herbs for hypertension - ann walker

8/14/2019 Herbs for Hypertension - Ann Walker

1/45

Dr Ann WalkerSenior Lecturer in Human Nutrition

Hugh Sinclair Unit of Human Nutrition

The University of Reading, UK

Member of the National Institute of Medical Herbalists

Member of the College of Practitioners of Phytotherapy

Making a real difference:

herbs for hypertension- new research, case histories & integrative medicine


2/45

Classification of hypertension (mm Hg)

< 150180>110Severe

160-179100-109Moderate

140-15990-99Mild

SystolicDiastolicCategory

*, UK Prospective Diabetes Study Br Med J 1998; 317:703-713.


3/45

Nutritional background

to hypertension


4/45

Hypertension: DASH diet study

l>400 people, RCT, multicentre study:-

1A typical USA diet

2 Low fat, low dairy, high fruit & veg, low Na diet

3Combination diet - as (2) above but includinglow-fat dairy products

lCombination diet lowered BP significantly more

than the other two diets

lCa is important for vascular tone and

myocardial function

*, Dietary Approaches to Stop Hypertension,

Sacks et al. (2001) N Engl J Med 344, 3.


5/45

Comparison of

systolic and diastolic

responses to the

DASH diets usingrandom zero and

24 hour

monitoring


6/45

Case study: hypertension on a low dairy diet

Patientdetails First visitNov 02 DietSupplements/dHerbs

IT, female,79 yrs,

non-smoker,good diet,except low

dairyintake,BMI 21,

PMH:

fainting

Bp two yrsago, saw

nutritionistwhoprescribedlow dairy.

Latest 'nurse'readings140/80 !!

Catarrh,

insomnia.

dairy,salt

seed oils

1g Ca+0.5g Mg,1g vit C1g Omega-3

360 mg Rutin

HawthornYarrow,Cramp bark,

Limeflowers


7/45

IT: response to hypotensive treatment

60

80

100

120

140

160

180

200

220

Nov Dec June Sept Jan April

Diastolic

Systolic

2002 2003 2004

Started bendrofluazide 5mg/d

Stress causedby husbands

dementia

Catarrh

sleeping OK


8/45

Hypertension: RCTs on magnesium

l Sweden 1994. 39 hypertensive patients taking beta-

blockers. 365 mg Mg (as aspartate)/day for 8 weeks

Significant decrease in systolic Bp

lHolland 1994. 91 women with hypertension. 480mg Mg (as aspartate)/day for 6 mo. Sig. drop (mm

Hg) of 2.7 systolic and 3.4 mm diastolic Bp

l Japan 1998. 60 hypertensive subjects: 480 mg Mg

(as oxide)/d for 8 weeks. Showed Mg to marginally

lower BP

l Mg is important for vascular tone and myocardial

function. Some studies have shown no effect.


9/45

Hypertension: RCTs on vitamin C

lObservational studies and small controlled trials

suggest an inverse correlation between vit C

intake or plasma vit C levels and hypertension.q

USA 1999: 39 on medication for Bp. 500 mg vitaminC/d. Outcome: Bp reduced by 10%

q UK 2000: 40 elderly subjects: 500 mg vit C for 3

months. Outcome: modest lowering systolic Bp

q USA 2002. 31 patients: 500mg. 1g or 2 g vitamin C.

No dose effect, but all significantly reduced Bp after 1month of treatment and this persisted until the end of

the trial.

lSome studies have shown no effect


10/45

Hypertension: RCTs on omega-3

lAustralia 1998: 69 overweight

hypertensives on drug treatment RCT

dietary fish to given >3 g omega-3 EFAs as

fish per day 16 weeks. Significant drop inBp compared with no fish

lUSA 1993: Two meta-analysis concluded

that omega-3 gives a dose-relatedsignificant drop in Bp in hypertensive

subjects.


11/45

Hypertension: RCTs etc on coenzyme Q10

q USA 1994: three clinic reports on a total of 559patients concluded that CoQ10 in doses ranging

from 75 to 600 mg/day is safe and effective

adjuctive treatment to drugs for hypertension in a

broad range of cardiovascular diseases.q India 1999: 59 patients with hypertension and

coronary heart disease: 120 mg/d for 8 weeks.

Significant reduction in systolic and diastolic blood

pressure in active group.q USA 2001: 83 subjects with systolic hypertension:

120 mg/d for 12 weeks. Mean reduction of 18

mm Hg in active group.


