Paula Viñas
José de Felippe Junior

Devemos ficar muito atentos , porque 1- sabemos da existência de plantas que funcionam como tratamento coadjuvante da hipertensão arterial e portanto são perigosas quando usadas conjuntamente com os medicamentos anti hipertensivos da medicina convencional; 2- existem plantas que provocam hiperetensão arterial. O médico deve estar atento para os efeitos hipertensivos de muitas plantas e até de certos doces ( alcaçuz).

Ervas Chinesas

The bioactivity of angiotensin II and the effects of related Chinese Herbs
Zhongguo Zhong Yao Za Zhi;28(5):394-7, 431, 2003 May. Shen YH; Chen CX
País de publicação: China
Resumo: OBJECTIVE: To review the bioactivity of angiotensin II and the effects of Chinese herbs on it. METHOD: The correlative documents published in recent years were summarized. RESULT: Angiotensin II plays an important role in the development of many diseases, such as hypertension, arteriosclerosis, myocardial lesion due to ischemia and reperfusion, cardiac hypertrophy and fibrosis, dysfunction of fibrinolytic system, thrombosis, renal failure etc. Some Chinese herbs inhibit the actions of angiotensin II. CONCLUSION: Further researches must be done to investigate the bioactivity of angiotensin II and the effects of Chinese herbs on preventing the body tissue from being impaired by it.

Ervas de Moroco

Ethnopharmacological survey of medicinal plants used for the treatment of diabetes mellitus, hypertension and cardiac diseases in the south-east region of Morocco (Tafilalet).
Ethnopharmacol;82(2-3):97-103, 2002 Oct. Eddouks M; Maghrani M; Lemhadri A; Ouahidi ML; Jouad H
País de publicação: Ireland
Resumo: In this study, the medicinal plants used in the treatment of diabetes mellitus, hypertension and cardiac diseases were inventoried based on the ethnopharmacological survey in south-eastern Morocco: Tafilalet region. Seven hundred persons including 320 diabetic patients and 380 patients with hypertension and cardiac disorders and 20 traditional herbal healers were interviewed in different areas of Tafilalet. The results indicated that 80% of patients interviewed used medicinal plants to treat diabetes, hypertension and cardiac diseases because they state that phytotherapy is cheaper (58%), more efficient (40%) and better (65%) than modern medicine. In this ethnobotanic enquiry, about 92 medicinal plants were cited. A lot of them are cited for the first time in Morocco. Many parameters have been evaluated such as knowledge of the toxic plants, doses, parts used, etc. Also, we have reported that 75% of type 2 diabetic patients used medicinal plants in association with modern drugs, while 10% of type 1 diabetic patients regularly used medicinal plants combined with insulin treatment. Some toxic plants have also been reported. In conclusion Tafilalet region disposes of a large phytotherapy knowledge which must be scientifically investigated especially in treating diabetes mellitus, hypertension and cardiac diseases.

Ervas da Ucrânia

Efficacy of combined herbal drug therapy in hypertension
Lik Sprava;(1):114-7, 2002. Chekman IS
País de publicação: Ukraine
Resumo: The article contains a summary of the published literature together with results of the author's investigations designed to study efficacies of combined herbal drugs as treatment of hypertension. Treated at length are pharmacological mechanisms of action and a clinical effectiveness of a new combined vegetal drug chomviotensin that has come to be widely used as treatment of hypertensive disease.

Ervas nos Estados Unidos da América

Selected complementary methods and nursing care of the hypertensive client.
Holist Nurs Pract;15(4):4-11, 2001 Jul. Sutherland JA
Resumo: The National Institutes of Health and the World Health Organization have targeted the treatment of mild or borderline hypertension as a critical health care issue. Conventional practitioners' focus on more intensive treatment for blood pressure elevations in the lower ranges is accompanying the consumer-driven movement toward the use of complementary methods. Over 60 million Americans used herbal therapies in the past year, and visits to complementary care practitioners are expected to increase beyond the 425 million now made annually. The purpose of this article is to identify four herbs that consumers commonly select for the treatment of hypertension and identify nursing care considerations for their use. Additionally, the article reviews research on the effectiveness of acupuncture for hypertension, along with nursing care implications for patients.
Herbs and alternative therapies in the hypertension clinic.
Am J Hypertens;14(9 Pt 1):971-5, 2001 Sep. Mansoor GA
Resumo: The use of alternative therapies, herbs, and supplements occurs at a very high rate among patients attending a variety of health care settings. Such therapy may cause significant interactions or effects on hypertension and other cardiovascular disorders and needs to be considered by clinicians. In this brief review, we highlight several commonly used alternative therapies that may have a clinical impact in the hypertensive patient. Several problems hinder our complete awareness of these effects. These problems include patients not informing physicians about alternative treatment or herbal use, the lack of consistent scientific standards for the bioactivity of many herbals or supplements, and the multiple names that each bioactive substance is sold under. Specific questioning regarding herbals and alternative therapies in the hypertension clinic is therefore needed. Herbals including ma huang, St. John's wort, yohimbine, garlic, and licorice all may cause important consequences in the hypertensive patient. Added care is needed in monitoring the use and effects of herbal and alternative therapies in the hypertensive population.

