Complementary and Alternative Medicine Use in Hypertension: The Good, the Bad, and the Ugly: Hypertension Treatment From Nature – Myth or Fact?

Thirty six percent of people in USA and Canada regularly use complementary and alternative medicine (CAM) for the prevention and treatment of different diseases, including hypertension. Generally, majority of the hypertensive patients do not disclose the use of such remedies, and also health care providers do not usually ask their hypertensive patients if they use CAM. The widespread consumption of CAM in hypertension requires clear understanding of their underlying mechanism of action, efficacy and safety. This chapter will provide a comprehensive list of CAM commonly used by Americans for the prevention and treatment of hypertension as well as their postulated mechanism of action. Modulation of drug metabolizing enzymes and their safety will also be covered along with the clinical consequences, i.e. drug-herb or herb-disease interactions. patients and healthcare providers should also be careful with using CAM therapies, because not only is there minimal evidence that several CAM products work to treat hypertension, but their safety hasn’t been well-established. Complementary and Alternative Medicine Use in Hypertension: The Good, the Bad, and the Ugly: Hypertension Treatment From Nature – Myth or Fact?

[1]  H. Krum,et al.  Coenzyme Q10 in cardiovascular disease. , 2007, Mitochondrion.

[2]  H. Sies,et al.  Acute consumption of flavanol-rich cocoa and the reversal of endothelial dysfunction in smokers. , 2005, Journal of the American College of Cardiology.

[3]  S. Chierchia,et al.  Effect of oral L-arginine on blood pressure and symptoms and endothelial function in patients with systemic hypertension, positive exercise tests, and normal coronary arteries. , 2004, The American journal of cardiology.

[4]  S. Tsugane,et al.  Lack of Long-Term Effect of Vitamin C Supplementation on Blood Pressure , 2002, Hypertension.

[5]  Chung S. Yang,et al.  The effects of green tea polyphenols on drug metabolism , 2012, Expert opinion on drug metabolism & toxicology.

[6]  G. Kudolo,et al.  The Effect of 3‐Month Ingestion of Ginkgo biloba Extract on Pancreatic β‐Cell Function in Response to Glucose Loading in Normal Glucose Tolerant Individuals , 2000, Journal of clinical pharmacology.

[7]  E. Vichinsky,et al.  Arginine therapy: a new treatment for pulmonary hypertension in sickle cell disease? , 2003, American journal of respiratory and critical care medicine.

[8]  S. Percival,et al.  Standardized capsule of Camellia sinensis lowers cardiovascular risk factors in a randomized, double-blind, placebo-controlled study. , 2009, Nutrition.

[9]  Y. Ohizumi,et al.  Cardiotonic principles of ginger (Zingiber officinale Roscoe). , 1982, Journal of pharmaceutical sciences.

[10]  Barbara Bloom,et al.  Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. , 2009, National health statistics reports.

[11]  H. Wollersheim,et al.  A systematic review on the influence of trial quality on the effect of garlic on blood pressure. , 2009 .

[12]  I. M. El-Ashmawy,et al.  Protective effect of volatile oil, alcoholic and aqueous extracts of Origanum majorana on lead acetate toxicity in mice. , 2005, Basic & clinical pharmacology & toxicology.

[13]  V. Papademetriou,et al.  Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in African‐American Patients With Hypertension , 2004, Journal of clinical hypertension.

[14]  S. Paul,et al.  Flavonoid-Rich Dark Chocolate Improves Endothelial Function and Increases Plasma Epicatechin Concentrations in Healthy Adults , 2004, Journal of the American College of Nutrition.

[15]  M. Patil,et al.  Comparative antihyperglycaemic and antihyperlipidemic effect of Origanum majorana extracts in NIDDM rats , 2011, Oriental Pharmacy and Experimental Medicine.

[16]  C. Lehmann,et al.  Effects of low habitual cocoa intake on blood pressure and bioactive nitric oxide: a randomized controlled trial. , 2007, JAMA.