12/45


13/45

Hawthorn (Crataegus spp)

- history of medicinal use1305: Petrus de Crescentis: gout

1695: recorded use for hypertension by an

anonymous healer (LeClerc, 1935)

1800s: used in Lorraine, France for insomnia,

palpitations

1907: Ellingwood: heart tonic

1900s: researched in Germany for cardio-

vascular disease


14/45

Hawthorn (Crataegus laevigata)

o Active constituents:

q flavonoids including vitexin

q procyanidins, epicatechins

o Physiological actions:q antioxidant, antisclerotic, smooth muscle

relaxant, hypotensive, vasodilator

o Traditional medicinal use:q hypertension, atherosclerosis, poor

circulation, heart disease (including angina,

arrhythmia)


15/45

FAM-1 Study

o The effects of a daily supplement of

Magnesium (600 mg/day as MgO) and/or

Hawthorn extract (500 mg/day 2.5 g of

dried leaves and flowers) for thetreatment of mild hypertension in

otherwise healthy subjects

oNo of volunteers: 36 (18M/18F)oDuration: 10 weeks


16/45

Diastolic blood pressure of 36 mildly hypertensive

men and women after a daily supplement of

600 mg Mg and/or 500 mg of Hawthorn extract

80

8284

86

88

90

92

94

96

98

100

Placebo Mg Hawthorn Mg +

Hawthorn

Baseline

10 weeks

*, P= 0.081 v. other treatments

Blood

pressure

(mmHg)

Walkeret al. 2002

*

*


17/45


18/45

W ELL -BE ING QUESTION NA I RE ( c on t .)

13. I feel energetic, active or vigorous 3 2 1 0

14. I feel dull or sluggish 3 2 1 0

15. I feel tired, worn out or exhausted 3 2 1 0

16. I have been waking up feeling fresh 3 2 1 0

17. I am happy and satisfied with my life 3 2 1 0

18. I feel well adjusted to my life situation 3 2 1 0

19. I live the kind of life I want to 3 2 1 0

20. I feel eager to tackle my daily tasks 3 2 1 0

21. I feel that I can easily handle any 3 2 1 0

serious problem or major change in my life

22. My daily life is full of things that are 3 2 1 0

interesting to me


19/45


20/45

Hawthorn - action in heart disease

Strengthens heart function

Normalises blood pressure

Lowers high blood cholesterol and

triglyceride levels Antioxidant - counters toxins

Anti-clotting

Lowers risk of heart attack andstroke


21/45

Insulin Resistance Syndrome (IRS)

o Linked to central obesity (apple-shape)

o HIGH CIRCULATING INSULIN

oInsulin resistance

o Raised blood glucose

o Increased blood triglyceride levels

o Reduced blood HDL cholesterolo Increased blood pressure


22/45

The FAM-2 study

o The effects of Hawthorn flavonoids (1200 mg

extract 5:1/day 6 g dried leaves and

flowers) for the treatment of high blood

pressure in type II diabeteso Double-blind

o Parallel, placebo-controlled

oNumber of volunteers: 80

o Duration of the study: 4 months, 3 clinic visits

o Intention-to-treat analysis


23/45

FAM 2 recruitment criteria

o Male and female type II diabetic patients with

high blood pressure

o Diastolic BP: 85-100 mmHg

o Systolic BP: 145-170 mmHg

o Age: 35-75 yrs

o Volunteers encouraged to continue their drug

treatment (as prescribed by their GP) and

maintain their dietary and lifestyle habits

throughout the study


24/45

FAM 2 study group characteristics

97.597.5% non-smokers

5542.5%'not stressed'

5560%little exercise

30.228.8BMI kg/m2

61.362.6Age mean28/1227/12Gender: M/F

Placebo

(n=40)

Hawthorn

(n=39)


25/45

Number of volunteers taking

hypoglycaemic drugs

2.11.9Av. no. drugs/

volunteer

76Others*

1612Gliclazide

2019Metformin34Insulin

Placebo

n = 40

Hawthorn

n = 39

Drug name

* Glimepide, Glipizide, Rosigliclazide, Acarabose, or Glibenclamide


26/45

No. of volunteers taking hypotensive drugs

2.22.5Average no. of

drugs/ volunteer

42Angiotensin II recptr

antagonists &other drugs

410Diuretics

76-blockers

108Ca channel blockers

1519ACE inhibitors

Placebo

n = 40

Hawthorn

n = 39

Drug group


27/45

No. of volunteers taking other drugs

for CVD

10Digoxin

31Clofibrates

68Aspirin

69Statins

Placebo

n = 40

Hawthorn

n = 39

Drug group


28/45


29/45

FAM2 study:

mean fructosamine and fibrinogen (mg/dL)

300

310

320

330

340

350

360

Placebo

baseline

Placebo

month 4

Hawthorn

baseline

Hawthorn

month 4

Fructosamine

Fibrinogen

*

*, > baseline (p = 0.005)


