SEMINAR REPORT

ON

MEDICINAL PLANTS FOR TREATMENT OF HIGH BLOOD

PRESSURE

BY

AZEEZ BLESSING OYIZA

FPA/ST/20/2-0365

SUBMITTED TO:

DEPARTMENT OF SCIENCE TECHNOLOGY,

SCHOOL OF SCIENCE AND COMPUTER STUDIES

THE FEDERAL POLYTECHNIC ADO-EKITI

IN PARTIAL FULFILLMENT OF THE AWARD OF NATIONAL

DIPLOMA (ND) IN SCIENCE TECHNOLOGY OF THE
FEDERAL POLYTECHNIC ADO EKITI

NOVEMBER, 2022

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 ABSTRACT

Hypertension, the leading risk factor for cardiovascular disease, originates from combined

genetic, environmental, and social determinants. Environmental factors include

overweight/obesity, unhealthy diet, excessive dietary sodium, inadequate dietary potassium,

insufficient physical activity, and consumption of alcohol. Prevention and control of

hypertension can be achieved through targeted and/or population-based strategies. For control of

hypertension, the traditional strategy used in health care practice is the targeted approach, which

seeks to achieve a clinically significant reduction in BP for individuals at the upper end of the BP

distribution. The targeted approach is used in the management of hypertensive patients, but it is

also well-proven as an effective strategy for hypertension prevention in those at high risk of

developing hypertension. The population-based strategy is based on mass environmental control

experience in public health.

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1.0 INTRODUCTION

Hypertension remains one of the most significant causes of mortality worldwide. It is

preventable by medication and lifestyle modification. Office blood pressure (BP), out-of-office

BP measurement with ambulatory BP monitoring, and self-BP measurement at home are reliable

and important data for assessing hypertension. Primary hypertension can be defined as an

elevated BP of unknown cause due to cardiovascular risk factors resulting from changes in

environmental and lifestyle factors. Another type, secondary hypertension, is caused by various

toxicities, iatrogenic disease, and congenital diseases. Complications of hypertension are the

clinical outcomes of persistently high BP that result in cardiovascular disease (CVD),

atherosclerosis, kidney disease, diabetes mellitus, metabolic syndrome, preeclampsia, erectile

dysfunction, and eye disease (Al-Disi et al., 2015).

In Africa in particular, a large portion of the population continues to use traditional medicines

rather than modern drugs for primary health care (WHO, 2001; 2002).

Several surveys have been carried out in Morocco on plants used against arterial hypertension

(Ziyyat et al., 1997). While studies on the topic are much less numerous in the other African

countries.

The rising prevalence of chronic diseases like hypertension poses a public health challenge.

Hypertension is becoming more common among women, adolescents, and older adults.

According to the Iraqi national survey for chronic disease risk factors conducted in 2006, 40.4%

of the Iraqi adult population has high blood pressure. In addition, hypertension is regarded as one

of the most important modifiable risk factors for coronary heart disease, stroke, congestive heart

disease, end-stage renal disease, and peripheral vascular disease. Blood pressure is actually a

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measure of two pressures, the systolic and the diastolic. The systolic pressure (the higher

pressure and the first number recorded) is the force that blood exerts on the artery walls as the

heart contracts to pump the blood to the peripheral organs and tissues. The diastolic pressure (the

lower pressure and the second number recorded) is residual pressure exerted on the arteries as

the heart relaxes between beats. 

1.1 PATHOPHYSIOLOGICAL DETERMINANTS OF HIGH BP

Hypertension can be divided into primary and secondary forms. Primary (essential) hypertension

accounts for the vast majority (>90%) of cases, and poor diet and insufficient physical activity

seem to be important and potentially reversible environmental causes. A specific, sometimes

remediable cause of hypertension can be identified in approximately 10% of adults with

hypertension, termed secondary hypertension (Roger et al., 2011). If the cause can be accurately

diagnosed and treated, patients with secondary hypertension can achieve normalization of BP or

marked improvement in BP control, with concomitant reduction in CVD risk (Roger et al.,

2011). The majority of patients with secondary hypertension have primary aldosteronism or renal

parenchymal or renal vascular disease, whereas the remainder may have more unusual endocrine

disorders or drug- or alcohol-induced hypertension.

1.2 HERBAL MEDICINES USED FOR THE TREATMENT OF HYPERTENSION

Many antihypertensive agents used in the treatment of hypertension (HTN) have some side

effects. Therefore, Secondary metabolites of some herbs and spices display antihypertensive

properties. Most herbal medicines control and reduce hypertension (HTN) by exerting

antioxidant, anti-inflammatory, and anti-apoptosis properties, stimulating the eNOS-NO

signaling pathway, suppressing endothelial permeability, and activating angiogenesis (Hashemi

et al., 2017).

