|Year : 2019 | Volume
| Issue : 3 | Page : 107-111
Effect of hibiscus sabdariffa on blood pressure in patients with stage 1 hypertension
Majid Jalalyazdi1, Javad Ramezani2, Azadeh Izadi-Moud1, Fereshteh Madani-Sani1, Shokufeh Shahlaei1, Shirin Sadat Ghiasi1
1 Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Cardiology, Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
|Date of Web Publication||2-Jul-2019|
Dr. Shirin Sadat Ghiasi
Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad
Source of Support: None, Conflict of Interest: None
Using different drug regimens has been proved to have effective effects on lowering blood pressure, but the adverse effects of long-term usage such medications is evident. According to recent trend in suing herbal and traditional medicines, researchers have been focused on evaluating the effect of different herbals on managing hypertension. The aim of the present study is the evaluation of the antihypertensive effect one of these herbs, sour tea (Hibiscus sabdariffa), on stage one hypertension. Patients with stage one hypertension who were diagnosed by a cardiologist has been included in the present clinical trial after giving informed consent. The patients were divided into two groups. The control and case group received the same lifestyle and dietary advices for controlling blood pressure. The case group received two standard cup of sour tea every morning for 1 month. The blood pressure of both groups was documented at baseline and at the end of the study and the results were analyzed using SPSS software. A total of 46 patients participated in this study and there was no significant difference in terms of age and body mass index between groups. There was a significant reduction in systolic blood pressure in both groups, but the mean reduction in systolic and diastolic blood pressure was significantly higher in the case group (P = 0.004 and P < 0.001, respectively). Using H. sabdariffa as sour tea two times a day can be effective in managing blood pressure in stage one hypertension along with lifestyle and dietary modification.
Keywords: Diastolic pressure, Hibiscus sabdariffa, hypertension, systolic pressure
|How to cite this article:|
Jalalyazdi M, Ramezani J, Izadi-Moud A, Madani-Sani F, Shahlaei S, Ghiasi SS. Effect of hibiscus sabdariffa on blood pressure in patients with stage 1 hypertension. J Adv Pharm Technol Res 2019;10:107-11
|How to cite this URL:|
Jalalyazdi M, Ramezani J, Izadi-Moud A, Madani-Sani F, Shahlaei S, Ghiasi SS. Effect of hibiscus sabdariffa on blood pressure in patients with stage 1 hypertension. J Adv Pharm Technol Res [serial online] 2019 [cited 2021 Oct 22];10:107-11. Available from: https://www.japtr.org/text.asp?2019/10/3/107/261971
| Introduction|| |
Hypertension has been considered as a risk factor of various diseases including ischemic heart and cerebrovascular disease as well as chronic kidney disease. Hypertension also accounts for increases in disability-adjusted life years and deaths worldwide.,, The global prevalence of hypertension among adults was 31.1% and its burden was higher in low- and middle-income countries. In addition, 26.6% of the population of Iran are hypertensive. It should be noted that in developing countries, insufficient treatment and unawareness, make the management of hypertensive individuals more challenging for healthcare systems.,
Good blood pressure control can prevent adverse cardiologic outcome including heart attacks and heart failures. There are different classes of antihypertensive drugs such as thiazides, beta-blockers, calcium channel blockers, angiotensin II receptor blockers, and alpha-blockers which are used clinically to treat hypertension. Based on 2017 American College of Cardiology/American Heart Association guideline, from 45.6% of hypertensive adults in united states, 36.2% were recommended to use antihypertensive medications which approximately half of them still had a higher blood pressure than the goal threshold. Thus, there is an urgent need for developing management strategies for this physiological disorder. On the other hand, there is an emerging use of herbal medicine (HM) as an alternative to chemical medicine (CM) which could have many reasons including side effects of CM. Putting these together with positive beliefs and experiences of HM among people and their traditions, makes them more eager to trust and use herbal medication. Traditions suggested herbs such as garlic, onion, Chinese herbal medicine, black and green tea, and sour tea or Hibiscus sabdariffa. Some studies have proven some of these medications positive effects.,,,,,,,,,,,, The latter one, which is our experimental agent, is a plant containing carbohydrates, proteins, fatty acids, flavonoid, minerals, and vitamins. Studies mentioned that this herb has anticancer, antibacterial, anti-oxidant, nephro- and hepato-protective, diuretic, anti-cholesterol, anti-diabetic, and anti-hypertensive properties., Despite the frequent usage of this alternative medicine among people, there is not adequate evidence and enough knowledge about its effectiveness in different medical conditions. Thus, knowing more details about this plant and conducting scientific and evidence-based studies seems to be necessary. According to these facts, this study aimed to evaluate the effect of H. sabdariffa on blood pressure.
