Skip to main content
NCBI home page
Frontiers in Pharmacology logoLink to Frontiers in Pharmacology
. 2024 May 31;15:1321523. doi: 10.3389/fphar.2024.1321523

Safety classification of herbal medicine use among hypertensive patients: a systematic review and meta-analysis

Dain Choi 1,2, Hyea Bin Im 1,2, Soo Jeung Choi 1,2,3, Dongwoon Han 1,2,3,*
PMCID: PMC11176523  PMID: 38881876

Abstract

Background

The use of herbal medicines (HMs) for the treatment of hypertension (HTN) is increasing globally, but research on the potential adverse effects and safety of HMs in HTN patients is limited. Therefore, this systematic review and meta-analysis aim to determine the global prevalence of HM usage among HTN patients and assess the safety of identified herbs based on current scientific evidence.

Methods

The PubMed/MEDLINE, EMBASE (Ovid), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases were searched for cross-sectional studies on the use of HM among HTN patients. Our review includes studies published in English up to the year 2023. After extracting and appraising the data from the studies, a meta-analysis was conducted using the Stata version 16.0 to estimate the pooled prevalence of HM use in patients with HTN (PROSPERO: CRD42023405537). The safety classification of the identified HM was done based on the existing scientific literature.

Results

This study analyzed 37 cross-sectional studies from 21 countries and found that 37.8% of HTN patients used HM to manage their health. The prevalence of HM use varied significantly based on publication year and geographical region. Among the 71 identified herbs, Allium sativum L., Hibiscus sabdariffa L., and Olea europaea L. were the most commonly used. However, four herbs were identified as contraindicated, 50 herbs required caution, and only 11 herbs were considered safe for use.

Conclusion

The study highlights the potential risks of toxicities and adverse effects associated with HM use in the treatment of HTN. Ensuring patient safety involves using safe HMs in appropriate doses and avoiding contraindicated HMs. Future research should focus on identifying commonly used herbs, especially in resource-limited countries with poor HTN management, and additional clinical research is required to assess the toxicity and safety of commonly used HMs.

Keywords: hypertension, herbal medicine, safety, adverse effects, systematic review, meta-analysis

1 Introduction

High blood pressure is a considerable global health concern (Kearney et al., 2005; Mills et al., 2016), presenting a significant risk factor for cardiovascular disease and premature death (Mills et al., 2020; Roth et al., 2020; Koya et al., 2023). Despite the availability of effective treatment options, over half of the diagnosed patients continue to struggle with managing hypertension (HTN) (Mohsen Ibrahim, 2018; Anand et al., 2019; Burnier and Egan, 2019; Mills et al., 2020; Schutte et al., 2021; Zhou et al., 2021), primarily due to poor adherence to antihypertensive medication, adding to the global disease burden (Kearney et al., 2005; Mills et al., 2020; Mohammed Nawi et al., 2021; Schutte et al., 2021; Hamrahian et al., 2022). Several behavioral risk factors are associated with non-adherence to medication (Burnier and Egan, 2019); complementary and alternative medicine (CAM) use is believed to be one of the contributing factors (Krousel-Wood et al., 2004; Krousel-Wood et al., 2010; Dhar et al., 2017). Among different types of CAM, herbal medicine (HM) is the most popular treatment used by HTN patients (Ali-Shtayeh et al., 2013; James et al., 2018b; Kifle et al., 2021; Palileo-Villanueva et al., 2022). HM has gained popularity as a treatment option for HTN, driven by personal beliefs, preference for natural remedies, cultural traditions, and barriers to accessing conventional care (Liwa et al., 2014; Rahmawati and Bajorek, 2017; Azizah et al., 2021).

However, concerns have been raised about the adulteration or contamination of HM with toxic substances such as heavy metals, as well as the risk of adverse effects when HM is taken with conventional medications due to the pharmacological properties of herbs that may interact with antihypertensive drugs (Pathak and Kothiyal, 2013; Posadzki et al., 2013; Ekor, 2014; Anwar et al., 2016; Azizah et al., 2021; Luo et al., 2021; Im et al., 2023). For instance, concurrent consumption of Azadirachta indica A. Juss, Aloe vera (L.) Burm. f., and Hibiscus sabdariffa L., along with antihypertensive drugs, can compromise the clinical effectiveness of conventional medication by reducing drug absorption (Rahmawati and Bajorek, 2017; Azizah et al., 2021). Furthermore, concurrent use increases the risk of adverse drug reactions, including headaches, gastrointestinal disorders, diarrhea, skin reactions, and frequent urination (Amira and Okubadejo, 2007; Olisa and Oyelola, 2009). Despite the lack of scientific evidence supporting the safety and clinical efficacy of HM (Shafiq et al., 2003; Amira and Okubadejo, 2007; Osamor and Owumi, 2010; Tabassum and Ahmad, 2011; Liwa et al., 2014; Asfaw Erku and Basazn Mekuria, 2016), its usage remains high among HTN patients, with as many as 70% using medicinal herbs due to accessibility and affordability, especially among vulnerable groups (McMahon et al., 1973; Clement et al., 2007; Cuzzolin and Benoni, 2009; Nuwaha and Musinguzi, 2013; Owusu et al., 2020).

These issues have raised concerns about the inappropriate use of HM among HTN patients, highlighting the importance of identifying potential toxicity and adverse effects associated with HM use and developing evidence-based clinical guidelines (Burnier and Egan, 2019). However, limited evidence is available to examine the use of HM among HTN patients and to evaluate the safety of commonly used HMs (Xiong et al., 2015a; Azizah et al., 2021). Therefore, this systematic review and meta-analysis aimed to investigate the pooled prevalence of HM use among HTN patients globally and assess the safety of identified herbs based on current scientific evidence.

2 Materials and methods

This systematic review was reported to comply with the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) checklist (Moher et al., 2009; Page et al., 2021; Supplementary Table S1). The rationale and methods of the study protocol were registered in the International Prospective Register of Systematic Reviews (PROSPERO, registration number: CRD42023405537).

2.1 Search strategy

An electronic database search was conducted on 19 June 2023 and included the systematic investigation of the PubMed/MEDLINE, EMBASE (Ovid), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases. The initial version was developed using keywords suggested by the literature based on previous studies, and a comprehensive search strategy including specific words, phrases, and controlled vocabulary was then developed by an information specialist in collaboration with two cardiologists and three public health specialists. The search strategy and results are provided in Supplementary Table S2. Medical subject heading (MeSH) terms, EMBASE subject headings (Emtree), and keywords from related articles were explored to guide the selection of relevant search terms. The search terms were further refined by referring to related literature reviews. Finally, variations in three major terms (hypertension, herbal medicine, and cross-sectional study) were used for the search.

2.2 Eligibility criteria

This review includes studies that (i) were published from inception to 2023, (ii) were published in English, (iii) report cross-sectional data of HM use among HTN patients, and (iv) report the name of each herb used and the corresponding number of users. Additionally, studies with mixed study populations (i.e., studies on chronic disease patients that include more than one disease group) were only included if the findings related to the HTN population were presented independently.

Studies were excluded if they met one or more of the following criteria: (i) lack of full English text; (ii) non-use of cross-sectional study designs; (iii) inclusion of non-hypertensive study samples or failure to separate data on hypertensive subjects from other study populations; (iv) failure to report the type of HM used by HTN patients and provide information on the number of users per HM type; (v) incorrect publication types, such as posters, letters, conference abstracts, review articles, or case reports (Mills and Bone, 2004).

2.3 Safety classification of identified herbal medicines

The safety of identified herbs was classified into four categories: potentially harmful to use, use with caution, safety evidence not available, and safe to use (Table 1), and these categories were determined based on the previous literature (Kennedy et al., 2016; Ahmed et al., 2017; Kim H.-L. et al., 2023; Im et al., 2023). The safety classification of identified HMs was determined by reviewing the existing scientific literature and reference material, including the latest published literature, websites, and textbooks related to safety (Ulbricht and Basch, 2005; Johnston, 2006; Gruenwald et al., 2007; Ulbricht, 2010; Gardner and McGuffin, 2013), and the quality of the evidence was assessed based on the hierarchy of evidence (Concato et al., 2000). Evidence from clinical studies on HTN patients was considered first, followed by human studies and animal studies.

TABLE 1.

Safety classification of identified herbal medicines used by HTN patients.

Category Classification Description
✕ Contraindicated for use The available evidence has shown adverse impacts on hypertension, following the use of the herb
△ Should be used with caution Caution must be taken when using this herb due to the lack of sufficient human evidence or limited research available. Therefore, it is advisable to use this herb under the guidance and supervision of a qualified healthcare practitioner
ᅳ Safety evidence not available No reference was found regarding the use of the herb for hypertension
○ Safe to use Available human evidence suggests that the herb can be safely used by hypertensive patients
Open in a new tab

If safety information for an HM was not identified in the above reference sources, we conducted an additional search on PubMed, EMBASE, and Google Scholar. When inconsistencies were found among the reviewed sources, we prioritized the most recently published study on the safety classification of an HM as the primary reference source (Ahmed et al., 2017; Im et al., 2023). Lastly, because the current study is primarily concerned with the safety classification of the identified herbs, the efficacy of each herb was simply categorized based solely on whether there was evidence of blood pressure (BP) lowering from either animal or clinical studies.

2.4 Data extraction and study quality assessment

Based on the eligibility criteria, three researchers (DC, HI, and SJ) conducted a full-text review using a review template that was developed to examine study characteristics (i.e., publication year, country, study design, setting, and research subjects) and the inclusion of primary study outcomes (i.e., the prevalence of HM use, as well as the type of HM used to treat HTN). The data extracted from each study were compared, and any discrepancies between the three reviewers were resolved through consultation with the senior researcher (DW).

The quality of the included studies was independently evaluated by three reviewers using a validated tool to assess the risk of bias in prevalence studies (Hoy et al., 2012). The tool consists of 10 questions that address four items of external validity of the study and six domains of internal validity issues. A score of 0 (no) or 1 (yes) was given for each item, and scores were summed across items to calculate an overall score that ranged from 0 to 10. Studies were then classified as having a low (0–3), moderate (4–6), or high (7–9) risk of bias.

2.5 Data synthesis and statistical analysis

A meta-analysis was conducted to estimate the pooled prevalence of HM use among HTN patients and the corresponding 95% confidence intervals (CI). Articles that did not report the prevalence of HM use (i.e., studies reporting the prevalence of CAM, biologically based therapies, or home remedy use) were excluded from the meta-analysis. The prevalence of HM use from each study was initially recorded in the Microsoft Excel spreadsheet. If a study only reported the number or percent values of HTN patients or HM use, the researchers re-calculated the value of events based on the given percentages. The recorded values were then imported into the Stata version 16.0 tool for further analysis. Due to high heterogeneity among the studies (I2 = 99.61%), a random-effect meta-analysis was conducted. The results were displayed using a forest plot.

The presence of publication bias was evaluated using the funnel plot and the Egger test (p = 0.013; Supplementary Figure S3). A subgroup meta-analysis was conducted to investigate potential differences in the use of HM by geographical region (i.e., individual countries and continents) and the publication year (i.e., studies published before 2011 versus after 2011).

3 Results

3.1 Selection of studies

The PRISMA flow diagram of the study selection process is shown in Figure 1. A total of 2,469 studies were identified from databases and other sources. After removing duplicate records, 2,335 articles were eligible for title and abstract review. During the title and abstract screening, 2,096 records were excluded, leaving 239 articles that were selected for the full-text review. During the full-text review, 201 articles were excluded for the following reasons: unavailability of full-text or English text, ineligible study design or publication type (i.e., reviews, conference abstracts, the letter to the editor, posters, case reports, and animal studies), unrelated to HTN patients, and insufficient reporting of the prevalence of HM use by HTN patients.

FIGURE 1.

FIGURE 1

Open in a new tab

Flow diagram of the search strategy.

A total of 251 additional records were identified by reviewing the reference lists of the 38 included studies. After removing duplicates, 122 additional studies were included for further review. However, during the full-text appraisal, 112 studies were excluded as they did not meet the inclusion criteria (i.e., unrelated to HTN patients, non-cross-sectional study). As a result, 48 articles were eligible for the risk of bias assessment.

3.2 Study quality and risk of bias assessment

The external validity of the reviewed studies showed a high risk of bias for the target population (item 1), sampling frame (item 2), and random sample selection (item 3) because most studies included in this review were conducted at a single hospital and used the convenience sampling method. In addition, as for the internal validity, most items exhibited a low risk of bias, except for item 9. The prevalence period (item 9) was considered to have a high risk of bias if a study did not report or examine the respondent’s HM use beyond the past 12 months. As a result, out of the 48 studies examined, 11 showed a high risk of bias, 7 exhibited a low risk of bias, and 30 displayed a moderate risk. Therefore, excluding 11 studies with a high risk of bias, 37 studies were included in the final review (Supplementary Table S4).

3.3 Characteristics of cross-sectional studies of HM use among HTN patients

In the review, a total of 37 cross-sectional studies conducted in 21 countries were examined. Among these, 27 studies were published after 2010, while ten were conducted between 2000 and 2010. The characteristics of the studies included in the review are illustrated in Table 2. The highest number of studies were carried out in Asia (48.6%), followed by Africa (35.1%), North America (13.5%), and Europe (2.7%). The sample sizes varied from a minimum of 19 participants to a maximum of 2,436 participants (Mahfudz and Chan, 2005; Ali-Shtayeh et al., 2013). Fifteen studies provided detailed information regarding the specific types of HM used and the number of users for each herb (Amira and Okubadejo, 2007; Clement et al., 2007; Gohar et al., 2008; Olisa and Oyelola, 2009; Ali-Shtayeh et al., 2013; Bahar et al., 2013; Kretchy et al., 2014; Tajadini et al., 2015; Baran et al., 2017; Liwa et al., 2017; James et al., 2018a; Al-Hadid et al., 2020; Adeniyi et al., 2021; Joachimdass et al., 2021; Kifle et al., 2021).

TABLE 2.

Characteristics of included studies.

No. Study (author, year) Country Setting Population Sample size a (Response rate) HM users N (%) No. of herbs identified e
Total 23,947* 6,316 166 d
1 Shafiq et al. (2003) India HTN clinic of a teaching hospital HTN patients visiting the HTN clinic 333 (63.9%) 48 (14.4%) NR
2 Mahfudz and Chan (2005) Malaysia Public primary care center HTN patients attending the outpatient HTN department 124 (NR) 19 (15.3%) 6
3 Yeh et al. (2006) United States National household survey (National Health Interview Survey) Adults ≥18 years of age Total: 31,044 (NR) 65 (0.8%) NR
HTN: 8,055*
4 Amira and Okubadejo (2007) Nigeria HTN clinic of the university teaching hospital HTN patients attending the HTN clinic for at least 6 months 225 (NR) 88 (39.1) b 5
5 Clement et al. (2007) Trinidad and Tobago 16 primary healthcare facilities Patients ≥16 years of age who confirmed their use of herbal remedies Total: 265 (NR) c 53 (71.6%) 15
HTN: 74* (28.0%)
6 Gohar et al. (2008) United Kingdom Secondary teaching hospital HTN patients attending the outpatient HTN clinic 153 (78.1%) 24 (15.7%)c 4
7 Olisa and Oyelola (2009) Nigeria Secondary hospital (state level) Ambulatory HTN patients attending the HTN clinic 480 (96.0%) 120 (25.0%) 24
8 Al-Hamdan et al. (2010) Saudi Arabia Community-based survey in 20 primary health centers All Saudi population aged 15–64 years Total: 4,719 (99.2%) 45 (8.3%) NR
HTN: 542*
9 Delgoda et al. (2010) Jamaica Eighteen pharmacies Patients or parents/carers of children visiting the study pharmacy 365 (91.5%) 103 (79.8%) NR
10 Nur (2010) Turkey Community-based survey at a semi-rural province Adults ≥18 years of age 3,876 (96.3%) 273 (48.8%) NR
HTN: 559*
11 Ali-Shtayeh et al. (2013) Palestine HTN outpatient departments at governmental hospitals, military medical clinics, and refugee camp clinics in eight towns HTN patients who had been diagnosed with HTN and attending the HTN outpatient clinic 4,575 (NR) 2,436 (53.25%)b 83
12 Bahar et al. (2013) Turkey Three primary care centers located within the same district Patients who had been diagnosed with HTN by a physician, receiving HTN treatment, and admitted to a primary care center 193 (NR) 99 (51.3%) 8
13 Wazaify et al. (2013) Jordan University teaching hospital Patients with CKD, dyslipidemia, and HTN cases attending the outpatient departments Total: 700 (91.3%) 44 (6.9%)c 9
HTN: 636*
14 Nuwaha and Musinguzi (2013) Uganda Community-based survey at two rural districts HTN patients ≥15 years of age 258 (91.8%) 73 (28.3%) NR
15 Hu et al. (2018) China Survey conducted within a local community of a metropolitan city HTN patients ≥35 years of age who have had HTN for a minimum of 12 months 318 (81.4%) 59 (18.6%) NR
16 Mollaoğlu et al. (2013) Turkey Outpatient clinics of a general hospital Adults ≥21 years of age and treated for one or more of six chronic diseases, including HTN, within the past year in Turkey 252 (NR) 51 (61.4%) NR
HTN: 83*
17 Açıkgöz et al. (2014) Turkey Tertiary care education hospital All patients admitted to outpatient cardiology clinics with prior prescription of at least one cardiovascular drug 390 (84.5%) 79 (29.7%) NR
HTN: 266*
18 Kretchy et al. (2014) Ghana Two tertiary teaching Hospitals HTN patients ≥18 years of age attending the outpatient departments 400 (100.0%) 51 (12.8%) 13
19 Boima et al. (2015) Ghana and Nigeria Three tertiary teaching hospitals and one general hospital HTN patients ≥18  years of age who had been diagnosed with HTN and placed on medication for at least 12 months 357 (NR) 62 (17.4%) NR
20 Li et al. (2015) China Community-based survey at the two rural counties HTN patients ≥30 years of age in two counties 665 (NR) 93 (14.0%) NR
21 Tajadini et al. (2015) Iran Telephone interview HTN patients participated in the KERCADER project in the Beast subspecialty clinic 612 (94.2%) 180 (29.4%) 3
22 Asfaw Erku and Basazn Mekuria (2016) Ethiopia University teaching hospital HTN patients ≥18 years of age who started taking medication for reduction of BP and visited the outpatient clinic 412 (97.4%) 189 (45.9%) NR
23 Lulebo et al. (2017) Congo Fifteen primary healthcare facilities HTN patients >18 years of age attending Kinshasa Primary Healthcare (KPHC) facilities 280 (NR) 119 (42.5%) NR
24 Baran et al. (2017) Turkey Tertiary hospital HTN patients ≥18 years attending the Family Health Center 465 (80.4%) 259 (55.7%)b 2
25 Liwa et al. (2017) Tanzania Tertiary teaching hospital Patients >18 years of age admitted with HTN-related diagnoses 213 (92.6%) 52 (24.4%) 15
26 Adidja et al. (2018) Cameroon Community-based survey at a single district HTN patients >21 years of age who were on hypertensive medication(s) for at least 1 month 183 (NR) 38 (20.8%) NR
27 James et al. (2018a) Sierra Leone Four public and two private health facilities HTN patients ≥18 years of age attending the outpatient departments 260 (NR) 148 (56.9%) 14
28 Peltzer& Pengpid (2019) Thailand Seven district hospitals Outpatients ≥21 years of age and had a chronic disease 1,396 (98.6%) 272 (32.5%) NR
HTN: 838*
29 Sabery et al. (2019) Iran Community-based survey at Kashan city Adults >60 years of age 770 (100.0%) 235 (68.5%) NR
HTN: 343*
30 Al-Hadid et al. (2020) Jordan A health center HTN patients ≥16 years of age who had been managed at a selected health center for at least 6 months 208 (100.0%) 107 (51.4%) 4
31 Alshabi (2020) Saudi Arabia University hospital Adults >18 years of age 1,000 (NR) 51 (43.6%) NR
HTN: 117*
32 El-Dahiyat et al. (2020) Jordan Two universities University students, staff, and their family members 378 (75.6%) 32 (88.9%) NR
HTN: 36*
33 Owusu et al. (2020) Jamaica Any of the seven chronic disease clinics in one of the four parishes under the WRHA Adults ≥18 years of age who had been diagnosed with HTN and/or T2DM and were attending a chronic disease clinic Total: 362 (95.3%) 224 (72.1%) a 6
HTN: 311* (90.1%)
34 Adeniyi et al. (2021) Jamaica Clinics for HTN and T2DM in the four parishes Adults ≥18 years of age who had been diagnosed with HTN and/or T2DM and attended health clinics in one of the four WRHA parishes 60 (NR) 48 (96.0%) 6
HTN: 50*
35 Joachimdass et al. (2021) Malaysia Primary healthcare clinic in the suburban district HTN patients ≥18 years of age who had attended the clinic for at least three prior appointments for HTN 294 (96.1%) 90 (30.6%) 52
36 Kifle et al. (2021) Ethiopia General hospital located in a town HTN patients ≥18 years of age who received medical care at the adult hypertensive care services 450 (94.7%) 167 (37.1%) 9
37 Thangsuk et al. (2021) Thailand Primary care clinic in university hospital Patients ≥35 years of age who had been diagnosed with essential HTN and taking at least one antihypertensive drug 450 (80.6%) 80 (17.8%) NR
Open in a new tab