[17]  Michael J.A. Williams,et al.  Aged garlic extract improves endothelial function in men with coronary artery disease , 2005, Phytotherapy research : PTR.

[18]  J. Blumberg,et al.  Cocoa Reduces Blood Pressure and Insulin Resistance and Improves Endothelium-Dependent Vasodilation in Hypertensives , 2005, Hypertension.

[19]  M. Suhaj Spice antioxidants isolation and their antiradical activity: a review , 2006 .

[20]  F. Tomás-Barberán,et al.  Flavonoids in Food and Their Health Benefits , 2004, Plant foods for human nutrition.

[21]  Adriana L. Gonzalez,et al.  Garlic components inhibit angiotensin II-induced cell-cycle progression and migration: Involvement of cell-cycle inhibitor p27(Kip1) and mitogen-activated protein kinase. , 2010, Molecular nutrition & food research.

[22]  A. Tejani,et al.  Garlic for the prevention of cardiovascular morbidity and mortality in hypertensive patients , 2012, The Cochrane database of systematic reviews.

[23]  A. Kriško,et al.  The effects of essential oils and aqueous tea infusions of oregano (Origanum vulgare L. spp. hirtum), thyme (Thymus vulgaris L.) and wild thyme (Thymus serpyllum L.) on the copper-induced oxidation of human low-density lipoproteins , 2007, International journal of food sciences and nutrition.

[24]  M. Nicolau,et al.  Inhibition of Angiotensin-Converting Enzyme by Quercetin Alters the Vascular Response to Bradykinin and Angiotensin I , 2002, Pharmacology.

[25]  C. Fraga,et al.  Inhibition of angiotensin converting enzyme activity by flavanol-rich foods. , 2006, Journal of agricultural and food chemistry.

[26]  T. Aburjai,et al.  Effect of ethnomedicinal plants used in folklore medicine in Jordan as antibiotic resistant inhibitors on Escherichia coli , 2010, BMC complementary and alternative medicine.

[27]  Marco Manca,et al.  Different Effect of Psyllium and Guar Dietary Supplementation on Blood Pressure Control in Hypertensive Overweight Patients: A Six-Month, Randomized Clinical Trial , 2007, Clinical and experimental hypertension.

[28]  D. Grobbee,et al.  Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials , 2002, Journal of hypertension.

[29]  Takamasa Ishii,et al.  Coenzyme Q10 can prolong C. elegans lifespan by lowering oxidative stress , 2004, Mechanisms of Ageing and Development.

[30]  Mark D. Huffman,et al.  AHA Statistical Update Heart Disease and Stroke Statistics — 2012 Update A Report From the American Heart Association WRITING GROUP MEMBERS , 2010 .

[31]  K. Folkers,et al.  Treatment of essential hypertension with coenzyme Q10. , 1994, Molecular aspects of medicine.

[32]  Abraham Weizman,et al.  Caffeine withdrawal increases lithium blood levels , 1995, Biological Psychiatry.

[33]  G. Wu,et al.  Arginine nutrition and cardiovascular function. , 2000, The Journal of nutrition.

[34]  A. Evans,et al.  Fish Consumption Is Associated With Lower Heart Rates , 2003, Circulation.

[35]  U. Kuhn,et al.  Comparison of the efficacy and tolerance of a garlic preparation vs. bezafibrate. , 1992, Arzneimittel-Forschung.

[36]  G. Littarru,et al.  Coenzyme Q10 in essential hypertension. , 1994, Molecular aspects of medicine.

[37]  K. Gough,et al.  A Potential Drug–Herbal Interaction between Ginkgo biloba and Efavirenz , 2012, Journal of the International Association of Physicians in AIDS Care.

[38]  J. Takasu,et al.  Aged garlic extract may be safe for patients on warfarin therapy. , 2006, The Journal of nutrition.

[39]  N. Tabassum,et al.  Role of natural herbs in the treatment of hypertension , 2011, Pharmacognosy reviews.

