Received: 20 November 2018 Revised: 5 March 2019 Accepted: 16 March 2019

DOI: 10.1002/ptr.6362

REVIEW

Does ginger supplementation lower blood pressure? A

systematic review and meta‐analysis of clinical trials

Hossein Hasani1 | Arman Arab2 | Amir Hadi3 | Makan Pourmasoumi4 |

Abed Ghavami5 | Maryam Miraghajani6,7

1
Department of Community Nutrition, School
of Nutritional Sciences and Dietetics, Tehran The aim of the present systematic review and meta‐analysis was to determine the
University of Medical Sciences, Tehran, Iran
efficacy of ginger supplementation on blood pressure (BP). PubMed, Scopus, ISI
2
Department of Community Nutrition, School
of Nutrition and Food Science, Food Security Web of Science, Cochrane Library, and Google Scholar were comprehensively
Research Center, Isfahan University of Medical searched until September 2018. Human clinical trials, which reported the effect of
Sciences, Isfahan, Iran
3
ginger supplementation on aortic and/or brachial BP, were included. Mean differ-
Halal Research Center of IRI, FDA, Tehran,
Iran ences were pooled using a random effects model. Standard methods were used for
4
Gastrointestinal and Liver Diseases Research assessment of heterogeneity, sensitivity analysis, and publication bias. Total of six
Center (GLDRC), Guilan University of Medical
Sciences (GUMS), Rasht, Iran
randomized clinical trials (345 participants) were included in the meta‐analysis.
5
Depart Pooled analysis suggested that ginger supplementation can reduced systolic BP
ment of Nutrition, School of Nutrition, Tabriz (MD: −6.36 mmHg, 95% confidence interval [−11.27, −1.46]; I2 = 89.8%; P = .011)
University of Medical Sciences, Tabriz, Iran
6 and diastolic BP (MD: −2.12 mmHg, 95% confidence interval [−3.92, −0.31];
Cancer Research Center, Shahid Beheshti
University of Medical Sciences, Tehran, Iran I2 = 73.4%; P = .002). When studies were categorized based on participants' mean
7
The Early Life Research Unit, Division of age, ginger dosage and duration of intervention, systolic BP and diastolic BP were sig-
Child Health, Obstetrics and Gynaecology,
University of Nottingham, Nottingham, UK nificantly decreased only in the subset of studies with mean age ≤ 50 years, follow‐
up duration of ≤8 weeks and ginger doses ≥3 g/d. Our findings revealed that ginger
Correspondence
Amir Hadi, Halal Research Center of IRI, FDA, supplementation has favorable effects on BP. Nonetheless, further studies are war-
Tehran, Iran. ranted before definitive conclusions may be reached.
Email: hadi@halal.ac.ir
Maryam Miraghajani, Cancer research center, K E Y W OR D S
Shahid Beheshti University of Medical
Sciences, Tehran, Iran. blood pressure, ginger, meta‐analysis, systematic review
Email: ms.miraghajani@yahoo.com; maryam.
sadatmiraghajani@nottingham.ac.uk

1 | I N T RO D U CT I O N standard guidelines for hypertension medical care, lifestyle modifica-

Hypertension, or high blood pressure (BP), is a global public health
problem with an increasing incidence worldwide (Bahadoran,
Mirmiran, Kabir, Azizi, & Ghasemi, 2017; Mills et al., 2016). Estimates
indicate that about 1 billion people suffer from this condition all over
the world and it is predicted that this number will reach more than 1.5
billion by 2025 (Kearney et al., 2005). Elevated BP has also been
known to be a strong risk factor for renal failure, stroke, heart disease,
and all‐cause mortality and morbidity (Kafeshani et al., 2017; Serban,
Sahebkar, Ursoniu, Andrica, & Banach, 2015). There are various
approaches to dealing with high BP in the community. In most
tions like dietary change (increasing consumption of fresh fruits, vege-
tables, low‐fat dairy products, and sodium reduction) and exercise, as
well as drug interventions were recommended, with confirmed effi-
cacy (Gabb et al., 2016; James et al., 2014; Moran et al., 2015). Nev-
ertheless, there is increasing interest in the use of natural BP‐
lowering compounds that may delay or circumvent drug therapy. In
this regard, herbal interventions have received much attention in the
literature (Homayouni, Haidari, Hedayati, Zakerkish, & Ahmadi, 2018;
Serban et al., 2016; Xiong, Wang, Zhang, & Li, 2015).
Ginger with the scientific name of Zingiber officinale is one of the
most widely used spices and medicinal plants around the world,