HTN, hypertension; T2DM, Type 2 diabetes mellitus; CKD, chronic kidney disease; BP, blood pressure; HL, hyperlipidemia; HM, herbal medicine; CAM, complementary and alternative medicine; NR, not reported.

*

The original study examined the use of HM among both HTN patients and non-HTN adults; thus, only the data on HTN patients were extracted and included in this review.

a

The researchers manually calculated the exact number of respondents as the prevalence was only reported as percentages in the published article.

b

This number indicates the number of CAM users as the original study encompasses the use of CAM, and only the number of individual HM users is reported (the overall number of HM users is not provided).

c

The original study encompasses the use of complementary medicine; thus, only the data on HM use were extracted and included in this review.

d

The total number of HMs indicated in this table excludes duplicate records (e.g., if an HM mortality was reported in more than one study, it is counted once).

e

The total number of herbal medicines with their full names mentioned in each study.

3.4 Prevalence of HM use among HTN patients

The prevalence of HM use among HTN patients ranged from 0.8% to 96.0% (Yeh et al., 2006; Adeniyi et al., 2021), the pooled prevalence was 37.8% (95% CI: 27.4%–48.9%; Table 3; Figure 2). Among the 21 countries included in this review, HM use was the lowest in the United States and the highest in Jamaica (Wazaify et al., 2013; Owusu et al., 2020). The prevalence of HM utilization varied significantly by publication year and geographic region, with higher utilization rates observed in studies published after 2011 (41.0%, 95% CI: 33.9%–48.3%) than those published before 2011 (28.6%, 95% CI: 11.3%–50.1%; p < 0.001). The highest use was reported in North America (62.5%, 95% CI: 9.0%–99.9%), followed by Asia (36.7%, 95% CI: 28.2%–45.7%) and Africa (30.9%, 95% CI: 22.8%–39.6%; Table 3; Figure 3).

TABLE 3.

Pooled prevalence of HM use by study characteristics.

Characteristic Included studies a Sample size Mean b (%) 95% CI p-value
Overall 37 23,947 37.8 27.4–48.9
Publication year
Before 2011 10 10,674 28.6 11.3–50.1 <0.001
After 2011 27 13,273 41.0 33.9–48.3
Geographical region
Africa 11 3,518 30.9 22.8–39.6 <0.001
Asia 20 11,657 36.7 28.2–45.7
Europe 1 153 15.7 10.3–22.4
North America 5 8,619 62.5 9.0–99.9
Open in a new tab

*Estimated using a random-effects model.

aNumber of studies included in each subgroup.

bPooled estimate.

FIGURE 2.

FIGURE 2

Open in a new tab

Pooled prevalence of HM use by HTN patients. This figure presents a forest plot of a random-effect meta-analysis. Thirty-seven studies on HTN patients reported the HM use rate and were included in the pooled estimation of HM use. The square blue dots and the dashed line passing through represent the effect size and corresponding 95% confidence intervals (CIs) reported in individual studies, and the green diamond on the bottom and the size of its lateral tips denote the pooled effect size and its 95% CI.

FIGURE 3.

FIGURE 3

Open in a new tab

Differences in the pooled prevalence of HM use by continents. This figure presents a forest plot of a random-effect meta-analysis. Subgroup meta-analysis was conducted to investigate potential differences in the prevalence of HM use by geographical region (i.e., Asia, North America, Africa, and Europe). The square blue dots and dashed line passing through represent the effect size and corresponding 95% CI reported in individual studies, and the green diamond on the bottom and the size of its lateral tips denote the pooled effect size and its 95% CI for each subgroup.

3.5 The most commonly used HM and reported indications for HM use

The use of 165 herbs was observed in the reviewed articles, but only the modalities used by ten or more study subjects were included in the safety evaluation. As a result, the use of 71 different HMs (individual herbs or mixture as preparation) was identified from 15 studies (Table 4). The most frequently used herbal medicines included Allium sativum L. (31.3%), H. sabdariffa L. (12.3%), Olea europaea L. (10.4%), and Crataegus oxyacantha L (8.0%).

TABLE 4.

Most commonly used HMs and reported indications for HM use among HTN patients.

No. Herbal medicines b No. of users a (Total= 3,922) N (%) Route Reported indication for HM use
English name Scientific name
1 Garlic a–o Allium sativum L. 1,229 (31.3) Oral, topical, inhalation Control or treat HTN, DM, or cancerreducing the side effects of prescription drugs; carminative; improve overall health; malaria; weight reduction; dyslipidemia; arthritis; hyperlipidemia; and meningitis
2 Roselle f , m Hibiscus sabdariffa L. 484 (12.3) Oral, topical, and inhalation Control or treat HTN or DM
3 Olive f Olea europaea L. 407 (10.4) Oral, topical, and inhalation Control or treat HTN, DM, or cancer
4 Hawthorn f Crataegus oxyacantha L. 314 (8.0) Oral, topical, and inhalation Control or treat HTN, DM, or cancer
5 Lemon f , g , j , k , o Citrus limon L. 288 (7.3) Oral Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
6 Green tea f , g , i Camellia sinensis (L.) Kuntze 248 (6.3) Oral, topical, and inhalation Control or treat HTN, DM, or cancer
7 Ginger b , e , f , k , n Zingiber officinale Rosc. 242 (6.2) Oral and topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
8 Anise f Pimpinella anisum L. 229 (5.8) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
9 Chamomile f , l Matricaria chamomilla L. 211 (5.4) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs, and malaria
10 Common sage f Salvia officinalis L. 181 (4.6) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
11 Rosemary f Salvia rosmarinus L. 142 (3.6) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
12 Cinnamon f , g , m Cinnamomum verum J. Presl. 121 (3.1) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
13 Fenugreek f , o , p Trigonella foenum-graecum L. 118 (3.0) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
14 Moringa e , h , k , l , n , o Moringa oleifera L. 118 (3.0) Oral Control or treat HTN or DM, weight reduction, arthritis, hyperlipidemia, meningitis, and tuberculosis
15 Peppermint f , p Mentha piperita L. 117 (3.0) Oral, topical, and inhalation Control or treat HTN or cancer, reducing the side effects of prescription drugs
16 Syrian oregano f Majorana syriaca (L.) Rafin. 117 (3.0) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
17 Parsley f Petroselinum crispum (Mill.) Nyman 109 (2.8) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
18 African moringa p Moringa stenoptela (Baker f.) Cufod. 105 (2.7) Oral Control or treat HTN
19 Black cumin f Nigella sativa L. 91 (2.3) Oral, topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
20 Honey k , l Honey 91 (2.3) Oral Control or treat HTN or DM, weight reduction, arthritis, asthma, and meningitis
21 Damakase p Ocimum lamiifolium Hochst. ex Benth. 81 (2.1) Oral Control or treat HTN
22 Cat thyme f Teucrium polium L. 79 (2.0) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
23 Chickweed f Stellaria media L. 75 (1.9) Oral and topical Control or treat HTN, reducing the side effects of prescription drugs
24 Marshmallow i Althaea officinalis L. 63 (1.6) Oral Control or treat HTN and DM
25 Wild laburnum p Calpurnia aurea (Ait.) Benth. 62 (1.6) Inhalation (nasal) Control or treat HTN
26 Pomegranate f Punica granatum L. 57 (1.5) Oral and topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
27 Guava f , o Psidium guajava L. 53 (1.4) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
28 Banana f , o Musa paradisiaca L. 48 (1.2) Oral and topical Control or treat HTN or cancer, reducing the side effects of prescription drugs
29 Barley f Hordeum vulgare L. 45 (1.1) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
30 Nepal dock p Rumex nepalensis Spreng. 44 (1.1) Oral Control or treat HTN
31 Fennel f Foeniculum vulgare Mill. 40 (1.0) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
32 Onion f , k Allium cepa L. 40 (1.0) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
33 Apple f , g , o Malus domestica Borkh. 30 (0.8) Oral Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
34 Sweet-marjoram f Origanum majorana L. 30 (0.8) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
35 Indian pennywort o Centella asiatica L. 28 (0.7) Oral Control or treat HTN
36 Almond f Prunus dulcis L. 25 (0.6) Oral and topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
37 Lupine f Lupinus albus L. 25 (0.6) Oral, topical, and inhalation Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
38 African redwood p Hagenia abyssinica J.F. Gmel. 24 (0.6) Oral Control or treat HTN
39 Carrot f , k , o Daucus carota L. 24 (0.6) Oral Control or treat HTN or cancer, reducing the side effects of prescription drugs
40 Papaya e , k , o Carica papaya L. 24 (0.6) Oral Control or treat HTN
41 Sweet peppers f Capsicum annuum L. 24 (0.6) Oral Control or treat HTN or DM, reducing the side effects of prescription drugs
42 Bitter gourd o Momordica charantia L. 23 (0.6) Oral Control or treat HTN
43 Black mulberry f Morus nigra L. 23 (0.6) Oral, topical Control or treat HTN or DM, reducing the side effects of prescription drugs
44 Cucumber f , o Cucumis sativus L. 22 (0.6) Oral Control or treat HTN
45 Safflower i Carthamus tinctorius L. 22 (0.6) Oral Control or treat HTN and DM
46 Bitter leaf b , h , l , o Vernonia amygdalina Delile 21 (0.5) Oral Control or treat HTN, improve overall health, weight reduction, arthritis, malaria, typhoid, abdominal pain, and tuberculosis
47 White wormwood f Artemisia herba-alba Asso. 21 (0.5) Oral Control or treat HTN or DM, reducing the side effects of prescription drugs
48 Palestine arum f Arum palaestinum Boiss. 20 (0.5) Oral and topical Control or treat HTN or cancer, reducing the side effects of prescription drugs
49 Cabbage f , o Brassica oleracea L. 19 (0.5) Oral and topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
50 Tosign (Dry thyme) p Thymus schimperi R. 19 (0.5) Oral Control or treat HTN
51 Licorice f Glycyrrhiza glabra L. 16 (0.4) Oral, topical, and inhalation Control or treat HTN, reducing the side effects of prescription drugs
52 Pink flax f Linum pubescens Willd. ex Schult. 16 (0.4) Oral and topical Control or treat HTN or cancer, reducing the side effects of prescription drugs
53 Sugar beet f Beta vulgaris L. 16 (0.4) Oral and topical Control or treat HTN, reducing the side effects of prescription drugs
54 Mekmeko f Rumex abyssinicus Jacq. 15 (0.4) Oral Control or treat HTN
55 Wild mustard f Sinapis arvensis L. 15 (0.4) Oral and topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
56 Kiwi f , o Actinidia deliciosa A. Chev 14 (0.4) Oral Control or treat HTN, reducing the side effects of prescription drugs
57 Pear f , h Pyrus communis L. 14 (0.4) Oral and topical Control or treat HTN, reducing the side effects of prescription drugs
58 Aloe b , e , k Aloe vera (L.) Burm.f. 13 (0.3) Oral Control or treat HTN or malaria
59 Flax seed g , m Linum usitatissimum L. 13 (0.3) Oral Control or treat HTN
60 Lime n , o Citrus aurantiifolia (Christm.) Swingle 13 (0.3) Oral Control or treat HTN
61 Neem e Azadirachta indica A. Juss. 13 (0.3) Oral Control or treat HTN or malaria
62 Roman nettle f Urtica pilulifera L. 13 (0.3) Oral and topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
63 Coffee f Coffea arabica L. 12 (0.3) Inhalation and topical Control or treat HTN, reducing the side effects of prescription drugs
64 Guinea henweed n Petiveria alliacea L. 12 (0.3) Oral Control or treat HTN
65 Grape f , o Vitis vinifera L. 11 (0.3) Oral Control or treat HTN or cancer, reducing the side effects of prescription drugs
66 Persimmon f Diospyros kaki L. 11 (0.3) Oral Control or treat HTN, reducing the side effects of prescription drugs
67 Petai o Parkia speciosa Hassk. 10 (0.3) Oral Control or treat HTN
68 Prickly pear f Opuntia ficus-indica (L.) Mill. 10 (0.3) Oral and topical control or treat HTN or cancer, reducing the side effects of prescription drugs
69 Sesame f Sesamum indicum L. 10 (0.3) Oral and topical Control or treat HTN, DM, or cancer, reducing the side effects of prescription drugs
70 Tamarind e , o Tamarindus indica L. 10 (0.3) Oral Control or treat HTN
71 White micromeria f Micromeria fruticosa (L.) Druce 10 (0.3) Oral and topical Control or treat HTN
Open in a new tab

HTN, hypertension; T2DM, Type 2 diabetes mellitus; HM, herbal medicine.

a

Table 4 includes studies that provide the specific names of the HMs used by HTN patients, along with the corresponding number of users exceeding 10.

b

Superscript numbers from 1 to 15 on every herbal modality indicate the study that reported use of that modality: Amira et al.

c

Clement et al.

d

Gohar et al.

e

Olisa et al.

f

Ali-Shtayeh et al.

g

Bahar et al.

h

Kretchy et al.

i

Tajadini et al.

j

Baran et al.

k

Liwa et al.

l

James et al.

m

Al-Hadid et al.

n

Adeniyi et al.

o

Joachimdass et al.

pKifle et al.

The most commonly reported indications for HM use were to control or treat HTN and diabetes mellitus-related symptoms, followed by weight reduction, arthritis, meningitis, hyperlipidemia, malaria, and tuberculosis (Table 4). Oral administration of the HM was the most common route of administration.

3.6 Safety classification of commonly used HMs

Supplementary Table S5 provides a detailed analysis of the safety classification of commonly used HMs among patients with HTN. In this review, 71 herbs were identified, and four of them were classified as contraindicated based on four safety criteria. Notably, clinical evidence involving human subjects was available for two of these herbs (Glycyrrhiza glabra L. and A. indica A. Juss.), while the safety classification for Arum palaestinum Boiss. and Micromeria fruticosa (L.) Druce relied solely on animal studies. Furthermore, 50 herbs were categorized to be used with caution, while 11 herbs were classified as safe and suitable for HTN patients. Lastly, the safety of the remaining six herbs could not be determined due to insufficient evidence in the current literature for HTN patients (Figure 4).

FIGURE 4.

FIGURE 4

Open in a new tab

Prevalence of HMs used among hypertensive patients by safety classification. HMs in these sections are classified as follows: (A) can be potentially harmful to use, (B) should not be used without the supervision of a qualified healthcare practitioner, (C) safety evidence for herbal medicines not available, and (D) safe to use among hypertensive patients. *Note: The prevalence of each herb’s use was calculated by dividing the number of users for a particular herb by the total number of herbal medicine users.

4 Discussion

The present study presents the first systematic review and meta-analysis of HM use among HTN patients, identifying herbs commonly and globally used and assessing their safety based on current evidence. In total, 37 cross-sectional studies were included, with a combined sample size of 23,947 HTN patients. Of these, 37.8% reported using one or more types of HM during their treatment. The prevalence of HM utilization varied significantly by publication year and continent. Higher utilization rates were observed in studies published after 2011 (41.0%) than before 2011 (28.6%). Additionally, there were significant regional variations, with the highest use reported in North America (62.5%) and the lowest in Europe (15.7%). These regional differences may be attributed to various factors, including geographical characteristics, social and cultural influences, sociodemographic characteristics of study participants, and the quality of conventional therapy (Liwa et al., 2014; Peltzer and Pengpid, 2018; Azizah et al., 2021). Consequently, further research is warranted to explore the potential associations among these factors.

