An Ayurvedic Arena for Hypertension Treatment

 

Indu Sharma, Dr. Bharat Parashar, Hitesh Kumar Dhamija , Ritu sharma

Manav Bharti University, Solan .

*Corresponding Author E-mail: indusharma2812@gmail.com

 

ABSTRACT:

Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). A number of plants have been described in Ayurveda and other traditional system of medicine for the treatment of hypertension. Conventional antihypertensive drugs are usually associated with many side effects. Research has found a variety of alternative therapies to be successful in reducing high blood pressure including diet, exercise, stress, management, supplements and herbs. About 75 to 80% of the world population use herbal medicines, mainly in developing countries, for primary health care because of their better acceptability with human body and lesser side effects. However, Ayurvedic knowledge needs to be coupled with modern medicine and more scientific research needs to be done to verify the effectiveness, and elucidate the safety profile of such herbal remedies for their antihypertensive potential, now a day’s herbal remedies are more in use due to fewer side effects. The present review article give idea about treatment of hypertension with the use of herbal plants.

 

KEY WORDS: Antihypertensive, Hypertension, Herbal plant, Modern medicine, Medicinal plants

 

INTRODUCTION:

Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body. Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. The normal level for blood pressure is below 120/80, where 120 represent the systolic measurement (peak pressure in the arteries) and 80 represents the diastolic measurement (minimum pressure in the arteries). Blood pressure between 120/80 and 139/89 is called prehypertension (to denote increased risk of hypertension), and a blood pressure of 140/90 or above is considered hypertension [1]. 

 

Hypertension (HTN) or high blood pressure (BP) is a chronic medical condition in which the BP in the arteries is elevated. It is classified as either primary (essential) or secondary. About 90 to 95% of cases are termed primary HTN, which refers to high BP for which no medical cause can be found [2] .  

 

The remaining 5 to 10% of cases, called secondary HTN, are caused by other conditions that affect the kidneys, arteries, heart, or endocrine system [3] .

 

Classification

Hypertension is usually classified as:

1. Primary (essential)   hypertension

2. Secondary  hypertension

 

Hypertension (HTN ) has several sub classification including, HTN stage I, HTN stage II, and isolated systolic HTN. Isolated systolic HTN refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. These classifications are made after averaging a patient's resting BP readings taken on two or more office visits. Individuals older than 50 years are classified as having HTN if their BP is consistently at least 140 mmHg systolic or 90 mmHg diastolic. Patients with BP s higher than 130/80 mmHg with concomitant presence of diabetes or kidney disease require further treatment. HTN is also classified as resistant if medications do not reduce BP to normal levels [4]. Exercise HTN is an excessively high elevation in BP during exercise [5] .  Hypertension (HTN) or high blood pressure, sometimes arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole) [6] .

 

Cause of hypertension

The exact causes of hypertension are usually unknown, there are several factors that have been highly associated with the condition. These include:

1.     Smoking

2.     Obesity or being overweight

3.     Diabetes

4.     Sedentary lifestyle

5.     Lack of physical activity

6.     High levels of salt intake (sodium sensitivity)

7.     Insufficient calcium, potassium, and magnesium consumption

8.     Vitamin D deficiency

9.     High levels of alcohol consumption

10.   Stress

11.   Aging

12.   Medicines such as birth control pills

13.   Genetics and a family history of hypertension

14.   Chronic kidney disease

15.   Adrenal and thyroid problems or tumors[1]

 

Pathophysiology

Most of the mechanisms associated with secondary HTN are generally fully understood. However, those associated with essential (primary) HTN are far less understood. What is known is that cardiac output is raised early in the disease course, with normal total peripheral resistance (TPR). Over time, cardiac output drops to normal levels, but TPR is increased. The following three theories have been proposed to explain this:

 

·Inability of the kidneys to excrete sodium, resulting in natriuretic factors such as atrial natriuretic factor being secreted to promote salt excretion with the side effect of raising TPR.