Phytotherapy Research. 2019;1–9. wileyonlinelibrary.com/journal/ptr © 2019 John Wiley & Sons, Ltd. 1
2 HASANI
especially in Asian countries (Ebrahimzadeh Attari et al., 2018;
Pourmasoumi et al., 2018). Traditionally, this spice was administered
to treat nervous diseases, gastrointestinal problems, cataract, rheuma-
tism, diabetes, and nausea caused by pregnancy and chemotherapy
(Chen, May, Zhou, Zhang, & Xue, 2016; Langner, Greifenberg, &
Gruenwald, 1998; White, 2007). In addition, ginger contains active
phenolic compounds such as gingerol, paradol, shogaol, and vitamin
C that have antioxidant, anti‐inflammatory, anticancer, and
antiatherosclerotic properties (Ali, Blunden, Tanira, & Nemmar, 2008;
Sahebkar, 2011; Shidfar et al., 2015; Thomson et al., 2002).
The effect of ginger supplementation on BP is considered in
some human randomized clinical trials (RCTs; Arablou, Aryaeian,
Valizadeh, Hosseini, & Djalali, 2014; Arzati et al., 2017; Azimi et al.,
2016; Nayebifar, Afzalpour, Kazemi, Eivary, & Mogharnasi, 2017;
SHahdadi, Sepehri, Poodineh Moghadam, & Kiani, 2014; Talaei,
Mozaffari, & Bahreini, 2014); however, the results are not fully
conclusive. Some studies have reported significant improvement in
systolic BP (SBP) and/or diastolic BP (DBP) as a result of ginger con-
sumption (Nayebifar et al., 2017; SHahdadi et al., 2014; Talaei et al.,
2014), whereas others did not observe such improvement (Arablou
et al., 2014; Arzati et al., 2017; Azimi et al., 2016). These inconsis-
tencies in clinical findings might be explained by the differences in
study design and/or characteristics of subjects (age, sex, health
status, and so on).
To the best of our knowledge, no study has been conducted trying
to summarize the effect of ginger on BP. Therefore, in this present
study, we aimed to perform a comprehensive systematic review and
meta‐analysis of available controlled trials to help quantify the overall
effect of ginger on BP in adults.
2 | MATERIALS AND METHODS
The protocol of the current research was registered in the interna-
tional prospective register of systematic reviews (PROSPERO) data-
base (http://www.crd.york.ac.uk/PROSPERO), with registration code
of CRD42018109975. In addition, during the preparation and presen-
tation of this review, the PRISMA guidelines (Moher, Liberati, Tetzlaff,
& Altman, 2009) were followed.
2.1 | Search strategy
Five databases, including PubMed (http://www.ncbi.nlm.nih.gov),
Scopus (http://www.scopus.com), Cochrane Library (http://www.
cochranelibrary.com), ISI Web of Science (http://www.webofscience.
com), and Google Scholar (http://scholar.google.com) were explored
with no language or time frame restriction up to September 15,
2018. The search strategy was drawn up using following keywords
and Medical Subject Heading terms: “Ginger,” “Zingiber,” “Zingiber
officinale,” combined with “BP,” “SBP,” and “DBP” (Table S1). We used
Boolean operators (“AND” and “OR”) to connect the terms listed
above. We checked the citation lists of review articles and included
ET AL.
studies. To reveal additional relevant studies, the reference lists of
all identified articles were also inspected.
2.2 | Study selection
The EndNote software, version X6 (Thomson Reuters), was used for
record management. After removing duplicates and publications
without an abstract, the remaining articles were independently
screened by two authors (A. H. and H. H.) based on the title and
abstract, and irrelevant records, animal studies, and reviews were
excluded. Then, the full text of remaining articles was investigated
profoundly to choose only related studies. Finally, all RCTs (either
parallel or crossover designs) that examined the effects of ginger
supplementation on BP in adults (age ≥ 18 years old) were selected.
Studies with short duration of follow‐up (<2 weeks), publications
with duplicate data, and also trials without an appropriate control
group were excluded. Disagreement between reviewers was resolved
by discussion or, if it was necessary, by consulting with a third
reviewer (M. P.).
2.3 | Data extraction
Two investigators (A. H. and H. H.) abstracted relevant data from the
selected trials. This process was verified by another investigator (M.
P.). The following methodological and outcome variables from each
included papers were extracted, using a data abstraction form: first
author's last name, publication time, country in which the study
was performed, research design, participant characteristics (mean
