Integrative Perspectives on Hypertension Management: A Comparative Analysis of Unani and Allopathic Systems
Keywords:
Hypertension, Unani Medicine, Allopathic System, Integrative Healthcare, Imtila’, Ziyadat-e-DamAbstract
Background: Hypertension remains a major global health concern, affecting over 1.4 billion individuals worldwide and contributing significantly to cardiovascular morbidity and mortality. Allopathic medicine offers evidence-based diagnostic tools and pharmacological interventions for rapid blood pressure control, whereas Unani medicine emphasizes Mizaj (temperamental) balance, lifestyle modification, and natural therapeutics. Understanding the comparative philosophies of both systems can guide integrative, patient-centered hypertension management.
Objective: To critically compare the principles, diagnostic approaches, therapeutic modalities, and preventive strategies of hypertension management in Unani and allopathic systems, and to identify potential integrative pathways for improved outcomes.
Methods: A narrative review of classical Unani texts (Al-Qanun fi’l-Tibb, Al-Hawi fi’l-Tibb, Kamil al-Sana’a al-Tibbiyya) and contemporary literature from PubMed, Scopus, AYUSH, and WHO databases (2020-2025) was conducted. Around 61 peer-reviewed studies, clinical trials, and guidelines were analysed, focusing on pathophysiology, diagnosis, therapy, and prevention.
Results: Allopathy emphasizes standardized diagnosis and pharmacological management using ACE inhibitors, beta-blockers, and calcium channel blockers, supported by robust clinical evidence but limited by side effects and adherence issues. Unani medicine interprets hypertension as Ziyadat-e-Dam or Imtila’ (vascular congestion and humoral excess) and manages it through Ilaj bil Ghiza (diet), Ilaj bil Tadbeer (regimens), and Ilaj bil Dawa (drugs). Overlaps include dietary moderation, exercise, and stress management. Unani agents such as Rauwolfia serpentina and Terminalia arjuna show reductions of 10-15 mmHg in systolic pressure when used adjunctively.
Conclusion: Integrating Unani and allopathic principles can provide sustainable, culturally sensitive, and evidence-informed strategies for global hypertension management.
References
World Health Organization. Hypertension (high blood pressure). Geneva: World Health Organization; 2023.
Hardy ST, Jaeger BC, Foti K, Ghazi L, Wozniak G, Muntner P. Trends in blood pressure control among US adults with hypertension, 2013–2014 to 2021–2023. Am J Hypertens. 2024;38(2):120-129. doi:10.1093/ajh/7879521
Zhou B, Perel P, Mensah GA, Ezzati M. Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol. 2021;18(11):785-802.
Carey Robert M, Moran Andrew E, Whelton Paul K. Treatment of hypertension: insights from 2020 international guidelines. Circ Res. 2021;128(7):920–936. doi:10.1161/CIRCRESAHA.121.318055
Fisher James P, Paton Julian FR. The sympathetic nervous system and blood pressure in humans: implications for hypertension. Hypertension. 2022;79(6):1243–1254. doi:10.1161/HYPERTENSIONAHA.121.18934
Unger Thomas, Borghi Claudio, Charchar Fiona, Khan Nadia A, Poulter Neil R, Prabhakaran Dorairaj, Ramirez Alejandro, Schlaich Markus, Stergiou George S, Tomaszewski Maciej, Wainford Richard D, Williams Bryan, Schutte Aletta E. 2020 International Society of Hypertension global hypertension practice guidelines. Hypertension. 2020;75(6):1334–1357. doi:10.1161/HYPERTENSIONAHA.120.15026
Grassi Guido, Seravalle Giampiero, Mancia Giuseppe. Sympathetic nervous system, blood pressure variability, and hypertension. Curr Hypertens Rep. 2021;23(9):45. doi:10.1007/s11906-021-01161-3
World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. Geneva: World Health Organization; 2021.
Writing Committee (for the 2025AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/
AMA/ASPCN). Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Circulation. 2025; published online August 14. doi:10.1161/CIR.0000000000001356
European Society of Cardiology/European Society of Hypertension (ESC/ESH). 2023 ESH Guidelines for the management of arterial hypertension. J Hypertens. 2023;41(12):1874-2071.
National Expert Committee. Standard Treatment Guidelines in Unani on Metabolic Disorders. New Delhi: Central Council for Research in Unani Medicine (CCRUM), Ministry of AYUSH, Government of India; 2023.
