clinical Trial Designs in Ayurveda: A Review of Challenges and Opportunities,” Journal of Ayurveda and Integrative Medicine 12, no. 3 (2021): 556–561, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377177/
46. Swapnil P. Borse, Devendra P. Singh, and Manish Nivsarkar, “Understanding the Relevance of Herb–Drug Interaction Studies with Special Focus on Interplays: A Prerequisite for Integrative Medicine,” Porto Biomedical Journal 4, no. 2 (2019), https://pmc.ncbi.nlm.nih.gov/articles/PMC6726296/

Appendix: Research Article Abstracts

1. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review

Authors: Ann D Colosia¹, Roberto Palencia, Shahnaz Khan

Abstract

Background: Hypertension and obesity are known to contribute, directly or indirectly, to the development of long-term complications of type 2 diabetes mellitus (T2DM). Knowing the prevalence of these comorbidities is important for determining the size of the population that may benefit from strategies that reduce blood pressure and weight while controlling blood glucose.

Methods: In this systematic literature review, electronic searches of PubMed, Embase, and the Cochrane Library were conducted to identify observational studies of hypertension and/or obesity prevalence in patients with T2DM throughout the world. The searches were limited to studies reported in English from January 1, 2001 to February 16, 2012.

Results: From a total of 2,688 studies, 92 observational studies provided prevalence rates for hypertension and/or obesity specifically in adults with T2DM. Fifteen studies of specific subtypes of hypertension or subpopulations with T2DM were subsequently excluded, leaving 78 studies (in 77 articles) for inclusion in this article. Of these, 61 studies reported hypertension prevalence, 44 reported obesity prevalence, and 12 reported the prevalence of hypertension with obesity. Most studies had a low risk of bias regarding diagnosis of T2DM (70/78), hypertension (59/69), or obesity (45/47). The continental regions with the most observational studies of hypertension or obesity prevalence were Europe (n = 30) and Asia (n = 26). Hypertension rates typically were high in all regions; most studies presented rates above 50%, and many presented rates above 75%. Obesity rates exceeded 30% in 38 of 44 studies and 50% in 14 of 44 studies, especially those assessing central obesity (based on waist circumference). Among obese adults, hypertension rates were at or above 70% in Asia and above 80% in Europe; rates were lower in North and South America but still above 30%.

Conclusion: Around the world, hypertension and obesity, separately or together, are common comorbidities in adults with T2DM.

2. Slowing the diabetes epidemic in the World Health Organization South-East Asia Region: the role of diet and physical activity

Authors: Viswanathan Mohan 1 , Vaidya Ruchi 1 , Rajagopal Gayathri 1 , Mookambika Ramya Bai 1 , Vasudevan Sudha 1 , Ranjit Mohan Anjana 1 , Rajendra Pradeepa 1

Abstract

The nutrition transition occurring in the World Health Organization South-East Asia Region, as a result of rapid urbanization and economic development, has perhaps made this region one of the epicentres of the diabetes epidemic. This review attempts to evaluate the role of diet and physical inactivity in the South-East Asia Region in promoting this epidemic and points to strategies to slow it down by lifestyle modification. The emerging new food-production technologies and supermarkets have made energy-dense foods more easily available. This includes refined carbohydrate foods like those with added sugars, and refined grains and unhealthy fats. In addition, increased availability of modern technology and motorized transport has led to decreased physical activity. South Asian diets tend to be based on high-carbohydrate foods, with a predominance of refined grains. All of these accentuate the risk of diabetes in people of this region, who already have a unique “south Asian phenotype”. However, there is increasing evidence that altering diet by replacing refined cereals like white rice with whole grains (e.g. brown rice) and increasing physical activity can help to prevent diabetes in high-risk individuals. An urgent, concerted effort is now needed to improve diet quality and encourage physical activity, by introducing changes in policies related to food and built environments, and improving health systems to tackle noncommunicable diseases like diabetes.