age, gender, and body mass index [BMI]), sample size, intervention
duration (week), type and dose of supplements/placebo used in
intervention/control group, and the interest outcomes including
SBP and DBP.
2.4 | Quality assessment
The methodological quality of enrolled studies was assessed using the
scoring system developed by Jadad, where total score ranges 0 to 5
points based on the five items: (a) randomization, (b) methods of ran-
domization, (c) blinding, (d) suitable method of double blinding, and (e)
withdrawn or dropout explanation. The scores of 3 or more repre-
sented high quality w 0–2 indicated a low‐quality study. This section
was also independently accomplished by two researchers (A. H. and
H. H.). Final scores were discussed by the investigators to make a
consensus.
2.5 | Statistical analysis
The mean change in BP parameters (SBP and DBP) and their corre-
sponding standard deviations (SDs) for ginger supplemented and
the control groups or periods were derived to calculate the differ-
ence in mean and its standard error (SE) for each study, which was
used as effect size for the meta‐analysis. In the case that SE of mean
HASANI ET AL.
was only reported, SD was calculated using the following formula:
SD = SE × square root (n), where n is the number of participants
in each group (Higgins & Green, 2014). When results were presented
in multiple time points, only data relating to the longest duration of
treatment were considered. All meta‐analyses were done using the
random effects model, which takes the between‐study variability
into account. The presence of between‐study heterogeneity was
2
assessed by the I statistic. Low, moderate, and high heterogeneity
was ascribed to I2 values less than 25%, between 25 and 50%, and
over 50%, respectively (Green & Higgins, 2005). To find the potential
sources of between‐study heterogeneity, we carried out
preplanned subgroup analysis based on participants' mean age, gin-
ger dosage, and duration of intervention. Heterogeneity between
subgroups was evaluated using a fixed‐effect model. Sensitivity anal-
ysis was also executed in order to evaluate the influence of every
single study on the overall effect size. We used the statistical asym-
metry tests (Egger's regression asymmetry test and Begg's adjusted
rank correlation test) to evaluate publication bias (Egger, Smith,
Schneider, & Minder, 1997; Begg & Mazumdar, 1994). All analyses
were carried out using the STATA software (version 11.2, Stata
Corp, College Station, TX, USA) and two‐sided p values <0.05 were
considered statistically significant.
3 | RESULTS
A total of 354 potentially relevant studies were identified through
electronic search. After removing duplicate records (n = 184), 170
FIGURE 1 PRISMA flow diagram of study
selection process [Colour figure can be
viewed at wileyonlinelibrary.com]
3
articles remained for screening the titles or abstracts; and 10 studies
of them were selected for the full‐text evaluation. Among the
remained articles, five were excluded for the following reasons: study
duration less than 2 weeks (n = 2) and duplication data (n = 2). There-
fore, six studies (Arablou et al., 2014; Arzati et al., 2017; Azimi et al.,
2016; Nayebifar et al., 2017; SHahdadi et al., 2014; Talaei et al.,
2014) met the eligibility criteria and were included in systematic
review and meta‐analysis. A flow chart of the systematic search and
study selection process is presented in Figure 1.
a
3.1 | Study characteristics
The included trials in the current meta‐analysis were carried out from
2014 to 2018 with 175 participants in supplementation and 170 in the
control groups. All the studies were accomplished in Iran and were
designed as parallel trials. Participant's mean age ranged from 22 to
54 years old. The dose of ginger varied between 0.5 and 3 g/d; and
the intervention duration ranged from 7 to 12 weeks. Most studies
were conducted on type 2 diabetes mellitus patients, and just two
studies (Nayebifar et al., 2017; SHahdadi et al., 2014) examined the
effects of ginger on patients with hyperlipidemia and overweight sub-
jects. Only two of included trials (Nayebifar et al., 2017; SHahdadi
et al., 2014) were exclusively performed on men or women, and the
remaining trials included both sexes. Baseline BMI of participants in
each study showed that all trials examined overweight subjects
(BMI > 25 kg/m2). The characteristics of the six eligible articles are
summarized in Table 1.
4 HASANI ET AL.