 

·An overactive renin-angiotensin system leads to vasoconstriction and retention of sodium and water. The increase in blood volume leads to HTN [7] .

 

·An overactive sympathetic nervous system, leading to increased stress responses [8] .

 

·It is also known that HTN is highly heritable and polygenic (caused by more than one gene) and a few candidate genes have been postulated in the etiology of this condition [9] .

 

HTN is a major independent risk factor for coronary artery disease, stroke, and kidney failure. Each increase of 20 mmHg in systolic BP and 10 mmHg in diastolic BP, over the range of 115/75 to 185/115 mmHg, doubles the risk of a fatal coronary event. There is evidence that some younger people with prehypertension or 'borderline hypertension' have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.(6)

 

Pathophysiology in diagrammatic form

 

Naturally occurring herbs for the treatment of hypertension

1.    Allium sativum (Garlic), it belongs to family Alliaceae:- Garlic has long been used for a variety of cardiovascular conditions, especially hyperlipidemia. It has also been reported to have hypotensive action. It is thought to increase nitric oxide production, resulting in smooth muscle relaxation and vasodilatation. One of the primary active compounds that gives garlic its characteristic odor and many of its healing benefits is called allicin. Meta-analysis of randomly chosen literary data has demonstrated that garlic is related to decrease of BP in patients with increased systolic pressure, but not in patients without increased systolic pressure [10] .Garlic preparations have been found to be superior to placebo in reducing BP in individuals with HTN [11] .

 

2.     Annona muricata (Prickly custard apple ), it belongs to family Annonaceae:- Muricata is a member of the family of custard apple trees called Annonaceae and a species of the genus Annona, known mostly for its edible fruits Annona. The tree grows natively in the Caribbean and Central America. The leaf extract of the plant has been reported to lower an elevated BP by decreasing the peripheral vascular resistance [12]

 

3.     Apium graveolens (celery), it belongs to family family Apiaceae :- Fresh celery juice can be mixed with vinegar to relieve dizziness and headache and shoulder pain associated with HTN. It is also administered in HTN associated with pregnancy and climacteric. (13)  It has also been reported to reduce systolic and diastolic BP. The difference of BP in human beings before and after treatment has been found to be significant (P<0.05), indicating that seeds of A. graveolens can be used as a safe and effective treatment of  hypertension. [14]

 

4.     Avena sativa (Dietary fiber , Green oat ), it belongs to Family  Poaceae /Gramineae :- A diet containing soluble fiber-rich whole oats can significantly reduce the need for antihypertensive medication and improve BP control [15]. The addition of oat cereals to the normal diet of patients with HTN has been found to significantly reduce both systolic and diastolic BP. Soluble fiber-rich whole oats may be an effective dietary therapy in the prevention and adjunct treatment of HTN [16] .

 

5.     Blond psyllium (Indian plantago ), it belongs to family  Plantaginaeae :- Preliminary clinical research shows that taking a B. psyllium (Plantago species) supplement 15 g daily can modestly lower BP; systolic by about 8 mmHg and diastolic by 2 mmHg .[17]

 

6.     Capparis cartilaginea (Lasaf), it belongs to  family  Cappaaraceae :-  It has been reported that crude extract of C. cartilaginea produces a dose-dependent decrease in BP and slight bradycardia in anesthetized rats.[18]

 

7.     Cassia absus (ChaKsu), it belongs to family  Caesalpiniaceae :- This plant is found in the tropical region and is found everywhere in India. It has been reported that an intravenous administration of a crude extract of C. absus produces a dose-related (1-30 mg/kg) decrease in BP, A sustained fall in BP of anesthetized animals and weak antiacetylcholine effect has been reported.[19]

 

8.     Carum copticum (Ajwain), it belongs to family Umbelliferae:- The crude extract of C. copticum (1-30 mg/kg) produces a fall in BP and heart rate (HR) of anesthetized normotensive (NMT) rats. Hypotension produced is very brief and returns to normal within a minute.[20]

