Abstract
Herbal remedies, supplements, and alternative therapeutic items are used by many patients with hypertension and cardiovascular diseases. Scientific knowledge about their efficacy and safety is lacking, and unfortunately, physicians are frequently not aware that patients are using these nontraditional forms of medical care. Patients may anticipate physicians’ disapproval of their use, or not realize that it is important for the physician to know what they are taking. Therefore, it is imperative that patients are asked nonjudgmental questions about current and past use of herbals and alternative therapies. Even when physicians are aware of such use, they feel poorly trained to identify the constituents and effects. Although many such therapies are innocuous, several herbal or alternative therapeutic items can significantly elevate blood pressure or cause interactions with cardiovascular drugs. Practitioners in cardiovascular medicine should be competent and know current scientific evidence for the benefits and adverse effects of herbal supplements and provide patients reasonable advice. In this brief article, we review the epidemiology of alternative therapy use, and select several important herbal or other supplements that patients with hypertension and cardiovascular diseases may be taking. We discuss the therapies considered biological in nature as opposed to mind-body interventions or manipulative body or energy therapies.
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Winslow LC, Kroll DJ: Herbs as medicines. Arch Intern Med 1998, 158:2192–2199. This review investigates pertinent definitions, the history of herbs in medicine, epidemiology and prevalence of herbal use, and relevant psychosocial issues.
Miller KL, Liebowitz RS, Newby LK: Complementary and alternative medicine in cardiovascular disease: a review of biologically based approaches. Am Heart J 2004, 147:401–411.
Rafferty AP, McGee HB, Miller CE, et al.: Prevalence of complementary and alternative medicine use: state-specific estimates from the 2001 Behavioral Risk Factor Surveillance System. Am J Public Health 2002, 92:1598–1600.
CDC: Self-treatment with herbal and other plant-derived remedies—rural Mississippi, 1993. MMWR Morb Mortal Wkly Rep 1995, 44:204–207.
Harnack LJ, Rydell SA, Stang J: Prevalence of use of herbal products by adults in the Minneapolis/St. Paul, Minn, metropolitan area. Mayo Clin Proc 2001, 76:688–694.
Final report of the White House Commission on Complementary and Alternative Medicine Policy. Available online at http://www.whccamp.hhs.gov/fr7.html Describes the economics, coverage, and reimbursement issues for herbal and complementary medicine.
Eisenberg DM, Davis RB, Ettner SL, et al.: Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 1998, 280:1569–1575.
Cappuccio FP, Duneclift SM, Atkinson RW, et al.: Use of alternative medicines in a multi-ethnic population. Ethn Dis 2000, 11:11–18.
Mikhail N, Wali S, Ziment I: Use of alternative medicine among Hispanics. J Altern Complement Med 2004, 10:851–859.
Eisenberg DM, Kessler RC, Van RompayMI, et al.: Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001, 135:344–351.
Palinkas LA, Kabongo ML: San Diego Unified Practice Research in Family Medicine Network. The use of complementary and alternative medicine by primary care patients. A SURF*NET study. J Fam Pract 2000, 49:1121–1130.
Fields LE, Burt VL, Cutler JA, et al.: The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension 2004, 44:398–404.
Cohen MH: Complementary and integrative medical therapies, the FDA, and the NIH: definitions and regulation. Dermatol Ther 2003, 16:777–784. Highlights legal rules governing CAM providers and practices. Additionally, significant developments, such as guidelines by the Federation of State Medical Boards to govern physician integration of CAM therapies, and recommendations for federal legislation and policy are presented.
US Food and Drug Administration: Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk. Docket number: 1995N-0304. http://www.fda.gov/OHRMS/DOCKETS/98fr/ 1995n-0304-nfr0001.pdf. 2004.
Banerjee SK, Maulik SK: Effect of garlic on cardiovascular disorders: a review. Nutr J 2002, 1:4.
Das I, Khan NS, Sooranna SR: Potent activation of nitric oxide synthase by garlic: a basis for its therapeutic applications. Curr Med Res Opin 1995, 13:257–263.