3.2 | Assessment of the quality of studies

Jaded
score

3
According to Jadad scores, all studies were classified as high‐quality

DBP ↔

DBP ↔

DBP ↔

DBP ↔
Results

SBP ↔

SBP ↔

SBP ↔

SBP ↔
studies (score ≥ 3) except in one study (Azimi et al., 2016). All were

DBP ↓

DBP ↓
SBP ↓

SBP ↓
randomized, and the randomization method was explained in most
papers except the studies by SHahdadi et al. (SHahdadi et al., 2014),

Placebo + training

Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; F, female; M, male; RCT, randomized controlled trial; SBP, systolic blood pressure; T2DM, type 2 diabetes mellitus.
Arablou et al. (Arablou et al., 2014), and Nayebifar et al. (Nayebifar
et al., 2017). Blindness was also reported in all studies except the
Comparison

Black tea
study by Azimi et al. (Azimi et al., 2016). Only three studies (Arablou
Placebo

Placebo

Placebo

Placebo
group

et al., 2014; Arzati et al., 2017; SHahdadi et al., 2014) were explained
the method of blindness. In addition, details related to dropouts were
reported in four studies (Arablou et al., 2014; Arzati et al., 2017;
0.5‐g/d ginger powder

1.6‐g/d ginger powder

3‐g/d ginger powder

2‐g/d ginger powder

3‐g/d ginger powder

3‐g/d ginger powder

Nayebifar et al., 2017; SHahdadi et al., 2014). The result of the quality
Dose and type of

assessment is reported in the last column of Table 1.

+ black tea
intervention

+ training

3.3 | Effect of ginger supplementation on BP

Forest plots summarizing the efficacy of ginger supplementation on

Hyperlipidemia
Subject type

SBP and DBP are shown in Figures 2 and 3, respectively. Pooling six
Overweight

trials together identified significant reduction for SBP (MD:

T2DM

T2DM

T2DM

T2DM

−6.36 mmHg; 95% CI [−11.27, −1.46]; P = .011) after ginger supple-

mentation than placebo consumption. However, significant heteroge-
neity was identified among the studies (I2 = 89.8%; P < .001).
Duration
(weeks)

Therefore, studies were classified by participants' mean age, ginger

7

8
12

10

10

dosage, and duration of the intervention. Subgroup analysis showed

that participants' mean age was potential sources of heterogeneity
Parallel (yes)

Parallel (yes)

Parallel (yes)

Parallel (yes)

Parallel (yes)
Parallel (no)
RCT design

(>50 years, I2 = 0.0%). However, results revealed that SBP was signif-
(blinding)

icantly decreased only in participants with mean age ≤ 50 years (MD:

−9.25 mmHg; 95% CI [−14.80, −3.70]; I2 = 88.1%), study duration
≤8 weeks (MD: −7.95 mmHg, 95% CI [−15.61, −0.29]; I2 = 94.4%),
Mean BMI

or ginger supplementation ≥3 g/day (MD: −9.46 mmHg, 95% CI

(kg/m2)

[−18.90, −0.01]; I2 = 94.3%; Table 2).

27

27

28

29

28

28

Pooled effect size also revealed a significant reduction in DBP fol-

lowing ginger supplementation (MD: −2.12 mmHg, 95% CI [−3.92,
Mean age

−0.31]; P = .002) with high inter‐studies heterogeneity (I2 = 73.4%;

(year)