Patients with HTN commonly turn to HM to manage a range of physical conditions. The most frequently reported reasons for using HM include controlling blood pressure (BP), managing common comorbidities associated with HTN, and alleviating side effects from prescription drugs, such as frequent urination, headaches, and fatigue (Joshi et al., 2010; Olowofela and Isah, 2017). Additionally, some patients use HM to enhance their overall health status and wellbeing. The decision to use HM among HTN patients is often based on the belief that HM is safer and has fewer adverse effects than conventional antihypertensive drugs. Some patients opt for non-conventional treatment modalities due to concerns about the potential toxicity or dissatisfaction with conventional medicine in meeting their healthcare needs (Ahmed et al., 2017).

Despite the widespread use of HM among HTN patients, previous reviews on HM use among HTN patients have overlooked the evaluation of the safety of commonly used herbs. Thus, this study evaluated the safety profiles of the 71 most common HMs used by HTN patients, as identified in the included studies. The results revealed that four herbs were contraindicated for use, while 11 herbs were considered safe for use. Of the four herbs classified as contraindicated, two had no evidence of efficacy in lowering BP, and the other two herbs, G. glabra and A. indica, were supported only by a limited number of animal studies and had no clinical evidence of efficacy (Khoshnam and Bahaoddini, 2013; Shah et al., 2014). While these animal studies demonstrated potential benefits in controlling BP and managing common comorbidities associated with hypertension, numerous adverse effects were observed. For example, the use of G. glabra was associated with increased BP, hypokalemic-induced secondary disorders, rhabdomyolysis, acute renal failure, metabolic alkalosis, acute tubular necrosis, uremic, and paralysis in cases of chronic use (Van Uum, 2005; Sontia et al., 2008; Nazari et al., 2017; Penninkilampi et al., 2017; Kwon et al., 2020). Similarly, the misuse of A. indica was linked to severe stomatitis, marked oliguria, sanguineous vomiting, and even death (Wajdy et al., 2021). As a result, the consumption of these herbs or supplements containing their extracts should be avoided for HTN patients. These results stress the importance of safety in using HM for HTN management and highlight the need for evidence-based recommendations to enhance healthcare practices for HTN patients.

Amidst the potential risks, several herbs have been identified to provide clinical benefits while also being safe for use. A. sativum, used by 31.3% of HTN patients worldwide, is a popular HM used for managing HTN. Patients turn to A. sativum not only for HTN control but also for managing diabetes mellitus, alleviating prescription drug side effects, and improving overall health. Numerous studies and reviews have reported the antihypertensive effects of A. sativum, with a mean reduction in systolic/diastolic BP of 8.3/5.5 mmHg observed after administration of various A. sativum preparations and doses ranging from 600 mg/day to 1,200 mg/day over a median follow-up of 12 weeks (Shouk et al., 2014; Chrysant and Chrysant, 2017; Ried, 2020; EKİCİ et al., 2023). Its use has not been linked to any harmful events among HTN patients, although caution is advised with higher doses to prevent minor gastrointestinal disturbances (Matsutomo, 2020).

Similarly, O. europaea and C. oxyacantha are HMs that are commonly used by HTN patients and are known for their safety and efficacy in managing HTN at recommended doses, with no significant side effects reported (Susalit et al., 2011; Cloud et al., 2020; Venkatakrishnan et al., 2020; Ismail et al., 2021; Sun Y. et al., 2022; Johnson-Moore et al., 2023). The mechanism of action of O. europaea involves ACE inhibition, Ca2+ channel blockade, vasodilation, and antioxidant effects of flavonoids such as quercetin and rutin. Clinical trials administering 500 mg/day of O. europaea leaf extract versus placebo or no treatment resulted in a significant reduction in systolic/diastolic BP of 11.5/4.8 mmHg over 8 weeks (EKİCİ et al., 2023; Álvares et al., 2024). The beneficial effects of 900 mg/day C. oxyacantha on HTN have been consistently reported, where significant reductions in both SBP and DBP of approximately 17.2 mmHg and 9.2 mmHg, respectively, have been observed, especially when used for at least 12 weeks. These effects are primarily attributed to its flavonoids and oligomeric proanthocyanidins. Specifically, quercetin, the major polyphenolic flavonoid in C. oxyacantha, has shown efficacy in reducing BP through its antioxidant, anti-inflammatory, and vasorelaxant properties (Al-Gareeb, 2012; Cloud et al., 2020). Compounds found in C. limon (hesperidin and naringin) and C. sinensis (catechin) also act as vasodilators with antioxidant, anti-inflammatory, and antihypertensive properties, contributing to the use of HM in HTN patients (Peng et al., 2014; Rawat et al., 2016; David, 2017; Shilpa and Souza, 2020).

Fifty herbs have been identified for use with caution, as some of them have been associated with serious adverse effects, while others lack sufficient human evidence to determine their safety, particularly in HTN patients. H. sabdariffa, the second most commonly used HM among HTN patients, is frequently used to manage mild ailments and lower BP, and clinical literature reported no harmful effects in HTN patients (McKay et al., 2010; Serban et al., 2015). However, caution is still advised when using H. sabdariffa, as some studies reported diuretic effects and hepatotoxicity associated with high doses (Hopkins et al., 2013; Diallo et al., 2019). Also, P. anisum L. and Salvia officinalis L. are generally considered safe, but high doses or frequent intake of P. anisum seeds and its oil may cause nausea, vomiting, and pulmonary edema (Singletary, 2022), and excessive use of S. officinalis with high thujone content can lead to allergic reactions in some individuals (Mills and Bone, 2004; Hamidpour et al., 2014). In addition, although the consumption of Stellaria media L. tea and Foeniculum vulgare Mill. has not shown any toxicity or adverse events in animal studies, their safety and efficacy in HTN patients have yet to be investigated. As a result, it is recommended to use these herbs under the supervision of a qualified healthcare practitioner.

Finally, the safety of six HMs, such as honey, Teucrium polium L., and Althaea officinalis L., could not be established due to the lack of scientific research on their potential toxicity in humans (Reinelt and Melzig, 2017; Kianitalaei et al., 2019; Akhbari et al., 2021; Gholami et al., 2022). Therefore, it is recommended to avoid using these HMs until clinical evidence is available to ensure safety. In addition, certain substances that are commonly used in foods, such as honey, A. officinalis, and Hordeum vulgare L., should only be consumed in moderation and in amounts typical of culinary practices because excessive consumption of these HM may result in potential adverse effects. These findings emphasize the importance of conducting clinical studies to establish the toxicity and safety of commonly used herbs.

Before interpreting the findings of this systematic review, it is important to consider the following limitations. First, the reviewed studies were selected from three databases and restricted to articles published in the English language, which many potentially limit the generalizability of findings regarding the utilization of HM among HTN patients. Second, significant variations in sample size and study settings were observed among the reviewed studies, with the sample size ranging from 74 to 4,575 participants and the study settings varying from primary healthcare centers to tertiary teaching hospitals. The number of hospitals surveyed varied from a single institution to as many as 16 facilities (Mahfudz and Chan, 2005; Clement et al., 2007; Ali-Shtayeh et al., 2013; Boima et al., 2015).

The extent of HM use investigated also varied among the studies, with four studies excluded from the final analysis as they only investigated whether patients used HM or not and did not report the number of users for individual HM modalities (Mahfudz and Chan, 2005; Wazaify et al., 2013; Boima et al., 2015; Owusu et al., 2020). Lastly, due to variations in study quality, numerous studies were omitted from the final analysis during the risk of bias assessment phase. Initially, 48 studies from 25 countries were considered for the review, but after the quality assessment of the studies, 37 cross-sectional studies from 21 countries remained for the final analysis. Hence, it is essential to consider the discrepancies when interpreting the results of this review, and additional studies with a focus on methodological rigor are needed to achieve a more comprehensive understanding of HM use among HTN patients globally. Despite these limitations, our findings offer valuable insights into the safety profile of HMs commonly used by HTN patients, facilitating the development of evidence-based guidance for policymakers and healthcare providers involved in HTN management.

5 Conclusion

The use of HM among HTN patients is widespread globally. Our study emphasizes the significance of recognizing the risks of toxicities and adverse effects associated with HM use for HTN treatment. To prioritize patient safety, it is crucial to take only HM classified as safe in normal doses and avoid contraindicated HM. The safety classification in this review can raise awareness among physicians and healthcare providers regarding potential adverse effects in HTN patients. Future research should prioritize identifying commonly used herbs among HTN patients, particularly in resource-limited countries with poor HTN management. Conducting additional clinical studies is imperative to thoroughly evaluate the toxicity and safety of these medicinal plants.

Acknowledgments

The authors would like to express their sincere gratitude to all the reviewers for their valuable comments and feedback.

Funding Statement

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Data availability statement

All data generated and analyzed, including study protocol, search strategy, list of included and excluded studies, extracted data, analysis plans, quality assessment, and assessment of publication bias, will be made available by the authors upon reasonable request. Requests to access these datasets should be directed to the corresponding author.

Author contributions

DC: conceptualization, data curation, formal analysis, methodology, writing–original draft, writing- review and editing, visualization, and software. HI: conceptualization, data curation, formal analysis, investigation, writing–review and editing, and software. SC: formal analysis, investigation, writing- review and editing. DH: conceptualization, supervision, writing–review and editing.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fphar.2024.1321523/full#supplementary-material

Table1.docx (33.8KB, docx)
Image1.tif (2.3MB, tif)
Table2.docx (30.4KB, docx)
Table5.docx (163KB, docx)
Table3.docx (30.9KB, docx)
Table4.docx (42.2KB, docx)

Abbreviations

BP, blood pressure; CAM, complementary and alternative medicine; CI, confidence interval; DM, diabetes mellitus; HM, herbal medicine; HTN, hypertension; RCT, randomized controlled trial.

