Effectiveness of herbs taken concurrently with antihypertensive drugs in managing hypertension and lipid outcomes. A systematic review and meta-analysis

PURPOSE

Hypertension is the primary cause of mortality. Hence globally, there is a growing interest in complementing antihypertensive drugs with herbs to alleviate blood pressure among hypertensive patients. Thus, this review aimed to evaluate the effectiveness of complementing drugs with herbs on blood pressure and lipid profile outcomes, the associated factors and the types of complementary herbs alongside their consumption regimes.

METHODS

This review is registered in PROSPERO on the National Institute of Health Database with an ID: CRD42021270481. Using the PICOS (population, intervention, comparison, outcome, study type) mnemonic formula and search strategy, we searched (January 2010 to February 2024) five electronic databases including Pubmed, Scopus, Web of Science, CINAHL (Cumulative Index for Nursing and Allied Health Literature) and Psychology & Behavioral Sciences Collection (PBSC). The inclusion criteria of the review were that all included papers had to be randomised control trials in English among hypertensive adults who complemented antihypertensive drugs with herbs. A Cochrane risk of bias assessment as well as a meta-analysis and narrative synthesis were conducted to answer the objectives.

RESULTS

Twenty-five randomised controlled trials involving 1996 participants from 14 countries were included. The risk of bias among included articles was assessed and presented using the Cochrane risk of bias tool and the graphs were generated. The effects of complementing antihypertensive drugs with different herb regimes on blood pressure and lipid profile outcomes were compared to those solely on antihypertensive drugs and placebo via a random model effects meta-analysis using the Revman manager. Systolic blood pressure (SBP) and triglycerides gave a significant reduction in favour of the intervention group which complemented herbs. The overall pooled systolic blood pressure showed a reduction of (SMD=0.81, 95 % CI 0.14-1.47, p < 0.02, p for heterogeneity=0.00001, I2 =97 %) while triglycerides were (SMD=0.73, 95 % CI 0.17-1.28, p < 0.01, p for heterogeneity=0.00001, I2 =85 %). However, diastolic blood pressure, total cholesterol, HDL and LDL did not exert significant outcomes.

CONCLUSION

The complemented herbs with antihypertensive drugs did show improvement in overall blood pressure management in the majority of the studies compared to the placebo group. Blood pressure and lipid profiles are the health outcomes that enable access to complementing herbs in controlling high blood pressure. Some limitations of this review are attributed to performance, detection and attrition bias in a few included articles alongside the presence of a high heterogeneity overall.

An Overview of the Versatility of the Parts of the Globe Artichoke (Cynara scolymus L.), Its By-Products and Dietary Supplements

Cynara scolymus, also known as the globe artichoke or artichoke, is grown as a food, mainly in the Mediterranean, Canary Islands, and Egypt, as well as in Asia and South America. It has also been associated with various health benefits and is used in plant-based dietary supplements and herbal infusions. Its edible parts, consisting of the head or capitula, flower, and leaves, have shown various biological activities, including anti-cancer, hepatoprotective and antimicrobial potential. The leaves are mainly used in infusions and extracts for their health-promoting properties, although all their edible parts may also be consumed as fresh, frozen, or canned foods. However, its primary health-promoting activity is associated with its antioxidant potential, which has been linked to its chemical composition, particularly its phenolic compounds (representing 96 mg of gallic acid equivalent per 100 g of raw plant material) and dietary fiber. The main phenolic compounds in the heads and leaves are caffeic acid derivatives, while the flavonoids luteolin and apigenin (both present as glucosides and rutinosides) have also been identified. In addition, heat-treated artichokes (i.e., boiled, steamed or fried), their extracts, and waste from artichoke processing also have antioxidant activity. The present paper reviews the current literature concerning the biological properties of different parts of C. scolymus, its by-products and dietary supplements, as well as their chemical content and toxicity. The literature was obtained by a search of PubMed/Medline, Google Scholar, Web of Knowledge, ScienceDirect, and Scopus, with extra papers being identified by manually reviewing the references.