35

52

54

50

22

50

P = .002). Subgroup analysis showed that participants' mean age was

potential sources of heterogeneity (>50 years, I2 = 0.0%). However,
(intervention/control)

the stratified analysis revealed that DBP was significantly decreased

only in the subset of studies with mean age ≤ 50 years (MD:
−2.84 mmHg; 95% CI [−5.09, −0.59]; I2 = 74.6%), follow‐up duration
Sample size
Characteristics of included studies

of ≤8 weeks (MD: −3.17 mmHg; 95% CI [−5.57, −0.77]; I2 = 80.6%),

8/8
30/30

33/30

41/39

23/22

40/41

and ginger doses ≥3 g/day (MD: −3.21 mmHg; 95% CI [−5.78,

−0.63]; I2 = 80.6%; Table 2).
Country

Iran

Iran

Iran

Iran

Iran

Iran

3.4 | Sensitivity analysis

Nayebifar et al. (2017)
SHahdadi et al. (2014)

Arablou et al. (2014)

Sensitivity analysis was performed by omitting individual studies and

Arzati et al. (2017)

Talaei et al. (2014)

Azimi et al. (2016)
(publication year)

assessing the effect on overall results of the meta‐analysis. This anal-

ysis for SBP revealed that omitting studies done by SHahdadi et al.
First author
TABLE 1

(2014) and Nayebifar et al. (2017) changes the results to nonsignifi-

cant values (MD: −6.30 mmHg; 95% CI [−13.01, 0.40] and MD:
−5.47 mmHg; 95% CI [−11.06, 0.12], respectively). Removal of the
HASANI ET AL. 5

FIGURE 2 Forest plot of the effect of ginger supplementation on systolic blood pressure [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 3 Forest plot of the effect of ginger supplementation on diastolic blood pressure [Colour figure can be viewed at wileyonlinelibrary.
com]

aforementioned studies changed the overall effect of DBP to nonsig- 3.5 | Publication bias
nificant, as well (MD: −1.83 mmHg; 95% CI [−4.17, 0.51]) and (MD:
−1.85 mmHg; 95% CI [−4.09, 0.37]) for SHahdadi et al. (2014) and Begg's rank correlation and Egger's weighted regression tests were
Nayebifar et al. (2017), respectively. performed to explore the publication bias. The tests found no
6 HASANI ET AL.

TABLE 2 Subgroup analysis to assess the effect of ginger supplementation on systolic blood pressure and diastolic blood pressure

No. of No. of P for P for between

Subgrouped by trials participants Effect sizea 95% CI I2 (%) heterogeneity subgroup heterogeneity

SBP
Age <.001
≤50 years 4 186 −9.25 [−14.80, −3.70] 88.1 <.001
>50 years 2 159 −0.79 [−3.63, 2.06] 0.0 .627
Duration .101
≤8 weeks 3 221 −7.95 [−15.61, −0.29] 94.4 .001
>8 weeks 3 124 −4.62 [−11.29, 2.05] 81.4 .005
Dose .005
<3 g/d 3 168 −3.52 [−7.72, 0.68] 67.9 .044
≥3 g/d 3 177 −9.46 [−18.90, −0.01] 94.3 <.001
DBP
Age .011
≤50 years 4 186 −2.84 [−5.09, −0.59] 74.6 .008
>50 years 2 159 −0.87 [−2.42, 0.69] 0.0 .002
Duration .103
≤8 weeks 3 221 −3.17 [−5.57, −0.77] 80.6 .006
>8 weeks 3 124 −0.63 [−3.65, 2.40] 65.5 .002
Dose
<3 g/d 3 168 −0.65 [−3.70, 2.40] 69.1 .039 .156
≥3 g/d 3 177 −3.21 [−5.78, −0.63] 80.6 .006

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure.

a
Calculated by random effects model.

evidence of publication bias for SBP (Begg's test = 0.85, Egger's
test = 0.29) and DBP (Begg's test = 0.18, Egger's test = 0.81).
3.6 | Adverse effects
Ginger has been supplemented in a wide range of doses in human
and animal investigations, and there is an extensive agreement
regarding its nontoxicity (Rondanelli et al., 2017; Weidner & Sigwart,
2000; White, 2007). However, there is documented that ginger can
result in some unwilling side effects such as dyspepsia, nausea, gas-
case, a comprehensive systematic review of available clinical trials can
represent the most reliable evidence of medicinal plant efficacy
(Colalto, 2018; Izzo, Hoon‐Kim, Radhakrishnan, & Williamson, 2016).
To our knowledge, this is the first systematic review and meta‐
analysis of RCTs regarding the effect of ginger supplementation on
BP parameters. Generally, results of this research suggest a potential
role of ginger as a BP lowering agent in spite of considerable heteroge-
neity. When studies were categorized based on participants' mean age,
ginger dosage, and duration of intervention, SBP and DBP were signif-
icantly decreased only in the subset of studies with mean age ≤ 50 years,