[40]  T. Sanders,et al.  Effect on blood lipids and haemostasis of a supplement of cod-liver oil, rich in eicosapentaenoic and docosahexaenoic acids, in healthy young men. , 1981, Clinical science.

[41]  S. M. Asdaq,et al.  Potential of garlic and its active constituent, S-allyl cysteine, as antihypertensive and cardioprotective in presence of captopril. , 2010, Phytomedicine : international journal of phytotherapy and phytopharmacology.

[42]  J. Parker,et al.  The effect of supplemental L-arginine on tolerance development during continuous transdermal nitroglycerin therapy. , 2002, Journal of the American College of Cardiology.

[43]  J. Suliburska,et al.  Effects of short-term garlic supplementation on lipid metabolism and antioxidant status in hypertensive adults. , 2008, Pharmacological reports : PR.

[44]  D. Bagchi,et al.  Antifungal activities of origanum oil against Candida albicans , 2001, Molecular and Cellular Biochemistry.

[45]  I. Mackraj,et al.  The Antihypertensive Effects of Quercetin in a Salt-sensitive Model of Hypertension , 2008, Journal of cardiovascular pharmacology.

[46]  T. Jain,et al.  Terpenoids—XXXIV : Structure and stereochemistry of zingiberol and juniper camphor , 1962 .

[47]  V. Ganji,et al.  Psyllium husk fibre supplementation to soybean and coconut oil diets of humans: effect on fat digestibility and faecal fatty acid excretion. , 1994, European journal of clinical nutrition.

[48]  Ian J. Brown,et al.  Food Omega-3 Fatty Acid Intake of Individuals (Total, Linolenic Acid, Long-Chain) and Their Blood Pressure: INTERMAP Study , 2007, Hypertension.

[49]  A. Gilani,et al.  Ginger Lowers Blood Pressure Through Blockade of Voltage-Dependent Calcium Channels , 2005, Journal of cardiovascular pharmacology.

[50]  S. Cosentino,et al.  In‐vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils , 1999, Letters in applied microbiology.

[51]  M. Thomson,et al.  Nitric oxide mediates the blood-pressure lowering effect of garlic in the rat two-kidney, one-clip model of hypertension. , 2006, The Journal of nutrition.

[52]  J. Shelhamer,et al.  The fish oil ingredient, docosahexaenoic acid, activates cytosolic phospholipase A2 via GPR120 receptor to produce prostaglandin E2 and plays an anti‐inflammatory role in macrophages , 2014, Immunology.

[53]  Sanjay Rajagopalan,et al.  Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure A Scientific Statement From the American Heart Association , 2013, Hypertension.

[54]  S. Dimauro,et al.  Atorvastatin decreases the coenzyme Q10 level in the blood of patients at risk for cardiovascular disease and stroke. , 2004, Archives of neurology.

[55]  H. Krauss,et al.  Evaluation of antihypertensive effect of 1-arginine supplementation in patients with mild hypertension assessed with ambulatory blood pressure monitoring , 2010, Medical science monitor : international medical journal of experimental and clinical research.

[56]  Joseph M Pappachan,et al.  Omega-3 fatty acids: a comprehensive review of their role in health and disease , 2009, Postgraduate Medical Journal.

[57]  S. Litwin,et al.  Quercetin-Supplemented Diets Lower Blood Pressure and Attenuate Cardiac Hypertrophy in Rats With Aortic Constriction , 2006, Journal of cardiovascular pharmacology.

[58]  Jackson T. Wright,et al.  A Randomized Trial of Intensive versus Standard Blood-Pressure Control. , 2016, The New England journal of medicine.

[59]  Xian-liang Zhou,et al.  Coenzyme Q10 treatment of cardiovascular disorders of ageing including heart failure, hypertension and endothelial dysfunction. , 2015, Clinica chimica acta; international journal of clinical chemistry.

[60]  D. Connell,et al.  Natural pungent compounds , 1972 .