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1.2.1 Ajwain (Carum copticum L.)

Carum copticum belongs to the Apiaceae family and grows in various regions of Central Europe,

Iran (particularly the eastern areas of Baluchistan), India, Afghanistan, and Pakistan. As a result

of its calcium channel blocking effect, C. copticum has a notable role in regulating heart rate and

blood pressure. The aqueous-methanolic extract of C. copticum Benth. Seeds (CSE) (1-30

mg/kg) causes a decrease in blood pressure (BP) and heart rate (HR) of normotensive (NMT)

rats. At larger doses (10-30 mg/kg), bradycardia has been reported (Hashemi et al., 2017)

1.2.2 Bindii (Tribulus terrestris)

Tribulus terrestris is a medicinal plant used for treating HYPERTENSION (HTN). Bindii causes

a decrease in BP in spontaneously hypertensive (SHR) rats. Its methanolic and aqueous extracts

(0.3–15 mg/mL) have been shown to have vasodilatory properties (Sinha and Agarwal, 2019).

This plant is used for its diuretic effects. Furthermore, all of the saponins (furostanol and

spirostanol saponins and sulphated saponins of tigogenin and diosgenin) of this plant prevent the

production of H2O2 along with the proliferation of vascular smooth muscle cells (VSMCs) (Singh

et al., 2015).

1.2.3 Black-Jack (Bidens pilosa L.)

Black Jack, from the Asteraceae family, is an annual plant that grows in South America and is

also found in tropical and subtropical regions around the world. Black Jack leaf extract was able

to inhibit and reduce hypertension (HTN) in different rat models (Rastogi et al., 2016). In

fructose-fed rats, six hours after treatment with 75 and 150 mg/kg of methanolic leaf extract,

SBP was decreased by 17% and 21%, respectively (Jacob and Narendhirakannan, 2019).

Additionally, B. pilosa has anti-cancer and anti-obesity effects as well as radical scavenging

ability (Shayganni et al., 2016).

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1.2.4 Black plum (Vitex doniana)

After oral administration of the fresh black plum fruit, both systolic blood pressure (SBP) and

Diastolic blood pressure (DBP) were considerably diminished in 45 minutes. BP began returning

to standard after 2 hours.

1.2.5 Greater burdock (Arctium Lappa)

Burdock is also used for the treatment of hypertension (HTN). This plant has reactive oxygen

species (ROS) scavenging action, is able to inhibit vascular inflammation, and can stimulate

vasorelaxation. Arctigenin (a dietary phytoestrogen) is one bioactive component in the dry seeds

of burdock that causes an increase in NO production and a decrease in the levels of superoxide

anion (Kaur and Khanna, 2012).

1.2.6 Burhead (Echinodorus grandiflorus)

Echinodorus grandiflorus is used in Brazilian folk medicine as a diuretic drug. The aqueous

extracts of this plant can cause a decline in the mean arterial pressure (MAP) in addition to

cardiac output and vascular resistance in School of Science and Rehabilitation Science (SHRs).

Burhead also induces persistent diuresis and decreased BP by activating muscarinic and

bradykinin receptors with effects on prostaglandins and nitric oxide pathways (Rawat et al.,

2016)

1.2.7 Cardamom (Elettaria cardamomum)

Elettaria cardamomum fruit powder has been assessed for its antihypertensive capability. In

powder form (3 g), it has been shown to reduce mean MAP as well as systolic blood pressure

(SBP) and Diastolic blood pressure (DBP) by 19 and 12 mm Hg, respectively in pre-

hypertensive subjects by increasing the total antioxidant status (Lacolley et al., 2012).

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1.2.8 Carrot (Daucus carota L.)

Carrot has been used in traditional medicine as an antihypertensive mediator. Daucus carota L.

improves endothelial function and regulates fluid balance. Carrot juice is rich in antioxidants,

which decrease oxidative stress and control the function and structure of blood vessels. Carrots

regulate BP because of the existence of potassium. Intravenous administration of the bioactive

components of the aerial parts of D. carota, including DC-2 and DC-3, triggered a decrease in

arterial BP in NMT rats. DC-2 and DC-3 can act by obstructing calcium channels (Sehgel et al.,

2013)

1.2.9 Cat’s Claw herb (Uncaria rhynchophylla)

Cat’s claw is an herb used in traditional Chinese medicine to treat hypertension (HTN). This

plant causes a decrease in BP and relieves different neurological symptoms. Hirsutine (an indole

alkaloid) is responsible for the hypotensive function of Uncaria rhynchophylla, which decreases

intracellular Ca2+ levels through its effect on the Ca2+ store and its effects on the voltage-

dependent Ca2+ channel (Rostamzadeh et al., 2016).