Silver Nanoparticles Formulation of Flower Head’s Polyphenols of Cynara scolymus L.: A Promising Candidate against Prostate (PC-3) Cancer Cell Line through Apoptosis Activation

Cynara scolymus L. (Family: Compositae) or artichoke is a nutritious edible plant widely used for its hepatoprotective effect. Crude extracts of flower, bract, and stem were prepared and evaluated for their in vitro antioxidant activity and phenolic content. The flower crude extract exhibited the highest phenolic content (74.29 mg GAE/gm) as well as the best in vitro antioxidant activity using total antioxidant capacity (TAC), ferric reducing antioxidant power (FEAP), and 1,1-diphenyl-2-picrylhyazyl (DPPH) scavenging assays compared with ascorbic acid. Phenolic fractions of the crude extracts of different parts were separated and identified using high-performance liquid chromatography HPLC-DAD analysis. The silver nanoparticles of these phenolic fractions were established and tested for their cytotoxicity and apoptotic activity. Results showed that silver nanoparticles of a polyphenolic fraction of flower extract (Nano-TP/Flowers) exhibited potent cytotoxicity against prostate (PC-3) and lung (A549) cancer cell lines with IC₅₀ values of 0.85 μg/mL and 0.94 μg/mL, respectively, compared with doxorubicin as a standard. For apoptosis-induction, Nano-TP/Flowers exhibited apoptosis in PC-3 with a higher ratio than in A549 cells. It induced total prostate apoptotic cell death by 227-fold change while it induced apoptosis in A549 cells by 15.6-fold change. Nano-TP/Flowers upregulated both pro-apoptotic markers and downregulated the antiapoptotic genes using RT-PCR. Hence, this extract may serve as a promising source for anti-prostate cancer candidates.

The Impact of Exercise on Redox Equilibrium in Cardiovascular Diseases

Cardiovascular diseases constitute the most important public health problem in the world. They are characterized by inflammation and oxidative stress in the heart and blood. Physical activity is recognized as one of the best ways to prevent these diseases, and it has already been applied in treatment. Physical exercise, both aerobic and anaerobic and single and multiple, is linked to the oxidant–antioxidant imbalance; however, this leads to positive adaptive changes in, among others, the increase in antioxidant capacity. The goal of the paper was to discuss the issue of redox equilibrium in the human organism in the course of cardiovascular diseases to systemize updated knowledge in the context of exercise impacts on the organism. Antioxidant supplementation is also an important issue since antioxidant supplements still have great potential regarding their use as drugs in these diseases.

Antimicrobial effects of Cynara scolymus essential oil: In vitro analysis

By benefits of using silicon and vermicompost based biofertilizers and also induction of drought stress for growing more efficient medicinal plants, we investigated such issues on growing Cynara scolymus (C. scolymus), as one of the most significant edible medicinal plants. In this regard, the antimicrobial effects of grown C. scolymus essential oil was investigated against some foodborne pathogens. Different concentrations of silicon and vermicompost with and without drought stress were considered for growing the plant and the extracted essential oils were extracted to examine their antimicrobial effects against different bacterial agents. Using vermicompost and silicon and 50% moisture discharge yielded significant increase in the mean diameter of growth inhibition zone and significant decrease in the minimum inhibitory concentration of tested bacteria (P <  0.05). The highest diameters of the inhibition zones of S. aureus, S. saprophyticus, P. aeruginosa, S. dysenteriae, and S. typhi were found for C. scolymus essential oil treated with 8 mmol silicon and conventional irrigation (14.92 mm), 4 mmol silicon and 50% moisture discharge (15.28 mm), 50% vermicompost and 50% moisture discharge (15.71 mm), 8 mmol silicon and conventional irrigation (17.34 mm) and 25% vermicompost, and 50% moisture discharge (15.48 mm), respectively. Antimicrobial effects of some treatments of C. scolymus were higher than some kinds of referenced antibiotics such as erythromycin. These findings could be used for the production of antibiotic drugs for specific purposes against certain bacteria.

Potential antidiabetic phytochemicals in plant roots: a review of in vivo studies

Background

Medicinal plants are used to treat various disorders, including diabetes, globally in a range of formulations. While attention has mainly been on the aerial plant parts, there are only a few review studies to date that are focused on the natural constituents present in the plant roots with health benefits. Thus, the present study was performed to review in vivo studies investigating the antidiabetic potential of the natural compounds in plant roots.