| Materials and Methods|| |
The present randomized controlled clinical trial was conducted to evaluate the effectiveness of sour tea (H. sabdariffa) on patients with stage one hypertension referred to an outpatient cardiology clinic in Imam Reza Hospital in Mashhad, Iran. Every patient who was aged between 18 and 70 years with stage 1 hypertension who were diagnosed by the same cardiologist were enrolled in the present study. These patients had systolic and diastolic blood pressure ranging from 130 to 139 and 80–89 mmHg, respectively. These patients did not have any previous medical illness, and none of them were pregnant or breastfeeding. According to this criterion, 46 patients were divided into two experimental and control group. After taking the informed consent and according to the declaration of Helsinki, patients' demographic information including age, gender, and body mass index was recorded. Blood pressure was taken by Riester minimums II Aneroid Sphygmomanometer under the consideration of a specialist by the same researcher which was not aware of the present study. The manometer cuff was putted on brachial artery as its edge was 2 cm upper the elbow brachial artery pulse. Blood pressure was taken in sited position for three times with 5 min' intervals. The average of three attempts was recorded. Twenty-three patients in experimental group received nonmedical treatment advices and two standard cup of sour tea (each cup with one sour tea bag containing 1.25 g H. sabdariffa (480 mL/d)) every day morning and night for 1 month (they did not use any other kind of teas). The instructions for using tea bags were given to the participants by the same researcher. All the tea bags were purchased from same reliable herbal shop and prescribed freely for the study participants. The other group only received the same nonmedical treatment advices as the control group. These advices included lowering weight under the consideration of a nutrition specialist, recommendation to have Dietary Approaches to Stop Hypertension (DASH), decreasing sodium and increasing potassium under the consideration of a nutrition specialist, and doing aerobic exercises at list 5 days a week for 30 min. The patients were visited by a cardiologist before and after the treatment, and their blood pressure was taken.
The proposal of our study was approved by the Institutional Ethics Committee of Mashhad University of Medical Sciences.
Data were analyzed using the statistical package for social sciences software version 22 (IBM Inc. Chicago, IL, USA). Continuous variables were checked for normality using the Shapiro–Wilk test. As all the continuous variables were normally distributed, the mean and standard deviation were used to present data. Categorical variables were presented using frequency and percentage. Comparison of continuous variables between groups was performed using the independent Student's t-test, whereas categorical variables were compared using the Chi-square test. Repeated measures analysis of variance (ANOVA) was Performed to assess the time and group effects. The statistical significance was defined as P < 0.05, and the confidence level was 0.95.
| Results|| |
A total of 46 participants (23, 50% in the tea group and 23, 50% in control group) participated in this study. The mean age of study participants was 49.83 ± 3.38 years. The mean body mass index (BMI) of the participants was 28.74 ± 3.50 kg/m2. There was no significant difference in terms of age and BMI between groups [Table 1]. Among the study participants, 25 (54.3%) were male and 21 (45.7%) were female. Among the intervention group, 12 participants (48.0%) were male and 11 participants (52.4%) were female, while in the control group, 13 participants (52.0%) were male and 10 participants (47.6%) were female. There was no significant difference in gender distribution pattern between the study groups (χ(df = 1) =0.09, P = 0.77).
Repeated measures ANOVA revealed a significant time (P < 0.001), group (P < 0.001) and time*group (P < 0.001) effect for systolic blood pressure. There was no significant difference between groups at baseline (P = 0.18). There was a significant reduction in systolic blood pressure in both groups (P < 0.05), but the mean reduction in systolic blood pressure was significantly higher in the intervention group (-7.43 mmHg) compared to the control group (−1.91 mmHg) (P = 0.004) [Table 2] and [Figure 1].
|Table 2: Comparison of systolic and diastolic blood pressure between the study groups at baseline|
Click here to view
|Figure 1: Changes in systolic blood pressure among intervention and control groups during the study|
Click here to view
Repeated measures ANOVA revealed a significant time (P < 0.001), group (P = 0.002) and time*group (P = 0.001) effect for diastolic blood pressure. There was no significant difference between groups at baseline (P = 0.88). There was a significant reduction in diastolic blood pressure in both groups (P < 0.05) but the mean reduction in diastolic blood pressure was significantly higher in the intervention group (-6.70 mmHg) compared to the control group (-3.96 mmHg) (P < 0.001) [Table 2] and [Figure 2].