1.2.10 Celery (Apium graveolens)

The seed extract of celery has been shown to have a BP-reducing effect in deoxy corticosterone

acetate (DOCA)–induced hypertensive rats. The hexane extract is considerably more effective in

reducing BP, probably by reducing levels of circulating catecholamines and diminishing

vascular resistance. Extraordinarily, it has antioxidant effects due to the virtue of its flavonoid

content (Song and Zou, 2012).

1.2.11 Chakshushya (Cassia absus L.)

Cassia absus is a plant of the family Fabaceae with Ayurvedic ethnomedical records. This plant

occurs in tropical areas and all over India. Intravenous administration of the alkaloid isolated

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from the seeds of Cassia absus Linn (1-30 mg/kg) reduces BP in rats. At higher doses (10 and 30

mg/kg), it causes a decline in HR. Frequent injection of a similar dose induces tachyphylaxis.

1.2.12 Chinese Sage (Salvia miltiorrhiza)

A traditional Chinese herb, Salvia miltiorrhiza, has been revealed to have cardioprotective

effects on animals and humans. In addition to its vasodilatory capability, Chinese sage possesses

anti-hypertensive properties including antioxidative effects through decreased ROS production,

increased antioxidative enzymes, and anti-proliferative activities by preventing platelet-derived

growth factor (PDGF)-induced proliferation of vascular smooth muscle cells (VSMCs), and

antiinflammatory capacity by inhibiting TNF-α and NF-κB production (Zhang et al., 2011).

1.2.13 Cinnamon (Cinnamomum zeylanicum)

Another plant used for the treatment of hypertension (HTN) is Cinnamomum zeylanicum.

Cinnamon has reduced BP in numerous rat models and in people with prediabetes and type2

diabetes (T2D). The aqueous extract of its stem bark causes a reduction in SBP and prevents

contractions prompted by potassium chloride (also known as KCl), related to the endothelium,

NO, and ATP-sensitive K+ channel (K ATP channel). The methanolic extract of the bark

increases NO levels (Pourjabali et al., 2017).

1.3 CAUSES OF HIGH BLOOD PRESSURE

The cause of hypertension is often not known. In many cases, it is the result of an underlying

condition.

High blood pressure that is not due to another condition or disease is known as primary or

essential hypertension. If an underlying condition is a cause of increased blood pressure, doctors

call this secondary hypertension.

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Primary hypertension can result from multiple factors, including:

 having obesity

 insulin resistance

 high salt intake

 excessive alcohol intake

 having a sedentary lifestyle

 smoking

Secondary hypertension has specific causes and is a complication of another health

problem.

Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no

longer filter out fluid. This excess fluid leads to hypertension. Hypertension can also cause CKD.

Other conditions that can lead to hypertension include:

 diabetes, due to kidney problems and nerve damage

 pheochromocytoma, a rare cancer of an adrenal gland

 Cushing’s syndrome

 congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands

 hyperthyroidism, or an overactive thyroid gland

 hyperparathyroidism, which affects calcium and phosphorous levels

 pregnancy

 sleep apnea

 obesity

1.3.1 Risk factors

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A number of factors increase the risk of hypertension.

 Age: Hypertension is more common in people who are more than 65 years. Blood

pressure can increase steadily with age as the arteries stiffen and narrow due to plaque

buildup.

 Ethnicity: Some ethnic groups are more prone to hypertension than others. African

Americans have a higher risk  than other ethnic groups, for example.

 Weight: Having obesity is a primary risk factor for hypertension.

 Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco

can increase blood pressure.

 Sex: According to a 2018 review trusted Source, males have a higher risk of developing

hypertension than females. However, this is only until after females reach menopause.

 Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease,

and high cholesterol levels can lead to hypertension, especially as people age.

1.3.2 Symptoms

A person with hypertension may not notice any symptoms, and so people often call it a “silent

killer.” Without detection, hypertension can damage the heart, blood vessels, and other organs,

such as the kidneys.

It is vital to check blood pressure regularly.

In rare and severe cases, high blood pressure can cause:

 sweating

 anxiety

 sleeping problems

 blushing

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However, most people with hypertension will experience no symptoms at all.

If high blood pressure becomes a hypertensive crisis, a person may experience headaches and

nosebleeds (Sinha and Agarwal, 2019).

1.3.3 Complications

Long-term hypertension can cause complications through atherosclerosis, where plaque develops

on the walls of blood vessels, causing them to narrow.

This narrowing makes hypertension worse, as the heart must pump harder to circulate the blood.