Alho

Investigation of antihypertensive mechanism of garlic in 2K1C hypertensive rat.
J Ethnopharmacol. 2003 Jun;86(2-3):219-24.
Sharifi AM, Darabi R, Akbarloo N.
Department of Pharmacology and Cellular and Molecular Research Center, School of Medicine, Iran University of Medical Sciences, P.O. Box 14155-6183, Tehran, Iran. sharifal@yahoo.com
This study sought to examine the antihypertensive mechanism of garlic in two-kidney-one-clip (2K1C) hypertensive rat. In this study, the effect of garlic on serum and tissue including: aorta, heart, kidney, lung as well as circulatory (serum) ACE activity in 2K1C rats were examined. Four groups of rats were selected: control "CTL", sham-operated "SHAM", hypertensive "H" and garlic-treated hypertensive "GT" group. Hypertension was induced by surgery. Four weeks post-clipping, single daily dose of 50mg of aqueous extract of garlic was given orally to "GT" rats for 4 weeks. Blood pressure was measured by tail-cuff method.ACE activity was determined using HPLC. The systolic blood pressure (SBP) was significantly increased in "H" compared to "CTL" group. In "GT" group, blood pressure was significantly decreased compared to "H" group. The ACE activity in all tissues of "H" group was significantly increased compared to controls which was significantly decreased in garlic-treated compared to non-treated hypertensive rats. These results indicated a negative correlation between consumption of garlic, blood pressure and ACE activity in serum and different tissues in 2K1C rats, suggesting that garlic has a significant blood pressure lowering effect, which could partly be mediated by reduction in ACE activity.

Effects of wild versus cultivated garlic on blood pressure and other parameters in hypertensive rats.
Heart Dis. 2000 Jan-Feb;2(1):3-9.
Mohamadi A, Jarrell ST, Shi SJ, Andrawis NS, Myers A, Clouatre D, Preuss HG.
Department of Medicine (Nephrology) and Pathology, Georgetown University Medical Center, 3900 Reservoir Road SE, Washington, DC 20007, USA.
Two separate studies were performed on hypertensive rats to assess the effects of wild, uncultivated garlic on elevated systolic blood pressure (SBP) and other cardiovascular parameters. Also, effects of wild garlic and cultivated garlic preparations were compared and the mechanisms behind pressure-lowering abilities of different garlic preparations were examined. The initial study determined that wild garlic lowers blood pressure. In the second study, cardiovascular effects of three different concentrations of wild garlic and two different cultivated garlics, i.e., a preparation low in allicin and one high in allicin, were compared. All three garlic preparations decreased SBP significantly. Wild garlic produced the greatest pressure-lowering effects, and the least pressure-lowering effects were seen with low-allicin garlic. Compared with control rats, circulating angiotensin II levels were significantly lower in all garlic-eating rats. Losartan decreased blood pressure significantly less and Nw-nitro-L arginine-methyl ester hydrochloride (LNAME) increased blood pressure significantly more in garlic-eating rats than in control rats, suggesting that the renin-angiotensin system (RAS) was less active and the nitric oxide system more active in garlic-consuming hypertensive rats. Accordingly, different garlic preparations, especially wild garlic, favorably influenced high SBP in hypertensive rats. These results suggest that both the RAS and the nitric oxide system are involved in the antihypertensive effects of garlic in hypertensive rats.

Hypotensive effect of long-acting garlic tablets allicor (a double-blind placebo-controlled trial)
Ter Arkh. 2002;74(3):76-8.
[Article in Russian]
Andrianova IV, Fomchenkov IV, Orekhov AN.
AIM: To evaluate a hypotensive action of long-acting garlic powder tablets allicor in patients with mild or moderate hypertension and to compare allicor effects with those of foreign analog--kwai garlic tablets. MATERIAL AND METHODS: A double-blind, randomized and placebo-controlled study enrolled 85 patients with mild or moderate hypertension. The patients were divided into 4 groups: group 1 received allicor in a dose 600 mg/day, group 2--2400 mg/day, group 3--kwai in a dose 900 mg/day, group 4--placebo. RESULTS: Allicor produced reaction in both systolic and diastolic pressure. An increase of allicor daily dose to 2400 mg does not provide an additional hypotensive effect. Kwai results in only systolic but not diastolic arterial pressure lowering. CONCLUSION: Allicor is more effective than kwai in reduction of diastolic blood pressure. It can be recommended as a hypotensive treatment in mild and moderate arterial hypertension.