Methods

We sorted relevant data in 2001-2019 from scientific databases and search engines, including Web of Knowledge, PubMed, ScienceDirect, Medline, Reaxys, and Google Scholar. The class of phytochemicals, plant families, major compounds, active constituents, effective dosages, type of extracts, time of experiments, and type of diabetic induction were described.

Results

In our literature review, we found 104 plants with determined antidiabetic activity in their root extracts. The biosynthesis pathways and mechanism of actions of the most frequent class of compounds were also proposed. The results of this review indicated that flavonoids, phenolic compounds, alkaloids, and phytosteroids are the most abundant natural compounds in plant roots with antidiabetic activity. Phytochemicals in plant roots possess different mechanisms of action to control diabetes, including inhibition of α-amylase and α-glucosidase enzymes, oxidative stress reduction, secretion of insulin, improvement of diabetic retinopathy/nephropathy, slow the starch digestion, and contribution against hyperglycemia.

Conclusion

This review concludes that plant roots are a promising source of bioactive compounds which can be explored to develop against diabetes and diabetes-related complications.

Graphical abstract

The effects of Cynara scolymus L. supplementation on liver enzymes: A systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis was conducted to summarise studies conducted on the effects of artichoke supplementation on liver enzymes.

METHODS

Suitable studies were detected by searching online databases, including Medline, Embase, Cochrane Library, and Scopus databases, until 05 June 2021. As liver enzymes were reported in different units, standardised mean differences (SMD) were used and data were pooled using a random-effects model. Heterogeneity, publication bias, and sensitivity analysis were also assessed.

RESULTS

Pooled analysis, of eight clinical trials, revealed that artichoke supplementation significantly reduced the concentration of aspartate aminotransferase (AST) (P = .001) and alanine transaminase (ALT) (P = .016), in comparison with placebo. Subgroup analysis suggested that artichoke administration significantly reduces AST and ALT in patients with non-alcoholic fatty liver disease (P = .003 for AST and P < .001 for ALT), and ALT among overweight/obese subjects (P = .025).

CONCLUSIONS

Artichoke supplementation elicited significant reductions in liver enzymes, especially among patients with non-alcoholic fatty liver disease.

Cardiac Oxidative Stress and the Therapeutic Approaches to the Intake of Antioxidant Supplements and Physical Activity

Reactive oxygen species (ROS) are strongly reactive chemical entities that include oxygen regulated by enzymatic and non-enzymatic antioxidant defense mechanisms. ROS contribute significantly to cell homeostasis in the heart by regulating cell proliferation, differentiation, and excitation-contraction coupling. When ROS generation surpasses the ability of the antioxidant defense mechanisms to buffer them, oxidative stress develops, resulting in cellular and molecular disorders and eventually in heart failure. Oxidative stress is a critical factor in developing hypoxia- and ischemia-reperfusion-related cardiovascular disorders. This article aimed to discuss the role of oxidative stress in the pathophysiology of cardiac diseases such as hypertension and endothelial dysfunction. This review focuses on the various clinical events and oxidative stress associated with cardiovascular pathophysiology, highlighting the benefits of new experimental treatments such as creatine supplementation, omega-3 fatty acids, microRNAs, and antioxidant supplements in addition to physical exercise