Hypertension-related atherosclerosis can lead to:

 heart failure and heart attacks

 aneurysm, or an atypical bulge in the wall of an artery that can burst

 kidney failure

 stroke

 amputation

 hypertensive retinopathies in the eye, which can lead to blindness

1.4 DIAGNOSIS OF HYPERTENSION: BP MEASUREMENT

1.4.1 Accurate BP measurement 

The science underpinning prevention and treatment of high BP has progressively become

stronger, but much remains to be done to ensure that this knowledge is translated to clinical

practice. A fundamental need is to improve the quality of the BP measurements used for

diagnosis and management of hypertension. Estimation of BP is highly prone to systematic and

random error, but simple guideline-recommended approaches minimize these errors.

Unfortunately, the quality of BP assessments in clinical practice is very poor (Sharifi et al.,

2003). Improvements in the quality of office-based measurements through training of clinicians

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or designated staff members is essential to translation of clinical practice recommendations for

detection and management of hypertension. An important complement or alternative is to train

patients in accurate measurement of BP. Initiatives such as Million Hearts and Target BP are

important steps in reaching this goal.

1.4.2 BP self-monitoring/Tele monitoring 

Several randomized controlled trials, systematic reviews, and meta-analyses have shown that

self-monitoring of BP (especially as a part of a multifaceted intervention) can lead to slightly

improved BP control, possibly as a result of better adherence to treatment (Leong et al., 2013).

The most effective approaches use telemonitoring (discussed later), whereby readings made at

home are relayed to a health care professional who can take appropriate action. These studies

showed that home telemonitoring for hypertension can produce reliable and accurate data and is

well-accepted by patients. Self-monitoring with self-titration of antihypertensive medication

compared with usual care resulted in lower SBP at 12 months among individuals with high CVD

risk in the TASMIN2 trial (Jaarin et al., 2015).

1.4.3 Ambulatory BP monitoring 

The United States Preventive Services Task Force and the 2017 American College of Cardiology

(ACC) and the American Heart Association (AHA) guideline recommend conducting out-of-

office BP measurements, preferably with ambulatory BP monitoring (ABPM), to confirm the

diagnosis of hypertension among patients with high BP in the clinic and to identify masked

hypertension (Kundu et al., 2013). Between 15% and 30% of adults with systolic blood pressure

(SBP) > 140 mm Hg or Diastolic blood pressure (DBP) > 90 mm Hg, based on measurements

obtained in the clinic, have white-coat hypertension, defined by mean awake SBP < 135 mm Hg

and DBP < 85 mm Hg based on ABPM (Bartolome et al., 2013). Although white-coat

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hypertension has been associated with only a modestly increased risk for CVD compared with

sustained normotension (nonhypertensive BP in the clinic and outside of the clinic on ABPM), a

recent large observational study indicates that white-coat hypertension may not be benign.

Additionally, between 15% and 30% of adults without hypertension, based on BP measured in

the clinic (SBP < 140 mm Hg and DBP < 90 mm Hg), have masked hypertension, mean awake

SBP > 135 mm Hg or DBP > 85 mm Hg on ABPM. In observational studies, masked

hypertension has consistently been associated with a 2 times higher risk for CVD. Patients with

clinic BP that is 10 mm Hg above or below the threshold for hypertension are the groups most

likely to have white-coat hypertension and masked hypertension, respectively. Despite the

potential value of Ambulatory Blood Pressure Monitoring (ABPM) for accurately diagnosing

hypertension, it is not commonly performed in clinical practice in the United States. Barriers

limiting the use of Ambulatory Blood Pressure Monitoring (ABPM) include the lack of

knowledge among clinicians in how to conduct the procedure, limited access to specialists to

conduct the test, and low reimbursement (Wang and Xiong, 2012). Addressing these barriers and

increasing the use of ABPM should be a high priority for ensuring antihypertensive medication is

appropriately initiated and intensified.

1.5 HYPERTENSION CONTROL

Prevention and control of hypertension can be achieved by application of targeted and/or

population-based strategies. The targeted approach is the traditional strategy used in health care

practice and seeks to achieve a clinically important reduction in BP for individuals at the upper

end of the BP distribution. The targeted approach is used in the management of patients with

hypertension, but the same approach is well-proven as an effective strategy for prevention of

hypertension in those at high risk of developing hypertension. The population-based strategy is

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derived from public health mass environmental control experience. It aims to achieve a smaller

reduction in BP that is applied to the entire population, resulting in a small downward shift in the

entire BP distribution (Singh et al., 2015).

CONCLUSION

In conclusion, this study has highlighted various medicinal and food plants used in Nigeria for

management of hypertension. Most of these plants are readily available and affordable at various

regions of the countries. However, more research is warranted to identify the most abundant

plant in each region of the country and educate individuals on proper use of the medicinal plants

with scientific evidence of efficacy. Further to scientific verification of pharmacological effect of

the medicinal plants, research to isolate and chemically characterize the bioactive principle

responsible for the antihypertensive effect should also be done as a prerequisite for drug

development candidature.

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