Thromboxane-B2, prostaglandin-E2 and hypertension in the rat 2-kidney 1-clip model: a possible mechanism of the garlic induced hypotension.
Prostaglandins Leukot Essent Fatty Acids. 2001 Jan;64(1):5-10.
Al-Qattan KK, Khan I, Alnaqeeb MA, Ali M.
Department of Biological Sciences, Faculty of Science, Kuwait University, P.O. Box 5969, Al-Safat 13060, Kuwait. qattan@kuc01.kuniv.edu.kw
Serum collected from unilaterally clipped and unclipped rats before and after treatment with water, garlic or cilazapril and subsequent to measuring blood pressure was assayed for thromboxane-B2 and prostaglandin-E2. The unclipped rats' thromboxane-B2 and prostaglandin-E2 levels were about 23 ng/ml and 2 ng/ml, respectively, and blood pressure was 126+/-3 mmHg. These values were not affected by either water or garlic administration. The clipped rats' thromboxane-B2 and prostaglandin-E2 concentrations were close to 34 ng/ml and 4 ng/ml, respectively, and declined only in response to garlic (by 15 ng/ml and 3 ng/ml) and cilazapril (by 12 ng/ml and 1.5 ng/ml). The blood pressure of these rats was 196+/-7 mmHg and again was reduced only by garlic to 169+/-14 mmHg and cilazapril to 137+/-5 mmHg. The no-treatment and water-treatment readings were significantly higher in the clipped rats. The data suggest that prostanoid system activity in the 2-kidney 1-clip rat is enhanced and mostly toward maintaining the hypertension. Furthermore, the blood pressure lowering effects of garlic and cilazapril might have been induced partially by a greater reduction in the synthesis of vasoconstrictor prostanoids.

Revisión: efectos cardiovasculares del ajo (Allium sativum)..
Arch Latinoam Nutr;50(3):219-29, 2000 Sep. García Gómez LJ; Sánchez-Muniz FJ
Resumo: Garlic has been used for centuries, and even nowadays is part of popular medicine in many cultures. New data have increased the interest in garlic and its role in normalization and treatment of cardiovascular disease risk factors. Recent studies have shown the complex composition of garlic, containing many compounds, that present potential positive effect in the field of health. The aim of the present paper was to review results of some studies that have found a relationship between garlic and cardiovascular diseases. From some of them it can be summarized that garlic can normalize plasma lipid, check lipid peroxidation, stimulate fibrinolytic activity, inhibit platelet aggregation, smooth the thickening and structural changes of artery wall related to aging and atherosclerosis, and decrease blood pressure. However, some other studies do not support these benefits. The positive effects found have promoted many study projects, nevertheless, the extract lability and the lack of result consensus call for a moderate consumption of garlic and garlic extracts
The composition variation due to gathering and aging together with the changes occurring in canning and industrial treatment makes necessary the application of some norms in the production and consumption of this functional food in order to guarantee its use in adequate form and doses.

Effect of dietary garlic (Allium Sativum) on the blood pressure in humans--a pilot study.
J Pak Med Assoc;50(6):204-7, 2000 Jun. Qidwai W; Qureshi R; Hasan SN; Azam SI
País de publicação: PAKISTAN
Resumo: OBJECTIVE: To find out whether individuals with blood pressures on the lower side consume more garlic in their diets. A pilot study to make grounds for more elaborate future trials. METHOD: A questionnaire was developed in order to estimate the dietary intake of garlic per person per month and to record three blood pressure readings on each individual. It was administered to 101 adult subjects, presenting to the Family Practice Centre of a hospital in the city of Karachi, Pakistan. The various demographic parameters including age, sex, marital status and education were recorded. Those subjects found to be overweight, with known history of hypertension, diabetes mellitus, ischaemic heart disease, and smoking and on medications, which effect blood pressure, were excluded from the study. This was done to remove the effect of confounding variables on Blood Pressure. The data was entered into the epi-info program and the analysis was done using the SPSS software. RESULTS: An average garlic use of 134 grams per case per month was found. 67% of the subjects used garlic in cooked food while the rest used either in the raw form or in pickles. 59% thought that dietary use of garlic is healthy. Subjects with blood pressure on the lower side are found to consume more garlic in their diets. (The mean difference is significant for systolic with p value of 0.05). CONCLUSION: This study shows that individuals whose blood pressures are on the lower side are more likely to consume more garlic in their diets. (Statistically significant for systolic blood pressure only). This was a pilot study and more elaborate trials are recommended to prove this association.

Patient preferences for novel therapy: an N-of-1 trial of garlic in the treatment for hypertension.
J Gen Intern Med;8(11):619-21, 1993 Nov. Estrada CA; Young MJ
Resumo: The authors used the N-of-1 clinical trial methodology to obtain insights about a patient's preference for garlic for the management of his hypertension. The 61-year-old man received garlic, 500 mg by mouth three times a day (3 weeks), or identical placebo (3 weeks) in three treatment pairs. While the patient was taking garlic the mean systolic blood pressure decreased by 2 mm Hg (95% confidence interval 0.4 to 4.7, p < 0.05), and the diastolic blood pressure decreased by 2.4 mm Hg (95% confidence interval 0.4 to 4, p < 0.025). The treatment effect of garlic was small, but the patient believed continuing garlic for the management of his hypertension was justified.