|Figure 2: Changes in diastolic blood pressure among intervention and control groups during the study|
Click here to view
There was no significant difference between genders in terms of changes in systolic and diastolic blood pressure (P > 0.05) [Table 3].
|Table 3: Comparison of systolic and diastolic mean difference between genders|
Click here to view
| Discussion|| |
The present clinical trial revealed that sour tea can be an effective medication for lowering blood pressure in individuals with stage 1 hypertension. The blood pressure was also decreased in control group after 1 month which could be due to nonmedical advice such as lowering weight, using DASH regiment, decreasing sodium and increasing potassium, as well as performing aerobic exercises.
H. sabdariffa has been studied in different clinical and experimental studies. The safety of H. sabdariffa tea and extracts have been stated in the literature. Its noteworthy to mention that this herbal medicine has been considered as an effective factor for reducing and up taking free radicals. Furthermore, improving lipid profile is another therapeutic effect of the sour tea. Anthocyanins of H. sabdariffa can inhibit low-density lipoprotein oxidation and therefore decrease the atherosclerotic process. Moreover, it has been showed that H. sabdariffa has a compound that causes nitric oxide release from vascular endothelium which follows by kidney filtration increase, a mechanism that clears its diuretic effect so on blood pressure. The main limitation of suggesting H. sabdariffa as a blood pressure lowering agent or an anti lipidemic medication is the heterogeneity of clinical trials' protocols. Different therapeutic doses has been reported for achieving the beneficial effect of sour tea. Haji Faraji et al. have conducted one of the first studies about the effect of H. sabdariffa on blood pressure. As same as our study, they have achieved similar result indicating the effect of sour tea on lowering the blood pressure. Furthermore, they have revealed that 3 days after stopping the treatment, both systolic and diastolic blood pressure was elevated to 7.9% and 5.6%. Furthermore, the most recent meta-analysis about this tea has demonstrated that H. sabdariffa have significant effect on lowering both systolic and diastolic blood pressure. Moreover, the sour tea has also antihypertensive effect on diabetic patients with mild hypertension. A recent study from our country has reported the effective effect of sour tea on lowering blood pressure in a 100 mildly hypertensive diabetic patients. They have used greater amount of tea for their patients and achieved the same goal as our study on nondiabetic patients., Based on current study results and similar studies, with regard to positive beliefs of this herbal medicine usage among people, considering sour tea in patients' diet along with life style modification as a treatment could be effective on high blood pressure.
The limitations of the study were our small sample size due to restricted time with regard to enrolling patients and only need to be conducted in one academic center. Poor assistance of patients was also restricted the sample of our study.
| Conclusion|| |
Using antihypertensive chemical medication has its own side effects and limitations. However, using herbal medicine could be a considerable choice with lesser adverse effects if used within appropriate amounts. In our population, positive beliefs about herbal medicine among people make them more eager to trust and use herbal medication. According to the current study results, consumption of sour tea (H. sabdariffa) could effectively lower blood pressure in patients with stage 1 hypertension. Thus, concerning this herb as a medicine for hypertensive people seems beneficial. However, further investigation is needed to clear its mechanisms and effectiveness details in longer follow ups.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al.
Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm hg, 1990-2015. JAMA 2017;317:165-82.
Blood Pressure Lowering Treatment Trialists' Collaboration, Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, et al.
Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: Meta-analysis of randomised trials. BMJ 2008;336:1121-3.
Yoon SS, Carroll MD, Fryar CD. Hypertension prevalence and control among adults: United States, 2011-2014. NCHS Data Brief 2015;(220)1-8.
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al.
Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation 2016;134:441-50.
Esteghamati A, Meysamie A, Khalilzadeh O, Rashidi A, Haghazali M, Asgari F, et al.
Third national surveillance of risk factors of non-communicable diseases (SuRFNCD-2007) in Iran: Methods and results on prevalence of diabetes, hypertension, obesity, central obesity, and dyslipidemia. BMC Public Health 2009;9:167.
Mittal BV, Singh AK. Hypertension in the developing world: Challenges and opportunities. Am J Kidney Dis 2010;55:590-8.
Whelton PK, He J, Muntner P. Prevalence, awareness, treatment and control of hypertension in North America, North Africa and Asia. J Hum Hypertens 2004;18:545-51.
