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Hypertension treatment with Combretum micranthum or Hibiscus sabdariffa, as decoction or tablet: a randomized clinical trial

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Hibiscus sabdariffa L. (local names: bissap, karkade) and Combretum micranthum (kinkeliba) are widely known in traditional medicines and popular beliefs for their antihypertensive effect. This study assessed the clinical effectiveness of these two plants in the galenic forms of tablet and brew (decoction) in noncomplicated hypertensive patients. In total, 219 hypertensive patients with systolic blood pressure (SBP) between 140 and 180 mmHg and/or diastolic blood pressure (DBP) between 90 and 110 mmHg, without cardiovascular or renal complications, were involved in a multicentric randomized clinical trial in Senegal comparing five treatment regimens: bissap tablets (2 × 375 mg/day), bissap brew (10 g of calyx/day), kinkeliba tablets (2 × 200 mg/day), kinkeliba brew (10 g of leaves/day), and captopril (2 × 50 mg/day) as control. During the 6 months’ follow-up, a significant and equivalent decrease of SBP was observed with the herbal drug approach (−19.5 ± 16.1 mmHg, p < 0.001) and control group (−19.7 ± 16.7, p < 0.001). Regarding the galenic forms, the brews tended to be slightly more effective than tablets (reduction of SBP: −20.7 ± 15.1 mmHg vs −18.7 ± 16.7). The rates of clinically significant effectiveness (decrease in SBP ≥ 10 mmHg) were 75%, 67%, and 65% with bissap, kinkeliba, and captopril, respectively. After 6 months, target blood pressure of <140/90 mmHg was attained by 49% of patients with bissap, 51% with kinkeliba and 40% with captopril. Bissap and kinkeliba appeared, at doses utilized, to be as effective as captopril over the 6 months’ follow-up. In subsequent studies, brews might be started with a lower dosage.

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  • 03 October 2020

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  1. de la Sierra A. New American and European hypertension guidelines, reconciling the differences. Cardiol Ther. 2019;8:157–66.

    Article  Google Scholar 

  2. World Health Organization. Hypertension. 2019.

  3. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  4. World Health Organization. A global brief on hypertension. 2013.

  5. Arima H, Barzi F, Chalmers J. Mortality patterns in hypertension. J Hypertens. 2011;29:S3–7.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  7. Singh S, Gupta SK, Sabir G, Gupta MK, Seth PK. A database for anti-diabetic plants with clinical/experimental trials. Bioinformation. 2009;4:263–8.

    Article  Google Scholar 

  8. James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health. 2018;3:e000895.

    Article  Google Scholar 

  9. Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol. 2014;10:4.

  10. Lucie AT, Emile AC, Dogo S, Valentin K, Mbacke S. Medicinal plants used in some rural districts in Senegal (West Africa). Am-Eurasian J Sustain Agric. 2012;6:325–32.

  11. 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.

    Article  CAS  Google Scholar 

  12. Da-Costa-Rocha I, Bonnlaender B, Sievers H, Pischel I, Heinrich M. Hibiscus sabdariffa L.—a phytochemical and pharmacological review. Food Chem. 2014;165:424–43.

    Article  CAS  Google Scholar 

  13. Riaz G, Chopra R. A review on phytochemistry and therapeutic uses of Hibiscus sabdariffa L. Biomed Pharmacother. 2018;102:575–86.

    Article  CAS  Google Scholar 

  14. 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.

    Article  CAS  Google Scholar 

  15. 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 

  16. 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.

    Article  CAS  Google Scholar 

  17. Zheoat AM, Gray AI, Igoli JO, Ferro VA, Drummond RM. Hibiscus acid from Hibiscus sabdariffa (Malvaceae) has a vasorelaxant effect on the rat aorta. Fitoterapia. 2019;134:5–13.

    Article  CAS  Google Scholar 

  18. de Morais Lima GR, de Sales IRP, Caldas Filho MRD, de Jesus NZT, de Sousa Falcão H, Barbosa-Filho JM, et al. Bioactivities of the genus Combretum (Combretaceae): a review. Molecules. 2012;17:9142–206.

    Article  Google Scholar 

  19. Welch CR. Chemistry and pharmacology of Kinkéliba (Combretum micranthum), a west African medicinal plant. 2018.

  20. Seck SM, Doupa D, Dia DG, Diop EA, Ardiet D-L, Nogueira RC, et al. Clinical efficacy of African traditional medicines in hypertension: a randomized controlled trial with Combretum micranthum and Hibiscus sabdariffa. J Hum Hypertens. 2018;32:75–81.

    Article  Google Scholar 

  21. Al-Anbaki M, Nogueira RC, Cavin A-L, Al-Hadid M, Al-Ajlouni I, Shuhaiber L, et al. Treating uncontrolled hypertension with Hibiscus sabdariffa when standard treatment is insufficient: pilot intervention. J Altern Complement Med. 2019;10.

  22. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67.

    Article  Google Scholar 

  23. Kpemissi M, Eklu-Gadegbeku K, Veerapur VP, Potârniche A-V, Adi K, Vijayakumar S, et al. Antioxidant and nephroprotection activities of Combretum micranthum: a phytochemical, in-vitro and ex-vivo studies. Heliyon. 2019;5:e01365.

    Article  Google Scholar 

  24. Zahoui OS, Soro TY, Yao KM, Nene-Bi SA, Traoré F. Effet hypotenseur d’un extrait aqueux de Combretum micranthum G. Don (Combretaceae). Phytothérapie. 2017;15:138–46.

    Article  Google Scholar 

  25. Prabowo P, Arwanto A, Soemantri D, Sukandar E, Suprihadi H, Parsudi I, et al. A comparison of valsartan and captopril in patients with essential hypertension in Indonesia. Int J Clin Pract. 1999;53:268–72.

    CAS  PubMed  Google Scholar 

  26. McKay DL, Chen C-YO, Saltzman E, Blumberg JB. Hibiscus Sabdariffa L. Tea (Tisane) lowers blood pressure in prehypertensive and mildly hypertensive adults. J Nutr. 2010;140:298–303.

    Article  CAS  Google Scholar 

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The patients and the professional staff involved in this study, Medical authorities in Senegal, DIXA AG, Patrick Moneuse and Christiane Ruffieux for the statistical revision, Liesl Graz for English revision of the text.

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Correspondence to Angélique Bourqui.

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In the future, we hope to raise money for further research on widely accessible health care solutions based on a shared-benefits agreement for the sale of hibiscus tablets for those patients who prefer not to have to prepare their brew every day.

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Bourqui, A., Niang, E.A.B., Graz, B. et al. Hypertension treatment with Combretum micranthum or Hibiscus sabdariffa, as decoction or tablet: a randomized clinical trial. J Hum Hypertens 35, 800–808 (2021).

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