References

  1. Abo-elmatty D. M., Essawy S. S., Badr J. M., Sterner O. (2013). Antioxidant and anti-inflammatory effects of Urtica pilulifera extracts in type2 diabetic rats. J. Ethnopharmacol. 145 (1), 269–277. 10.1016/j.jep.2012.11.002 [DOI] [PubMed] [Google Scholar]
  2. Açıkgöz S. K., Açıkgöz E., Topal S., Okuyan H., Yaman B., Er O., et al. (2014). Effect of herbal medicine use on medication adherence of cardiology patients. Complement. Ther. Med. 22 (4), 648–654. 10.1016/j.ctim.2014.05.013 [DOI] [PubMed] [Google Scholar]
  3. Adane F., Asres K., Ergete W., Woldekidan S., Abebe A., Lengiso B., et al. (2021). Composition of the essential oil Thymus schimperi and evaluation of its acute and subacute toxicity in wistar albino rats: in silico toxicity studies. Evid. Based Complement. Altern. Med. 2021, 5521302. 10.1155/2021/5521302 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Adane F., Assefa W., Alem M. B., Dessalegn M. (2023). Sub-chronic toxicity of the aqueous leaf extract of Ocimum lamiifolium Hochst. ex Benth on biochemical parameters and histopathology of liver and kidney in rats: in vivo and in-silico toxicity studies. BMC Complement. Med. Ther. 23 (1), 30. 10.1186/s12906-023-03863-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Adeniyi O., Washington L., Glenn C. J., Franklin S. G., Scott A., Aung M., et al. (2021). The use of complementary and alternative medicine among hypertensive and type 2 diabetic patients in Western Jamaica: a mixed methods study. PloS one 16 (2), e0245163. 10.1371/journal.pone.0245163 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Adidja N. M., Agbor V. N., Aminde J. A., Ngwasiri C. A., Ngu K. B., Aminde L. N. (2018). Non-adherence to antihypertensive pharmacotherapy in Buea, Cameroon: a cross-sectional community-based study. BMC Cardiovasc. Disord. 18, 1–9. 10.1186/s12872-018-0888-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Adokoh C. K., Asante D.-B., Acheampong D. O., Kotsuchibashi Y., Armah F. A., Sirikyi I. H., et al. (2019). Chemical profile and in vivo toxicity evaluation of unripe Citrus aurantifolia essential oil. Toxicol. Rep. 6, 692–702. 10.1016/j.toxrep.2019.06.020 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Aekthammarat D., Pannangpetch P., Tangsucharit P. (2019). Moringa oleifera leaf extract lowers high blood pressure by alleviating vascular dysfunction and decreasing oxidative stress in L-NAME hypertensive rats. Phytomedicine 54, 9–16. 10.1016/j.phymed.2018.10.023 [DOI] [PubMed] [Google Scholar]
  9. Ahmad N. I., Rahman S. A., Leong Y.-H., Azizul N. H. (2019). A review on the phytochemicals of Parkia Speciosa, stinky beans as potential Phytomedicine. J. Food Sci. Nutr. Res. 2 (3), 151–173. 10.26502/jfsnr.2642-11000017 [DOI] [Google Scholar]
  10. Ahmed M., Hwang J. H., Choi S., Han D. (2017). Safety classification of herbal medicines used among pregnant women in Asian countries: a systematic review. BMC Complement. Altern. Med. 17 (1), 489. 10.1186/s12906-017-1995-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Ahmed-Farid O., Abdelrazek A. M., Elwakel H., Mohamed M. M. (2023). Hordeum vulgare ethanolic extract mitigates high salt-induced cerebellum damage via attenuation of oxidative stress, neuroinflammation, and neurochemical alterations in hypertensive rats. Metab. Brain Dis. 38 (7), 2427–2442. 10.1007/s11011-023-01277-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ajebli M., Eddouks M. (2019). Antihypertensive activity of Petroselinum crispum through inhibition of vascular calcium channels in rats. J. Ethnopharmacol. 242, 112039. 10.1016/j.jep.2019.112039 [DOI] [PubMed] [Google Scholar]
  13. Ajijolakewu K. A., Ayoola A. S., Agbabiaka T. O., Zakariyah F. R., Ahmed N. R., Oyedele O. J., et al. (2021). A review of the ethnomedicinal, antimicrobial, and phytochemical properties of Musa paradisiaca (plantain). Bull. Natl. Res. Cent. 45 (1), 86. 10.1186/s42269-021-00549-3 [DOI] [Google Scholar]
  14. Akaberi M., Hosseinzadeh H. (2016). Grapes (Vitis vinifera) as a potential candidate for the therapy of the metabolic syndrome. Phytother. Res. 30 (4), 540–556. 10.1002/ptr.5570 [DOI] [PubMed] [Google Scholar]
  15. Akhbari M., Jabbari M., Ayati M. H., Namazi N. (2021). The effects of oral consumption of honey on key metabolic profiles in adult patients with type 2 diabetes mellitus and nondiabetic individuals: a systematic review of clinical trials. Evid. Based Complement. Altern. Med. 2021, 6666832. 10.1155/2021/6666832 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Akhtar S., Rauf A., Imran M., Qamar M., Riaz M., Mubarak M. S. (2017). Black carrot (Daucus carota L.), dietary and health promoting perspectives of its polyphenols: a review. T Trends Food Sci. Technol. 66, 36–47. 10.1016/j.tifs.2017.05.004 [DOI] [Google Scholar]
  17. Al Batran R., Al-Bayaty F., Jamil Al-Obaidi M. M., Abdualkader A. M., Hadi H. A., Ali H. M., et al. (2013). In vivo antioxidant and antiulcer activity of Parkia speciosa ethanolic leaf extract against ethanol-induced gastric ulcer in rats. PloS one 8 (5), e64751. 10.1371/journal.pone.0064751 [DOI] [PMC free article] [PubMed] [Google Scholar] [Retracted]
  18. Al Disi S. S., Anwar M. A., Eid A. H. (2016). Anti-hypertensive herbs and their mechanisms of action: part I. Front. Pharmacol. 6, 323. 10.3389/fphar.2015.00323 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Al-Gareeb A. I. A. (2012). Effect of hawthorn extract on blood pressure and lipid profile in patients with stage I hypertension: a placebo-controlled, double-blind randomized trial. Mustansiriya Med. J. 11 (1), 52–57. [Google Scholar]
  20. Al-Hadid D., Musa R. J., Al-Talhuni A., Alkrad J. A. (2020). Prevalence of traditional herbs and supplements use among hypertensive patients in om elamad health center. Pharmacogn. J. 12 (6s), 1612–1622. 10.5530/pj.2020.12.221 [DOI] [Google Scholar]
  21. Al-Hamdan N., Saeed A., Kutbi A., Choudhry A. J., Nooh R. (2011). Characteristics, risk factors, and treatment practices of known adult hypertensive patients in Saudi Arabia. Int. J. Hypertens. 2010. 10.4061/2010/168739 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Alshabi A. M. (2020). Knowledge and attitudes toward use of herbal medicine among Saudi Arabian Patients. Curr. Top. Nutraceutical Res. 18 (4). 10.37290/ctnr2641-452X.18:303-309 [DOI] [Google Scholar]
  23. Ali-Shtayeh M. S., Jamous R. M., Jamous R. M., Salameh N. M. (2013). Complementary and alternative medicine (CAM) use among hypertensive patients in Palestine. Complement. Ther. Clin. Pract. 19 (4), 256–263. 10.1016/j.ctcp.2013.09.001 [DOI] [PubMed] [Google Scholar]
  24. Aliwaini S., Lubbad A. M. (2016). Anti carcinogenic effect of roman nettle against chemical induced colon cancer in sprague–dawley rats. IUG J. Nat. Stud. 24 (2). [Google Scholar]
  25. Al-Qudah M. (2016). Histological and biochemical studies on liver of female rats treated with different concentrations of ethanolic extract of Arum palaestinum . J. Appl. Environ. Biol. Sci. 6 (7), 1. [Google Scholar]
  26. Al-Qura’n S. (2005). Ethnobotanical survey of folk toxic plants in southern part of Jordan. Toxicon 46 (2), 119–129. 10.1016/j.toxicon.2005.04.010 [DOI] [PubMed] [Google Scholar]
  27. Aluko E. O., Olubobokun T. H., Enobong I. B., Atang D. E. (2013). Comparative study of effect of honey on blood pressure and heart rate in healthy male and female subjects. Br. J. Med. Med. Res. 3 (4), 2214–2221. 10.9734/bjmmr/2013/4152 [DOI] [Google Scholar]
  28. Álvares A. A., Garcêz A., Silva L. T., Averbuch N., Garavaglia J. (2024). Olive leaf extract effect on cardiometabolic risk factors: a systematic review and meta-analysis of randomized clinical trials. Nutr. Rev., nuad164. 10.1093/nutrit/nuad164 [DOI] [PubMed] [Google Scholar]
  29. Al-Waili N. (1986). Treatment of diabetes mellitus by Artemisia herba-alba extract: preliminary study. Clin. Exp. Pharmacol. Physiol. 13 (7), 569–573. 10.1111/j.1440-1681.1986.tb00940.x [DOI] [PubMed] [Google Scholar]
  30. Amira O. C., Okubadejo N. U. (2007). Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria. BMC Complement. Altern. Med. 7, 30–35. 10.1186/1472-6882-7-30 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Anand T., Joseph L. M., Geetha A., Prabhakaran D., Jeemon P. (2019). Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob. Health 7 (6), e761–e771. 10.1016/s2214-109x(19)30077-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Andargie Y., Sisay W., Molla M., Norahun A., Singh P. (2022). Evaluation of the antiulcer activity of methanolic extract and solvent fractions of the leaves of Calpurnia aurea (Ait.) Benth.(Fabaceae) in rats. Evid. Based Complement. Altern. Med. 2022, 4199284. 10.1155/2022/4199284 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Anh N. H., Kim S. J., Long N. P., Min J. E., Yoon Y. C., Lee E. G., et al. (2020). Ginger on human health: a comprehensive systematic review of 109 randomized controlled trials. Nutrients 12 (1), 157. 10.3390/nu12010157 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Anwar M. A., Al Disi S. S., Eid A. H. (2016). Anti-hypertensive herbs and their mechanisms of action: part II. Front. Pharmacol. 7 (50), 50–25. 10.3389/fphar.2016.00050 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Arma M. R., Sumarni S. (2020). Effectiveness of beetroot (beta vulgaris L) extracts on blood pressure level among postpartum mothers with hypertension. Str. Health Sci. J. 9 (2), 678–685. 10.30994/sjik.v9i2.356 [DOI] [Google Scholar]
  36. Asfaw Erku D., Basazn Mekuria A. (2016). Prevalence and correlates of complementary and alternative medicine use among hypertensive patients in Gondar town, Ethiopia. Evid. Based Complement. Altern. Med. 2016, 6987636. 10.1155/2016/6987636 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Asiwe J. N., Kolawole T. A., Ben-Azu B., Ajayi A. M., Ojetola A. A., Moke E. G., et al. (2022). Up-regulation of B-cell lymphoma factor-2 expression, inhibition of oxidative stress and down-regulation of pro-inflammatory cytokines are involved in the protective effect of cabbage (Brassica oleracea) juice in lead-induced endothelial dysfunction in rats. J. Trace Elem. Med. Biol. 73, 127014. 10.1016/j.jtemb.2022.127014 [DOI] [PubMed] [Google Scholar]
  38. Assad T., Khan R. A., Feroz Z. (2014). Evaluation of hypoglycemic and hypolipidemic activity of methanol extract of Brassica oleracea . Chin. J. Nat. Med. 12 (9), 648–653. 10.1016/s1875-5364(14)60099-6 [DOI] [PubMed] [Google Scholar]
  39. Assefa B., Glatzel G., Buchmann C. (2010). Ethnomedicinal uses of Hagenia abyssinica (Bruce) JF Gmel. among rural communities of Ethiopia. J. Ethnobiol. Ethnomedicine 6, 20–10. 10.1186/1746-4269-6-20 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Astutik F. E. F., Zuhroh D. F., Ramadhan M. R. L. (2021). The effect of gotu kola (Centella asiatica L.) tea on blood pressure of hypertension. Enferm. Clin. 31, S195–S198. 10.1016/j.enfcli.2020.12.021 [DOI] [Google Scholar]
  41. Avello M., Jofre P., Pastene E., Fernandez P. (2014). Use of citrus limon, L.(lemon) in treating blood pressure sudden rises. Int. J. Pharmacogn. Phytochem. Res. 6 (3), 606–611. [Google Scholar]
  42. Awaad A. A., El‐Meligy R. M., Zain G. M., Safhi A. A., Al Qurain N. A., Almoqren S. S., et al. (2018). Experimental and clinical antihypertensive activity of Matricaria chamomilla extracts and their angiotensin‐converting enzyme inhibitory activity. Phytother. Res. 32 (8), 1564–1573. 10.1002/ptr.6086 [DOI] [PubMed] [Google Scholar]
  43. Ayal G., Belay A., Kahaliw W. (2019). Evaluation of wound healing and anti-inflammatory activity of the leaves of Calpurnia aurea (Ait.) Benth (fabaceae) in mice. Wound Med. 25 (1), 100151. 10.1016/j.wndm.2019.100151 [DOI] [Google Scholar]
  44. Ayşe K., Ertuğrul K. (2020). Medical and cosmetic applications of persimmon (Diospyros Kaki): toxicity assessment-A review. Int. J. Tradit. Complement. Med. Res. 1 (3), 162–176. [Google Scholar]
  45. Azemi A. K., Nordin M. L., Hambali K. A., Noralidin N. A., Mokhtar S. S., Rasool A. H. G. (2022). Phytochemical contents and pharmacological potential of Parkia speciosa hassk. For diabetic vasculopathy: a review. Antioxidants 11 (2), 431. 10.3390/antiox11020431 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Azizah N., Halimah E., Puspitasari I. M., Hasanah A. N. (2021). Simultaneous use of herbal medicines and antihypertensive drugs among hypertensive patients in the community: a review. J. Multidiscip. Healthc. 14, 259–270. 10.2147/jmdh.s289156 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Bahadoran Z., Mirmiran P., Kabir A., Azizi F., Ghasemi A. (2017). The nitrate-independent blood pressure–lowering effect of beetroot juice: a systematic review and meta-analysis. Adv. Nutr. 8 (6), 830–838. 10.3945/an.117.016717 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Bahar Z., Kizilci S., Beser A., Besen D. B., Gördes N., Ersin F., et al. (2013). Herbal therapies used by hypertensive patients in Turkey. Afr. J. Tradit. Complement. Altern. Med. 10 (2), 292–298. 10.4314/ajtcam.v10i2.14 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Bahmani M., Shirzad H., Mirhosseini M., Mesripour A., Rafieian-Kopaei M. (2016). A review on ethnobotanical and therapeutic uses of fenugreek (Trigonella foenum-graceum L). J. Evid. Based Complement. Altern. Med. 21 (1), 53–62. 10.1177/2156587215583405 [DOI] [PubMed] [Google Scholar]
  50. Bakour M., Al-Waili N., El-Haskoury R., El-Menyiy N., Al-Waili T., Ali A., et al. (2017). Comparison of hypotensive, diuretic and renal effects between cladodes of Opuntia ficus-indica and furosemide. Asian pac. J. Trop. Med. 10 (9), 900–906. 10.1016/j.apjtm.2017.08.016 [DOI] [PubMed] [Google Scholar]
  51. Baran A. K., Demirci H., Budak E., Candar A., Akpınar Y. (2017). What do people with hypertension use to reduce blood pressure in addition to conventional medication–Is this related to adherence? Eur. J. Integr. Med. 13, 49–53. 10.1016/j.eujim.2017.07.004 [DOI] [Google Scholar]
  52. Bardai S. E., Lyoussi B., Wibo M., Morel N. (2001). Pharmacological evidence of hypotensive activity of Marrubium vulgare and Foeniculum vulgare in spontaneously hypertensive rat. Clin. Exp. Hypertens. 23 (4), 329–343. 10.1081/ceh-100102671 [DOI] [PubMed] [Google Scholar]
  53. Basch E., Gabardi S., Ulbricht C. (2003). Bitter melon (Momordica charantia): a review of efficacy and safety. Am. J. Health-Syst. Pharm. 60 (4), 356–359. 10.1093/ajhp/60.4.356 [DOI] [PubMed] [Google Scholar]
  54. Basch E., Mphil S. B., Collins J., Dacey C., Harrison M., Szapary P., et al. (2007). Flax and flaxseed oil (Linum usitatissimum): a review by. J. Soc. Integr. Oncol. 5 (3), 92–105. 10.2310/7200.2007.005 [DOI] [PubMed] [Google Scholar]
  55. Belsty T., Ekanem P. E., Gebremedhin G., Gebreselassie H., Kebede H. (2019). Evaluation of Rumex nepalensis Spreng. root extract on biochemical and histopathologic parameters of mice liver. J. Anat. Soc. India 68 (3), 205–210. 10.4103/jasi.jasi_48_19 [DOI] [Google Scholar]
  56. Benjamim C. J. R., Porto A. A., Valenti V. E., Sobrinho A. C. d.S., Garner D. M., Gualano B., et al. (2022). Nitrate derived from beetroot juice lowers blood pressure in patients with arterial hypertension: a systematic review and meta-analysis. Front. Nutr. 9, 823039. 10.3389/fnut.2022.823039 [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Benkhaira N., Ech-Chibani N., Fikri-Benbrahim K. (2021). Ethnobotanical survey on the medicinal usage of two common medicinal plants in Taounate Region: Artemisia herba-alba Asso and Ormenis mixta (L.) Dumort. Ethnobot. Res. Appl. 22, 1–19. 10.32859/era.22.48.1-19 [DOI] [Google Scholar]
  58. Birhanu Z., Wuhab M., Abula T. (2015). Antimalarial activity of Calpurnia aurea hydroalcoholic leaf extract in mice infected with Plasmodium berghei . PharmacologyOnLine 2, 73–79. [Google Scholar]
  59. Boima V., Ademola A. D., Odusola A. O., Agyekum F., Nwafor C. E., Cole H., et al. (2015). Factors associated with medication nonadherence among hypertensives in Ghana and Nigeria. Int. J. Hypertens. 2015, 205716. 10.1155/2015/205716 [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Bonilla Ocampo D. A., Paipilla A. F., Marín E., Vargas-Molina S., Petro J. L., Pérez-Idárraga A. (2018). Dietary nitrate from beetroot juice for hypertension: a systematic review. Biomolecules 8 (4), 134. 10.3390/biom8040134 [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Bouyahya A., Chamkhi I., Benali T., Guaouguaou F.-E., Balahbib A., El Omari N., et al. (2021). Traditional use, phytochemistry, toxicology, and pharmacology of Origanum majorana L. J. Ethnopharmacol. 265, 113318. 10.1016/j.jep.2020.113318 [DOI] [PubMed] [Google Scholar]
  62. Brasil G. A., Ronchi S. N., do Nascimento A. M., de Lima E. M., Romão W., da Costa H. B., et al. (2014). Antihypertensive effect of Carica papaya via a reduction in ACE activity and improved baroreflex. Planta Med. 80 (17), 1580–1587. 10.1055/s-0034-1383122 [DOI] [PubMed] [Google Scholar]
  63. Bunaim M. K., Kamisah Y., Mohd Mustazil M. N., Fadhlullah Zuhair J. S., Juliana A. H., Muhammad N. (2021). Centella asiatica (L.) Urb. prevents hypertension and protects the heart in chronic nitric oxide deficiency rat model. Front. Pharmacol. 12, 742562. 10.3389/fphar.2021.742562 [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Bunbupha S., Pakdeechote P., Maneesai P., Prachaney P., Boonprom P. (2019). Carthamus Tinctorius L. extract attenuates cardiac remodeling in L-NAME-induced hypertensive rats by inhibiting the NADPH oxidase-mediated TGF-β1 and MMP-9 pathway. Ann. Anat. 222, 120–128. 10.1016/j.aanat.2018.12.006 [DOI] [PubMed] [Google Scholar]
