Clinical Considerations
➤ General considerations and classification
– Hypertension is defined by the World Health Organization (WHO) as systolic blood pressure >139 mmHg and/or diastolic pressure >90 mmHg.
– Classification according to severity
• First degree: 140–159/90–99 mmHg
• Second degree: 160–179/100–109 mmHg
• Third degree: ≥180/≥110 mmHg
• Isolated systolic hypertension: ≥140/<90 mmHg
– Arterial hypertension can be found in 25–30 % of the population. The incidence increases with age.
➤ General treatment measures: Lifestyle changes should be carried out before initiation of therapy (e. g., endurance sports, dietary measures such as reduced refined fat and sugar intake, weight and stress reduction).
➤ Clinical value of herbal medicine
– Although a number of very safe and effective synthetic drugs are available, the patient compliance rates with these drugs are rather low.
– Although few study data are available on herbal antihypertensives, and although they tend to be low-potency medications, many European patients request them.
– We feel that medically supervised attempts to manage hypertension using herbal preparations are justifiable in the initial stages of the disease. Moreover, herbal preparations make it easier for relatively young and older patients to accept the lifelong need for treatment.
Hypertension Recommended Herbal Remedies (Overview)
Sympatholytics
➤ Rauwolfia (Rauwolfia serpentina).
– Action: Rauwolfia total extract has antihypertensive and sympatholytic effects due to various constituents, especially reserpine and raubasine.
• Immediate blood pressure reduction cannot be expected.
– Contraindications: Depression, peptic ulcer, pheochromocytoma, pregnancy and lactation.
– Dosage and administration: To ensure consistency of potency and for safety, use should be restricted to commercial oral rauwolfia products.
– Side effects: Sedation, dryness of the mouth, nasal congestion, reduced sex drive, depression. These effects can be reduced or avoided by reducing the dose.
– Interactions: Digitalis or other cardiac glycosides, neuroleptics, barbiturates, levodopa.
Vasodilators
➤ Garlic cloves (Allii sativi bulbus,).
– Action
• The constituents allicin and ajoene cause hyperpolarization of vascular smooth-muscle cells, resulting in vasodilatation. This is presumably due to a non-potassium channel-related reduction in the intracellular calcium concentration.
• Thanks to their wide therapeutic range (e. g., antioxidant, slightly antilipemic, fibrinolytic, and inhibitory of platelet aggregation), garlic extracts are useful for adjunctive treatment of all forms of arteriosclerosis.
• The antihypertensive effect of garlic takes a while to become noticeable.The maximum effect develops after around 6 months of treatment. Dry garlic powder extracts have the largest therapeutic effect.
– Contraindications: Hemophilia A and other coagulation disorders.
– Dosage and administration: 600–900 mg per day, equivalent to 1.8–2.7 g of fresh garlic.
– Side effects: Gastrointestinal irritation and allergic reactions are rare side effects. Typical smelling.
Warning: Although garlic preparations are unlikely to affect blood coagulation enough to contraindicate it before or after surgery, it is safest to discontinue use before or after major surgery.
Drugs with Unclear Effects
➤ Mistletoe (Visci albi herba, see p. 93).
– Action: The antihypertensive constituents in aqueous mistletoe extracts have not yet been identified. They are said to reduce occasional symptoms such as headaches, dizziness, restlessness, nervousness, and reduced exercise tolerance.
– Dosage and administration
• Tea: Pour 1 cup of cold water onto 2.5 g (1 teaspoon) of the finely chopped herb, allow to stand at room temperature for 12 hours, then strain.
• Dosage: One to two cups per day. Tincture (1 : 1) 20 to 30 drops, several times daily.