Brown MJ, Cruickshank JK, Dominiczak AF, MacGregor GA, Poulter NR, Russell GI, et al.
Better blood pressure control: How to combine drugs. J Hum Hypertens 2003;17:81-6.
Wright JM, Musini VM, Salzwedel DM, Dormuth C. First-line diuretics versus other classes of antihypertensive drugs for hypertension. Cochrane Database of Systematic Reviews 2009;4:5-9.
Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr., et al.
Potential US population impact of the 2017 ACC/AHA high blood pressure guideline. Circulation 2018;137:109-18.
Welz AN, Emberger-Klein A, Menrad K. Why people use herbal medicine: Insights from a focus-group study in Germany. BMC Complement Altern Med 2018;18:92.
Ernst E. Complementary/alternative medicine for hypertension: A mini-review. Wien Med Wochenschr 2005;155:386-91.
Haji Faraji M, Haji Tarkhani A. The effect of sour tea (Hibiscus sabdariffa
) on essential hypertension. J Ethnopharmacol 1999;65:231-6.
Herrera-Arellano A, Flores-Romero S, Chávez-Soto MA, Tortoriello J. Effectiveness and tolerability of a standardized extract from Hibiscus sabdariffa
in patients with mild to moderate hypertension: A controlled and randomized clinical trial. Phytomedicine 2004;11:375-82.
Herrera-Arellano A, Miranda-Sánchez J, Avila-Castro P, Herrera-Alvarez S, Jiménez-Ferrer JE, Zamilpa A, et al.
Clinical effects produced by a standardized herbal medicinal product of Hibiscus sabdariffa
on patients with hypertension. A randomized, double-blind, lisinopril-controlled clinical trial. Planta Med 2007;73:6-12.
Hopkins AL, Lamm MG, Funk JL, Ritenbaugh C. Hibiscus sabdariffa
L. in the treatment of hypertension and hyperlipidemia: A comprehensive review of animal and human studies. Fitoterapia 2013;85:84-94.
McKay DL, Chen CY, Saltzman E, Blumberg JB. Hibiscus sabdariffa
L. Tea (tisane) lowers blood pressure in prehypertensive and mildly hypertensive adults. J Nutr 2010;140:298-303.
Mozaffari-Khosravi H, Jalali-Khanabadi BA, Afkhami-Ardekani M, Fatehi F, Noori-Shadkam M. The effects of sour tea (Hibiscus sabdariffa
) on hypertension in patients with type II diabetes. J Hum Hypertens 2009;23:48-54.
Negishi H, Xu JW, Ikeda K, Njelekela M, Nara Y, Yamori Y. Black and green tea polyphenols attenuate blood pressure increases in stroke-prone spontaneously hypertensive rats. J Nutr 2004;134:38-42.
Odigie IP, Ettarh RR, Adigun SA. Chronic administration of aqueous extract of Hibiscus sabdariffa
attenuates hypertension and reverses cardiac hypertrophy in 2K-1C hypertensive rats. J Ethnopharmacol 2003;86:181-5.
Onyenekwe PC, Ajani EO, Ameh DA, Gamaniel KS. Antihypertensive effect of roselle (Hibiscus sabdariffa
) calyx infusion in spontaneously hypertensive rats and a comparison of its toxicity with that in wistar rats. Cell Biochem Funct 1999;17:199-206.
Sakai Y, Murakami T, Yamamoto Y. Antihypertensive effects of onion on NO synthase inhibitor-induced hypertensive rats and spontaneously hypertensive rats. Biosci Biotechnol Biochem 2003;67:1305-11.
Serban C, Sahebkar A, Ursoniu S, Andrica F, Banach M. Effect of sour tea (Hibiscus sabdariffa
L.) on arterial hypertension: A systematic review and meta-analysis of randomized controlled trials. J Hypertens 2015;33:1119-27.
Wang J, Xiong X. Outcome measures of Chinese herbal medicine for hypertension: An overview of systematic reviews. Evid Based Complement Alternat Med 2012;2012:697237.
Da-Costa-Rocha I, Bonnlaender B, Sievers H, Pischel I, Heinrich M. Hibiscus sabdariffa
L. – A phytochemical and pharmacological review. Food Chem 2014;165:424-43.
Mahadevan N, Kamboj P. Hibiscus sabsariffa
Linn.- An overview, 2009;77-83.
Guardiola S, Mach N. Therapeutic potential of Hibiscus sabdariffa
: A review of the scientific evidence. Endocrinol Nutr 2014;61:274-95.