Can garlic lower blood pressure? A pilot study.
Pharmacotherapy;13(4):406-7, 1993 Jul-Aug. McMahon FG; Vargas R
Resumo: A popular garlic preparation containing 1.3% allicin at a large dose (2400 mg) was evaluated in this open-label study in nine patients with rather severe hypertension (diastolic blood pressure > or = 115 mm Hg). Sitting blood pressure fell 7/16 (+/- 3/2 SD) mm Hg at peak effect approximately 5 hours after the dose, with a significant decrease in diastolic blood pressure (p < 0.05) from 5-14 hours after the dose. No significant side effects were reported. Our results indicate that this garlic preparation can reduce blood pressure. Further controlled studies are needed, particularly with more conventional doses (e.g., < or = 900 mg/day), in patients with mild to moderate hypertension and under placebo-controlled, double-blind conditions.

Digitálico

The old but reliable digitalis: persistent concerns and expanded indications.
Comentários: Comment In:Int J Clin Pract. 2001 Mar;55(2):77-8
Source: Int J Clin Pract;55(2):108-14, 2001 Mar. Abarquez RF
Resumo: Digitalis has been an old but reliable drug for 240 years. Concerns regarding its clinical indications and benefits still exist in the absence of a reduction in all-cause mortality. While intravenous digitalis is used without question in cases of atrial fibrillation, it is still controversial in sinus rhythm, despite the Digitalis Investigation Group (DIG) study showing a significant reduction in death and the need for hospitalisation for congestive heart failure in both diastolic and systolic dysfunction. The influence of digitalis in acute myocardial infarction, coronary artery disease and sudden cardiac death remains speculative. In cases of uncomplicated hypertension, it appears to prevent the onset of left ventricular dysfunction and myocardial infarction. Thus, digitalis can be a cost-effective agent with added benefits.

Ginseng Coreano

Effects of red ginseng upon vascular endothelial function in patients with essential hypertension.
Am J Chin Med;28(2):205-16, 2000. Sung J; Han KH; Zo JH; Park HJ; Kim CH; Oh BH
Resumo: This study is to estimate the effect of Korean red ginseng on vascular endothelial cell dysfunction in patients with hypertension. Seventeen patients with hypertension who were divided into ginseng-treated (7) and non-treated (10) groups and 10 normotensive subjects were included. To assess the function of the vascular endothelial cell, changes of forearm blood flow to infusion of acetylcholine, sodium nitroprusside and bradykinin in incremental doses were measured by venous occlusion plethysmography. In the ginseng-treated hypertensive group, forearm blood flows at the highest dose of acetylcholine and bradykinin were significantly higher than those of the non-treated hypertensive group and were not different from those of the control group. In the case of sodium nitroprusside infusion, no significant differences were observed between the control, non-treated and treated groups. In conclusion, Korean red ginseng can improve the vascular endothelial dysfunction in patients with hypertension possibly through increasing synthesis of nitric oxide.

Effect of red ginseng on blood pressure in patients with essential hypertension and white coat hypertension.
Am J Chin Med;26(2):199-209, 1998. : Han KH; Choe SC; Kim HS; Sohn DW; Nam KY; Oh BH; Lee MM; Park YB; Choi YS; Seo JD; Lee YW
Resumo: The objective of this study is to evaluate the changes of diurnal blood pressure pattern after 8 weeks of red ginseng medication (4.5 g/day) by 24 hour ambulatory blood pressure monitoring. In 26 subjects with essential hypertension, 24 hour mean systolic blood pressure decreased significantly (p = 0.03) while diastolic blood pressure only showed a tendency of decline (p = 0.17). The decrease in pressures were observed at daytime (8 A.M.-6 P.M.) and dawn (5 A.M.-7 A.M.). In 8 subjects with white coat hypertension, no significant blood pressure change was observed. We suggest that red ginseng might be useful as a relatively safe medication adjuvant to current antihypertensive medications.

Clinical and experimental study of improving left ventricular diastolic function by total saponins of panax notoginseng
Zhongguo Zhong Xi Yi Jie He Za Zhi;17(12):714-7, 1997 Dec. Feng PF; Qin NP; Qiao Q
País de publicação: CHINA
Resumo: OBJECTIVE: To investigate the effect of total saponins of Panax Notoginseng (TSPNS) on left ventricular diastolic function in patients with essential hypertension (EH) and possible mechanism. METHODS: Left ventricular diastolic function (peak E, peak A, E/A, A area fraction, E area fraction), left ventricular muscle mass index (LV-MI), intraerythrocytic calcium and calcium pump activity on erythrocytes membrance of 30 patients with EH before and after the combined treatment of captopril and TSPNS were measured. Captopril was used singly on 30 patients above mentioned that were also studied as self-control. Observation of TSPNS and normal saline was used on a matched control in treating SHR rats. WKY rats of similar age were also studied as normal control. RESULTS: Left ventricular diastolic function were improved markedly by TSPNS. The activity of calcium pump on membrance of sarcoplasmic reticulum were increased and the myocardial intracellular calcium were decreased and the left ventricular muscle mass were reduced after treatment of TSPNS. The calcium and calcium pump of erythrocyte showed marked simple correlation with myocardial cell. CONCLUSIONS: The TSPNS could improve myocardial relaxation function due to enhancing calcium pump activity and inhibiting intracellular calcium overload and lightening left ventricular muscle mass.