Sharifi AM, Darabi R, Akbarloo N: Investigation of antihypertensive mechanism of garlic in 2K1C hypertensive rat. J Ethnopharmacol 2003, 86:219–224.
Ackermann RT, Mulrow CD, Ramirez G, et al.: Garlic shows promise for improving some cardiovascular risk factors. Arch Intern Med 2001, 161:813–824.
Silagy CA, Neil HA: A meta-analysis of the effect of garlic on blood pressure. J Hypertens 1994, 12:463–468.
Turner B, Molgaard C, Marckmann P: Effect of garlic (Allium sativum) powder tablets on serum lipids, blood pressure and arterial stiffness in normo-lipidaemic volunteers: a randomised, double-blind, placebo-controlled trial. Br J Nutr 2004, 92:701–706.
Piscitelli SC, Burstein AH, Welden N, et al.: The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis 2002, 35:234–238.
Knuppel L, Linde K: Adverse effects of St. John’s Wort: a systematic review. J Clin Psychiatry 2004, 65:1470–1479.
Bilia AR, Gallori S, Vincieri FF: St. John’s Wort and depression: efficacy, safety and tolerability: an update. Life Sci 2002, 70:3077–3096.
Hypericum Depression Trial Study Group: Effect of Hypericum perforatum (St. John’s Wort) in major depressive disorder: a randomized controlled trial. JAMA 2002, 287:1807–1814.
Zullino D, Borgeat F: Hypertension induced by St. John’s Wort: a case report. Pharmacopsychiatry 2003, 36:32.
Patel S, Robinson R, Burk M: Hypertensive crisis associated with St. John’s Wort. Am J Med 2002, 112:507–508.
Markowitz JS, Donovan JL, DeVane CL, et al.: Effect of St John’s Wort on drug metabolism by induction of cytochrome P450 3A4 enzyme. JAMA 2003, 290:1500–1504. The ability of St. John’s Wort to alter the activity of the cytochrome P450 (CYP) enzymes after administrating for 14 days is assessed.
Mueller SC, Uehleke B, Woehling H, et al.: Effect of St John’s Wort dose and preparations on the pharmacokinetics of digoxin. Clin Pharmacol Ther 2004, 75:546–557.
Sugimoto K, Ohmori M, Tsuruoka S, et al.: Different effects of St John’s Wort on the pharmacokinetics of simvastatin and pravastatin. Clin Pharmacol Ther 2001, 70:518–524.
Jiang X, Williams KM, Liauw WS, et al.: Effect of St John’s Wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004, 57:592–599.
Tannergren C, Engman H, Knutson L, et al.: St John’s Wort decreases the bioavailability of R-and S-verapamil through induction of the first-pass metabolism. Clin Pharmacol Ther 2004, 75:298–309.
Mai I, Bauer S, Perloff ES, et al.: Hyperforin content determines the magnitude of the St John’s Wort-cyclosporine drug interaction. Clin Pharmacol Ther 2004, 76:330–340.
Hebert MF, Park JM, Chen YL, et al.: Effects of St. John’s Wort (Hypericum perforatum) on tacrolimus pharmacokinetics in healthy volunteers. J Clin Pharmacol 2004, 44:89–94.
Ruschitzka F, Meier PJ, Turina M, et al.: Acute heart transplant rejection due to St. John’s Wort. Lancet 2000, 355:548–549.
Ernst E: St John’s Wort supplements endanger the success of organ transplantation. Arch Surg 2002, 137:316–319.
Piscitelli SC, Burstein AH, Chaitt D, et al.: Indinavir concentrations and St. John’s Wort. Lancet 2000, 355:547–548.
de Maat MM, Hoetelmans RM, Math t RA, et al.: Drug interaction between St John’s Wort and nevirapine. AIDS 2001, 15:420–421.
Hall SD, Wang Z, Huang SM, et al.: The interaction between St John’s Wort and an oral contraceptive. Clin Pharmacol Ther 2003, 74:525–535.