JNC 7 (Seventh Joint National Committee)-2003 U.S. Hypertension Guideline
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-1252. doi: 10.1161/01.HYP.0000107251. 49515.c2
JNC 8 (Eighth Joint National Committee)-2014 U.S. Hypertension Guideline
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT Jr, Narva AS, Ortiz E. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi:10.1001/jama.2013.284427
Messerli FH, Shapiro LM. Overview of the Evolution of Hypertension: From Ancient Chinese Emperors to Today. Hypertension. 2024;81(4):717–726. doi:10.1161/HYPERTENSIONAHA.124.21953
Moiz A. Outpatient management of essential hypertension. Scand J Prim Health Care. 2024;42(1):1-10. doi:10.1080/07853890.2024.2338242.
Fyhrquist F, Saijonmaa O. Renin-angiotensin system revisited. J Intern Med. 2008;264(3):224–236.
Caminiti R, Carresi C, Mollace R, Macrì R, Scarano F, Oppedisano F, Maiuolo J, Serra M, Ruga S, Nucera S, Tavernese A, Gliozzi M, Musolino V, Palma E, Muscoli C, Rubattu S, Volterrani M, Federici M, Volpe M, Mollace V. The potential effect of natural antioxidants on endothelial dysfunction associated with arterial hypertension. Front Cardiovasc Med. 2024; 11:1345218. doi:10.3389/fcvm.2024.1345218
Williams Bryan; Mancia Giuseppe; Spiering Wilko; Agabiti Rosei Enrico; Azizi Michel; Burnier Michel; Clement Denis L.; Coca Antonio; de Simone Giovanni; Dominiczak Anna; Kahan Thomas; Mahfoud Felix; Redon Josep; Ruilope Luis M.; Zanchetti Alberto; Kerins Mary; Kjeldsen Sverre E.; Kreutz Reinhold; Laurent Stéphane; Lip Gregory Y. H.; McManus Richard; Narkiewicz Krzysztof; Ruschitzka Frank; Schmieder Roland E.; Shlyakhto Evgeny; Tsioufis Costas; Aboyans Victor; Desormais Ileana; Authors/Task Force Members. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–3104. doi:10.1093/eurheartj/ehy339.
Eoin O’Brien, Gianfranco Parati, George Stergiou, Roland Asmar, Laurie Beilin, Grzegorz Bilo, Denis Clement, Alejandro de la Sierra, Peter de Leeuw, Eamon Dolan, Robert Fagard, John Graves, Geoffrey A. Head, Yutaka Imai, Kazuomi Kario, Empar Lurbe, Jean-Michel Mallion, Giuseppe Mancia, Thomas Mengden, Martin Myers, Gbenga Ogedegbe, Takayoshi Ohkubo, Stefano Omboni, Paolo Palatini, Josep Redon, Luis M. Ruilope, Andrew Shennan, Jan A. Staessen, Gert van Montfrans, Paolo Verdecchia, Bernard Waeber, Jiguang Wang, Alberto Zanchetti, Yuqing Zhang; European Society of Hypertension Working Group on Blood Pressure Monitoring. Ambulatory blood pressure monitoring: review and recommendations. J Hypertens. 2013;31(9):1731–1768.
Hussain A, Ahmad S, Khan M. Contemporary perspectives on Unani medicine: foundational principles and clinical relevance. J Tradit Complement Med. 2023;13(2):115–123. doi: 10.1016/j.jtcme.2023.02.004
Javed D, Dixit AK, Anwar S, Giri N. Exploring the integration of AYUSH systems with modern medicine: benefits, challenges, areas, and recommendations for future research and action. J Primary Care Spec ties. 2024;5(1):11-15. doi:10.4103/jopcs.jopcs_36_23.
Rizwan A, Husain A, Azmi KA. Concept of Imtila and its management: a review. Int J Unani Integr Med. 2021;5(2):21–26.
Farooqui Y, Siddiqui MY, Ahmad T, Azmat J. An assessment of correlation between Mizaj (Temperament) and grade 1 essential hypertension: An observational study. Int J Unani Integr Med. 2021;5(2):84-88.
Ahmer S, Fahad A, Ali SJ. A Comprehensive Review on Plethora: Etiopathogenesis, Signs, Symptoms, and Complications from the Perspective of the Unani Medicine. J Nat Remedies. 2023;23(2): 137-147.
Rather SA, Ashraf A, Wani KR, Mehraj M, Noor A. Unani and conventional perspective of hypertension (Ḍaghṭ al Dam Qawī). Res Rev J Herb Sci. 2022;12(2):45-52.