Achillea wilhelmsii

Antihypertensive and antihyperlipidemic effects of Achillea wilhelmsii.
[So] Source: Drugs Exp Clin Res;26(3):89-93, 2000. Asgary S; Naderi GH; Sarrafzadegan N; Mohammadifard N; Mostafavi S; Vakili R
País de publicação: SWITZERLAND
Resumo: Achillea wilhelmsii C. Koch (Asteraceae) is widely found in different parts of Iran. This plant is full of flavonoids and sesquiterpene lactones, which have been shown to be effective in lowering blood lipids and hypertension. We conducted a double-blind placebo controlled clinical trial to study the antihyperlipidemic and antihypertensive effects of Achillea drops. We randomly selected 120 men and women, aged 40-60 years, and divided them in two distinct groups of moderate hyperlipidemic and primary hypertensive subjects. They were treated either with hydroalcoholic extract or with placebo in the form of 15-20 drops twice daily for more than 6 months. Blood pressure and serum lipids (total cholesterol, triglyceride, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol) were measured in the groups for 3 periods of 2 months each. The mean and standard deviation of alternations in these variables between the group taking placebo and that taking drugs was calculated by Student's t-test. The results showed a significant decrease in triglycerides after of 2 months while decreases in triglycerides, total cholesterol and LDL-cholesterol were significant after 4 months. Levels of HDL-cholesterol were significantly increased after 6 months' treatment. A significant decrease was observed in diastolic and systolic blood pressure after 2 and 6 months, respectively (p < 0.05).

Folhas de Qat

Hypertensive effects of qat
Med Trop (Mars);58(3):266-8, 1998. Mion G; Oberti M; Ali AW
País de publicação: FRANCE
Resumo: Chewing of Qat leaves which contain amphetamine alkaloids is a traditional drug practice in the horn of Africa. Cathine and cathinone are responsible for the desired psychogenic (suppression of hunger, mind stimulation, euphoria) and sympathicomimetic effects. In this study, we monitored seven volunteers during a traditional qat ritual. An increase in systolic and diastolic pressure was observed in three patients including one presenting predisposing chronic arterial hypertension. Peak pressure was observed approximately seven hours after beginning the ritual. The three patients presenting pressure changes were not significantly different from the four unaffected patients with regard to age or duration of qat use. These findings suggest that qat use by untreated hypertensive patients who react strongly to vasoconstrictive effects can lead to hypertension and resulting cardiovascular complications.

Phyllanthus amarus

Diuretic, hypotensive and hypoglycaemic effect of Phyllanthus amarus.
Indian J Exp Biol;33(11):861-4, 1995 Nov. Srividya N; Periwal S
País de publicação: INDIA
[Ab] Resumo: Diuretic, hypotensive and hypoglycaemic effects of Phyllanthus amarus (syn. Phyllanthus niruri) on human subjects were assessed. Nine mild hypertensives (four of them also suffering from diabetes mellitus) were treated with a preparation of the whole plant of P. amarus for 10 days. Suitable parameters were studied in the blood and urine samples of the subjects, along with physiological profile and dietary pattern before and after the treatment period. Significant increase in 24 hr urine volume, urine and serum Na levels was observed. A significant reduction in systolic blood pressure in non-diabetic hypertensives and female subjects was noted. Blood glucose was also significantly reduced in the treated group. Clinical observations revealed no harmful side effects. These observations indicate that P. amarus is a potential diuretic, hypotensive and hypoglycaemic drug for humans.

Terminalia Arjuna

Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure.
Int J Cardiol;49(3):191-9, 1995 May. Bharani A; Ganguly A; Bhargava KD País de publicação: IRELAND
Resumo: Twelve patients with refractory chronic congestive heart failure (Class IV NYHA), related to idiopathic dilated cardiomyopathy (10 patients); previous myocardial infarction (one patient) and peripartum cardiomyopathy (one patient), received Terminalia Arjuna, an Indian medicinal plant, as bark extract (500 mg 8-hourly) or matching placebo for 2 weeks each, separated by 2 weeks washout period, in a double blind cross over design as an adjuvent to maximally tolerable conventional therapy (Phase I). The clinical, laboratory and echocardiographic evaluation was carried out at baseline and at the end of Terminalia Arjuna and placebo therapy and results were compared. Terminalia Arjuna, compared to placebo, was associated with improvement in symptoms and signs of heart failure, improvement in NYHA Class (Class III vs. Class IV), decrease in echo-left ventricular enddiastolic (125.28 +/- 27.91 vs. 134.56 +/- 29.71 ml/m2; P < 0.005) and endsystolic volume (81.06 +/- 24.60 vs. 94.10 +/- 26.42 ml/m2; P < 0.005) indices, increase in left ventricular stroke volume index (44.21 +/- 11.92 vs. 40.45 +/- 11.56 ml/m2; P < 0.05) and increase in left ventricular ejection fractions (35.33 +/- 7.85 vs. 30.24 +/- 7.13%; P < 0.005). On long term evaluation in an open design (Phase II), wherein Phase I participants continued Terminalia Arjuna in fixed dosage (500 mg 8-hourly) in addition to flexible diuretic, vasodilator and digitalis dosage for 20-28 months (mean 24 months) on outpatient basis, patients showed continued improvement in symptoms, signs, effort tolerance and NYHA Class, with improvement in quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)