  65. Burnier M., Egan B. M. (2019). Adherence in hypertension: a review of prevalence, risk factors, impact, and management. Circ. Res. 124 (7), 1124–1140. 10.1161/circresaha.118.313220 [DOI] [PubMed] [Google Scholar]
  66. Cardoso C. A., Oliveira G. M. M. d., Gouveia L. d.A. V., Moreira A. S. B., Rosa G. (2018). The effect of dietary intake of sesame (Sesamumindicum L.) derivatives related to the lipid profile and blood pressure: a systematic review. Crit. Rev. Food Sci. Nutr. 58 (1), 116–125. 10.1080/10408398.2015.1137858 [DOI] [PubMed] [Google Scholar]
  67. Cesarone M., Belcaro G., De Sanctis M., Incandela L., Cacchio M., Bavera P., et al. (2001). Effects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trial. Angiology 52 (2_Suppl. l), S15–S18. 10.1177/000331970105202s04 [DOI] [PubMed] [Google Scholar]
  68. Chakraborty A. J., Uddin T. M., Zidan B. R. M., Mitra S., Das R., Nainu F., et al. (2022). Allium cepa: a treasure of bioactive phytochemicals with prospective health benefits. Evid. Based Complement. Altern. Med. 2022, 4586318. 10.1155/2022/4586318 [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Chen S., Li J., Gao M., Li D., Shen R., Lyu L., et al. (2022). Association of caffeine intake with all-cause and cardiovascular mortality in elderly patients with hypertension. Front. Nutr. 9, 1023345. 10.3389/fnut.2022.1023345 [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. Chrysant S. G., Chrysant G. S. (2017). Herbs used for the treatment of hypertension and their mechanism of action. Curr. Hypertens. Rep. 19, 77–10. 10.1007/s11906-017-0775-5 [DOI] [PubMed] [Google Scholar]
  71. Clement Y. N., Morton-Gittens J., Basdeo L., Blades A., Francis M.-J., Gomes N., et al. (2007). Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad. BMC Complement. Altern. Med. 7 (1), 4–9. 10.1186/1472-6882-7-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  72. Cloud A., Vilcins D., McEwen B. (2020). The effect of hawthorn (Crataegus spp.) on blood pressure: a systematic review. Adv. Integr. Med. 7 (3), 167–175. 10.1016/j.aimed.2019.09.002 [DOI] [Google Scholar]
  73. Concato J., Shah N., Horwitz R. I. (2000). Randomized, controlled trials, observational studies, and the hierarchy of research designs. N. Engl. J. Med. 342 (25), 1887–1892. 10.1056/nejm200006223422507 [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Costa E. S., França C. N., Fonseca F. A., Kato J. T., Bianco H. T., Freitas T. T., et al. (2019). Beneficial effects of green banana biomass consumption in patients with pre-diabetes and type 2 diabetes: a randomised controlled trial. Br. J. Nutr. 121 (12), 1365–1375. 10.1017/s0007114519000576 [DOI] [PubMed] [Google Scholar]
  75. Cui W., Luo K., Xiao Q., Sun Z., Wang Y., Cui C., et al. (2023). Effect of mulberry leaf or mulberry leaf extract on glycemic traits: a systematic review and meta-analysis. Food Funct. 14 (3), 1277–1289. 10.1039/d2fo02645g [DOI] [PubMed] [Google Scholar]
  76. Cuzzolin L., Benoni G. (2009). Safety issues of phytomedicines in pregnancy and paediatrics. Herb. drugs ethnomedicine Mod. Med., 381–396. 10.1007/978-3-540-79116-4_21 [DOI] [Google Scholar]
  77. Dai Y.-L., Li Y., Wang Q., Niu F.-J., Li K.-W., Wang Y.-Y., et al. (2022). Chamomile: a review of its traditional uses, chemical constituents, pharmacological activities and quality control studies. Molecules 28 (1), 133. 10.3390/molecules28010133 [DOI] [PMC free article] [PubMed] [Google Scholar]
  78. Damtie D., Mekonnen Y., Eyado A. (2017). Acute oral toxicity study of Thymus serrulatus and Thymus schimperi from Ethiopia. Ethiop. J. Sci. Technol. 10 (3), 181–192. 10.4314/ejst.v10i3.3 [DOI] [Google Scholar]
  79. da Paixà T. P., Silva J. P., Oliveira F. R., Silva N., Santos P. C., Baetas A. C., et al. (2016). In vitro and in vivo assessment of genotoxic activity of Petiveria alliacea . Afr. J. Pharm. Pharmacol. 10 (34), 718–727. 10.5897/AJPP2016.4581 [DOI] [Google Scholar]
  80. Da Silva M. V. B., dos Santos Barbosa G., da Rocha A. C., da Rocha D., da Silva T. A., da Silva J. A., et al. (2022). Therapeutic potential of flavonoid-rich plants in the treatment of arterial hypertension and diabetes mellitus: focus on antioxidant role. Res. Soc. Dev. 11 (8), e52911831364. 10.33448/rsd-v11i8.31364 [DOI] [Google Scholar]
  81. David R. (2017). Effectiveness of lemon juice in reduction of blood pressure among people with essential hypertension in peelamedu, coimbator. Community Public Health Nurs. 2 (2), 27–41. 10.21088/cphn.2455.8621.2217.4 [DOI] [Google Scholar]
  82. Delgoda R., Younger N., Barrett C., Braithwaite J., Davis D. (2010). The prevalence of herbs use in conjunction with conventional medicines in Jamaica. Complement. Ther. Med. 18 (1), 13–20. 10.1016/j.ctim.2010.01.002 [DOI] [PubMed] [Google Scholar]
  83. Demján V., Sója A., Kiss T., Fejes A., Gausz F. D., Szűcs G., et al. (2022). Stellaria media tea protects against diabetes-induced cardiac dysfunction in rats without affecting glucose tolerance. J. Tradit. Complement. Med. 12 (3), 250–259. 10.1016/j.jtcme.2021.08.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  84. Dhar L., Earnest J., Ali M. (2017). A systematic review of factors influencing medication adherence to hypertension treatment in developing countries. Open J. Epidemiol. 7, 211–250. 10.4236/ojepi.2017.73018 [DOI] [Google Scholar]
  85. Diallo M., Traore M., Balde M., Camara A., Baldé E., Traore S., et al. (2019). Prevalence, management and ethnobotanical investigation of hypertension in two Guinean urban districts. J. Ethnopharmacol. 231, 73–79. 10.1016/j.jep.2018.07.028 [DOI] [PubMed] [Google Scholar]
  86. Djordjević S., Nikolić N. Ć. (2021). Hawthorn (Crataegus spp.) from botanical source to phytopreparations. Lek. sirovine 41, 63–71. 10.5937/leksir2141063d [DOI] [Google Scholar]
  87. Dosoky N. S., Setzer W. N. (2018). Biological activities and safety of Citrus spp. essential oils. Int. J. Mol. Sci. 19 (7), 1966. 10.3390/ijms19071966 [DOI] [PMC free article] [PubMed] [Google Scholar]
  88. Duttaroy A. K., Jørgensen A. (2004). Effects of kiwi fruit consumption on platelet aggregation and plasma lipids in healthy human volunteers. Platelets 15 (5), 287–292. 10.1080/09537100410001710290 [DOI] [PubMed] [Google Scholar]
  89. Ekici E., Tuncay H. O., Akalin E., Bucak A. Y., Üresin U. Y. (2023). Evaluation of the efficacy, safety, and mechanism of action of plants traditionally used in the treatment of hypertension in Turkey. J. Herb. Med. 43, 100835. 10.1016/j.hermed.2023.100835 [DOI] [Google Scholar]
  90. Ekor M. (2014). The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front. Pharmacol. 4, 177. 10.3389/fphar.2013.00177 [DOI] [PMC free article] [PubMed] [Google Scholar]
  91. El-Dahiyat F., Rashrash M., Abuhamdah S., Abu Farha R., Babar Z. U. D. (2020). Herbal medicines: a cross-sectional study to evaluate the prevalence and predictors of use among Jordanian adults. J. Pharm. Policy Pract. 13 (1), 2. 10.1186/s40545-019-0200-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  92. Enejoh O. S., Ogunyemi I. O., Bala M. S., Oruene I. S., Suleiman M. M., Ambali S. F. (2015). Ethnomedical importance of Citrus aurantifolia (christm) swingle. Pharma Innov. 4 (8), 1. [Google Scholar]
  93. Eno A., Owo O., Itam E., Konya R. (2000). Blood pressure depression by the fruit juice of Carica papaya (L.) in renal and DOCA‐induced hypertension in the rat. Phytother. Res. 14 (4), 235–239. 10.1002/1099-1573(200006)14:4<235::aid-ptr574>3.0.co;2-g [DOI] [PubMed] [Google Scholar]
  94. Erejuwa O. O., Sulaiman S. A., Wahab M. S. A., Sirajudeen K. N., Salleh M. S. M., Gurtu S. (2011). Differential responses to blood pressure and oxidative stress in streptozotocin-induced diabetic wistar-kyoto rats and spontaneously hypertensive rats: effects of antioxidant (Honey) treatment. Int. J. Mol. Sci. 12 (3), 1888–1907. 10.3390/ijms12031888 [DOI] [PMC free article] [PubMed] [Google Scholar]
  95. Eslampour E., Asbaghi O., Hadi A., Abedi S., Ghaedi E., Lazaridi A.-V., et al. (2020). The effect of almond intake on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Complement. Ther. Med. 50, 102399. 10.1016/j.ctim.2020.102399 [DOI] [PubMed] [Google Scholar]
  96. Evania D., Punjastuti B., Yunitasari P., Maryati S. (2022). The impact of cucumber (cucumissativus) juice on blood pressure in elderly with hypertension. KnE Life Sci., 481–487. 10.18502/kls.v7i2.10346 [DOI] [Google Scholar]
  97. Foshati S., Nouripour F., Sadeghi E., Amani R. (2022). The effect of grape (Vitis vinifera) seed extract supplementation on flow-mediated dilation, blood pressure, and heart rate: a systematic review and meta-analysis of controlled trials with duration-and dose-response analysis. Pharmacol. Res. 175, 105905. 10.1016/j.phrs.2021.105905 [DOI] [PubMed] [Google Scholar]
  98. García-Pérez M.-E., Alfonso-Castillo A., Lores O. F., Batista-Duharte A., Lemus-Rodríguez Z. (2018). Toxicological evaluation of an aqueous suspension from leaves and stems of Petiveria alliacea L.(Phytolaccaceae). J. Ethnopharmacol. 211, 29–37. 10.1016/j.jep.2017.09.022 [DOI] [PubMed] [Google Scholar]
  99. Gardner Z., McGuffin M. (2013). American Herbal Products Association’s botanical safety handbook. Boca Raton, FL: CRC Press. [Google Scholar]
  100. Gayer B. A., Avendano E. E., Edelson E., Nirmala N., Johnson E. J., Raman G. (2019). Effects of intake of apples, pears, or their products on cardiometabolic risk factors and clinical outcomes: a systematic review and meta-Analysis. Curr. Dev. Nutr. 3 (10), nzz109. 10.1093/cdn/nzz109 [DOI] [PMC free article] [PubMed] [Google Scholar]
  101. Gebrekidan A., Desta A. A. (2019). Assessment on the levels of selected essential and non-essential metals in sesame seeds (Sesamum indicum L.) collected from Sheraro town, Northwest Tigray, Ethiopia. Bull. Chem. Soc. Ethiop. 33 (2), 191–202. 10.4314/bcse.v33i2.1 [DOI] [Google Scholar]
  102. Geleta B., Makonnen E., Debella A., Tadele A. (2016). In vivo antihypertensive and antihyperlipidemic effects of the crude extracts and fractions of Moringa stenopetala (Baker f.) Cufod. leaves in rats. Front. Pharmacol. 7, 97. 10.3389/fphar.2016.00097 [DOI] [PMC free article] [PubMed] [Google Scholar]
  103. Getiye Y., Tolessa T., Engidawork E. (2016). Antihypertensive activity of 80% methanol seed extract of Calpurnia aurea (Ait.) Benth. subsp. aurea (Fabaceae) is mediated through calcium antagonism induced vasodilation. J. Ethnopharmacol. 189, 99–106. 10.1016/j.jep.2016.04.056 [DOI] [PubMed] [Google Scholar]
  104. Gholami Z., Sohrabi Z., Zare M., Pourrajab B., Nasimi N. (2022). The effect of honey on lipid profiles: a systematic review and meta-analysis of controlled clinical trials. Br. J. Nutr. 127 (10), 1482–1496. 10.1017/s0007114521002506 [DOI] [PubMed] [Google Scholar]
  105. Gohar F., Greenfield S. M., Beevers D. G., Lip G. Y., Jolly K. (2008). Self-care and adherence to medication: a survey in the hypertension outpatient clinic. BMC Complement. Altern. Med. 8, 4. 10.1186/1472-6882-8-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  106. Gonfa Y. H., Beshah F., Tadesse M. G., Bachheti A., Bachheti R. K. (2021). Phytochemical investigation and potential pharmacologically active compounds of Rumex nepalensis: an appraisal. Beni-Suef Univ. J. Basic Appl. Sci. 10 (1), 18–11. 10.1186/s43088-021-00110-1 [DOI] [Google Scholar]
  107. Gruenwald J., Brendler T., Jaenicke C. (2007). PDR for Herbal Medicines. 4th Edition. Montvale, NJ: Thomson, Reuters. [Google Scholar]
  108. Gu D.-T., Tung T.-H., Jiesisibieke Z. L., Chien C.-W., Liu W.-Y. (2022). Safety of cinnamon: an umbrella review of meta-analyses and systematic reviews of randomized clinical trials. Front. Pharmacol. 12, 790901. 10.3389/fphar.2021.790901 [DOI] [PMC free article] [PubMed] [Google Scholar]
  109. Gunde M. C., Amnerkar N. D. (2016). Nutritional, medicinal and pharmacological properties of papaya (Carica papaya linn.): a review. J. Innov. Pharm. Biol. Sci. 3 (1), 162–169. [Google Scholar]
  110. Hadis M., Gebreyohannes Y., Gemeda N. (2020). Potential therapeutic uses of Moringa stenopetala: a scoping review. J. Glob. Health Sci. 2 (2). 10.35500/jghs.2020.2.e26 [DOI] [Google Scholar]
  111. Haj‐Husein I., Tukan S., Alkazaleh F. (2016). The effect of marjoram (Origanum majorana) tea on the hormonal profile of women with polycystic ovary syndrome: a randomised controlled pilot study. J. Hum. Nutr. Diet. 29 (1), 105–111. 10.1111/jhn.12290 [DOI] [PubMed] [Google Scholar]
  112. Hamidpour M., Hamidpour R., Hamidpour S., Shahlari M. (2014). Chemistry, pharmacology, and medicinal property of sage (Salvia) to prevent and cure illnesses such as obesity, diabetes, depression, dementia, lupus, autism, heart disease, and cancer. J. Tradit. Complement. Med. 4 (2), 82–88. 10.4103/2225-4110.130373 [DOI] [PMC free article] [PubMed] [Google Scholar]
  113. Hamrahian S. M., Maarouf O. H., Fülöp T. (2022). A critical review of medication adherence in hypertension: barriers and Facilitators Clinicians should consider. Patient prefer. Adherence 16, 2749–2757. 10.2147/ppa.s368784 [DOI] [PMC free article] [PubMed] [Google Scholar]
  114. Han E. H., Lim M. K., Lee S. H., Rahman M. M., Lim Y.-H. (2019). An oral toxicity test in rats and a genotoxicity study of extracts from the stems of Opuntia ficus-indica var. saboten . BMC Complement. Altern. Med. 19, 31–10. 10.1186/s12906-019-2442-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  115. Hariyanti R., Hadisaputro S., Sumarni S., Widyastuti E. (2020). The effectiveness of cucumber suri juice (cucumis sativus) on blood pressure in menopausal hypertension. Str. J. Ilm. Kesehat. 9 (2), 1771–1778. 10.30994/sjik.v9i2.532 [DOI] [Google Scholar]
  116. Hasani H., Arab A., Hadi A., Pourmasoumi M., Ghavami A., Miraghajani M. (2019). Does ginger supplementation lower blood pressure? A systematic review and meta‐analysis of clinical trials. Phytother. Res. 33 (6), 1639–1647. 10.1002/ptr.6362 [DOI] [PubMed] [Google Scholar]
  117. Hasimun D. P., Sulaeman A., Maharani I. D. P. (2022). Supplementation of Carica papaya leaves (Carica papaya L.) in nori preparation reduced blood pressure and arterial stiffness on hypertensive animal model. J. Young Pharm. 12 (1), 63–66. 10.5530/jyp.2020.12.12 [DOI] [Google Scholar]
  118. Hassani F. V., Shirani K., Hosseinzadeh H. (2016). Rosemary (Rosmarinus officinalis) as a potential therapeutic plant in metabolic syndrome: a review. Naunyn-Schmiedeb. Arch. Pharmacol. 389, 931–949. 10.1007/s00210-016-1256-0 [DOI] [PubMed] [Google Scholar]
  119. Hatmal M., Abderrahman S., Alsholi D. (2017). Determining the anti-tumor effects of differnt extracting methods of Arum palaestinum on different cancer cell lines by in vitro assay. Pharmacologyonline 1, 28–45. [Google Scholar]
  120. Hong S. J., Yoon S., Jo S. M., Jeong H., Youn M. Y., Kim Y. J., et al. (2022). Olfactory stimulation by fennel (Foeniculum vulgare Mill.) essential oil improves lipid metabolism and metabolic disorders in high fat-induced obese rats. Nutrients 14 (4), 741. 10.3390/nu14040741 [DOI] [PMC free article] [PubMed] [Google Scholar]
  121. Hopkins A. L., Lamm M. G., Funk J. L., Ritenbaugh C. (2013). Hibiscus sabdariffa L. in the treatment of hypertension and hyperlipidemia: a comprehensive review of animal and human studies. Fitoterapia 85, 84–94. 10.1016/j.fitote.2013.01.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  122. Hosseini A., Razavi B. M., Hosseinzadeh H. (2022). Protective effects of pomegranate (Punica granatum) and its main components against natural and chemical toxic agents: a comprehensive review. Phytomedicine 109, 154581. 10.1016/j.phymed.2022.154581 [DOI] [PubMed] [Google Scholar]
  123. Hoy D., Brooks P., Woolf A., Blyth F., March L., Bain C., et al. (2012). Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J. Clin. Epidemiol. 65 (9), 934–939. 10.1016/j.jclinepi.2011.11.014 [DOI] [PubMed] [Google Scholar]
  124. Hu J., Webster D., Cao J., Shao A. (2018). The safety of green tea and green tea extract consumption in adults–results of a systematic review. Regul. Toxicol. Pharmacol. 95, 412–433. 10.1016/j.yrtph.2018.03.019 [DOI] [PubMed] [Google Scholar]
  125. Huang H., Zhou G., Pu R., Cui Y., Liao D. (2022). Clinical evidence of dietary supplementation with sesame on cardiovascular risk factors: an updated meta-analysis of randomized controlled trials. Crit. Rev. Food Sci. Nutr. 62 (20), 5592–5602. 10.1080/10408398.2021.1888689 [DOI] [PubMed] [Google Scholar]
  126. Husein A. I., Ali-Shtayeh M. S., Jondi W. J., Zatar N.A.-A., Abu-Reidah I. M., Jamous R. M. (2014). In vitro antioxidant and antitumor activities of six selected plants used in the Traditional Arabic Palestinian herbal medicine. Pharm. Biol. 52 (10), 1249–1255. 10.3109/13880209.2014.886274 [DOI] [PubMed] [Google Scholar]
  127. Hutachok N., Koonyosying P., Pankasemsuk T., Angkasith P., Chumpun C., Fucharoen S., et al. (2021). Chemical analysis, toxicity study, and free-radical scavenging and iron-binding assays involving coffee (Coffea arabica) extracts. Molecules 26 (14), 4169. 10.3390/molecules26144169 [DOI] [PMC free article] [PubMed] [Google Scholar]