[61]  K. Minaker,et al.  High-carbohydrate, high-fiber diets increase peripheral insulin sensitivity in healthy young and old adults. , 1990, The American journal of clinical nutrition.

[62]  Y. Clement,et al.  Can green tea do that? A literature review of the clinical evidence. , 2009, Preventive medicine.

[63]  H. Blume,et al.  Pharmaceutical quality of different Ginkgo biloba brands , 2002, The Journal of pharmacy and pharmacology.

[64]  W. Qidwai,et al.  Role of Garlic Usage in Cardiovascular Disease Prevention: An Evidence-Based Approach , 2013, Evidence-based complementary and alternative medicine : eCAM.

[65]  C. Xie,et al.  Persimmon (Diospyros kaki L.) leaves: a review on traditional uses, phytochemistry and pharmacological properties. , 2015, Journal of ethnopharmacology.

[66]  Y. Dohi,et al.  Effects of Ascorbic Acid on Ambulatory Blood Pressure in Elderly Patients with Refractory Hypertension , 2006, Arzneimittelforschung.

[67]  J. Simons,et al.  On the effect of garlic on plasma lipids and lipoproteins in mild hypercholesterolaemia. , 1995, Atherosclerosis.

[68]  B. H. Patterson,et al.  Ascorbic Acid Status and Subsequent Diastolic and Systolic Blood Pressure , 2001, Hypertension.

[69]  T. Jalili,et al.  Therapeutic potential of quercetin to decrease blood pressure: review of efficacy and mechanisms. , 2012, Advances in nutrition.

[70]  A. Caggiula,et al.  Relation of body mass and alcohol, nutrient, fiber, and caffeine intakes to blood pressure in the special intervention and usual care groups in the Multiple Risk Factor Intervention Trial. , 1997, The American journal of clinical nutrition.

[71]  J. Keaney,et al.  Treatment of hypertension with ascorbic acid , 1999, The Lancet.

[72]  R. Olson,et al.  Randomized, Double-Blind, Placebo- Controlled Trial of Coenzyme Q10 in Isolated Systolic Hypertension , 2001, Southern medical journal.

[73]  E. Schömig,et al.  Effect of cocoa and tea intake on blood pressure: a meta-analysis. , 2007, Archives of internal medicine.

[74]  Langbehn,et al.  Ratios of cis- and trans-Sabinene Hydrate in Origanum majorana L. and Origanum microphyllum (Bentham) Vogel. , 2000, Biochemical systematics and ecology.

[75]  Jackson T. Wright,et al.  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). , 2014, JAMA.

[76]  Yukiko Yamamoto,et al.  Antihypertensive Effect of Quercetin in Rats Fed with a High-Fat High-Sucrose Diet , 2006, Bioscience, biotechnology, and biochemistry.

[77]  H. Alho,et al.  Control of arterial tone after long‐term coenzyme Q10 supplementation in senescent rats , 1998, British journal of pharmacology.

[78]  R. Yazdanparast,et al.  Comparative effects of Artemisia dracunculus, Satureja hortensis and Origanum majorana on inhibition of blood platelet adhesion, aggregation and secretion. , 2008, Vascular pharmacology.

[79]  M. Ivanov,et al.  Antioxidant and Antihypertensive Activity of Extract from Thymus serpyllum L. in Experimental Hypertension , 2013, Plant Foods for Human Nutrition.

[80]  Sanjay Jain,et al.  Garlic supplementation prevents oxidative DNA damage in essential hypertension , 2005, Molecular and Cellular Biochemistry.

[81]  K. Kangawa,et al.  Green tea reverses endothelial dysfunction in healthy smokers , 2004, Heart.

[82]  J. Anderson,et al.  Metabolic effects of high-carbohydrate, high-fiber diets for insulin-dependent diabetic individuals. , 1991, The American journal of clinical nutrition.

[83]  A. Bast,et al.  The supplement-drug interaction of quercetin with tamsulosin on vasorelaxation. , 2015, European journal of pharmacology.