30/45

FAM 2 study:

mean blood pressure data

70

80

90

100

110

120

130

140

150

160

Placebo

baseline

Placebo

month 4

Hawthorn

baseline

Hawthorn

month 4

Diastolic

Systolic

*

*, responsep=0.035 cf placebo


31/45

FAM 2 study:

Blood pressure: baseline - outcome

-4

-3.5

-3

-2.5

-2

-1.5

-1

-0.5

0

0.5

1

Diastolic

Systolic

Placebo Hawthorn

p=0.016 p=0.096 cf baseline

p=0.035 cf placebo

s u y:


32/45

s u y:lipid data - subset analysis

(Hawthorn n = 28, placebo n = 32):

0

1

2

3

4

5

6

Placebo

baseline

Placebo

month 4

Hawthorn

baseline

Hawthorn

month 4

Total chol

LDL chol

HDL chol

TAG

* *


33/45

FAM 2 study: subset analysis:

lipaemic control, baseline - outcome

-0.3

-0.2

-0.1

0

0.1

0.2

0.3

0.4

Total cholesterol

HDL chol

TAG

Placebo

Hawthorn

p=0.068p=0.015 cf placebo

p=0.015p=0.017 cf baseline


34/45

Fasting insulin: subset analysis

0

10

20

30

40

50

60

70

80

Placebo (n = 20) Hawthorn (n = 21)

Baseline

After 4 months

*


35/45

Insulin: % change from baseline

-10

-5

0

5

10

15

20

Placebo Hawthorn

*significantly different from placebo,p = 0.02

*

FAM 2 t d


36/45

FAM-2 study:

Well being questionnaire

2

3

4

5

67

8

9

Placebo

baseline

Placebo

month 4

Hawthorn

baseline

Hawthorn

month 4

DepressionAnxiety

Vitality


37/45

FAM-2 study:

Well being questionnaire

0

10

20

30

40

50

60

Placebo

baseline

Placebo

month 4

Hawthorn

baseline

Hawthorn

month 4

Positive well-being

Total well-being


38/45

Case study: hypertension + drug treatment

Patientdetails

First visitNov 02

DietSupplements/d

HerbsCM, female55 yrs,

good diet,but low onwholegrains& oily fishPMH

Hospitalisedfor 'fainting'spells causedby Atenolol.On thyroxine,

HRT

Bp for 2 yrs10mg/d

Ca channelblocker

low vitality,fluidretention,cramps,restless legs,palpitations.

fruit&veg

seed oils, use

olive oil

Multi (A-Z)1g vit C300 mg Mg1g Omega-3360 mg Rutin

Hawthorn5 dried

herb/day


39/45

CM: response to hypotensive treatment

0

20

40

60

80

100

120

140

June Aug Oct Jan

Diastolic

Systolic

2003 2004

Other minor

symptoms

resolved


40/45

Case study: hypertension no drug treatment

Patientdetails First visitFeb 03 DietSupplements/dHerbs

SW,male,

37 yrs,poordiet,low inF&V,

whole-grains,dairy &oily fish

Bp 6 mo,overwork,

low vitality,sore

throatcatarrh,

cramps,stiff neck,headacheocc.

fruit&veg, oily fish &wholegrains,

seed oils, use olive oil

Multi (high potency)1g vit C & 1g Omega-31g Ca+500mg Mg

Hawthorn5 dried herb/daySkullcap, Cramp bark,Valerian, Withania, Astragalus,Ginger


41/45

SW: response to hypotensive treatment

(no drug therapy) - 2003

0

20

40

60

80

100120

140

160

180

Feb April August Nov

Diastolic

Systolic

Vitality

improved,

signed off


42/45

Safety of Hawthorn

o Low acute toxicity: LD50: 6 g/kg body weight - similar

to food

o No restriction on long-term use

o No interaction with modern drugs including digoxin

(new study)

o No adverse reactions expected

o No contraindications known

oNo significant adverse events have been reported inclinical trials

o Overdose: not known

o Use of machines/driving: no adverse effects

expected.


43/45


44/45


45/45

Acknowledgements

University of Reading:q Dr George Marakis, Dr Rafe Bundy, Jessica Hope

Diabetes Centre, RBH:q Dr Hugh Simpson, Eleanor Simpson

Royal Berkshire Hospital, Pathology Lab:q Paul Robinson

Funding for human studies:q Lamberts Healthcare Ltd & Lichtwer Pharma UK Ltd

q The University of Reading

New Vitality Clinic:q Leigh Deller-Smith, Caroline Galloway,

Dr Steve Hicks, Dr Alan Lakin, Freda Miller

herbs for hypertension - ann walker

Documents