ABSTRACT
Pre-experimental one group pertest post-test research design was adopted to investigate the effectiveness of aqueous flower extract of Hibiscus sabdariffa in reduction of blood pressure, serum lipids among 60 prehypertensive patients. A self-structured questionnaire and manual sphygmomanometer and stethoscope monitored blood pressure levels before and after administering Hibiscus sabdariffa extract. Results showed a significant drop in blood pressure levels among prehypertensive patients with a mean difference score of 12.75, and a substantial decrease in total cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low density lipoprotein (VLDL) levels. The calculated paired ‘t’ test value of 16.280 was statistically significant at P < 0.001 level, indicating that oral supplementation of Hibiscus sabdariffa’s flower extract is effective in reducing blood pressure and serum cholesterol in prehypertensive patients.
KEYWORDS: Aqueous flower extract, blood pressure, Hibiscus sabdariffa, prehypertensive patients, reduction, serum lipids
INTRODUCTION
The major health issue faced in our day-to-day life is hypertension in total, hypertension and its direct effects are responsible for 12% of all deaths.[1] Hypertension causes alterations in the various functions of the bodily system, including cardiovascular, renal and central nervous system, leading to various diseases.[2,3] Lifestyle changes (diet, weight, and activity) are regarded as first-line treatment for prehypertensive individuals; however, pharmacological therapy should be undertaken in partial or nonresponsive instances. Fruits, vegetables, and whole-grain cereals, are particularly rich sources of phytochemicals, notably polyphenols. People are unaware of the importance of consuming plant-based juices is common nowadays.[4]
Hibiscus sabdariffa calyces and beverages produced from them are known as aqueous flower extracts of Hibiscus sabdariffa, sweetened and frequently seasoned with cinnamon and cloves or hibiscus flower petals, cinnamon. nutmeg, ginger, cloves, and spices boil in medium fame and prepare a drink, in other regions of the world. In vitro studies reveal that Hibiscus sabdariffa possesses antioxidant activities, and extracts of this flower have been shown to have hypocholesterolaemia and antihypertensive characteristics in animal models.[5,6] According to the research, this plant contains anticarcinogenic, microbicidal, nephro- and antihepatotoxic, diuretic, cholesterol-lowering agent, antihyperglycemic agent and blood pressure lowering agent. Through its antioxidant properties, dietary HSE may lower the occurrence of atherosclerosis.[7,8] In hypercholesterolemia and obese adults, an aqueous extract of Hibiscus lowers the total cholesterol (TC) and low-density lipoprotein (LDL) blood triglyceride levels.[9] Several methods have been postulated to explain cholesterol and lipid-modulating properties of Hibiscus, such as inhibition of HMG-CoA reductase or inhibition of triacylglycerol production by Hibiscus acid racemization.[10]
METHODS AND MATERIALS
Pre-experimental one group pertest post-test research design was adopted to investigate the effectiveness of aqueous flower extract of Hibiscus sabdariffa in reduction of blood pressure, serum lipids among 60 prehypertensive patients. The study was conducted for 6 weeks from January 23 2023 till 4 March 2023 who attended the General Medicine Outpatient Department of host institution. After obtaining the clearance from the Institutional Human Ethics Committee (IHEC) of Saveetha Institute of Medical and Technical Sciences and a formal permission from the departmental head of General Medicine, the study was conducted. Prehypertensive (elevated BP) patients of both sexes between 35 and 60 years of age, who have the systolic BP can range from 120 to 129 mm Hg, whereas the patients with diastolic BP more than 80 mm Hg (according to American Heart Association Category of BP) are willing to participate in the study, can able to read, write, speak, and understand Tamil or English were included in the present study. Participants having Stage I HT (systolic BP 130-139 mm Hg and diastolic BP (80-89 mm Hg), Stage II HT (systolic BP 140-159 mm Hg and diastolic BP (90-99 mm Hg) and systolic BP > 160 mm Hg and diastolic BP > 100 mm Hg (according to American Heart Association Category of BP), any other disorder such as psychiatric illness, substance abuse, co morbid illness, who are in alternative system of medicine, not available during study period, not being open to communicate and cooperation were excluded, a written informed consent was obtained from them before conducting the study. After recruiting the prehypertensive patients through purposive sampling technique, all the 60 prehypertensive patients were randomly assigned to either the experimental group or the control group by using the lottery method. On Day 1, the demographic data and clinical information was collected using self-structured questionnaire, followed by that, monitored blood pressure level with help of manual sphygmomanometer and stethoscope and fasting lipid profile before and after the administration of aqueous extract of Hibiscus sabdariffa. From Day 2 (preparation of Hibiscus flower extract), Hibiscus sabdariffa aqueous extract 20 ml is boiled with 100 ml water for 5 minutes and is given 3 times daily before or 30 minutes after meals for 6 weeks, with the compromise of not modifying their eating habits. Everyone who participated was given a pamphlet with guidelines on the preparation of medicinal drink. For the control group, routine hospital care was followed. On Day 43, the study participants were reassessed for the blood pressure level and fasting lipid profile. The acquired data have been compiled and analysed using statistical methods.