Metabolomics of Artichoke Bud Extract in Spontaneously Hypertensive Rats

Hypertension adversely affects the quality of life in humans across modern society. Studies have attributed increased reactive oxygen species production to the pathophysiology of hypertension. So far, a specific drug to control the disease perfectly has not been developed. However, artichoke, an edible vegetable, plays an essential role in treating many diseases due to its potent antioxidant activities. The objective of this study is to evaluate the effect of artichoke bud extract (ABE) on heart tissue metabolomics of hypertensive rats. Spontaneously hypertensive rats and Wistar-Kyoto (WKY) rats were divided into six groups, then exposed to different doses comprising ABE, Enalapril Maleate, or 1% carboxylmethyl cellulose for 4 weeks. Their blood pressures were recorded at 0, 2, 3, and 4 weeks after the start of the test period. Thereafter, all rats were anesthetized, and blood was collected from their cardiac apexes. Then, we measured the levels for 15 kinds of serum biochemical parameters. An established orthogonal partial least square-discriminant analysis model completed the metabolomic analysis. Hypertensive rats in the ABE group exhibited well-controlled blood pressure, relative to those in the model group. Specifically, artichoke significantly lowered serum levels for total protein (TP), albumin (ALB), and uric acid (UA) in the hypertensive rats. This effect involved the action of eight metabolites, including guanine, 1-methylnicotinamide, p-aminobenzoic acid, NAD, NADH, uridine 5'-monophosphate, adenosine monophosphate, and methylmalonic acid. Collectively, these findings suggest that ABE may play a role in affecting oxidative stress and purine, nicotinate, and nicotinamide metabolism.

Effects of artichoke on blood pressure: A systematic review and meta-analysis

PURPOSE

Clinical trials considering the effects of artichoke supplementation on blood pressure have yielded different and contradictory outcomes. Thus, a systematic review and meta-analysis were performed to assess effects of artichoke administration on blood pressure.

METHODS

Related studies were detected by searching the Cochrane Library, PubMed, Embase and Scopus databases up to 15 March 2020. Weighted Mean Differences (WMD) were pooled using a random-effects model. Heterogeneity, sensitivity analyses, and publication bias were evaluated using standard methods.

RESULTS

Pooled analysis of eight randomized controlled trials revealed that artichoke supplementation did not have an effect on systolic blood pressure (SBP), (WMD: -0.77 mmHg, 95 % CI: -2.76 to 1.22) or diastolic blood pressure (DBP) (WMD: -0.11 mmHg, 95 % CI: -1.72 to 1.50) when compared to the placebo group. However, subgroup analyses based on health status suggested that artichoke administration among hypertensive patients may significantly reduce SBP (WMD: -3.19 mmHg, 95 % CI: -3.32 to -3.06) and DBP (WMD: -2.33 mmHg, 95 % CI: -2.23 to -2.43), but no such reduction was found in NAFLD patients. Furthermore, our results indicated that artichoke supplementation for 12 weeks led to a significantly decreased DBP (WMD: -2.33 mmHg, 95 % CI: -2.43 to -2.23), but 8 weeks of intervention did not (WMD: 0.80 mmHg, 95 % CI: -1.06 to 2.66).

CONCLUSION

Artichoke supplementation may potentially lead to SBP and DBP reduction in hypertensive patients. In addition, artichoke supplementation for 12 weeks may significantly improve DBP.

Medicinal Plants in the Treatment of Peptic Ulcer Disease: A Review

Peptic Ulcer Disease (PUD) is the most common disorder of the stomach and duodenum, which is associated with Helicobacter pylori infection. PUD occurs due to an imbalance between offensive and defensive factors and Proton Pump Inhibitors (PPI), Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and antibiotics are frequently used for the treatment. Recently, medicinal plants have emerged as efficacious, safe and widely available alternative therapies for PUD. The aim of this review was to study the medicinal plants and phytochemicals, which have been used for PUD treatment to evaluate the potential role of natural compounds to develop herbal remedies for PUD. Information was obtained using a literature search of electronic databases, such as Web of Science, Google Scholar, PubMed, Sci Finder, Reaxys and Cochrane. Common and scientific names of the plants and keywords such as 'peptic ulcer', 'gastric ulcer', 'stomach ulcer' and 'duodenal ulcer' were used for search. Eventually, 279 plants from 89 families were identified and information on the plant families, part of the plant used, chemical constituents, extracts, ulcer model used and dosage were abstracted. The results indicated that most of the anti-PUD plants were from Asteraceae (7.1%) and Fabaceae (6.8%) families while flavonoids (49%), tannins (13%), saponins (10%) and alkaloids (9%) were the most common natural compounds in plants with anti-PUD activity.

The effects of supplementation with Cynara scolymus L. on anthropometric indices: А systematic review and dose-response meta-analysis of clinical trials

BACKGROUND

Studies on the efficacy of artichoke administration on anthropometric indices gave different outcomes. Hence, a systematic review and dose-response meta-analysis were accomplished to understand the effects of artichoke administration on anthropometric indices.