Centella asiatica

The microcirculatory activity of Centella asiatica in venous insufficiency. A double-blind study
Minerva Cardioangiol;42(6):299-304, 1994 Jun. Cesarone MR; Laurora G; De Sanctis MT; Incandela L; Grimaldi R; Marelli C; Belcaro G
País de publicação: ITALY
Resumo: In 87 patients with chronic venous hypertensive microangiopathy the efficacy of oral FTTCA (Centella asiatica) administered for 60 days was tested. The microcirculatory effects of two dosages (30 mg bid and 60 mg bid) versus placebo was assessed in a double blind study. The compound was well tolerated and no unwanted effects were observed. Microcirculatory parameters--peri-malleolar skin flux at rest (RF) and transcutaneous PO2 and PCO2--improved as did the abnormally increased RF, PCO2 decreased and PO2 increased in comparison with values measured at inclusion. These results confirm the efficacy of FTTCA in venous hypertensive microangiopathy. Furthermore the effects of FTTCA appear to be dose-related.

Plantas que bloqueiam os canais de cálcio (vide tópico específico neste site)

Plant-derived drugs acting on cellular Ca2+ mobilization in vascular smooth muscle: tetramethylpyrazine and tetrandrine.
Stem Cells;12(1):64-7, 1994 Jan. Kwan CY
Resumo: The pharmacological profiles of the active ingredients extracted and purified from two well-known Chinese traditional medicinal plants were reviewed. These herbal drugs include tetramethylpyrazine (TMP) and tetrandrine (TET); both have been clinically used in China for the treatment of cardiovascular diseases due to their vasodilatory actions. Studies from this laboratory have confirmed previously reported characteristics of TMP as a Ca2+ antagonist in vascular tissues. However, it also elicited inhibitory effects in response to a wide variety of receptor stimulations as indicated by functional studies and radioligand binding studies using isolated subcellular membranes. TET also inhibited the vascular contraction in response to depolarization by KCl and phenylephrine. It has been found to interact directly with the L-type Ca2+ channel and alpha-adrenoceptor subtypes. Recently, its action on T-type Ca2+ channels has also been demonstrated. These findings collectively suggest that studies of the vasodilatory and antihypertensive effects of these plant-derived drugs on the regulation of cytosolic Ca2+ in vascular smooth muscle are consistent with the current hypothesis of Ca2+ dysfunction as an important etiological factor for the pathogenesis of hypertension.

Alcaçuz : provoca hipertensão arterial

Liquorice-induced rise in blood pressure: a linear dose-response relationship.
J Hum Hypertens;15(8):549-52, 2001 Aug. Sigurjónsdóttir HA; Franzson L; Manhem K; Ragnarsson J; Sigurdsson G; Wallerstedt S
Resumo: To clarify the dose-response and the time-response relationship between liquorice consumption and rise in blood pressure and explore the inter-individual variance this intervention study was designed and executed in research laboratories at University hospitals in Iceland and Sweden. Healthy, Caucasian volunteers who also served as a control for himself/herself consumed liquorice in various doses, 50-200 g/day, for 2-4 weeks, corresponding to a daily intake of 75-540 mg glycyrrhetinic acid, the active substance in liquorice. Blood pressure was measured before, during and after liquorice consumption. Systolic blood pressure increased by 3.1-14.4 mm Hg (P < 0.05 for all), demonstrating a dose-response but not a time-response relationship. The individual response to liquorice followed the normal distribution. Since liquorice raised the blood pressure with a linear dose-response relationship, even doses as low as 50 g of liquorice (75 mg glycyrrhetinic acid) consumed daily for 2 weeks can cause a significant rise in blood pressure. The finding of a maximal effect of liquorice after only 2 weeks has important implications for all doctors dealing with hypertension. There does not seem to be a special group of responders since the degree of individual response to liquorice consumption followed the normal distribution curve.