tric irritant, and heartburn in high dosage (Chrubasik, Pittler, &
Roufogalis, 2005; Kafeshani, 2015; Pourmasoumi et al., 2018). Fur-
thermore, ginger could reduce the bleeding time and should be con-
sumed with caution along with blood thinners such as warfarin
(coumadin) or aspirin (Nurtjahja‐Tjendraputra, Ammit, Roufogalis,
Tran, & Duke, 2003).
4 | DISCUSSION
Although the facts showed that herbal remedies are generally better
tolerated than synthetic medications, there is a lack of conclusive infor-
mation in efficacy and their possible side effects on diseases, which
made it one of the most important problems faced by doctors. In this
follow‐up duration of ≤8 weeks, and ginger doses ≥3 g/day.
The precise mechanisms for the effect of ginger on BP reduction
are not fully explored. However, the antihypertensive effect of ginger
can be partly attributed to its antioxidative activities (Azimi et al.,
2016; Ghayur, Gilani, Afridi, & Houghton, 2005). Laboratory results
indicate that ginger contains abundant phenolic compounds such as
various types of gingerols, shogaols, zingerone, and paradol, which
can possess a notable capacity to enhance antioxidant activity
(Kikuzaki & Nakatani, 1993; Masuda, Kikuzaki, Hisamoto, & Nakatani,
2004). These components can decrease BP level via reducing lipid per-
oxidation, which is a key factor to vascular blockage causing vasocon-
striction and increase BP (Afshari et al., 2007; Ahmed, Seth, &
Banerjee, 2000; Shobana & Naidu, 2000). It has also been shown that
the consumption of polyphenols limits the development of
HASANI ET AL. 7

