Clinical efficacy of African traditional medicines in hypertension: A randomized controlled trial with Combretum micranthum and Hibiscus sabdariffa

Abstract

Medicinal plants are widely used as a first-line therapy for hypertension, often without comparative clinical data. A prospective, randomized controlled trial was conducted to assess efficacy of Combretum micranthum (kinkeliba) and Hibiscus sabdariffa (bissap), in the galenic form of capsules of plant powder, on blood pressure in adult patients with non-complicated hypertension ( > 140/90 mm Hg). One hundred and twenty five patients were randomly allocated into group 1 (kinkeliba leaves 190 mg × 2/day), or group 2 (bissap calyx 320 mg × 2/day), or group 3 (ramipril 5 mg /day) during four consecutive weeks. Blood and urinary samples were collected on day 0 and 28 while patients’ blood pressure was measured weekly. In all three groups SBP and DBP decreased over 3 weeks of treatment (P < 0.001). For SBP, mean decrease was higher with ramipril (−16.7 ± 8.4 mm Hg) than with kinkeliba (−12.2 ± 6.6 mm Hg, P = 0.016) and bissap (−11.2 ± 3.3 mm Hg, P = 0.001). For DBP, mean decrease with ramipril (−6.7 ± 3.6 mm Hg) was more important than with kinkeliba (−5.0 ± 3.0 mm Hg, P = 0.011) but not statistically different to bissap group (−6.0 ± 4.7 mm Hg, P = 0.271). A significant natriuretic effect was observed in the kinkeliba and bissap groups but not in patients under ramipril treatment. At the end of the four weeks, 39% [95% CI: 25.7–54.3] of patients in the ramipril group, 37% [95% CI: 23.6–51.9] of patients in the kinkeliba group and 21% [95% CI: 11.7–35.9] of those taking bissap had normalized their BP.

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References

  1. 1.

    Dalal S, Beunza JJ, Volmink J, Adebamowo C, Bajunirwe F, Njelekela M, Mozaffarian D, et al. Non-communicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol. 2011;40:885–901.

    Article  Google Scholar 

  2. 2.

    Alwan A, Armstrong T, Cowan M, Riley L. Non-communicable Diseases Country Profiles 2011. Geneva, Switzerland: World Health Organization; 2011.

    Google Scholar 

  3. 3.

    Alwan A, Maclean DR, Riley LM, d’Espaignet ET, Mathers CD, Stevens GA, et al. Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries. Lancet. 2010;376:1861–8.

    Article  Google Scholar 

  4. 4.

    Lawes CM, Vander Hoorn S, Rodgers A. (2008) International Society of Hypertension. Global burden of blood-pressure-related disease. Lancet. 2001;371:1513–8.

    Article  Google Scholar 

  5. 5.

    Abegunde D, Mathers CD, Adam T, Ortegon M, Strong K. The burden and costs of chronic diseases in low-income and middle-income countries. Lancet. 2007;370:1929–38.

    Article  Google Scholar 

  6. 6.

    Welch CR. Chemistry and pharmacology of kinkéliba (Combretum micranthum), a West African medicinal plant. PhD Thesis, Medicinal Chemistry, New Brunswick-New Jersey, Geneva, US, 2010. pp 268.

  7. 7.

    World Health Organization Geneva 2013. WHO traditional medicine strategy: 2014–23. http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf. Accessed 25 Sept 2014.

  8. 8.

    Serban C, Sahebkar A, Ursoniu S, Andrica F, Banach M. Effect of sour tea (Hibiscus sabdariffa L.) on arterial hypertension: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2015;33:1119–27.

    CAS  Article  Google Scholar 

  9. 9.

    Mathieu G, Meissa D. Traditional leafy vegetables in senegal: diversity and medicinal uses. Afr J Tradit Complement Altern Med. 2007;4:469–75.

    Article  Google Scholar 

  10. 10.

    Mahadevan N, Kamboj S, Kamboj P. Hibiscus sabdariffa Linn.–an overview. Nat Prod Radiance. 2009;8:77–83.

    Google Scholar 

  11. 11.

    Eloff JN, Katerere DR, McGaw LJ. The biological activity and chemistry of the southern African Combretaceae. J Ethnopharmacol. 2008;119:686–99.

    CAS  Article  Google Scholar 

  12. 12.

    Hopkins AL, Lamm MG, Funk JL, Ritenbaugh C. Hibiscus sabdariffa L. in the treatment of hypertension and hyperlipidemia: a comprehensive review of animal and human studies. Fitoterapia. 2013;85:84–94.

    CAS  Article  Google Scholar 

  13. 13.

    Chrysant SG. The clinical significance and costs of herbs and food supplements used by complementary and alternative medicine for the treatment of cardiovascular diseases and hypertension. J Hum Hypertens. 2016;30:1–6.

    CAS  Article  Google Scholar 

  14. 14.

    European Medicines Agency. Guideline on quality of herbal medicinal products/ traditional herbal medicinal products. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2011/09/WC500113209.pdf. Accessed 26 Sept 2014.

  15. 15.

    Herrera-Arellano A, Flores-Romero S, Chávez-Soto MA, Tortoriello J. Effectiveness and tolerability of a standardized extract from Hibiscus sabdariffa in patients with mild to moderate hypertension: a controlled and randomized clinical trial. Phytomedicine. 2004;11:375–82.