Han KH, Choe SC, Kim HS, et al.: Effect of red ginseng on blood pressure in patients with essential hypertension and white coat hypertension. Am J Chin Med 1998, 26:199–209.
Caron MF, Hotsko AL, Robertson S, et al.: Electrocardiographic and hemodynamic effects of Panax ginseng. Ann Pharmacother 2002, 36:758–763.
Cicero AF, Derosa G, Brillante R, et al.: Effects of Siberian ginseng on elderly quality of life: a randomized clinical trial. Arch Gerontol Geriatr Suppl 2004, 15:69–73.
Achike FI, Kwan CY: Nitric oxide, human diseases and the herbal products that affect the nitric oxide signalling pathway. Clin Exp Pharmacol Physiol 2003, 30:605–615.
Siegel RK: Ginseng abuse syndrome. Problems with the panacea. JAMA 1979, 241:1614–1615.
Yuan CS, Wei G, Dey L, et al.: American ginseng reduces warfarin’s effect in healthy patients: a randomized, controlled trial. Ann Intern Med 2004, 141:23–27.
Walker BR, Edwards CR: Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess. Endocrinol Metab Clin North Am 1994, 23:359–377.
Quinkler M, Stewart PM: Hypertension and the cortisol-cortisone shuttle. J Clin Endocrinol Metab 2003, 88:2384–2392.
Russo S, Mastropasqua M, Mosetti MA, et al.: Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol 2000, 20:145–148.
Hasegawa J, Suyama Y, Kinugawa T, et al.: Echocardiographic findings of the heart resembling dilated cardiomyopathy during hypokalemic myopathy due to licorice-induced pseudoaldosteronism. Cardiovasc Drugs Ther 1998, 12:599–600.
Lin SH, Yang SS, Chau T, et al.: An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci 2003, 325:153–156.
Dellow EL, Unwin RJ, Honour JW: Pontefract cakes can be bad for you: Refractory hypertension and liquorice excess. Nephrol Dial Transplant 1999, 14:218–220.
Sigurjonsdottir HA, Manhem K, Axelson M, et al.: Subjects with essential hypertension are more sensitive to the inhibition of 11 beta-HSD by liquorice. J Hum Hypertens 2003, 17:125–131.
Grossman E, Rosenthal T, Peleg E, et al.: Oral yohimbine increases blood pressure and sympathetic nervous outflow in hypertensive patients. J Cardiovasc Pharmacol 1993, 22:22–26.
Goldberg MR, Hollister AS, Robertson D: Influence of yohimbine on blood pressure, autonomic reflexes, and plasma catecholamines in humans. Hypertension 1983, 5:772–778.
Musso NR, Vergassola C, Pende A, et al.: Yohimbine effects on blood pressure and plasma catecholamines in human hypertension. Am J Hypertens 1995, 8:565–557.
Ruck B, Shih RD, Marcus SM: Hypertensive crisis from herbal treatment of impotence. Am J Emerg Med 1999, 17:317–318.
Onrot J, Goldberg MR, Biaggioni I, et al.: Oral yohimbine in human autonomic failure. Neurology 1987, 37:215–220.
Ernst E, Pittler MH: Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol 1998, 159:433–436.
Kane GC, Lipsky JJ: Drug-grapefruit interactions. Mayo Clin Proceed 2000, 75:933–942. The medications involved in drug-grapefruit juice interactions are discussed, and the clinical implications of these interactions are addressed.
Huang SM, Hall SD, Watkins P, et al.: Center for Drug Evaluation and Research and Office of Regulatory Affairs, Food and Drug Administration, Rockville, MD, USA. Drug interactions with herbal products and grapefruit juice: a conference report. Clin Pharmacol Ther 2004, 75:1–12.
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Vora, C.K., Mansoor, G.A. Herbs and alternative therapies: Relevance to hypertension and cardiovascular diseases. Current Science Inc 7, 275–280 (2005). https://doi.org/10.1007/s11906-005-0025-0
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DOI: https://doi.org/10.1007/s11906-005-0025-0