[84]  Karin Persson,et al.  Effects of Cocoa Extract and Dark Chocolate on Angiotensin-converting Enzyme and Nitric Oxide in Human Endothelial Cells and Healthy Volunteers–A Nutrigenomics Perspective , 2011, Journal of cardiovascular pharmacology.

[85]  A. Lu,et al.  Expert Consensus on the Treatment of Hypertension with Chinese Patent Medicines , 2013, Evidence-based complementary and alternative medicine : eCAM.

[86]  I. Arnault,et al.  Effects of garlic powders with varying alliin contents on hepatic drug metabolizing enzymes in rats. , 2003, Journal of agricultural and food chemistry.

[87]  Arthur D. Smith,et al.  Ascorbic acid overdosing: a risk factor for calcium oxalate nephrolithiasis. , 1992, The Journal of urology.

[88]  M. Polansky,et al.  Whole Cinnamon and Aqueous Extracts Ameliorate Sucrose-Induced Blood Pressure Elevations in Spontaneously Hypertensive Rats , 2006, Journal of the American College of Nutrition.

[89]  Anne W. Taylor,et al.  Tea consumption is inversely related to 5-year blood pressure change among adults in Jiangsu, China: a cross-sectional study , 2014, Nutrition Journal.

[90]  E. Ernst Complementary and alternative medicine (CAM) for disease prevention. , 2012, Preventive medicine.

[91]  G. Ferns,et al.  Effect of vitamin C on ambulatory blood pressure and plasma lipids in older persons , 2000, Journal of hypertension.

[92]  I. Chang,et al.  Antioxidant effects of Origanum majorana L. on superoxide anion radicals , 2001 .

[93]  C. Binns,et al.  The effects of 12-week psyllium fibre supplementation or healthy diet on blood pressure and arterial stiffness in overweight and obese individuals , 2011, British Journal of Nutrition.

[94]  W. Klaus,et al.  Chocolate and blood pressure in elderly individuals with isolated systolic hypertension. , 2003, JAMA.

[95]  E. Choi,et al.  Anti- and prooxidant effects of chronic quercetin administration in rats. , 2003, European journal of pharmacology.

[96]  G. Bartosz,et al.  Antioxidative and prooxidative effects of quercetin on A549 cells , 2007, Cell biology international.

[97]  S. Ülker,et al.  Vitamins Reverse Endothelial Dysfunction Through Regulation of eNOS and NAD(P)H Oxidase Activities , 2003, Hypertension.

[98]  F. Shidfar,et al.  High-cocoa polyphenol-rich chocolate improves blood pressure in patients with diabetes and hypertension , 2015, ARYA atherosclerosis.

[99]  P. Barnes,et al.  Trends in the use of complementary health approaches among adults: United States, 2002-2012. , 2015, National health statistics reports.

[100]  S Shizukuishi,et al.  Bioenergetics in clinical medicine. XVI. Reduction of hypertension in patients by therapy with coenzyme Q10. , 1981, Research communications in chemical pathology and pharmacology.

[101]  Hypothalamic and plasma total nitrate/nitrite concentrations in spontaneously hypertensive rats , 1996, Experimental physiology.

[102]  T. Hatano,et al.  Inhibitory effects of various flavonoids isolated from leaves of persimmon on angiotensin-converting enzyme activity. , 1987, Journal of natural products.

[103]  Chun-Hsien Yu,et al.  Evaluation of NO-suppressing activity of several Mediterranean culinary spices. , 2007, Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association.

[104]  A. Avcı,et al.  Effects of garlic extract consumption on blood lipid and oxidant/antioxidant parameters in humans with high blood cholesterol. , 2004, The Journal of nutritional biochemistry.

[105]  M. Niaz,et al.  Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease , 1999, Journal of Human Hypertension.

[106]  X. Xiong,et al.  Garlic for hypertension: A systematic review and meta-analysis of randomized controlled trials. , 2015, Phytomedicine : international journal of phytotherapy and phytopharmacology.