atheromatous lesions, which is considered a key mechanism in the intake and physical activity were not considered in most included
endothelial lesions occurring in atherosclerosis (Grassi, Desideri, & studies, and we could not consider them in present analysis.
Ferri, 2010). Furthermore, ginger phenolic compounds have
vasodilatory properties, through increasing plasma nitric oxide con-
5 | CO NC LUSIO N
centration (Srinivasan, 2017; Wu et al., 2018). Nitric oxide can also
reduce the plasma level of proinflammatory cytokines, reduce the
The present paper suggests the potential for improving SBP and DBP
platelet aggregation, and improve endothelium function (Puzserova &
following ginger supplementation, particularly when used in high dose
Bernatova, 2016). In addition, ginger consumption has reported lipid
(>3 g/d), short intervention period (≤ 8 weeks) and participants with
profile improving characteristics (Pourmasoumi et al., 2018), which
mean age ≤ 50 years. However, future high‐quality investigations
may reduce the risk of lipid oxidation and vascular blockage.
with different dose and duration of ginger supplementation are
It is also proposed that phenolic compounds in the ginger have a
required to confirm the potential beneficial effect of ginger supple-
cholinergic action (Ghayur, Khan, & Gilani, 2007). These cholinergic
mentation on BP.
compounds cause a fall in BP by activation of muscarinic acetylcho-
line receptors located on the epithelium of blood vessels. Muscarinic
ACKNOWLEDGEMENTS
acetylcholine receptors, are acetylcholine receptors that form G
None.
protein‐coupled receptor complexes in the cell membranes of certain
neurons and other cells (Eglen, 2006; Ghayur et al., 2005). The
CONFLIC T OF INT E RE ST
activation of these receptors induces cardiac slowing and reduce car-
diac output and contribute to a noticeable reduction in arterial BP The authors declare no conflict of interest.
(Ishii & Kurachi, 2006).
Another possible explanation for this is voltage‐dependent calcium AUTHOR CONT R IBUT ION
channel‐blocking activity of ginger. Inhibition of Ca2+ entrance in cor- A. H. and H. H. carried out the concept, design, and drafting of this
onary and peripheral arterial smooth muscle and the heart reduces the study. A. H. and H. H. searched databases, screened articles and
ability of Ca2+ to act as an intracellular messenger. Thus, calcium extracted data. A. H performed the acquisition, analysis, and interpre-
channel blockers are smooth muscle dilators and have a negative ino- tation of data. All authors critically revised the manuscript. All authors
tropic impression on the functioning myocardial cells of the atria and approved the final version of the manuscript. A. H and M. M are the
ventricles. (Ghayur & Gilani, 2005). Also, ginger has an effect on guarantors of this study.
angiotensin‐converting enzyme that is a central component of the
renin‐angiotensin system and controls BP by constriction of blood FUNDING INFORMATION
vessels and regulating the volume of fluids in the body (Akinyemi,
This research did not receive any specific grant from funding agencies
Ademiluyi, & Oboh, 2014; Akinyemi et al., 2015).
in the public, commercial, or not‐for‐profit sectors.
Another suggested mechanism may include the serotonergic
antagonistic property of ginger; however, the mechanism of the effect
ORCID
of serotonin on BP is still unclear (Ojulari, Olatubosun, Okesina, &
Amir Hadi https://orcid.org/0000-0001-9952-6579
Owoyele, 2014), but it was suggested that serotonin may promote
Makan Pourmasoumi https://orcid.org/0000-0001-9335-7276
an increase in total peripheral resistance (Watts, Morrison, Davis, &
Barman, 2012). Furthermore, the 6‐gingerole, 8‐gingerole, 10‐
RE FE RE NC E
gingerole, and 6‐shogoal, exhibit a vasodilator effect via nitric oxide‐
releasing and calcium antagonist mechanism (Ali et al., 2008). Afshari, A. T., Shirpoor, A., Farshid, A., Saadatian, R., Rasmi, Y., Saboory, E., …
Allameh, A. (2007). The effect of ginger on diabetic nephropathy, plasma
The present meta‐analysis has several limitations that must be kept
antioxidant capacity and lipid peroxidation in rats. Food Chemistry,
in mind while interpreting the overall findings. First, because we 101(1), 148–153. https://doi.org/10.1016/j.foodchem.2006.01.013
restricted our searches to abstract/title/keywords, there is a possibil-
Ahmed, RS, Seth, V, Banerjee, B. (2000). Influence of dietary ginger
ity that we have missed studies that measured BP after ginger therapy, (Zingiber officinales Rosc) on antioxidant defense system in rat: Com-
but were perhaps designed with another endpoint in mind. Second, a parison with ascorbic acid.
high degree of heterogeneity was detected in both outcomes. Akinyemi, A. J., Ademiluyi, A. O., & Oboh, G. (2014). Inhibition of
Although we have explored the source of heterogeneity, the interpre- angiotensin‐1‐converting enzyme activity by two varieties of ginger
tation of findings may be influenced by the level of heterogeneity (Zingiber officinale) in rats fed a high cholesterol diet. Journal of Medici-
nal Food, 17(3), 317–323. https://doi.org/10.1089/jmf.2012.0264
observed. Third, it should also be mentioned that all included studies
were done in Iran, and the data regarding the effect of ginger on BP Akinyemi, A. J., Thome, G. R., Morsch, V. M., Stefanello, N., Goularte, J. F.,
in other countries are still lacking. Fourth, the different effects of gin- Belló‐Klein, A., … Schetinger, M. R. C. (2015). Effect of dietary supple-
mentation of ginger and turmeric rhizomes on angiotensin‐1
ger among male and female remain unknown because the majority of
converting enzyme (ACE) and arginase activities in L‐NAME induced
included studies have enrolled both genders of participants concomi- hypertensive rats. Journal of Functional Foods, 17, 792–801. https://
tantly. Finally, the effect of some confounding factors such as dietary doi.org/10.1016/j.jff.2015.06.011
8 HASANI
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SUPPORTING INFORMATION
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Supporting Information section at the end of the article.
How to cite this article: Hasani H, Arab A, Hadi A,
Pourmasoumi M, Ghavami A, Miraghajani M. Does ginger sup-
plementation lower blood pressure? A systematic review and
meta‐analysis of clinical trials. Phytotherapy Research.
2019;1–9. https://doi.org/10.1002/ptr.6362