  128. Im H. B., Ghelman R., Portella C. F. S., Choi D., Han D., Kunwor S. K., et al. (2023). Assessing the safety and use of medicinal herbs during pregnancy: a cross-sectional study in São Paulo, Brazil. Front. Pharmacol. 14, 1268185. 10.3389/fphar.2023.1268185 [DOI] [PMC free article] [PubMed] [Google Scholar]
  129. Ishaq A. R., El-Nashar H. A., Younis T., Mangat M. A., Shahzadi M., Ul Haq A. S., et al. (2022). Genus Lupinus (Fabaceae): a review of ethnobotanical, phytochemical and biological studies. J. Pharm. Pharmacol. 74 (12), 1700–1717. 10.1093/jpp/rgac058 [DOI] [PubMed] [Google Scholar]
  130. Islas J. F., Acosta E., Zuca G., Delgado-Gallegos J. L., Moreno-Treviño M. G., Escalante B., et al. (2020). An overview of Neem (Azadirachta indica) and its potential impact on health. J. Funct. Foods 74, 104171. 10.1016/j.jff.2020.104171 [DOI] [Google Scholar]
  131. Ismail M. A., Norhayati M. N., Mohamad N. (2021). Olive leaf extract effect on cardiometabolic profile among adults with prehypertension and hypertension: a systematic review and meta-analysis. PeerJ 9, e11173. 10.7717/peerj.11173 [DOI] [PMC free article] [PubMed] [Google Scholar]
  132. James P. B., Kamara H., Bah A. J., Steel A., Wardle J. (2018a). Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone. Complement. Ther. Clin. Pract. 31, 7–15. 10.1016/j.ctcp.2018.01.001 [DOI] [PubMed] [Google Scholar]
  133. James P. B., Wardle J., Steel A., Adams J. (2018b). Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob. Health 3 (5), e000895. 10.1136/bmjgh-2018-000895 [DOI] [PMC free article] [PubMed] [Google Scholar]
  134. James-Martin G., Williams G., Stonehouse W., O’Callaghan N., Noakes M. (2015). Health and nutritional properties of pears (Pyrus): a literature review. Adelaide: CSIRO. [Google Scholar]
  135. Jang H.-H., Lee J., Lee S.-H., Lee Y.-M. (2020). Effects of Capsicum annuum supplementation on the components of metabolic syndrome: a systematic review and meta-analysis. Sci. Rep. 10 (1), 20912. 10.1038/s41598-020-77983-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  136. Joachimdass R. J., Subramaniam K., Sit N. W., Lim Y. M., Teo C. H., Ng C. J., et al. (2021). Self-management using crude herbs and the health-related quality of life among adult patients with hypertension living in a suburban setting of Malaysia. Plos one 16 (9), e0257336. 10.1371/journal.pone.0257336 [DOI] [PMC free article] [PubMed] [Google Scholar]
  137. Johnston D. (2006). Natural standard herb and supplement reference: evidence based clinical reviews. Ulst. Med. J. 75, 166. [Google Scholar]
  138. Johnson S. A., Navaei N., Pourafshar S., Akhavan N. S., Elam M. L., Foley E., et al. (2016). Fresh pear (Pyrus communis) consumption may improve blood pressure in middle‐aged men and women with metabolic syndrome. FASEB J. 30, 1175.1112. 10.1096/fasebj.30.1_supplement.1175.12 [DOI] [Google Scholar]
  139. Johnson-Moore T., Pooler D., Hooker H., Crentsil N., Kas-Osoka U., Fullas F., et al. (2023). A review of the uses of five dietary supplements in the management of hypertension and a composite survey. Int. J. Sci. Res. Arch. (IJSRA) 8 (02), 074–084. 10.30574/ijsra.2023.8.2.0207 [DOI] [Google Scholar]
  140. Joshi V. D., Dahake A. P., Suthar A. P. (2010). Adverse effects associated with the use of antihypertensive drugs: an overview. Int. J. Pharm. Tech. Res. 2, 10–13. [Google Scholar]
  141. Kamath J., Rahul N., Kumar C. A., Lakshmi S. M. (2008). Psidium guajava L: a review. Int. J. Green Pharm. 2 (1), 9. 10.4103/0973-8258.39155 [DOI] [Google Scholar]
  142. Kamyab R., Namdar H., Torbati M., Ghojazadeh M., Araj-Khodaei M., Fazljou S. M. B. (2021). Medicinal plants in the treatment of hypertension: a review. Adv. Pharm. Bull. 11 (4), 601–617. 10.34172/apb.2021.090 [DOI] [PMC free article] [PubMed] [Google Scholar]
  143. Karimi Z., Firouzi M., Dadmehr M., Javad‐Mousavi S. A., Bagheriani N., Sadeghpour O. (2021). Almond as a nutraceutical and therapeutic agent in Persian medicine and modern phytotherapy: a narrative review. Phytother. Res. 35 (6), 2997–3012. 10.1002/ptr.7006 [DOI] [PubMed] [Google Scholar]
  144. Karimzadeh L., Behrouz V., Sohrab G., Hedayati M., Emami G. (2022). A randomized clinical trial of beetroot juice consumption on inflammatory markers and oxidative stress in patients with type 2 diabetes. J. Food Sci. 87 (12), 5430–5441. 10.1111/1750-3841.16365 [DOI] [PubMed] [Google Scholar]
  145. Kaur L. (2019). A review on antihypertensive properties of Raphanus sativus, Daucus carota and Tribulus terrestris . J. Crit. Rev. 6 (6), 2019. [Google Scholar]
  146. Kawakami K., Yamada K., Takeshita H., Yamada T., Nomura M. (2021). Antihypertensive effect of lemon juice squeezed residue on spontaneously hypertensive rats. F. Food Sci. Technol. Res. 27 (3), 521–527. 10.3136/fstr.27.521 [DOI] [Google Scholar]
  147. Kearney P. M., Whelton M., Reynolds K., Muntner P., Whelton P. K., He J. (2005). Global burden of hypertension: analysis of worldwide data. Lancet 365 (9455), 217–223. 10.1016/S0140-6736(05)17741-1 [DOI] [PubMed] [Google Scholar]
  148. Kennedy D., Lupattelli A., Koren G., Nordeng H. (2016). Safety classification of herbal medicines used in pregnancy in a multinational study. BMC Complement. Altern. Med. 16, 102–109. 10.1186/s12906-016-1079-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  149. Khoshnam S. E., Bahaoddini A. (2013). The effect of hydro-alcoholic extract of Glycyrrhiza glabra on the cardiovascular system of male rats with normal blood pressure and its interaction with cholinergic and adrenergic systems. Physiol. Pharmacol. 17 (3), 349–358. [Google Scholar]
  150. Kianitalaei A., Feyzabadi Z., Hamedi S., Qaraaty M. (2019). Althaea officinalis in traditional medicine and modern phytotherapy. J. Adv. Pharm. Educ. Res. 9 (S2), 154–161. [Google Scholar]
  151. Kifle Z. D., Belayneh Y. M. (2020). Antidiabetic and anti-hyperlipidemic effects of the crude hydromethanol extract of Hagenia abyssinica (Rosaceae) leaves in streptozotocin-induced diabetic mice. Diabetes Metab. Syndr. Obes. 13, 4085–4094. 10.2147/dmso.s279475 [DOI] [PMC free article] [PubMed] [Google Scholar]
  152. Kifle Z. D., Yesuf J. S., Atnafie S. A. (2020). Evaluation of in vitro and in vivo anti-diabetic, anti-hyperlipidemic and anti-oxidant activity of flower crude extract and solvent fractions of Hagenia abyssinica (rosaceae). J. Exp. Pharmacol. 12, 151–167. 10.2147/jep.s249964 [DOI] [PMC free article] [PubMed] [Google Scholar]
  153. Kifle Z. D., Yimenu D. K., Kidanu B. B. (2021). Complementary and alternative medicine use and its associated factors among hypertensive patients in Debre Tabor General Hospital, Ethiopia. Metabol. Open 12, 100132. 10.1016/j.metop.2021.100132 [DOI] [PMC free article] [PubMed] [Google Scholar]
  154. Kim B., Lee H. S., Kim H.-J., Lee H., Lee I.-y., Ock S., et al. (2023a). Momordica charantia (bitter melon) efficacy and safety on glucose metabolism in Korean prediabetes participants: a 12-week, randomized clinical study. Food Sci. Biotechnol. 32 (5), 697–704. 10.1007/s10068-022-01214-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  155. Kim H.-L., Lee E. M., Ahn S. Y., Kim K.-i., Kim H. C., Kim J. H., et al. (2023b). The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin. Hypertens. 29 (1), 11. 10.1186/s40885-023-00234-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  156. Kim S. J., Anh N. H., Jung C. W., Long N. P., Park S., Cho Y. H., et al. (2022). Metabolic and cardiovascular benefits of apple and apple-derived products: a systematic review and meta-analysis of randomized controlled trials. Front. Nutr. 9, 766155. 10.3389/fnut.2022.766155 [DOI] [PMC free article] [PubMed] [Google Scholar]
  157. Kim S. K., Jung J., Jung J. H., Yoon N., Kang S. S., Roh G. S., et al. (2020). Hypoglycemic efficacy and safety of Momordica charantia (bitter melon) in patients with type 2 diabetes mellitus. Complement. Ther. Med. 52, 102524. 10.1016/j.ctim.2020.102524 [DOI] [PubMed] [Google Scholar]
  158. Kmail A., Jaradat N., Mansour B., Abu-Labdeh R., Zakarneh S., Abu-Farha S., et al. (2022). Phytochemical analysis, cytostatic, cytotoxic, and anti-inflammatory effects of Arum palaestinum, Ocimum basilicum, and Trigonella foenum-graecum in human monocytic cell line (THP-1)-derived macrophages. Eur. J. Integr. Med. 54, 102159. 10.1016/j.eujim.2022.102159 [DOI] [Google Scholar]
  159. Komakech R., Kim Y.-g., Matsabisa G. M., Kang Y. (2019). Anti-inflammatory and analgesic potential of Tamarindus indica Linn.(Fabaceae): a narrative review. Integr. Med. Res. 8 (3), 181–186. 10.1016/j.imr.2019.07.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  160. Koya S. F., Pilakkadavath Z., Chandran P., Wilson T., Kuriakose S., Akbar S. K., et al. (2023). Hypertension control rate in India: systematic review and meta-analysis of population-level non-interventional studies, 2001–2022. Lancet Reg. Health Southeast Asia 9, 100113. 10.1016/j.lansea.2022.100113 [DOI] [PMC free article] [PubMed] [Google Scholar]
  161. Kretchy I. A., Owusu-Daaku F., Danquah S. (2014). Patterns and determinants of the use of complementary and alternative medicine: a cross-sectional study of hypertensive patients in Ghana. BMC Complement. Altern. Med. 14 (1), 44–47. 10.1186/1472-6882-14-44 [DOI] [PMC free article] [PubMed] [Google Scholar]
  162. Krishna R. N., Anitha R., Ezhilarasan D. (2020). Aqueous extract of Tamarindus indica fruit pulp exhibits antihyperglycaemic activity. Avicenna J. Phytomed. 10 (5), 440–447. [PMC free article] [PubMed] [Google Scholar]
  163. Krousel-Wood M., Thomas S., Muntner P., Morisky D. (2004). Medication adherence: a key factor in achieving blood pressure control and good clinical outcomes in hypertensive patients. Curr. Opin. Cardiol. 19 (4), 357–362. 10.1097/01.hco.0000126978.03828.9e [DOI] [PubMed] [Google Scholar]
  164. Krousel‐Wood M. A., Muntner P., Joyce C. J., Islam T., Stanley E., Holt E. W., et al. (2010). Adverse effects of complementary and alternative medicine on antihypertensive medication adherence: findings from the cohort study of medication adherence among older adults. J. Am. Geriatr. Soc. 58 (1), 54–61. 10.1111/j.1532-5415.2009.02639.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  165. Kuru P. (2014). Tamarindus indica and its health related effects. Asian pac. J. Trop. Biomed. 4 (9), 676–681. 10.12980/apjtb.4.2014apjtb-2014-0173 [DOI] [Google Scholar]
  166. Kwon Y.-J., Son D.-H., Chung T.-H., Lee Y.-J. (2020). A review of the pharmacological efficacy and safety of licorice root from corroborative clinical trial findings. J. Med. Food 23 (1), 12–20. 10.1089/jmf.2019.4459 [DOI] [PubMed] [Google Scholar]
  167. Laurindo L. F., Barbalho S. M., Marquess A. R., Grecco A. I. d.S., Goulart R. d.A., Tofano R. J., et al. (2022). Pomegranate (Punica granatum L.) and metabolic syndrome risk factors and outcomes: a systematic review of clinical studies. Nutrients 14 (8), 1665. 10.3390/nu14081665 [DOI] [PMC free article] [PubMed] [Google Scholar]
  168. Leong X.-F., Rais Mustafa M., Jaarin K. (2013). Nigella sativa and its protective role in oxidative stress and hypertension. Evid. Based Complement. Altern. Med. 2013, 120732. 10.1155/2013/120732 [DOI] [PMC free article] [PubMed] [Google Scholar]
  169. Li X., Peng M., Li Y., Kang Z., Hao Y., Sun H., et al. (2015). Chinese herbal therapy and western drug use, belief and adherence for hypertension management in the rural areas of Heilongjiang province, China. PLoS One 10, e0123508. 10.1371/journal.pone.0123508 [DOI] [PMC free article] [PubMed] [Google Scholar]
  170. Lim S. H., Choi C.-I. (2019). Pharmacological properties of Morus nigra L.(black mulberry) as a promising nutraceutical resource. Nutrients 11 (2), 437. 10.3390/nu11020437 [DOI] [PMC free article] [PubMed] [Google Scholar]
  171. Liu C., Kurakane S., Takita J., Itano R., Soga T., Oikawa A., et al. (2012). Antihypertensive effects of unripe persimmon (Diospyros kaki L. cv. Hiratanenashi) fruit and its component in spontaneously hypertensive rats. Food Sci. Technol. Res. 18 (3), 391–398. 10.3136/fstr.18.391 [DOI] [Google Scholar]
  172. Liwa A., Roediger R., Jaka H., Bougaila A., Smart L., Langwick S., et al. (2017). Herbal and alternative medicine use in Tanzanian adults admitted with hypertension-related diseases: a mixed-methods study. Int. J. Hypertens. 2017, 5692572. 10.1155/2017/5692572 [DOI] [PMC free article] [PubMed] [Google Scholar]
  173. Liwa A. C., Smart L. R., Frumkin A., Epstein H.-A. B., Fitzgerald D. W., Peck R. N. (2014). Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review. Curr. Hypertens. Rep. 16, 437–439. 10.1007/s11906-014-0437-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  174. Lucius K. (2022). Integrative medicine in the management of hypertension. Integr. Complement. Ther. 28 (5), 240–250. 10.1089/ict.2022.29043.klu [DOI] [Google Scholar]
  175. Lulebo A. M., Mapatano M. A., Mutombo P. B., Mafuta E. M., Samba G., Coppieters Y. (2017). Prevalence and determinants of use of complementary and alternative medicine by hypertensive patients attending primary health care facilities in Kinshasa, Democratic Republic of the Congo: a cross-sectional study. BMC Complement. Altern. Med. 17, 1–9. 10.1186/s12906-017-1722-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  176. Luo B., Mohammad W. T., Jalil A. T., Saleh M. M., Al-Taee M. M., Alshahrani M. Y., et al. (2023). Effects of almond intake on oxidative stress parameters: a systematic review and meta-analysis of clinical trials. Complement. Ther. Med. 73, 102935. 10.1016/j.ctim.2023.102935 [DOI] [PubMed] [Google Scholar]
  177. Luo L., Wang B., Jiang J., Fitzgerald M., Huang Q., Wei J., et al. (2021). Heavy metal contaminations in herbal medicines: determination, comprehensive risk assessments, and solutions. Front. Pharmacol. 11, 595335. 10.3389/fphar.2020.595335 [DOI] [PMC free article] [PubMed] [Google Scholar]
  178. Luz D. A., Pinheiro A. M., Silva M. L., Monteiro M. C., Prediger R. D., Maia C. S. F., et al. (2016). Ethnobotany, phytochemistry and neuropharmacological effects of Petiveria alliacea L.(Phytolaccaceae): a review. J. Ethnopharmacol. 185, 182–201. 10.1016/j.jep.2016.02.053 [DOI] [PubMed] [Google Scholar]
  179. Mahdavi-Roshan M., Salari A., Ghorbani Z., Ashouri A. (2020). The effects of regular consumption of green or black tea beverage on blood pressure in those with elevated blood pressure or hypertension: a systematic review and meta-analysis. Complement. Ther. Med. 51, 102430. 10.1016/j.ctim.2020.102430 [DOI] [PubMed] [Google Scholar]
  180. Mahendran G., Rahman L. U. (2020). Ethnomedicinal, phytochemical and pharmacological updates on Peppermint (Mentha× piperita L.)—a review. Phytother. Res. 34 (9), 2088–2139. 10.1002/ptr.6664 [DOI] [PubMed] [Google Scholar]
  181. Mahfudz A., Chan S. (2005). Use of complementary medicine amongst hypertensive patients in a public primary care clinic in Ipoh. Med. J. Malays. 60 (4), 454–459. [PubMed] [Google Scholar]
  182. Majeed U., Shafi A., Majeed H., Akram K., Liu X., Ye J., et al. (2022). Grape (Vitis vinifera L.) phytochemicals and their biochemical protective mechanisms against leading pathologies. Food Chem. 134762, 134762. 10.1016/j.foodchem.2022.134762 [DOI] [Google Scholar]
  183. Malekmohammad K., Rafieian-Kopaei M., Sardari S., Sewell R. D. (2021). Toxicological effects of Mentha x piperita (peppermint): a review. Toxin Rev. 40 (4), 445–459. 10.1080/15569543.2019.1647545 [DOI] [Google Scholar]
  184. Martins M., Ribeiro M. H., Miranda A., Lopes S., Franco R., Paiva J., et al. (2023). New foods with history: nutritional and toxic profile of prickly pear. J. Food Meas. Charact. 17 (1), 956–972. 10.1007/s11694-022-01680-z [DOI] [Google Scholar]
  185. Matsutomo T. (2020). Potential benefits of garlic and other dietary supplements for the management of hypertension. Exp. Ther. Med. 19 (2), 1479–1484. 10.3892/etm.2019.8375 [DOI] [PMC free article] [PubMed] [Google Scholar]
  186. McKay D. L., Chen C. O., Saltzman E., Blumberg J. B. (2010). Hibiscus sabdariffa L. tea (tisane) lowers blood pressure in prehypertensive and mildly hypertensive adults. J. Nutr. 140 (2), 298–303. 10.3945/jn.109.115097 [DOI] [PubMed] [Google Scholar]
  187. McMahon F. G., Cole P. A., Ryan J. R. (1973). A study of hypertension in the inner city. A student hypertension survey. Am. Heart J. 85 (1), 65–71. 10.1016/0002-8703(73)90526-7 [DOI] [PubMed] [Google Scholar]
  188. Meher B., Dash D. K., Roy A. (2014). A review on: phytochemistry, pharmacology and traditional uses of Tamarindus indica L. World J. Pharm. Pharm. Sci. 3 (10), 229–240. [Google Scholar]
  189. Mekonnen T., Urga K., Engidawork E. (2010). Evaluation of the diuretic and analgesic activities of the rhizomes of Rumex abyssinicus Jacq in mice. J. Ethnopharmacol. 127 (2), 433–439. 10.1016/j.jep.2009.10.020 [DOI] [PubMed] [Google Scholar]
  190. Melesie Taye G., Bule M., Alemayehu Gadisa D., Teka F., Abula T. (2020). In vivo antidiabetic activity evaluation of aqueous and 80% methanolic extracts of leaves of Thymus schimperi (Lamiaceae) in alloxan-induced diabetic mice. Diabetes Metab. Syndr. Obes. 13, 3205–3212. 10.2147/dmso.s268689 [DOI] [PMC free article] [PubMed] [Google Scholar]