[107]  E. Ferrannini,et al.  Insulin resistance in essential hypertension. , 1987, The New England journal of medicine.

[108]  A. Fugh-Berman Herbs and dietary supplements in the prevention and treatment of cardiovascular disease. , 2000, Preventive cardiology.

[109]  K. Shetty,et al.  Phenolic antioxidants from clonal oregano (Origanum vulgare) with antimicrobial activity against Helicobacter pylori , 2005 .

[110]  J. Hodgson,et al.  Dietary Protein and Soluble Fiber Reduce Ambulatory Blood Pressure in Treated Hypertensives , 2001, Hypertension.

[111]  C. Kendall,et al.  Viscous and nonviscous fibres, nonabsorbable and low glycaemic index carbohydrates, blood lipids and coronary heart disease. , 2000, Current opinion in lipidology.

[112]  C. Frampton,et al.  A randomized, double-blind, placebo-controlled crossover study of coenzyme Q10 therapy in hypertensive patients with the metabolic syndrome. , 2012, American journal of hypertension.

[113]  N. Robinson,et al.  Glycated haemoglobin and blood pressure‐lowering effect of cinnamon in multi‐ethnic Type 2 diabetic patients in the UK: a randomized, placebo‐controlled, double‐blind clinical trial , 2010, Diabetic medicine : a journal of the British Diabetic Association.

[114]  F. Facchinetti,et al.  l-Arginine supplementation in women with chronic hypertension: impact on blood pressure and maternal and neonatal complications , 2010, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[115]  M. Ali,,et al.  Thromboxane-B2, prostaglandin-E2 and hypertension in the rat 2-kidney 1-clip model: a possible mechanism of the garlic induced hypotension. , 2001, Prostaglandins, leukotrienes, and essential fatty acids.

[116]  J. Tamargo,et al.  Protective effects of the flavonoid quercetin in chronic nitric oxide deficient rats , 2002, Journal of hypertension.

[117]  R. Muniyappa,et al.  Cocoa consumption for 2 wk enhances insulin-mediated vasodilatation without improving blood pressure or insulin resistance in essential hypertension. , 2008, The American journal of clinical nutrition.

[118]  S. Doggrell,et al.  Rat models of hypertension, cardiac hypertrophy and failure. , 1998, Cardiovascular research.

[119]  J. Williamson,et al.  Effect of Ginkgo biloba on blood pressure and incidence of hypertension in elderly men and women. , 2010, American journal of hypertension.

[120]  S. Higano,et al.  Long-term L-arginine supplementation improves small-vessel coronary endothelial function in humans. , 1998, Circulation.

[121]  S. Kuriyama The relation between green tea consumption and cardiovascular disease as evidenced by epidemiological studies. , 2008, The Journal of nutrition.

[122]  L. Fabre,et al.  EFFECTS OF UBIQUINONE AND RELATED SUBSTANCES ON SECRETION OF ALDOSTERONE AND CORTISOL. , 1965, The American journal of physiology.

[123]  B. Lyoussi,et al.  Ethnopharmacological survey of plants used in the traditional treatment of hypertension and diabetes in south-eastern Morocco (Errachidia province). , 2007, Journal of ethnopharmacology.

[124]  M. Eddouks,et al.  Anti-hyperglycaemic activity of the aqueous extract of Origanum vulgare growing wild in Tafilalet region. , 2004, Journal of ethnopharmacology.

[125]  J. Y. Kim,et al.  Garlic powder intake and cardiovascular risk factors: a meta-analysis of randomized controlled clinical trials , 2014, Nutrition research and practice.

[126]  M. Khayyal,et al.  Ginkgo biloba extract (EGb 761) normalizes hypertension in 2K, 1C hypertensive rats: role of antioxidant mechanisms, ACE inhibiting activity and improvement of endothelial dysfunction. , 2011, Phytomedicine : international journal of phytotherapy and phytopharmacology.