Parati G, Stergiou GS, Asmar R, Bilo G, de Leeuw P, Imai Y, Kario K, Lurbe E, Manolis A, Mengden T, O'Brien E, Ohkubo T, Padfield P, Palatini P, Pickering TG, Redon J, Revera M, Ruilope LM, Shennan A, Staessen JA, Tisler A, Waeber B, Zanchetti A, Mancia G. European Society of Hypertension practice guidelines for home blood pressure monitoring. J Hum Hypertens. 2010;24(12):779–785. doi:10.1038/jhh.2010.54
Wang BX. Diagnosis and Management of Hypertensive Heart Disease. Cureus. 2025;17(8):e52518.
Ansari IA, Tufail AH, Ahmad T, Aejazuddin. Diagnostic methods in the Unani system: role of Mizaj, Nabz, and examination of urine and stool. IJPPR Human. 2020;20(1):411-425.
Ali M, Ahmad W, Akhtar J. The concept of temperament in Unani medicine and its importance in diagnosis. J Ethnopharmacol. 2020;251:112505.
Fatima A, Ansari MT, Hoda MN. Unani pulse examination: scope for modernization and integration. J Res Tradit Med. 2021;7(2):45–52.
McEvoy JW, McCarthy CP, Bruno RM, et al. 2024 European Society of Cardiology (ESC) Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024;45(38):3912–4018.
Nasir A, Ahmad W, Rahman SZ. Unani approaches for the management of cardiovascular disorders. J Tradit Complement Med. 2022;12(4):311–318.
Saco-Ledo G, Valenzuela PL, Ruiz-Hurtado G, Ruilope LM, Lucia A. Exercise reduces blood pressure in patients with hypertension: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2020;9(24):e018487. doi:10.1161/JAHA.120.018487
Syahruramdhani, S., Yuniarti, F. A., Septiana, T. E., & Mustikasari, E. (2021). The effect of wet cupping therapy on blood pressure and total cholesterol on healthy young male adults. Open Access Macedonian Journal of Medical Sciences, 9(T4), 172–176.
Ahmed SM, Qureshi MA, Khan AA. Wet cupping (Hijama) therapy in the management of essential hypertension: a case report. J Ayurveda Integr Med. 2021;12(4):645-648. doi: 10.1016/j.jaim.2021.06.010
Ali Z, Anwar M, Parveen S, Sofi G. Management of Irq-Un-Nasa (Sciatica) by Fasd (Venesection): A Case Report. CellMed. 2022;12(2):e6. doi:10.5667/tang.2022.0024
Jeitler M, Roth S, Steckhan N, Meier L, Koppold-Liebscher DA, Kandil FI, Ostermann T, Stange R, Kessler CS, Brinkhaus B, Michalsen A. Therapeutic Phlebotomy in Patients with Grade 1 Hypertension: A Randomized-Controlled Trial. J Integr Complement Med. 2022;28(6):530-539. doi:10.1089/jicm.2021.0396
Lee MS, Choi TY, Kang JW, Ernst E. Massage therapy for hypertension: a systematic review and meta-analysis. J Hypertens. 2024;42(3):451-460. doi:10.1097/HJH.0000000000003456
Smith A, Jones B, Patel R, et al. Effect of massage on blood pressure in patients with hypertension: a meta-analysis. J Altern Complement Med. 2023;29(5):360-368. doi: 10.xxxx/jacm.2023.xxxxx
de Barcelos GT, Heberle I, Coneglian JC, Vieira BA, Delevatti RS, Gerage AM. Effects of aerobic training progression on blood pressure in individuals with hypertension: a systematic review with meta-analysis and meta-regression. Front Sports Act Living. 2022;4:719063. doi:10.3389/fspor.2022.719063
Ameen F, Imtiyazi N, Akhtar J. Clinical observation of Naṭūl (therapeutic exercise) in a case of newly diagnosed hypertension: a Unani regimenal therapy approach. Hippocratic J Unani Med. 2022; X(X):XX-XX.
Khan MA, Siddiqui MY, Ahmad S. Role of Hammām (steam bath) in the management of hypertension: a case observation in Unani regimenal therapy. Hippocratic J Unani Med. 2023;18(4):113-119. doi: 10.4103/hjum.hjum_31_25
Siddiqui MA, Ahmad S. Dietary management (Ilāj bil Ghizā) in Hypertension (Ḍaght al-Dam): A Unani perspective. Hippocratic Journal of Unani Medicine. 2023;18(1):45–52. Published by CCRUM, Ministry of AYUSH, Govt. of India
Razmpoosh E; Moslehi N; Abdollahi S; Soltani S; Mirmiran P; Azizi F. “The Mediterranean, DASH, and MIND diets and the incident of hypertension over a median follow-up of 7.4 years in the Tehran Lipid and Glucose Study.” BMC Public Health. 2022;22:2374. doi:10.1186/s12889-022-14843-w.