    CAS  Article  Google Scholar 

  16. 16.

    Herrera-Arellano A, Miranda-Sánchez J, Avila-Castro P, Herrera-Alvarez S, Jiménez-Ferrer JE, Zamilpa A, et al. Clinical effects produced by a standardized herbal medicinal product of Hibiscus sabdariffa on patients with hypertension. A randomized, double-blind, lisinopril-controlled clinical trial. Planta Med. 2007;73:6–12.

    CAS  Article  Google Scholar 

  17. 17.

    McKay DL, Chen CY, Saltzman E, Blumberg JB. Hibiscus sabdariffa L. tea (tisane) lowers blood pressure in prehypertensive and mildly hypertensive adults. J Nutr. 2010;140:298–303.

    CAS  Article  Google Scholar 

  18. 18.

    Mozaffari-Khosravi H, Ahadi Z, Barzegar K. The effect of green tea and sour tea on blood pressure of patients with type 2 diabetes: a randomized clinical trial. J Diet Suppl. 2013;10:105–15.

    Article  Google Scholar 

  19. 19.

    Mozaffari-Khosravi H, Jalali-Khanabadi BA, Afkhami-Ardekani M, Fatehi F, Noori-Shadkam M. The effects of sour tea (Hibiscus sabdariffa) on hypertension in patients with type II diabetes. J Hum Hypertens. 2009;23:48–54.

    CAS  Article  Google Scholar 

  20. 20.

    Joven J, March I, Espinel E, Fernández-Arroyo S, Rodríguez-Gallego E, Aragonès G, et al. Hibiscus sabdariffa extract lowers blood pressure and improves endothelial function. Mol Nutr Food Res. 2014;58:1374–8.

    CAS  Article  Google Scholar 

  21. 21.

    Jiménez-Ferrer E, Alarcón-Alonso J, Aguilar-Rojas A, Zamilpa A, Jiménez-Ferrer CI, Tortoriello J, et al. Diuretic effect of compounds from Hibiscus sabdariffa by modulation of the aldosterone activity. Planta Med. 2012;78:1893–8.

    Article  Google Scholar 

  22. 22.

    Ojeda D, Jiménez-Ferrer E, Zamilpa A, Herrera-Arellano A, Tortoriello J, Alvarez L. Inhibition of angiotensin convertin enzyme (ACE) activity by the anthocyanins delphinidin- and cyanidin-3-O-sambubiosides from Hibiscus sabdariffa. J Ethnopharmacol. 2010;127:7–10.

    CAS  Article  Google Scholar 

  23. 23.

    Diallo D, Guissou IP, Haïdara M, Tall C, Kasido OMJ. Recherche sur la médecine traditionnelle Africaine: hypertension. The African Health Monitor. WHO Publication office for Africa; Brazzaville, 2010.

  24. 24.

    Diatta W, Lo M, Fall AD, Bassene S, Sagna S, Badji K, et al. Popular Traditional Herbal Medicines from the Jóolas of Essyl in the Rural Community of Enampor (Ziguinchor, Sénégal). In: Juliani RH, Simon JE, Chi-Tang H, editors. African natural plant products: new discoveries and challenges in chemistry and quality. Washington D.C: American Chemical Society (ACS) Symposium Series; 2009. p. 111–34.

    Google Scholar 

  25. 25.

    de Morais Lima GR, de Sales IR, Caldas Filho MR, de Jesus NZ, de Sousa Falcão H, Barbosa-Filho JM, et al. Bioactivities of the genus Combretum (Combretaceae): a review. Molecules. 2012;17:142–206.

    Article  Google Scholar 

  26. 26.

    Olajide OA, Makinde JM, Okpako DT. Evaluation of the anti-inflammatory property of the extract of Combretum micranthum G. Don (Combretaceae). Inflammopharmacology. 2003;11:293–8.

    Article  Google Scholar 

  27. 27.

    Touré A, Xu X, Michel T, Bangoura M. In vitro antioxidant and radical scavenging of Guinean kinkeliba leaf (Combretum micranthum G. Don) extracts. Nat Prod Res. 2011;25:1025–36.

    Article  Google Scholar 

  28. 28.

    Ojewole JA. Cardiovascular effects of mollic acid glucoside, a 1 alpha-hydroxycycloartenoid saponin extractive from Combretum molle R.Br. ex G.Don (Combretaceae) leaf. Cardiovasc J Afr. 2008;19:128–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Nsuadi Manga F, El Khattabi C, Fontaine J, Berkenboom G, Duez P, Lami Nzunzu J, et al. Vascular effects and antioxidant activity of two Combretum species from Democratic Republic of Congo. J Ethnopharmacol. 2012; 142:194–200.

    CAS  Article  Google Scholar 

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Acknowledgements

The patients involved in this study, International Society of Nephrology (ISN), Medical authorities in Senegal, Pharmacie de l’Orangerie and Antenna Technologies, Unité Mixte Internationale Environnement-Santé-Société UMI-3189. Gabrial Erismann for English revision of the manuscript.

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Correspondence to Sidy Mohamed Seck.

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Seck, S.M., Doupa, D., Dia, D.G. et al. Clinical efficacy of African traditional medicines in hypertension: A randomized controlled trial with Combretum micranthum and Hibiscus sabdariffa. J Hum Hypertens 32, 75–81 (2018). https://doi.org/10.1038/s41371-017-0001-6

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