METHODS

Related clinical trials were found by searching in PubMed, Embase, the Cochrane Library and Scopus databases up to 29 February 2020. Weighted Mean Differences (WMD) were analyzed using a random-effects model. Heterogeneity, publication bias and sensitivity analysis were assessed for anthropometric indices.

RESULTS

Pooled analysis of 10 randomized controlled trials (RCTs) suggested that the artichoke administration has effect on waist circumference (WMD: -1.11 cm, 95 % CI: -2.08 to - 0.14), as opposed to the other anthropometric indices including weight (WMD: -0.62 kg, 95 % CI: -1.86 to 0.61) or BMI (WMD: -0.12, 95 % CI: -0.43 to 0.20). However, the analysis of the subgroups according to the health status showed that artichoke supplementation in hypertensive patients significantly reduced weight (WMD: -2.34 kg, 95 % CI: -3.11 to -1.57) but not the other indicators (WMD: -0.06 kg, 95 % CI: 0.78 to 0.67).

CONCLUSIONS

The artichoke supplementation has effect on the waist circumference, but not on the other anthropometric indices. For establishment of more accurate conclusion more studies with longer administration duration are need to be done.

Medicinal plants in the adjunctive treatment of patients with type-1 diabetes: a systematic review of randomized clinical trials

Propose

This study aims to systematically review the randomized controlled trials that address the effectiveness and safety of herbal medicine in patients with type 1 diabetes.

Methods

The Cochrane Library (latest issue); MEDLINE (until recent); EMBASE (until recent); AMED (Allied and Complementary Medicine Database) (until recent); and CINHAL (until recent) were searched electronically for the identification of trials until October 2019. Articles were initially screened based on title and abstract and then by full text by two independent authors. References of retrieved studies were hand-searched for further studies. Risk of bias was assessed according to the Cochrane handbook of systematic reviews of interventions. The results were summarized into GRADE (grading of recommendations, assessment, development and evaluation) tables. No meta-analysis was applicable as only one study was found for each intervention.

Results

Four RCTs were finally included in the systematic review with an overall moderate quality of conduct and low quality of reporting. The sample sizes were very small. The results of these RCTs show that cinnamon pills and Berberine/Silymarine compound capsules may decrease blood glucose indices from baseline, while fenugreek seeds and fig leaf decoction do not show any statistically significant effect.

Conclusions

The evidence is scarce and no recommendations can be made based on current evidence. Further trials with more rigorous methodology and stronger quality of reporting are needed to make conclusions.

Production of Vegetables and Artichokes Is Associated with Lower Cardiovascular Mortality: An Ecological Study

Mortality due to cardiovascular disease (CVD), including cerebrovascular disease (CED) and ischaemic heart disease (IHD), was considerably different in eight municipalities of the province of Castellón, Community of Valencia (Spain) during the period of 1991-2011. In addition, these villages showed differences in agricultural practices and production. Since high vegetable consumption has been linked to decreased all-cause, CVD, and CED mortalities, we hypothesized that the diversity in vegetable and artichoke production, used as proxies for their consumption, could be associated with the diversity of mortality rates. In order to test our hypothesis, we estimated the smoothed standardized mortality ratios (SMRs) of CVD, CED, and IHD mortalities and a directed, age-adjusted mortality rate (AMR). We used a multilevel linear regression analysis to account for the ecological nature of our study. After adjustment, the CVD and CED SMRs were inversely associated with vegetable and artichoke production, with a reduction in SMRs for CVD: -0.19 (95% Confidence Interval [CI] -0.31 to -0.07) and -0.42 (95% CI -0.70 to -0.15) per hectare/10³ inhabitants, respectively. The SMRs for CED also decreased: -0.68 (95% CI -1.61 to -0.19) and -1.47 (95% CI -2.57 to -0.36) per hectare/10³ inhabitants, respectively. The SMRs for IHD were not associated with vegetal and artichoke production. When the directed AMR was used, CED mortality was consistent with the previous results, whereas the CVD mortality association was lost. Our results indicate that vegetable and artichoke production may act as protective factors of CED and CVD mortalities.