  191. Mengistu M., Abebe Y., Mekonnen Y., Tolessa T. (2012). In vivo and in vitro hypotensive effect of aqueous extract of Moringa stenopetala . Afr. Health Sci. 12 (4), 545–551. 10.4314/ahs.v12i4.23 [DOI] [PMC free article] [PubMed] [Google Scholar]
  192. Mequanint W., Makonnen E., Urga K. (2011). In vivo anti-inflammatory activities of leaf extracts of Ocimum lamiifolium in mice model. J. Ethnopharmacol. 134 (1), 32–36. 10.1016/j.jep.2010.11.051 [DOI] [PubMed] [Google Scholar]
  193. Mesmar J., Abdallah R., Badran A., Maresca M., Baydoun E. (2022). Origanum syriacum phytochemistry and pharmacological properties: a comprehensive review. Molecules 27 (13), 4272. 10.3390/molecules27134272 [DOI] [PMC free article] [PubMed] [Google Scholar]
  194. Mills K. T., Bundy J. D., Kelly T. N., Reed J. E., Kearney P. M., Reynolds K., et al. (2016). Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation 134 (6), 441–450. 10.1161/circulationaha.115.018912 [DOI] [PMC free article] [PubMed] [Google Scholar]
  195. Mills K. T., Stefanescu A., He J. (2020). The global epidemiology of hypertension. Nat. Rev. Nephrol. 16 (4), 223–237. 10.1038/s41581-019-0244-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  196. Mills S. Y., Bone K. (2004). The essential guide to herbal safety. Elsevier Health Sciences. [Google Scholar]
  197. Mirmiran P., Houshialsadat Z., Gaeini Z., Bahadoran Z., Azizi F. (2020). Functional properties of beetroot (Beta vulgaris) in management of cardio-metabolic diseases. Nutr. Metab. 17, 3–15. 10.1186/s12986-019-0421-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  198. Mohajeri G., Safaee M., Sanei M. H. (2014). Effects of topical Kiwifruit on healing of neuropathic diabetic foot ulcer. J. Res. Med. Sci. 19 (6), 520–524. [PMC free article] [PubMed] [Google Scholar]
  199. Mohammed Nawi A., Mohammad Z., Jetly K., Abd Razak M. A., Ramli N. S., Wan Ibadullah W. A. H., et al. (2021). The prevalence and risk factors of hypertension among the urban population in southeast asian countries: a systematic review and meta-analysis. Int. J. Hypertens. 2021, 6657003–6657014. 10.1155/2021/6657003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  200. Moher D., Liberati A., Tetzlaff J., Altman D. G. PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann. Intern. Med. 151 (4), 264–W64. 10.7326/0003-4819-151-4-200908180-00135 [DOI] [PubMed] [Google Scholar]
  201. Mohsen Ibrahim M. (2018). Hypertension in developing countries: a major challenge for the future. Curr. Hypertens. Rep. 20, 38–10. 10.1007/s11906-018-0839-1 [DOI] [PubMed] [Google Scholar]
  202. Mollaoğlu M., Aciyurt A. (2013). Use of complementary and alternative medicine among patients with chronic diseases. Acta Clin. Croat. 52 (2), 181–188. [PubMed] [Google Scholar]
  203. Mondal A., Banerjee S., Bose S., Das P. P., Sandberg E. N., Atanasov A. G., et al. (2021). Cancer preventive and therapeutic potential of banana and its bioactive constituents: a systematic, comprehensive, and mechanistic review. Front. Oncol. 11, 697143. 10.3389/fonc.2021.697143 [DOI] [PMC free article] [PubMed] [Google Scholar]
  204. Musharraf H. M., Arman M. S. I. (2018). Prophetic medicine is the cheapest, safest and the best remedy in the prevention and treatment of hypertension (high blood pressure)–a mini review. Int. J. Mol. Biol. Open Access 3 (6), 245–250. 10.15406/ijmboa.2018.03.00084 [DOI] [Google Scholar]
  205. Nassiri‐Asl M., Hosseinzadeh H. (2009). Review of the pharmacological effects of Vitis vinifera (Grape) and its bioactive compounds. Phytotherapy Res. 23 (9), 1197–1204. 10.1002/ptr.2761 [DOI] [PubMed] [Google Scholar]
  206. Nassiri‐Asl M., Hosseinzadeh H. (2016). Review of the pharmacological effects of Vitis vinifera (Grape) and its bioactive constituents: an update. Phytother. Res. 30 (9), 1392–1403. 10.1002/ptr.5644 [DOI] [PubMed] [Google Scholar]
  207. Navaei N., Pourafshar S., Akhavan N. S., Litwin N. S., Foley E. M., George K. S., et al. (2019). Influence of daily fresh pear consumption on biomarkers of cardiometabolic health in middle-aged/older adults with metabolic syndrome: a randomized controlled trial. Food Funct. 10 (2), 1062–1072. 10.1039/c8fo01890a [DOI] [PubMed] [Google Scholar]
  208. Nazari S., Rameshrad M., Hosseinzadeh H. (2017). Toxicological effects of Glycyrrhiza glabra (licorice): a review. Phytother. Res. 31 (11), 1635–1650. 10.1002/ptr.5893 [DOI] [PubMed] [Google Scholar]
  209. Niazmand S., Esparham M., Hassannia T., Derakhshan M. (2011). Cardiovascular effects of Teucrium polium L. extract in rabbit. Pharmacogn. Mag. 7 (27), 260–264. 10.4103/0973-1296.84244 [DOI] [PMC free article] [PubMed] [Google Scholar]
  210. Nikkhah Bodagh M., Maleki I., Hekmatdoost A. (2019). Ginger in gastrointestinal disorders: a systematic review of clinical trials. Food Sci. Nutr. 7 (1), 96–108. 10.1002/fsn3.807 [DOI] [PMC free article] [PubMed] [Google Scholar]
  211. Nur N. (2010). Knowledge and behaviours related to herbal remedies: a cross-sectional epidemiological study in adults in Middle Anatolia, Turkey. Health Soc. Care Community 18 (4), 389–395. 10.1111/j.1365-2524.2010.00911.x [DOI] [PubMed] [Google Scholar]
  212. Nuwaha F., Musinguzi G. (2013). Use of alternative medicine for hypertension in Buikwe and Mukono districts of Uganda: a cross sectional study. BMC Complement. Altern. Med. 13, 301–306. 10.1186/1472-6882-13-301 [DOI] [PMC free article] [PubMed] [Google Scholar]
  213. Olaiya C., Choudhary M., Ogunyemi O., Nwauzoma A. (2013). Nutraceuticals from bitter leaf (Vernonia amygdalina Del.) protects against cadmium chloride induced hypertension in albino rats. Nat. Sci. 11 (6), 136–145. [Google Scholar]
  214. Olisa N. S., Oyelola F. T. (2009). Evaluation of use of herbal medicines among ambulatory hypertensive patients attending a secondary health care facility in Nigeria. Int. J. Pharm. Pract. 17 (2), 101–105. 10.1211/ijpp.17.02.0005 [DOI] [PubMed] [Google Scholar]
  215. Olowofela A. O., Isah A. O. (2017). A profile of adverse effects of antihypertensive medicines in a tertiary care clinic in Nigeria. Ann. Afr. Med. 16 (3), 114–119. 10.4103/aam.aam_6_17 [DOI] [PMC free article] [PubMed] [Google Scholar]
  216. Onakpoya I. J., O'Sullivan J., Heneghan C. J. (2015). The effect of cactus pear (Opuntia ficus-indica) on body weight and cardiovascular risk factors: a systematic review and meta-analysis of randomized clinical trials. Nutrition 31 (5), 640–646. 10.1016/j.nut.2014.11.015 [DOI] [PubMed] [Google Scholar]
  217. Onyema-iloh O., Meludu S., Iloh E., Dioka C., Obi-Ezeani C. (2018). Effects of methanolic extract of Vernonia amygdalina on electrolytes and renal biomarkers in NaCl–induced hypertensive male wistar rats. J. Pharm. Res. Int. 23 (1), 1–7. 10.9734/jpri/2018/41908 [DOI] [Google Scholar]
  218. Orgah J. O., He S., Wang Y., Jiang M., Wang Y., Orgah E. A., et al. (2020). Pharmacological potential of the combination of Salvia miltiorrhiza (Danshen) and Carthamus tinctorius (Honghua) for diabetes mellitus and its cardiovascular complications. Pharmacol. Res. 153, 104654. 10.1016/j.phrs.2020.104654 [DOI] [PubMed] [Google Scholar]
  219. Osamor P. E., Owumi B. E. (2010). Complementary and alternative medicine in the management of hypertension in an urban Nigerian community. BMC Complement. Altern. Med. 10, 36–39. 10.1186/1472-6882-10-36 [DOI] [PMC free article] [PubMed] [Google Scholar]
  220. Osuna-Martínez U., Reyes-Esparza J., Rodríguez-Fragoso L. (2014). Cactus (Opuntia ficus-indica): a review on its antioxidants properties and potential pharmacological use in chronic diseases. Nat. Prod. Chem. Res. 2, 153. 10.4172/2329-6836.1000153 [DOI] [Google Scholar]
  221. Owusu S., Gaye Y.-E., Hall S., Junkins A., Sohail M., Franklin S., et al. (2020). Factors associated with the use of complementary and alternative therapies among patients with hypertension and type 2 diabetes mellitus in Western Jamaica: a cross-sectional study. BMC Complement. Med. Ther. 20 (1), 314. 10.1186/s12906-020-03109-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  222. Page M. J., McKenzie J. E., Bossuyt P. M., Boutron I., Hoffmann T. C., Mulrow C. D., et al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int. J. Surg. 88, 105906. 10.1016/j.ijsu.2021.105906 [DOI] [PubMed] [Google Scholar]
  223. Palatini P., Fania C., Mos L., Garavelli G., Mazzer A., Cozzio S., et al. (2016). Coffee consumption and risk of cardiovascular events in hypertensive patients. Results from the HARVEST. Int. J. Cardiol. 212, 131–137. 10.1016/j.ijcard.2016.03.006 [DOI] [PubMed] [Google Scholar]
  224. Palileo-Villanueva L. M., Palafox B., Amit A. M. L., Pepito V. C. F., Ab-Majid F., Ariffin F., et al. (2022). Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines. BMC Complement. Med. Ther. 22 (1), 252. 10.1186/s12906-022-03730-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  225. Park S. W., Shin K. C., Yoou S.-K., Park H. J., Eun S. H., Bae Y. M., et al. (2019). Effects of an ethanolic extract of mulberry fruit on blood pressure and vascular remodeling in spontaneous hypertensive rats. Clin. Exp. Hypertens. 41 (3), 280–286. 10.1080/10641963.2018.1469645 [DOI] [PubMed] [Google Scholar]
  226. Pathak L., Kothiyal P. (2013). Antihypertensive drugs interaction with herbal medicine—review. Int. J. Pharm. Phytopharm. Res. 3 (2), 139–143. [Google Scholar]
  227. Patil R. A., Lokwani P. S., Amrutkar S. V. (2022). Phytochemical evaluation and antihypertensive activity of Malus domestica peel in experimental animals. Pharmacophore 13 (3), 1–7. 10.51847/ectmxxm8iw [DOI] [Google Scholar]
  228. Peltzer K., Pengpid S. (2018). Prevalence and determinants of traditional, complementary and alternative medicine provider use among adults from 32 countries. Chin. J. Integr. Med. 24, 584–590. 10.1007/s11655-016-2748-y [DOI] [PubMed] [Google Scholar]
  229. Peng X., Zhou R., Wang B., Yu X., Yang X., Liu K., et al. (2014). Effect of green tea consumption on blood pressure: a meta-analysis of 13 randomized controlled trials. Sci. Rep. 4 (1), 6251. 10.1038/srep06251 [DOI] [PMC free article] [PubMed] [Google Scholar]
  230. Penninkilampi R., Eslick E., Eslick G. (2017). The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis. J. Hum. Hypertens. 31 (11), 699–707. 10.1038/jhh.2017.45 [DOI] [PubMed] [Google Scholar]
  231. Popoola J. O., Aworunse O. S., Oyesola O. L., Akinnola O. O., Obembe O. O. (2020). <i/>A systematic review of pharmacological activities and safety ofMoringa oleifera . J. Herbmed Pharmacol. 9 (3), 174–190. 10.34172/jhp.2020.24 [DOI] [Google Scholar]
  232. Posadzki P., Watson L., Ernst E. (2013). Herb–drug interactions: an overview of systematic reviews. Br. J. Clin. Pharmacol. 75 (3), 603–618. 10.1111/j.1365-2125.2012.04350.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  233. Prasad S., Hima R., Trainee P. S. (2020). Efficacy of supplementation of kiwi fruit juice on selected hypertensive adult patients of Suchindrum in Kanniyakumari District. Int. J. Adv. Res. Eng. Technol. 7 (5), 2394–3785. [Google Scholar]
  234. Punoševac M., Radović J., Leković A., Kundaković-Vasović T. (2021). A review of botanical characteristics, chemical composition, pharmacological activity and use of parsley. Arh. Farm. 71 (Notebook 3), 177–196. 10.5937/arhfarm71-30800 [DOI] [Google Scholar]
  235. Putri A. A., Mukaromah I., Pratiwi N. D., Alivian G. N. (2022). Utilization of African Leaves (Vernonia amygdalina) to lower blood pressure in patients with hypertension: a systematic review. Int. J. Biomed. Nurs. Rev. 1 (1), 52–56. 10.20884/1.ijbnr.2022.1.1.6534 [DOI] [Google Scholar]
  236. Radha M. H., Laxmipriya N. P. (2015). Evaluation of biological properties and clinical effectiveness of Aloe vera: a systematic review. J. Tradit. Complement. Med. 5 (1), 21–26. 10.1016/j.jtcme.2014.10.006 [DOI] [PMC free article] [PubMed] [Google Scholar]
  237. Rahimi R., Ardekani M. R. S. (2013). Medicinal properties of Foeniculum vulgare Mill. in traditional Iranian medicine and modern phytotherapy. Chin. J. Integr. Med. 19, 73–79. 10.1007/s11655-013-1327-0 [DOI] [PubMed] [Google Scholar]
  238. Rahmawati R., Bajorek B. V. (2017). Self-medication among people living with hypertension: a review. Fam. Pract. 34 (2), 147–153. 10.1093/fampra/cmw137 [DOI] [PubMed] [Google Scholar]
  239. Rambod M., Rakhshan M., Tohidinik S., Nikoo M. H. (2020). The effect of lemon inhalation aromatherapy on blood pressure, electrocardiogram changes, and anxiety in acute myocardial infarction patients: a clinical, multi-centered, assessor-blinded trial design. Complement. Ther. Clin. Pract. 39, 101155. 10.1016/j.ctcp.2020.101155 [DOI] [PubMed] [Google Scholar]
  240. Rana R., Mehmood M. H., Shaukat B., Shahid S., Malik A., Murtaza B. (2022). Evaluation of the cardiovascular effects of Coriandrum sativum and Citrus limon to treat arsenic-Induced endothelial damage and hypertension in rats. Life 12 (11), 1842. 10.3390/life12111842 [DOI] [PMC free article] [PubMed] [Google Scholar]
  241. Rawat P., Singh P. K., Kumar V. (2016). Anti-hypertensive medicinal plants and their mode of action. J. Herb. Med. 6 (3), 107–118. 10.1016/j.hermed.2016.06.001 [DOI] [Google Scholar]
  242. Reinelt N., Melzig M. (2017). Marshmallow (Althaea officinalis L.). Z. fur Phytother. 38, 91–96. 10.1055/s-0043-103256 [DOI] [Google Scholar]
  243. Richardson D. P., Ansell J., Drummond L. N. (2018). The nutritional and health attributes of kiwifruit: a review. Eur. J. Nutr. 57, 2659–2676. 10.1007/s00394-018-1627-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  244. Ried K. (2020). Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: a review and meta-analysis. Exp. Ther. Med. 19 (2), 1472–1478. 10.3892/etm.2019.8374 [DOI] [PMC free article] [PubMed] [Google Scholar]
  245. Rodríguez-Artalejo F., López-García E. (2017). Coffee consumption and cardiovascular disease: a condensed review of epidemiological evidence and mechanisms. J. Agric. Food Chem. 66 (21), 5257–5263. 10.1021/acs.jafc.7b04506 [DOI] [PubMed] [Google Scholar]
  246. Roth G. A., Mensah G. A., Johnson C. O., Addolorato G., Ammirati E., Baddour L. M., et al. (2020). Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J. Am. Coll. Cardiol. 76 (25), 2982–3021. 10.1016/j.jacc.2020.11.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  247. Rouhi-Boroujeni H., Heidarian E., Rouhi-Boroujeni H., Deris F., Rafieian-Kopaei M. (2017). Medicinal plants with multiple effects on cardiovascular diseases: a systematic review. Curr. Pharm. Des. 23 (7), 999–1015. 10.2174/1381612822666161021160524 [DOI] [PubMed] [Google Scholar]
  248. Ruyvaran M., Zamani A., Mohamadian A., Zarshenas M. M., Eftekhari M. H., Pourahmad S., et al. (2022). Safflower (Carthamus tinctorius L.) oil could improve abdominal obesity, blood pressure, and insulin resistance in patients with metabolic syndrome: a randomized, double-blind, placebo-controlled clinical trial. J. Ethnopharmacol. 282, 114590. 10.1016/j.jep.2021.114590 [DOI] [PubMed] [Google Scholar]
  249. Sabbaghzadegan S., Golsorkhi H., Soltani M. H., Kamalinejad M., Bahrami M., Kabir A., et al. (2021). Potential protective effects of Aloe vera gel on cardiovascular diseases: a mini‐review. Phytother. Res. 35 (11), 6101–6113. 10.1002/ptr.7219 [DOI] [PubMed] [Google Scholar]
  250. Sabery M., Adib-Hajbaghery M., Rafiee S. (2019). Satisfaction with and factors related to medicinal herb consumption in older Iranian adults. Eur. J. Integr. Med. 25, 100–105. 10.1016/j.eujim.2018.12.005 [DOI] [Google Scholar]
  251. Sah A., Naseef P. P., Kuruniyan M. S., Jain G. K., Zakir F., Aggarwal G. (2022). A comprehensive study of therapeutic applications of Chamomile. Pharmaceuticals 15, 1284. 10.3390/ph15101284 [DOI] [PMC free article] [PubMed] [Google Scholar]
  252. Sanati S., Razavi B. M., Hosseinzadeh H. (2018). A review of the effects of Capsicum annuum L. and its constituent, capsaicin, in metabolic syndrome. Iran. J. Basic Med. Sci. 21 (5), 439–448. 10.22038/IJBMS.2018.25200.6238 [DOI] [PMC free article] [PubMed] [Google Scholar]
  253. Sane R., Dawkhar S., Ambulkar P., Mandole R. (2018). The effect of a polyherbal oral formulation in the management of essential hypertension: an open label, pilot clinical study. Int. J. Basic Clin. Pharmacol. 7 (7), 1427. 10.18203/2319-2003.ijbcp20182694 [DOI] [Google Scholar]
  254. Santana L. F., Inada A. C., Espirito Santo B. L. S. D., Filiú W. F., Pott A., Alves F. M., et al. (2019). Nutraceutical potential of Carica papaya in metabolic syndrome. Nutrients 11 (7), 1608. 10.3390/nu11071608 [DOI] [PMC free article] [PubMed] [Google Scholar]
  255. Schutte A. E., Srinivasapura Venkateshmurthy N., Mohan S., Prabhakaran D. (2021). Hypertension in low-and middle-income countries. Circ. Res. 128 (7), 808–826. 10.1161/circresaha.120.318729 [DOI] [PMC free article] [PubMed] [Google Scholar]
  256. Seifu E. (2015). Actual and potential applications of Moringa stenopetala, underutilized indigenous vegetable of Southern Ethiopia: a review. Int. J. Agric. Food Res. 3 (4). 10.24102/ijafr.v3i4.381 [DOI] [Google Scholar]
  257. Serban C., Sahebkar A., Ursoniu S., Andrica F., Banach M. (2015). Effect of sour tea (Hibiscus sabdariffa L.) on arterial hypertension: a systematic review and meta-analysis of randomized controlled trials. J. Hypertens. 33, 1119–1127. 10.1097/hjh.0000000000000585 [DOI] [PubMed] [Google Scholar]