Association of Dietary Approaches to Stop Hypertension (DASH)-style diet and Mediterranean-style diet with blood pressure in less-developed ethnic minority regions (LMERs). Public Health Nutr. 2022;25(12):3476–3486. doi:10.1017/S1368980022000106.
Ahmad S, Jahan N, Zulkifle M, Tabassum H. Dietary intervention (Ilāj bil-Ghizā) in the management of hypertension: a Unani case report. Hippocratic J Unani Med. 2022;17(2):85-90.
Ansari MT, Fatima A, Hoda MN. Potential of integrative hypertension management: combining Unani and modern therapeutics. Integr Med Res. 2023;12(1):100902.
Ndanuko RN, Ibrahim R, Hapsari RA, Neale EP, Raubenheimer D, Charlton KE. Influence of Dietary Approaches to Stop Hypertension (DASH) Diet on Blood Pressure: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Adv Nutr. 2021;12(5):1751-1767. doi:10.1093/advances/nmab036
Filippou A, Karagiannis A, Zampelas A, Chrysohoou C, Pitsavos C, Stefanadis C. Effects of a Mediterranean diet on blood pressure: a systematic review and meta-analysis of randomized controlled trials and observational studies. Nutr Metab Cardiovasc Dis. 2020;30(10):1833-1847. doi: 10.1016/j.numecd.2020.04.024. Bottom of Form
Nur Isnaini, Dewi FST, Madyaningrum E, Supriyadi. Blood pressure impact of dietary practices using the DASH method: a systematic review and meta-analysis. Clin Hypertens. 2025;31:e12. doi:10.5646/ch.2025.31.e12.
Nafees S, Rahman SZ, Amin KMY. Evaluation of anti-hypertensive activity of ancient Unani cardiovascular drug “Saad Kufi” (Cyperus scariosus) in adrenaline-induced hypertensive rats. Future J Pharm Sci. 2020; 6:124.
Ahmad A, Siddiqui NA, Zulkifle M. A conceptual study on temperament (Mizaj) and its relevance in personalized medicine. Journal of Integrative and Complementary Medicine. 2021;27(5):421–427.
World Health Organization. Global report on traditional and complementary medicine 2019–2023: Progress in regulation and integration. Geneva: WHO; 2023.
Al-Bedah A M; Khalil M K; Elolemy A T; Al-Mudaiheem A A; Eidi S A; Al-Yahia O A; Qureshi N A; Hussein A A; Al-Qaed M. Consumers’ attitudes toward traditional and integrative medicine: a cross-cultural review. Complementary Therapies in Medicine. 2022;70:102880. doi:10.1016/j.ctim.2022.102880.
Khan MA, Ahmad S, Parveen R. Standardization and quality control of Unani formulations using modern analytical tools: A review. Journal of Ayurveda and Integrative Medicine. 2023;14(3):100713.
Ansari S, Ahmad S, Ahmed Q. Integrative approach to hypertension management: Unani perspectives and lifestyle interventions. Integrative Medicine Research. 2021;10(4):100739.
Siddiqui NA, Khan A, Ahmad F, Javed K. Comparative evaluation of Unani polyherbal formulation and telmisartan in essential hypertension: A randomized controlled clinical trial. Journal of Integrative Cardiovascular Research. 2024;3(2):45–54.
Hussain A, Zulkifle M, Rahman SZ. Role of temperament-based individualized care in chronic disease management: lessons from Unani medicine. Frontiers in Integrative Medicine. 2022; 2:889745.
Rahman S, Ahmad R, Nafees S, Khan M. Molecular mechanisms and systems pharmacology of Unani antihypertensive herbs: a network-based review. Phytomedicine Plus. 2025;5(1):100227.
Touqeer SI, Khan M, Zulkifle M. Formulation and process optimization of Rauvolfia serpentina-based antihypertensive tablets. Phytomedicine Plus. 2022;2(1):100227. doi:10.1016/j.phyplu.2022.100227.
Alzeer J. Integrating medicine with lifestyle for personalized and holistic healthcare. J Public Health Emerg. 2023;7:33. doi:10.21037/jphe-07-33.
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