3. Understanding hypertension in the light of Ayurveda

Authors: Maanasi Menon, Akhilesh Shukla

Abstract

Different theories have been proposed to explain hypertension from an Ayurvedic perspective, but there is no consensus amongst the experts. A better understanding of the applied physiology and etio-pathogenesis of hypertension in the light of Ayurvedic principles is being attempted to fill this gap. A detailed review of available Ayurvedic literature was carried out to understand the physiology of blood pressure and etio-pathogenesis of hypertension from the perspective of Ayurveda. Many parallels were drawn from the concepts such as Shad Kriyakala (six stages of Dosha imbalance) and Avarana of Doshas (occlusion in the normal functioning of the Doshas) to the modern pathogenesis of hypertension to gain a deeper understanding of it.

Hypertension without specific symptoms in its mild and moderate stages cannot be considered as a disease in Ayurveda. It appears to be an early stage of pathogenesis and a risk factor for development of diseases affecting the heart, brain, kidneys and eyes etc. Improper food habits and modern sedentary lifestyle with or without genetic predisposition provokes and vitiates all the Tridoshas to trigger the pathogenesis of hypertension. It is proposed that hypertension is to be understood as the Prasara-Avastha which means spread of vitiated Doshas from their specific sites, specifically of Vyana Vata, Prana Vata, Sadhaka Pitta and Avalambaka Kapha along with Rakta in their disturbed states. The Avarana (occlusion of normal functioning) of Vata Dosha by Pitta and Kapha can be seen in the Rasa-Rakta Dhathus, which in turn hampers the functioning of the respective Srotas (micro-channels) of circulation.

4. Endothelial Dysfunction in Hypertension: Current Concepts and Clinical Implications

Authors: Giovanna Gallo, Massimo Volpe, Carmine Savoia

Abstract

Endothelium plays a fundamental role in the cardiovascular system, forming an interface between blood and adjacent tissues by regulating the vascular tone through the synthesis of nitric oxide, prostaglandins and other relaxing factors. Endothelial dysfunction is characterized by vasoconstriction, cell proliferation and shifting toward a proinflammatory and prothrombic state. In hypertension endothelial dysfunction may be involved in the initiation and development of vascular inflammation, vascular remodeling, and atherosclerosis and is independently associated with increased cardiovascular risk. Different conditions such as impaired vascular shear stress, inflammation and oxidative stress, activation of the renin angiotensin system have been described as important pathophysiological mechanisms involved in the development of endothelial dysfunction.

The release of extracellular vesicles by neighboring cells in the vascular wall has emerged as an important regulator of endothelial function and with potential antihypertensive properties and beneficial effects by counteracting the hypertension mediated organ damage. Furthermore, macrovesicles are emerging as an innovative therapeutic approach for vascular protection, allowing the delivery of bioactive molecules, such as miRNA and drugs interacting with the renin angiotensin system. In this review we summarize the available evidence about the pathophysiological implications of endothelial dysfunction in cardiovascular diseases, focusing on hypertension and its sequelae, and the potential innovative therapeutic strategies targeting the endothelium with the aim to improve vascular function and remodeling.

5. Sympathetic overactivity, hypertension and cardiovascular disease: state of the art

Authors: Guido Grassi, Luciano F Drager

Abstract

Cardiovascular disease (CVD) remains the most prevalent cause of premature death worldwide. It had been suspected for decades that increased activity of the sympathetic nervous system (SNS) might play a pathogenetic role in the development and progression of hypertension, heart failure (HF) and CVD. The use of microneurographic techniques to directly assess the SNS has allowed this field to advance considerably in recent years. We now have compelling evidence for a key role of sympathetic overactivity in the pathogenesis and progression of hypertension and associated hypertension-mediated organ damage (such as endothelial dysfunction, arterial stiffness and left ventricular hypertrophy), HF (with or without reduced left ventricular ejection fraction).

Sympathetic overactivity also drives increased cardiovascular risk in the settings of obesity, metabolic syndrome, chronic kidney disease and obstructive sleep apnoea, among other conditions. Thus, sympathetic overactivity is an important factor that drives patients through the CVD continuum, from the early appearance of cardiovascular risk factors, to impairments of the structure and function of components of the heart and arteries, to established CVD, and ultimately to a life-threatening cardiovascular event. A deeper understanding of the role of sympathetic overactivity in the pathogenesis of CVD and HF will support the optimization of therapeutic interventions for these conditions.