Alarcón-Alonso J, Zamilpa A, Aguilar FA, Herrera-Ruiz M, Tortoriello J, Jimenez-Ferrer E. Pharmacological characterization of the diuretic effect of Hibiscus sabdariffa
) extract. J Ethnopharmacol 2012;139:751-6.
Mozaffari-Khosravi H, Ahadi Z, Barzegar K. The effect of green tea and sour tea on blood pressure of patients with type 2 diabetes: A randomized clinical trial. J Diet Suppl 2013;10:105-15.
Ajay M, Chai HJ, Mustafa AM, Gilani AH, Mustafa MR. Mechanisms of the anti-hypertensive effect of Hibiscus sabdariffa
L. calyces. J Ethnopharmacol 2007;109:388-93.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]
|This article has been cited by|
||Hibiscus sabdariffa, a Treatment for Uncontrolled Hypertension. Pilot Comparative Intervention
| ||Marwah Al-Anbaki,Anne-Laure Cavin,Renata Campos Nogueira,Jaafar Taslimi,Hayder Ali,Mohammed Najem,Mustafa Shukur Mahmood,Ibrahim Abdullah Khaleel,Abdulqader Saad Mohammed,Hasan Ramadhan Hasan,Laurence Marcourt,Fabien Félix,Nicolas Vinh Tri Low-Der’s,Emerson Ferreira Queiroz,Jean-Luc Wolfender,Marie Watisse´e,Bertrand Graz |
| ||Plants. 2021; 10(5): 1018 |
|[Pubmed] | [DOI]|
||The effect of Hibiscus sabdariffa (sour tea) compared to other herbal teas and antihypertension drugs on cardiometabolic risk factors: Result from a systematic review and meta-analysis
| ||Maryam Shafiee,Vida Mohammadi,Asma Kazemi,Hajar Davarpanah,Seyedeh Maryam Tabibzadeh,Siavash Babajafari,Hosein Rostami,Seyed Mohammad Mazloomi |
| ||Journal of Herbal Medicine. 2021; 29: 100471 |
|[Pubmed] | [DOI]|
||A Randomized, Double-Blind, Placebo-Controlled Trial to Determine the Effectiveness of a Polyphenolic Extract (Hibiscus sabdariffa and Lippia citriodora) for Reducing Blood Pressure in Prehypertensive and Type 1 Hypertensive Subjects
| ||Javier Marhuenda,Silvia Pérez-Piñero,Raúl Arcusa,Desirée Victoria-Montesinos,Fernando Cánovas,Maravillas Sánchez-Macarro,Ana María García-Muñoz,María Querol-Calderón,Francisco Javier López-Román |
| ||Molecules. 2021; 26(6): 1783 |
|[Pubmed] | [DOI]|
||Antioxidant Food Components for the Prevention and Treatment of Cardiovascular Diseases: Effects, Mechanisms, and Clinical Studies
| ||Dan-Dan Zhou,Min Luo,Ao Shang,Qian-Qian Mao,Bang-Yan Li,Ren-You Gan,Hua-Bin Li,Guodong Zhang |
| ||Oxidative Medicine and Cellular Longevity. 2021; 2021: 1 |
|[Pubmed] | [DOI]|
||Phytotherapy for Cardiovascular Disease: A Bench-to-Bedside Approach
| ||Mervin Chávez-Castillo,Ángel Ortega,Pablo Duran,Daniela Pirela,María Marquina,Climaco Cano,Juan Salazar,Maricarmen C. Gonzalez,Valmore Bermúdez,Joselyn Rojas-Quintero,Manuel Velasco |
| ||Current Pharmaceutical Design. 2020; 26(35): 4410 |
|[Pubmed] | [DOI]|
||Advances in the mechanisms of Hibiscus sabdariffa L. on hypertension
| ||Hua Liu,Ze-Ming Liang,Rui-ting Li,Yi-Gang Yu,T. Coenye,H. Huang |
| ||E3S Web of Conferences. 2020; 145: 01039 |
|[Pubmed] | [DOI]|
||Effect of sour tea supplementation on liver enzymes, lipid profile, blood pressure, and antioxidant status in patients with non-alcoholic fatty liver disease: A double-blind randomized controlled clinical trial
| ||Fatemeh Izadi,Amirhosein Farrokhzad,Babak Tamizifar,Mohammad Javad Tarrahi,Mohammad Hassan Entezari |
| ||Phytotherapy Research. 2020; |
|[Pubmed] | [DOI]|