RESULTS AND DISCUSSION
The pretest mean score of systolic BP was 149.50 ± 14.42, and the post-test mean score was 131.33 ± 10.96. The average difference score was 18.17. The derived paired ‘t’ test value of 13.207 was statistically significant at the P < 0.001 level. The pretest mean diastolic blood pressure was 97.33 ± 6.60, while the post-test mean was 84.58 ± 5.14. The mean difference score was 12.75. The paired ‘t’ test value of 16.280 was statistically significant at P < 0.001, indicating a significant drop in blood pressure among prehypertensive patients in the experimental group after administering aqueous extract of Hibiscus sabdariffa (As depicted in Table 1). A study by Kadhim MA et al. (2023)[11] found that Hibiscus tea intake significantly reduced blood pressure in stage 1 or 2 hypertensive individuals. The study involved 70 participants and found a significant difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP). The intervention group showed a higher mean reduction in SBP (6.58 mm Hg) compared to the control group (−1.71 mm Hg) and a larger mean reduction in DBP (−5.00 mm Hg) compared to the control group. Hence, the findings of the present study and the above studies clearly depict that Hibiscus extract can be a useful medication for lowering blood pressure in persons with stage 1 hypertension.
Table 1.
Effectiveness of Hibiscus Sabdariffa Extract on Blood Pressure among Prehypertensive Patients (n=60)
| Blood Pressure | Pretest | Post-test | Mean Difference Score | Paired ‘t’ test & P | ||
|---|---|---|---|---|---|---|
|
|
|
|||||
| Mean | S.D | Mean | S.D | |||
| Systolic BP | 149.50 | 14.42 | 131.33 | 10.96 | 18.17 | t=13.207, P=0.0001, S*** |
| Diastolic BP | 97.33 | 6.60 | 84.58 | 5.14 | 12.75 | t=16.280, P=0.0001, S*** |
***p < 0.001, S –Significant
The pretest mean score of TC was 251.01 ± 8.17, and the post-test mean score was 193.28 ± 30.44. The mean difference score was 57.73, with a calculated paired ‘t’ test value of 14.153. The mean difference score was 41.62, with a calculated paired ‘t’ test value of 30.990. The mean difference score for HDL was 35.05 ± 3.97, and the mean difference score for triglycerides was 192.21 ± 7.69. The mean difference score for VLDL was 37.48 ± 4.56, and the mean difference score was 19.92. The paired ‘t’ test value of 17.255 was statistically significant at P < 0.001, indicating a substantial decrease in TC, triglycerides, LDL, HDL, and VLDL levels among prehypertensive patients in the experimental group after the administration of Hibiscus sabdariffa aqueous extract (As depicted in Table 2). Aguirre-García et al. (2019)[12] conducted a study on the effects of Hibiscus on blood lipid profiles in 20 volunteers aged 45-64 years old. They found that those taking Hibiscus medication had significantly lower blood lipid concentrations compared to controls. This study and previous research indicate that regular use of Hibiscus may reduce the risk of cardiovascular disease.
Table 2.
Effectiveness of Hibiscus Sabdariffa Extract on Total Cholesterol, Triglycerides, LDL, HDL, VLDL among Prehypertensive Patients (n=60)
| Parameters | Pretest | Post-Test | Mean Difference Score | Paired ‘t’ test & P | ||
|---|---|---|---|---|---|---|
|
|
|
|||||
| Mean | S.D | Mean | S.D | |||
| Total Cholesterol | 251.01 | 8.17 | 193.28 | 30.44 | 57.73 | t=14.153, P=0.0001, S*** |
| LDL | 164.85 | 5.54 | 123.23 | 7.95 | 41.62 | t=30.990, P=0.0001, S*** |
| HDL | 35.05 | 3.97 | 58.46 | 6.08 | 23.41 | t=27.373, P=0.0001, S*** |
| Triglycerides | 432.23 | 9.85 | 192.21 | 7.69 | 240.02 | t=167.959, P=0.0001, S*** |
| VLDL | 37.48 | 4.56 | 17.56 | 8.26 | 19.92 | t=17.255, P=0.0001, S*** |
***p < 0.001, S –Significant
Relationship between the post-test level of blood pressure among prehypertensive patients and their selected demographic variables in the experimental group
Lifestyle practice (χ2 = 19.203, P = 0.004), previous history (χ2 = 13.756, P = 0.032), and BMI (χ2 = 11.231, P = 0.024) had significantly influenced post-test systolic and diastolic blood pressure levels in prehypertensive patients, with significant associations observed at P < 0.05.
CONCLUSION
Based on the findings of the current study, it was evident that there was a significant effect of Hibiscus extract in the reduction of blood pressure and serum cholesterol.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
The authors would like to thank all the study participants for their cooperation in completing the study successfully.
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