  258. Shafiq N., Gupta M., Kumari S., Pandhi P. (2003). Prevalence and pattern of use of complementary and alternative medicine (CAM) in hypertensive patients of a tertiary care center in India. Int. J. Clin. Pharmacol. Ther. 41 (7), 294–298. 10.5414/cpp41294 [DOI] [PubMed] [Google Scholar]
  259. Shah A. J., Gilani A.-H., Hanif H. M., Ahmad S., Khalid S., Bukhari I. (2014). Neem (Azadirachta indica) lowers blood pressure through a combination of Ca++ channel blocking and endothelium-dependent muscarinic receptors activation. Int. J. Pharmacol. 10 (8), 418–428. 10.3923/ijp.2014.418.428 [DOI] [Google Scholar]
  260. Shah S., Cho I.-J., Lee W., Pyun W. B., Ha E. (2023). Coffee intake and hypertension in Korean adults: results from KNHANES 2012–2016. Clin. Hypertens. 29 (1), 20–28. 10.1186/s40885-023-00239-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  261. Shehab N. G., Abu-Gharbieh E. (2012). Constituents and biological activity of the essential oil and the aqueous extract of Micromeria fruticosa (L.) Druce subsp. serpyllifolia . Pak. J. Pharm. Sci. 25 (3), 687–692. [PubMed] [Google Scholar]
  262. Shilpa T., Souza J. D. (2020). Effectiveness of Lemon juice on reduction of blood pressure among hypertensive clients in selected rural community, Mangaluru. Asian J. Nurs. Educ. Res. 10 (1), 31–37. 10.5958/2349-2996.2020.00008.7 [DOI] [Google Scholar]
  263. Shirani F., Foshati S., Tavassoly M., Clark C. C., Rouhani M. H. (2021). The effect of red pepper/capsaicin on blood pressure and heart rate: a systematic review and meta‐analysis of clinical trials. Phytother. Res. 35 (11), 6080–6088. 10.1002/ptr.7217 [DOI] [PubMed] [Google Scholar]
  264. Shoaei‐Hagh P., Kamelan Kafi F., Najafi S., Zamanzadeh M., Heidari Bakavoli A., Ramezani J., et al. (2021). A randomized, double‐blind, placebo‐controlled, clinical trial to evaluate the benefits of Nigella sativa seeds oil in reducing cardiovascular risks in hypertensive patients. Phytother. Res. 35 (8), 4388–4400. 10.1002/ptr.7140 [DOI] [PubMed] [Google Scholar]
  265. Shoara R., Hashempur M. H., Ashraf A., Salehi A., Dehshahri S., Habibagahi Z. (2015). Efficacy and safety of topical Matricaria chamomilla L. (chamomile) oil for knee osteoarthritis: a randomized controlled clinical trial. Complement. Ther. Clin. Pract. 21 (3), 181–187. 10.1016/j.ctcp.2015.06.003 [DOI] [PubMed] [Google Scholar]
  266. Shouk R., Abdou A., Shetty K., Sarkar D., Eid A. H. (2014). Mechanisms underlying the antihypertensive effects of garlic bioactives. Nutr. Res. 34 (2), 106–115. 10.1016/j.nutres.2013.12.005 [DOI] [PubMed] [Google Scholar]
  267. Singh R., Chaudhary M., Chauhan E. S. (2022). Stellaria media Linn.: a comprehensive review highlights the nutritional, phytochemistry, and pharmacological activities. J. HerbMed Pharmacol. 11 (3), 330–338. 10.34172/jhp.2022.38 [DOI] [Google Scholar]
  268. Singletary K. W. (2022). Anise. Potential health benefits. Nutr. Today 57 (2), 96–109. 10.1097/nt.0000000000000534 [DOI] [Google Scholar]
  269. Sinha A., Meena A., Panda P., Srivastava B., Gupta M., Padhi M. (2012). Phytochemical, pharmacological and therapeutic potential of Hordeum vulgare Linn.-a review. Asian J. Res. Chem. 5 (10), 1303–1308. [Google Scholar]
  270. Sochorova L., Prusova B., Cebova M., Jurikova T., Mlcek J., Adamkova A., et al. (2020). Health effects of grape seed and skin extracts and their influence on biochemical markers. Molecules 25 (22), 5311. 10.3390/molecules25225311 [DOI] [PMC free article] [PubMed] [Google Scholar]
  271. Sontia B., Mooney J., Gaudet L., Touyz R. M. (2008). Pseudohyperaldosteronism, liquorice, and hypertension. J. Clin. Hypertens. 10 (2), 153–157. 10.1111/j.1751-7176.2008.07470.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  272. Srinivasan K. (2016). Biological activities of red pepper (Capsicum annuum) and its pungent principle capsaicin: a review. Crit. Rev. Food Sci. Nutr. 56 (9), 1488–1500. 10.1080/10408398.2013.772090 [DOI] [PubMed] [Google Scholar]
  273. Stohs S. J., Hartman M. J. (2015). Review of the safety and efficacy of Moringa oleifera . Phytother. Res. 29 (6), 796–804. 10.1002/ptr.5325 [DOI] [PMC free article] [PubMed] [Google Scholar]
  274. Sun L., Chi B., Xia M., Ma Z., Zhang H., Jiang H., et al. (2022a). LC–MS-based lipidomic analysis of liver tissue sample from spontaneously hypertensive rats treated with extract hawthorn fruits. Front. Pharmacol. 13, 963280. 10.3389/fphar.2022.963280 [DOI] [PMC free article] [PubMed] [Google Scholar]
  275. Sun Y., Liu J., Xin L., Wen J., Zhou Q., Chen X., et al. (2022b). Traditional Chinese medicine is associated with reduced risk of readmission in rheumatoid arthritis patients with anemia: a retrospective cohort study. Evid. Based Complement. Altern. Med. 2022, 4553985. 10.1155/2022/4553985 [DOI] [PMC free article] [PubMed] [Google Scholar]
  276. Surma S., Oparil S. (2021). Coffee and arterial hypertension. Curr. Hypertens. Rep. 23, 38. 10.1007/s11906-021-01156-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  277. Susalit E., Agus N., Effendi I., Tjandrawinata R. R., Nofiarny D., Perrinjaquet-Moccetti T., et al. (2011). Olive (Olea europaea) leaf extract effective in patients with stage-1 hypertension: comparison with Captopril. Phytomedicine 18 (4), 251–258. 10.1016/j.phymed.2010.08.016 [DOI] [PubMed] [Google Scholar]
  278. Svendsen M., Tonstad S., Heggen E., Pedersen T. R., Seljeflot I., Bøhn S. K., et al. (2015). The effect of kiwifruit consumption on blood pressure in subjects with moderately elevated blood pressure: a randomized, controlled study. Blood Press 24 (1), 48–54. 10.3109/08037051.2014.976979 [DOI] [PubMed] [Google Scholar]
  279. Tabassum N., Ahmad F. (2011). Role of natural herbs in the treatment of hypertension. Pharmacogn. Rev. 5 (9), 30–40. 10.4103/0973-7847.79097 [DOI] [PMC free article] [PubMed] [Google Scholar]
  280. Taiwo I. A., Odeigah P. G. C., Jaja S., Mojiminiyi F. (2010). Cardiovascular effects of Vernonia amygdalina in rats and the implications for treatment of hypertension in diabetes. Researcher 2 (1), 76–79. [Google Scholar]
  281. Tajadini H., Divsalar K., Mehrabani M., Haghdoost A. A., Esmaili Z., Shadkam M., et al. (2015). The frequency of using herbal medicines among patients with hypertension in Kerman, Iran, 2012-2013. J. Evid. Based Complement. Altern. Med. 20 (3), 199–202. 10.1177/2156587215573141 [DOI] [PubMed] [Google Scholar]
  282. Takeda L. N., Laurindo L. F., Guiguer E. L., Bishayee A., Araújo A. C., Ubeda L. C. C., et al. (2022). Psidium guajava L.: a systematic review of the multifaceted health benefits and economic importance. Food Rev. Int. 39, 4333–4363. 10.1080/87559129.2021.2023819 [DOI] [Google Scholar]
  283. Thaipitakwong T., Supasyndh O., Rasmi Y., Aramwit P. (2020). A randomized controlled study of dose-finding, efficacy, and safety of mulberry leaves on glycemic profiles in obese persons with borderline diabetes. Complement. Ther. Med. 49, 102292. 10.1016/j.ctim.2019.102292 [DOI] [PubMed] [Google Scholar]
  284. Thangsuk P., Pinyopornpanish K., Jiraporncharoen W., Buawangpong N., Angkurawaranon C. (2021). Is the association between herbal use and blood-pressure control mediated by medication adherence? A cross-sectional study in primary care. Int. J. Environ. Res. Public Health 18 (24), 12916. 10.3390/ijerph182412916 [DOI] [PMC free article] [PubMed] [Google Scholar]
  285. Toulabi T., Yarahmadi M., Goudarzi F., Ebrahimzadeh F., Momenizadeh A., Yarahmadi S. (2022). Effects of flaxseed on blood pressure, body mass index, and total cholesterol in hypertensive patients: a randomized clinical trial. Explore 18 (4), 438–445. 10.1016/j.explore.2021.05.003 [DOI] [PubMed] [Google Scholar]
  286. Toungos M. D. (2019). Tamarind (Tamarindus indicus L) fruit of potential value but underutilized in Nigeria. Int. J. Innov. Food Nutr. Sustain. Agric. 7 (1), 1–10. [Google Scholar]
  287. Tripathy B., Satyanarayana S., Khan K. A., Raja K. (2017). An updated review on traditional uses, taxonomy, phytochemistry, pharmacology and toxicology of Origanum majorana . Int. J. Pharm. Res. Health Sci. 5 (4), 1717–1723. 10.21276/ijprhs.2017.04.01 [DOI] [Google Scholar]
  288. Tyagi S., Nanher A., Sahay S., Kumar V., Bhamini K., Nishad S. K., et al. (2015). Kiwifruit: health benefits and medicinal importance. Rashtriya Krishi 10 (2), 98–100. [Google Scholar]
  289. Ugbogu E. A., Ude V. C., Elekwa I., Arunsi U. O., Uche-Ikonne C., Nwakanma C. (2018). Toxicological profile of the aqueous-fermented extract of Musa paradisiaca in rats. Avicenna J. Phytomed. 8 (6), 478–487. [PMC free article] [PubMed] [Google Scholar]
  290. Ulbricht C., Basch E., Burke D., Cheung L., Ernst E., Giese N., et al. (2008). Fenugreek (Trigonella foenum-graecum L. Leguminosae): an evidence-based systematic review by the natural standard research collaboration. J. Herb. Pharmacother. 7 (3-4), 143–177. 10.1080/15228940802142852 [DOI] [PubMed] [Google Scholar]
  291. Ulbricht C. E. (2010). Natural standard herb and supplement guide: an evidence-based reference. Missouri, USA: Elsevier/Mosby. [Google Scholar]
  292. Ulbricht C. E., Basch E. M. (2005). Natural standard herb and supplement reference: evidence-based clinical reviews. St. Louis, MO: Mosby. [Google Scholar]
  293. Umer S., Tekewe A., Kebede N. (2013). Antidiarrhoeal and antimicrobial activity of Calpurnia aurea leaf extract. BMC Complement. Altern. Med. 13, 21–25. 10.1186/1472-6882-13-21 [DOI] [PMC free article] [PubMed] [Google Scholar]
  294. Ursoniu S., Sahebkar A., Andrica F., Serban C., Banach M., Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, et al. (2016). Effects of flaxseed supplements on blood pressure: a systematic review and meta-analysis of controlled clinical trial. Clin. Nutr. 35 (3), 615–625. 10.1016/j.clnu.2015.05.012 [DOI] [PubMed] [Google Scholar]
  295. Uuh‐Narvaez J. J., Segura‐Campos M. R. (2021). Cabbage (Brassica oleracea var. capitata): a food with functional properties aimed to type 2 diabetes prevention and management. J. Food Sci. 86 (11), 4775–4798. 10.1111/1750-3841.15939 [DOI] [PubMed] [Google Scholar]
  296. Valenzuela R., Das U. N., Videla L. A., Llorente C. G. (2018). Nutrients and diet: a relationship between oxidative stress, aging, obesity, and related noncommunicable diseases. Oxid. Med. Cell. Longev. 2018, 7460453. 10.1155/2018/7460453 [DOI] [PMC free article] [PubMed] [Google Scholar]
  297. Van Uum S. (2005). Liquorice and hypertension. Neth J. Med. 63 (4), 119–120. [PubMed] [Google Scholar]
  298. Varshney R., Budoff M. J. (2016). Garlic and heart disease. J. Nutr. 146, 416S–421S. 10.3945/jn.114.202333 [DOI] [PubMed] [Google Scholar]
  299. Velmurugan C., Bhargava A. (2013). Anti-diabetic and hypolipidemic activity of fruits of Pyrus communis L. in hyperglycemic rats. Asian J. Pharm. Clin. Res. 6 (5), 108–111. [Google Scholar]
  300. Venkatakrishnan K., Chiu H.-F., Wang C.-K. (2020). Impact of functional foods and nutraceuticals on high blood pressure with a special focus on meta-analysis: review from a public health perspective. Food Funct. 11 (4), 2792–2804. 10.1039/d0fo00357c [DOI] [PubMed] [Google Scholar]
  301. Verma T., Sinha M., Bansal N., Yadav S. R., Shah K., Chauhan N. S. (2021). Plants used as antihypertensive. Nat. Prod. bioprospecting 11, 155–184. 10.1007/s13659-020-00281-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  302. Wahdi A., Astuti P., Puspitosari D. R., Maisaroh S., Pratiwi T. F. (2020). The Effectiveness of giving papaya fruit (Carica papaya) toward blood pressure on elderly hypertension patients. IOP Conf. Ser. Earth Environ. Sci. 519, 012007. 10.1088/1755-1315/519/1/012007 [DOI] [Google Scholar]
  303. Wajdy J., Tayseer A., Dheyaa K. (2021). Constituents, pharmacological and toxicological effects of Meliaazadirachta-A review. Sapporo Med. J. 55. [Google Scholar]
  304. Wazaify M., Alawwa I., Yasein N., Al-Saleh A., Afifi F. U. (2013). Complementary and alternative medicine (CAM) use among Jordanian patients with chronic diseases. Complement. Ther. Clin. Pract. 19 (3), 153–157. 10.1016/j.ctcp.2013.03.001 [DOI] [PubMed] [Google Scholar]
  305. Wei P., Zhao F., Wang Z., Wang Q., Chai X., Hou G., et al. (2022). Sesame (Sesamum indicum L.): a comprehensive review of nutritional value, phytochemical composition, health benefits, development of food, and industrial applications. Nutrients 14 (19), 4079. 10.3390/nu14194079 [DOI] [PMC free article] [PubMed] [Google Scholar]
  306. Wibowo M. A., Anita D. C. (2021). Cucumber juice treatment to the decrease of systolic and diastolic blood pressure. Pak. J. Med. Health Sci. 15 (3), 1137–1140. [Google Scholar]
  307. Xie C., Xie Z., Xu X., Yang D. (2015). Persimmon (Diospyros kaki L.) leaves: a review on traditional uses, phytochemistry and pharmacological properties. J. Ethnopharmacol. 163, 229–240. 10.1016/j.jep.2015.01.007 [DOI] [PubMed] [Google Scholar]
  308. Xiong X., Li X., Zhang Y., Wang J. (2015a). Chinese herbal medicine for resistant hypertension: a systematic review. BMJ Open 5 (1), e005355. 10.1136/bmjopen-2014-005355 [DOI] [PMC free article] [PubMed] [Google Scholar]
  309. Xiong X., Wang P., Li S., Li X., Zhang Y., Wang J. (2015b). Garlic for hypertension: a systematic review and meta-analysis of randomized controlled trials. Phytomedicine 22 (3), 352–361. 10.1016/j.phymed.2014.12.013 [DOI] [PubMed] [Google Scholar]
  310. Xu R., Yang K., Ding J., Chen G. (2020). Effect of green tea supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Medicine 99 (6), e19047. 10.1097/md.0000000000019047 [DOI] [PMC free article] [PubMed] [Google Scholar]
  311. Yamaji T., Harada T., Hashimoto Y., Nakano Y., Kajikawa M., Yoshimura K., et al. (2022). Relationship of daily coffee intake with vascular function in patients with hypertension. Nutrients 14 (13), 2719. 10.3390/nu14132719 [DOI] [PMC free article] [PubMed] [Google Scholar]
  312. Yaqoob N., Fatimah M., Naqvi F., Sarfraz J., Mushtaq S., Chiragh S. (2021). Comparative evaluation of Aloe vera and Diclofenac on body weight, blood pressure and renal function of hypertensive rats. Proc. S.Z.M.C. 35, 39–44. 10.47489/p000s351z7821-6mc [DOI] [Google Scholar]
  313. Yeh G. Y., Davis R. B., Phillips R. S. (2006). Use of complementary therapies in patients with cardiovascular disease. Am. J. Cardiol. 98 (5), 673–680. 10.1016/j.amjcard.2006.03.051 [DOI] [PubMed] [Google Scholar]
  314. Yu G., Luo Z., Zhou Y., Zhang L., Wu Y., Ding L., et al. (2019). Uncovering the pharmacological mechanism of Carthamus tinctorius L. on cardiovascular disease by a systems pharmacology approach. Biomed. Pharmacother. 117, 109094. 10.1016/j.biopha.2019.109094 [DOI] [PubMed] [Google Scholar]
  315. Zeggwagh N., Farid O., Michel J., Eddouks M. (2008). Cardiovascular effect of Artemisia herba alba aqueous extract in spontaneously hypertensive rats. Methods Find. Exp. Clin. Pharmacol. 30 (5), 375–381. 10.1358/mf.2008.30.5.1186081 [DOI] [PubMed] [Google Scholar]
  316. Zhang R., Zhang Q., Zhu S., Liu B., Liu F., Xu Y. (2022). Mulberry leaf (Morus alba L.): a review of its potential influences in mechanisms of action on metabolic diseases. Pharmacol. Res. 175, 106029. 10.1016/j.phrs.2021.106029 [DOI] [PubMed] [Google Scholar]
  317. Zhao C.-N., Meng X., Li Y., Li S., Liu Q., Tang G.-Y., et al. (2017). Fruits for prevention and treatment of cardiovascular diseases. Nutrients 9 (6), 598. 10.3390/nu9060598 [DOI] [PMC free article] [PubMed] [Google Scholar]
  318. Zhao X.-X., Lin F.-J., Li H., Li H.-B., Wu D.-T., Geng F., et al. (2021). Recent advances in bioactive compounds, health functions, and safety concerns of onion (Allium cepa L.). Front. Nutr. 8, 669805. 10.3389/fnut.2021.669805 [DOI] [PMC free article] [PubMed] [Google Scholar]
  319. Zhou B., Perel P., Mensah G. A., Ezzati M. (2021). Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat. Rev. Cardiol. 18 (11), 785–802. 10.1038/s41569-021-00559-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  320. Zhou Q., Lei X., Fu S., Li Z., Chen Y., Long C., et al. (2022). Efficacy of cinnamon supplementation on glycolipid metabolism in T2DM diabetes: a meta-analysis and systematic review. Front. Physiol. 13, 960580. 10.3389/fphys.2022.960580 [DOI] [PMC free article] [PubMed] [Google Scholar]
  321. Zhou X., Tang L., Xu Y., Zhou G., Wang Z. (2014). Towards a better understanding of medicinal uses of Carthamus tinctorius L. in traditional Chinese medicine: a phytochemical and pharmacological review. J. Ethnopharmacol. 151 (1), 27–43. 10.1016/j.jep.2013.10.050 [DOI] [PubMed] [Google Scholar]
  322. Ziaei S., Heidari M., Amin G., Kochmeshki A., Heidari M. (2009). Inhibitory effects of germinal angiotensin converting enzyme by medicinal plants used in Iranian traditional medicine as antihypertensive. J. Kerman Univ. Med. Sci. 16 (4), 134–143. [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Table1.docx (33.8KB, docx)
Image1.tif (2.3MB, tif)
Table2.docx (30.4KB, docx)
Table5.docx (163KB, docx)
Table3.docx (30.9KB, docx)
Table4.docx (42.2KB, docx)

Data Availability Statement

All data generated and analyzed, including study protocol, search strategy, list of included and excluded studies, extracted data, analysis plans, quality assessment, and assessment of publication bias, will be made available by the authors upon reasonable request. Requests to access these datasets should be directed to the corresponding author.

Articles from Frontiers in Pharmacology are provided here courtesy of Frontiers Media SA

RESOURCES