‘Licorice hypertension' also caused by licorice tea

Ned Tijdschr Geneeskd;145(15):744-7, 2001 Apr 14. Brouwers AJ; van der Meulen J
País de publicação: Netherlands
Resumo: A 41-year-old woman, who presented with (apparent) essential hypertension, was treated with atenolol and candesartan. This treatment, however, was unsuccessful. After the addition of hydrochlorothiazide (HCT) to the combination, she developed hypokalaemia with muscle cramps and weakness. This hypokalaemia persisted for more than 4 weeks after discontinuation of HCT and starting potassium suppletion. As a result of polyuria (> 4000 ml/day) found in a 24-hour urine collection, it was discovered that the patient drank at least 3 litres of liquorice tea a day. She had denied eating liquorice sweets, a well-known cause of hypertension in the Netherlands, but no one had thought of asking her if she drank liquorice tea. Blood pressure and serum potassium normalized about 2 months after she stopped drinking liquorice tea, and medication was withdrawn. In a patient presenting with hypertension and hypokalaemia, who denies eating liquorice sweets, one should consider the consumption of other products containing liquorice such as liquorice tea. In the Netherlands liquorice tea is increasingly popular and has recently become available on a large scale. Therefore more cases such as the one described may be expected in coming years.

Liquorice and its health implications.

J R Soc Health;120(2):83-9, 2000 Jun. Olukoga A; Donaldson D
Resumo: This article presents an overview of the health implications of liquorice. Liquorice has beneficial applications in the medicinal and the confectionery sectors; the substance, therefore, is both widely available and commercially attractive. However, the ingestion of liquorice, and/or its active metabolites, can sometimes produce an acquired form of apparent mineralocorticoid excess (AME) syndrome, expressed as sodium retention, potassium loss and suppression of the renin-angiotensin-aldosterone system, in addition to clinical consequences such as raised blood pressure and oedema. Moreover, these metabolic changes, the mechanisms underlying which are highlighted in the accompanying text, are associated with a number of additional clinical symptoms. Considering the easy availability of liquorice itself and also of other products containing its active metabolites, it is quite possible that the health burden of liquorice-induced morbidity could be substantial. Healthcare practitioners need to be fully aware of the risks in view of a large number of reports in the literature concerning its toxicity.

Structure and mechanism of action and inhibition of steroid dehydrogenase enzymes involved in hypertension.
Endocr Res;24(3-4):521-9, 1998 Aug-Nov. Duax WL; Ghosh D
Resumo: Members of the NADPH-dependent short chain dehydrogenase/reductase (SDR) family control blood pressure, fertility, and natural and neoplastic growth. Despite the fact that only one amino acid residue is strictly conserved in the 100 known members of the family, all appear to have a dinucleotide-binding Rossmann fold and homologous catalytic residues including the conserved tyrosine. Variation in the binding pocket creates specificity for steroids, prostaglandins, sugars and alcohols. The critically important tyrosine appears to maintain a fixed position relative to the scaffolding of the Rossmann fold and the cofactor position, while the substrate-binding pocket alters in such a way that the dehydrogenation/reduction reaction site is brought into bonding distance of the tyrosine hydroxyl group. Licorice induces high blood pressure by inhibiting an SDR in the kidney. The crystal structure of the complex of 3alpha,20beta-hydroxysteroid dehydrogenase and carbenoxolone reveals the mechanism of enzyme inhibition by licorice. The most potent dehydrogenase enzyme inhibitors are those that displace substrate and cofactor and form strong hydrogen bonds to one or more amino acid residues involved in catalysis.

Structure and function of steroid dehydrogenases involved in hypertension, fertility, and cancer.
Steroids;62(1):95-100, 1997 Jan. Duax WL; Ghosh D
Resumo: Short-chain dehydrogenase reductase (SDR) enzymes influence mammalian reproduction, hypertension, neoplasia, and digestion. The three-dimensional structures of two members of the SDR family reveal the position of the conserved catalytic triad, a possible mechanism of keto-hydroxyl interconversion, the molecular mechanism of inhibition, and the basis for selectivity. Glycyrrhizic acid, the active ingredient in licorice, and its metabolite carbenoxolone are potent inhibitors of bacterial 3 alpha, 20 beta-hydroxysteroid dehydrogenase (3 alpha, 20 beta-HSD). The three-dimensional structure of the 3 alpha,20 beta-HSD carbenoxolone complex unequivocally verifies the postulated active site of the enzyme, shows that inhibition is a result of direct competition with the substrate for binding, and provides a plausible model for the mechanism of inhibition of 11 beta-hydroxysteroid dehydrogenase and 15-hydroxyprostaglandin dehydrogenase by carbenoxolone. The structure of human 17 beta-hydroxysteroid dehydrogenase type 1 (17 beta-HSD) suggests the details of binding of estrone and 17 beta-estradiol in the active site of the enzyme and the possible roles of various amino acids in the catalytic cleft. The SDR family includes over 50 proteins from human, mammalian, insect, and bacterial sources. Only five residues are conserved in all members of the family, including the YXXXK sequence. X-ray crystal structures of five members of the family have been completed. When the alpha-carbon backbone of the cofactor binding domains of the five structures are superimposed, the conserved residues are at the core of the structure and in the cofactor binding domain, but not in the substrate binding pocket.

Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess.
Endocrinol Metab Clin North Am;23(2):359-77, 1994 Jun. Walker BR; Edwards CR
Resumo: Excessive ingestion of licorice induces a syndrome of hypokalemia and hypertension that reflects increased activation of renal mineralocorticoid receptors by cortisol. A similar syndrome of cortisol-dependent mineralocorticoid excess occurs in congenital deficiency of the enzyme 11 beta-hydroxysteroid dehydrogenase, which normally inactivates cortisol to cortisone. It has been shown that licorice inhibits 11 beta-dehydrogenase, preventing local inactivation of cortisol and allowing cortisol inappropriate access to intrinsically nonspecific renal mineralocorticoid receptors. Further studies with licorice and its derivatives have revealed a widespread role for 11 beta-dehydrogenase in regulating tissue sensitivity to cortisol. Deficient 11 beta-dehydrogenase activity provides a novel pathogenetic mechanism for hypertension, and current research suggests that several common forms of hypertension can be explained by the mechanisms that operate in licorice-induced hypertension.

Pimenta turca ( doce de Alcaçus) : provoca aumento de pressão arterial

Turkish pepper (extra hot).
Postgrad Med J;76(897):426-8, 2000 Jul. Woywodt A; Herrmann A; Choi M; Goebel U; Luft FC
Resumo: A 38 year old female office worker was admitted with a newly discovered blood pressure of 250/110 mm Hg. Evaluation for secondary forms of hypertension was negative and treatment was begun. Sodium excretion was markedly reduced, plasma aldosterone was normal, and plasma renin activity was low. Therefore, presence of an aldosterone-like activity was suspected. Eventually, the patient confessed to abusing [quot ]Turkish Pepper[quot ], a brand of Scandinavian liquorice candies and [quot ]Fisherman's Friend[quot ], another brand of liquorice candies, concurrently. After eliminating liquorice from her diet, the hypertension disappeared thus allowing her antihypertensive treatment to be stopped.

Efedra ( Ma Huang ) provoca hipertensão arterial

Hypersensitivity myocarditis associated with ephedra use .
J Toxicol Clin Toxicol;37(4):485-9, 1999. Zaacks SM; Klein L; Tan CD; Rodriguez ER; Leikin JB
[Ab] Resumo: BACKGROUND: Ephedrine has previously been described as a causative factor of vasculitis but myocarditis has not yet been associated with either ephedrine or its plant derivative ephedra. CASE REPORT: A 39-year-old African American male with hypertension presented to Rush Presbyterian St. Luke's Medical Center with a 1-month history of progressive dyspnea on exertion, orthopnea, and dependent edema. He was taking Ma Huang (Herbalife) 1-3 tablets twice daily for 3 months along with other vitamin supplements, pravastatin, and furosemide. Physical examination revealed a male in mild respiratory distress. The lung fields had rales at both bases without audible wheezes. Internal jugular venous pulsations were 5 cm above the sternal notch. Medical therapy with intravenous furosemide and oral enalapril was initiated upon admission. Cardiac catheterization with coronary angiography revealed normal coronary arteries, a dilated left ventricle, moderate pulmonary hypertension, and a pulmonary capillary wedge pressure of 34 mm Hg. The patient had right ventricular biopsy performed demonstrating mild myocyte hypertrophy and an infiltrate consisting predominantly of lymphocytes with eosinophils present in significantly increased numbers. Treatment for myocarditis was initiated with azothioprine 200 mg daily and prednisone 60 mg per day with a tapering course over 6 months. Anticoagulation with warfarin and diuretics was initiated and angiotensin-converting enzyme inhibition was continued. Hydralazine was added later. One month into therapy, an echocardiogram demonstrated improved left ventricular function with only mild global hypokinesis. A repeat right ventricular biopsy 2 months after the first admission showed no evidence of myocarditis. At 6 months, left ventricular ejection fraction was normal (EFN 50%) and the patient asymptomatic. CONCLUSION: Ephedra (Ma Huang) is the suspected cause of hypersensitivity myocarditis in this patient due to the temporal course of disease and its propensity to induce vasculitis.

Tabaco pode causar hipertensão arterial

Does smokeless tobacco cause hypertension?
South Med J;88(7):716-20, 1995 Jul. Westman EC
Resumo: This article reviews the literature regarding the cardiovascular effects of smokeless tobacco use. Articles were identified using a MEDLINE search of the English-language literature from 1966 to 1992 and a manual search of bibliographies of identified articles. From 875 articles regarding smokeless tobacco, 12 pertinent articles were identified. Smokeless tobacco caused a clinically significant acute elevation of systolic blood pressure, diastolic blood pressure, or pulse in 5 of 6 experimental trials. Smokeless tobacco was weakly associated with chronic hypertension in 4 of 6 cross-sectional studies. Health care practitioners should be aware that smokeless tobacco may elevate blood pressure up to 90 minutes after use. Smokeless tobacco use should be considered a potential cause of sodium retention and poor blood pressure control because of its nicotine, sodium, and licorice content.