6. Traditional herbs: a remedy for cardiovascular disorders

Authors: Subha Rastogi, Madan Mohan Pandey, A K S Rawat

Abstract

Background: Medicinal plants have been used in patients with congestive heart failure, systolic hypertension, angina pectoris, atherosclerosis, cerebral insufficiency, venous insufficiency and arrhythmia since centuries. A recent increase in the popularity of alternative medicine and natural products has revived interest in traditional remedies that have been used for the treatment of cardiovascular diseases.

Aim: The purpose of this review is to provide updated, comprehensive and categorized information on the history and traditional uses of some herbal medicines that affect the cardiovascular system in order to explore their therapeutic potential and evaluate future research opportunities.

Methods: Systematic literature searches were carried out and the available information on various medicinal plants traditionally used for cardiovascular disorders was collected via electronic search (using Pubmed, SciFinder, Scirus, GoogleScholar, JCCC@INSTIRC and Web of Science) and a library search for articles published in peer-reviewed journals. No restrictions regarding the language of publication were imposed.

Results: This article highlights the cardiovascular effects of four potent traditional botanicals viz. Garlic (Allium sativum), Guggul (Commiphora wightii), Hawthorn (Crataegus oxyacantha) and Arjuna (Terminalia arjuna). Although these plants have been used in the treatment of heart disease for hundreds of years, current research methods show us they can be utilized effectively in the treatment of cardiovascular diseases including ischemic heart disease, congestive heart failure, arrhythmias and hypertension.

Conclusion: Although the mechanisms of action are not very clear, there is enough evidence of their efficacy in various cardiovascular disorders. However, for bringing more objectivity and also to confirm traditional claims, more systematic, well-designed animal and randomized clinical studies with sufficient sample sizes are necessary. Multidisciplinary research is still required to exploit the vast potential of these plants. Potential synergistic and adverse side effects of herb-drug interactions also need to be studied. These approaches will help in establishing them as remedies for cardiovascular diseases and including them in the mainstream of healthcare system.

7. RCTs and other clinical trial designs in Ayurveda: A review of challenges and opportunities

Authors: Pushya A Gautama

Abstract

Currently, there is a paucity of clinical trial designs that comprehensively evaluate the efficacy of most complementary and alternative systems of medicine (CAMs) like Ayurveda. Several factors such as complex interventions, individualized therapy, etc., make designing Ayurveda clinical trials challenging. The prevalent randomized control trial (RCT) designs largely involve symptomatology/pathology-based recruitment and standardized interventions in carefully monitored trial environments. The present paper critically reviews the suitability of the dominant RCT model to Ayurveda and argues for newer, more sensitive trial models including modified RCTs and other clinical trial designs. It also explores the merits of a non-hierarchical approach to clinical evidence generation.

8. Understanding the relevance of herb–drug interaction studies with special focus on interplays: a prerequisite for integrative medicine

Authors: Swapnil P Borse, BPharm, PhD, Devendra P Singh, MPharm, PhD, Manish Nivsarkar, PhD

Abstract

Integrative medicine refers to the blending of conventional and evidence-based complementary medicines and therapies with the aim of using the most appropriate of either or both modalities for ultimate patient benefits. One of the major hurdles for the same is the chances of potential herb–drug interactions (HDIs). These HDIs could be beneficial or harmful, or even fatal; therefore, a thorough understanding of the eventualities of HDIs is essential so that a successful integration of the modern and complementary alternative systems of medicine could be achieved.

Here, we summarize all the important points related to HDIs, including types, tools/methods for study, and prediction of the HDIs, along with a special focus on interplays between drug metabolizing enzymes and transporters. In addition, this article covers future perspective, with a focus on background endogenous players of interplays and approaches to predict the drug–disease–herb interactions so as to fetch the desired effects of these interactions.