 

9.     Cassia occidentalis (coffee weed) it belongs to family caesalpiniaceae :- The leaf of this plant is used in local folk medicine as an antihypertensive agent. In vitro studies of the leaf extract have shown a relaxant effect on the aortic rings. The studies revealed that cassia extract may be relaxing smooth muscle and reducing BP by inhibiting Ca 2+ influx through receptor-operated channel and voltage-sensitive channel, showing its nonselectivity on these Ca2+ channels.[21]

 

10.   Commelina virginica(Virginia Dayflower), it belongs to family commelinaceae :- It is a perennial herbaceous plant in the dayflower family. Whole plant extract has been reported to decrease the tension of phenylephrine-stimulated isolated guinea pig aorta rings by 15 to 35%.[22]

11.   Castanospermum austral (Black bean), it belongs to family Fabaceae :- Crude extract of C. australe has been reported to cause a fall in systolic as well as diastolic BP in a dose-dependent manner (1-100 mg/kg). This fall in BP has been attributed to the saponin fraction and medicogenic acid glucoside present in the crude extract[23].

 

12.   Daucus carota (Carrot), it belongs to family Umbelliferae :- It has been used in traditional medicine to treat HTN. Activity-directed fractionation of aerial parts of D. carota resulted in the isolation of two coumarin glycosides coded as DC-2 and DC-3. Intravenous administration of these compounds caused a dose-dependent (1-10 mg/kg) fall in arterial BP. These results indicate that DC-2 and DC-3 may be acting through blockade of calcium channels, and this effect may be responsible for the BP-lowering effect of the compounds observed in the in vivo studies.[24]

 

13.   Fuchsia magellanica (Hardy fuchsia, chiKo), it belongs to family Onagraceae :- This plant is native to Southern Argentina and Chile. Infusion of the leaf extract reduces body temperature, acts as a diuretic, and lowers BP.[25]

 

14.   Glycine max (soybean), it belongs to family Fabaceae: - Soybean has been found to be effective as a hypotensive agent.[26]

 

15.   Hibiscus sabdariffa (Roselle), it belongs to family Malvaceae :- The leaves, calyx, and corolla of this plant are used traditionally in many West African countries for various medicinal purposes and as edibles. The antihypertensive effect of this plant extract has been variously studied. One study reported the antihypertensive effect of calyx of Hibiscus sabdariffa (HS)[27] . Clinical trials of the plant extract in human being have shown reliable evidence of antihypertensive effects. A standardized dose of HS (9.6 mg per day) given to 39 patients and captopril, 50 mg per day, given to the same number of patients did not show significant difference relative to hypotensive effects, antihypertensive effectiveness and tolerability.[28]

 

16.   Lavandula stoechas (French Lavender ), it belongs to family  Lamiaceae :- Crude extract of L. stoechas has been reported to produce a fall in BP and HR in anesthetized NMT rats. Pretreatment of atropine abolished the cardiovascular responses, suggesting that the antihypertensive and bradycardia effects of the crude extract may be mediated through mechanism(s) similar to that of acetylcholine.[29]

 

17.   Lycopersicon esculentum (Tomato), it belongs to family Solanaceae:- Tomato extract contains carotenoids, such as lycopene, beta carotene, and vitamin- E, which are known as effective antioxidants, to inactivate free radicals and to slow the progress of atherosclerosis. A study showed that extract of tomato (Lyc-O-Mato) modestly reduces BP in patients.[30]

 

18.   Musanga cecropiaceae (Umbrella tree, Cork wood), it belongs to family Cecropiaceae :- The ethanol extract of the plant stem bark has been reported to have antidiarrheal activity.[31] Several workers have demonstrated the scientific efficacy of the latex and the leaf extract as a vasorelaxant, and therefore a hypotensive agent. [32]

 

19.   Ocimum basilicum (Basil), it belongs to family Lamiaceae :- It has been reported that a crude extract of O. basilicum causes a fall in systolic, diastolic, and mean BP in a dose-dependent manner with median effective dose of 30 mg/kg. The antihypertensive effect is brief and returns to normal within two minutes. This cardiovascular effect of the extract has been attributed to eugenol, which exerts its effect by blocking the calcium channels[33].

 

20.   Pinus pinaster  (Maritime pine), it belongs to family  Pinaceae :- Pycnogenol is an extract from French maritime pine bark. It is most commonly known as a treatment for venous insufficiency and other vascular conditions. But it is being studied for a long list of other conditions, including HTN. Preliminary clinical research shows that pycnogenol 200 mg/day can modestly lower BP in people with mild HTN. It has been reported to act by inhibiting angiotensin-converting enzymes .[34]

 

21.   Rauwolfia serpentine (Rauwolfia), it belongs to family Apocynaceae :- Extracts of its different parts and of plants resembling to rauwolfia were used in Hindu medicine for snakebite, insomnia, insanity, and many other diseases and complaints. This is considered to be the most powerful hypotensive plant. Reserpine, the purified alkaloid of R. serpentina, was the first potent drug widely used in the long-term treatment of HTN. Only a small dose is required to achieve results and to avoid side effects. Nasal congestion is the most common side effect. In 1952, reserpine was introduced under the name Serpasil in the treatment of HTN, tachycardia, and thyrotoxicosis.[35]

 

22.   Sesamum  indicum (sesame), it belongs to family Pedaliaceae :- Alcoholic extract of seeds (1-30 mg/kg) caused hypotension in anesthetized rats. A fall in systolic as well as diastolic BP in dose-dependent manner was observed. The investigators suggested that sesamin is a useful prophylactic treatment in HTN and cardiovascular hypertrophy.[36]

 

23.  Theobroma cacao (chocolate , cocoa butter), it belongs to family Malvaceae :-  Cocoa powder, enriched with flavonoid constituents, is used for preventing cardiovascular disease. Flavonoids, contained in chocolate, stimulate formation of nitric oxide, increase vasodilatation, and reduce endothelial dysfunction. A growing body of clinical research also shows that daily consumption of dark or milk chocolate (T. cacao), 46 to 105 g daily, providing 213 to 500 mg of cocoa polyphenols, can lower systolic BP by about 5 mmHg and diastolic by about 3 mmHg.[37]

 

24.   Uncaria rhynchophylla (Cat’s claw herb), it belongs to family Rubiaceae  :- A methanol extract of the hooks of an Uncaria species was found to have a potent and long-lasting hypotensive effect in rats and the activity was different from that of U. rhynchophylla and its analogue. Further studies of the extract resulted in the isolation of 3-indole alkaloid, glycoside, cadambine, dihydrocadambine, and isodihydrocadambine. The latter two were found to be the hypotensive principles, whereas cadambine was inactive .[38]

 

25.   Vitex doniana (black plum), it belongs to family verbenaceae :- The extract was found to exert hypotensive effect. Both the systolic and diastolic BPs were significantly reduced within 45 min after oral administration of the extract. The BP began to return to normal after 2 hours.[39]

 

26.   Zingiber officinale (Ginger), it belongs to family zingiberaceae :- Ginger root is commonly used in Asian cooking. It acts to improve blood circulation and relaxes muscles surrounding blood vessels. BP-lowering effect of ginger is mediated through blockade of voltage-dependent calcium channels. [40]

 

CONCLUSION:

The above written herbal plants have potent anti – hypertensive effect. The different herbal plants are used as anti hypertensive in all over the world . The use of herbal anti-diabetic drugs is not common among the patients suffering from hypertension. Doctors should encourage these patients for using these herbal drugs & these may help in managing the disease and prove beneficial to patients

 

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Received on 06.04.2012       Accepted on 10.05.2012     

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Asian J. Pharm. Res. 2(2): April-June 2012; Page 54-58