Current Hypertension Reviews - Volume 19, Issue 2, 2023

Background: Hypertension is a cardiovascular disorder that is an incurable clinical condition. It requires lifelong therapy for its management along with long terms application of synthetic drugs associated with severe toxicity in multiple organs. However, the therapeutic application of herbal medicines to treat hypertension has gained considerable attention. The limitations and hurdles associated with conventional plant extract medications are their safety, efficacy, dose, and unknown biological activity. Objective: In the modern era, the active phytoconstituent-based formulation has come into trend. Various extraction techniques have been reported to extract and isolate active phytoconstituents. Pharmacognostic, physiochemical, phytochemical, and quantitative analytical methods were developed for their qualitative and quantitative analysis. The passage of time and changes in lifestyle also modulate the variable cause of hypertension. Single-drug-based approach therapy cannot efficiently control the cause of hypertension. Designing a potent herbal formulation with different active constituents and modes of action against hypertension is necessary to effectively manage hypertension. Methods: This review comprises a selection of three different plants, Boerhavia diffusa, Rauwolfia Serpentina, and Elaeocarpus ganitrus exhibiting antihypertension activity. Results: The objective behind selecting individual plants is their active constituents which have different mechanisms of action for the treatment of hypertension. This review comprises the various extraction methods of the active phytoconstituents and pharmacognostic, physiochemical, phytochemical, and quantitative analysis parameters, respectively. It also lists active phytoconstituents present in plants and the different pharmacological modes of action. Selected plant extracts have different antihypertensive mechanisms. Extract of Boerhavia diffusa consisting of Liriodendron & Syringaresnol mono β-D-Glucosidase exhibit Ca²⁺ channel antagonistic activity; where Reserpine is a phytoconstituent of Rauwolfia serpentina, which depletes catecholamine, Ajmalin shows an antiarrhythmic effect by blocking the sodium channel and the aqueous extract of E. ganitrus seeds reduces mean arterial blood pressure by inhibiting the ACE enzyme. Conclusion: It has been revealed that poly-herbal formulation of respective phytoconstituent can be used as potent antihypertensive medicine to treat hypertension effectively.

Background: Medicinal plants have been found beneficial in the control and therapy of many ailments as they contain bioactive compounds, and many of them are used as precursors in the biosynthesis of natural medicines. Diuretics are used as a primary treatment in patients with edema associated with liver cirrhosis and kidney diseases, hyperkalemia, hypertension, heart failure, or renal failure. Furthermore, they are also used to increase the excretion of sodium and reduce blood volume. Due to various adverse events associated with synthetic diuretics, there is a need to investigate alternate plant-based bioactive components that have effective diuretic activity with minimal side effects. Objective: This review compiled the reported bioactive compounds from different plant sources along with their mechanisms of diuretic activity. Methods: Different sources were used to collect information regarding herbal plants with therapeutic value as diuretics. These included published peer-reviewed journal articles, scholarly articles from StatPearls, and search engines like Google Scholar, PubMed, Scopus, Springer, ScienceDirect, Wiley, etc. Results: In this review, it was found that flavonoids like rutin, acacetin, naringenin, etc. showed significant diuretic activity in experimental models by various mechanisms, but mostly by blocking the sodium-potassium-chloride co-transporter, while some bioactive compounds showed diuretic actions via other mechanisms as well. Conclusion: Research on clinical trials of these isolated bioactive compounds needs to be further conducted. Thus, this review provides an understanding of the potential diuretic bioactive compounds of plants for further research and pharmaceutical applications.

Hypertension is a significant hazardous aspect for several diseases, like cardiovascular disease, kidney failure, and brain disease. Hypertension has become the most lethal condition globally, affecting approximately 1 billion people aged around 30-79 years worldwide. In the year 2022, India was ranked 170th for men and 193rd for women for HTN diagnosis rates among 200 countries worldwide. The main risk factor for cardiac failure and stroke is hypertension. The conventional classes of antihypertensive medications currently available have some side effects. Previously, hypertension has been discussed by various researchers using conventional drug-targeting methods such as ACE inhibitors, aldosterone inhibitors, or renin inhibitors. Recently, novel drug delivery technologies utilizing nanoparticles and new pharmacological classes like ACE2 and APA inhibitors have been studied for the medication of hypertension. In this review, we have covered the epidemiology of hypertension in India, its pathophysiology, medications used in the management of hypertension using nanotechnology, and antihypertensive drugs currently available in the market that are approved and patented. Finally, we have covered how hypertension can be managed with the help of smart devices and artificial intelligence (AI) for improved therapy.

Cardiac circadian rhythms are an important regulator of body functions, including cardiac activities and blood pressure. Disturbance of circadian rhythm is known to trigger and aggravate various cardiovascular diseases. Thus, modulating the circadian rhythm can be used as a therapeutic approach to cardiovascular diseases. Through this work, we intend to discuss the current understanding of cardiac circadian rhythms, in terms of quantifiable parameters like BP and HR. We also elaborate on the molecular regulators and the molecular cascades along with their specific genetic aspects involved in modulating circadian rhythms, with specific reference to cardiovascular health and cardiovascular diseases. Along with this, we also presented the latest pharmacogenomic and metabolomics markers involved in chronobiological control of the cardiovascular system along with their possible utility in cardiovascular disease diagnosis and therapeutics. Finally, we reviewed the current expert opinions on chronotherapeutic approaches for utilizing the conventional as well as the new pharmacological molecules for antihypertensive chronotherapy.

Background: Nebivolol has a dual mechanism of action, exerting a moderate b- blockade effect and reducing peripheral arterial resistance, as a result, the antihypertensive effect of nebivolol may be higher than that of a potent vasodilator CCB such as amlodipine. Aim: The study evaluated the effect of two nebivolol/valsartan on 24 hour ambulatory blood pressure versus amlodipine/valsartan in grade II or III hypertension patients or having uncontrolled BP despite treatment. Ambulatory blood pressure monitoring is a powerful method to monitor the changes in blood pressure over the 24 hour. Materials and Methods: A total of 74 from 90 patients continued the study. Fourty patients received amlodipine 10 mg/valsartan 160 mg (group I), and thirty-four patients received nebivolol 5 mg/ valsartan 160 mg (group II). Peripheral blood pressure readings were measured at randomization at 6 and 12 weeks. Ambulatory blood pressure was measured at randomization and 12 weeks. Results: Both drug combinations showed high efficacy in reducing peripheral and 24 hour ambulatory BP. There was no statistically significant difference between the groups in lowering peripheral systolic and diastolic blood pressure at 6 and 12 weeks. Furthermore, both groups failed to show any significant difference in reducing 24 hour SBP and DBP. Regarding day SBP, the blood pressure dropped by -5.63 ± 14.87 in group I and -6.25 ± 11.59 in group II (p = 0.844). Also, group I reduced the day DBP average by -2.53 ± 9.83 and group II by -3.61 ± 9.78 (p = 0.640). In addition, both drug combinations had no statistically significant difference in lowering night SBP and DBP average. Conclusion: Both treatment groups reached the target ambulatory blood pressure, and there was no statistically significant difference between both groups as a regard reduction in all ambulatory blood pressure readings.

Background: Previous research suggests the role of social determinants of health (SDH) in the prevalence of hypertension. Objective: The study aimed to estimate the contribution of SDH to the prevalence of hypertension. Methods: We recruited 3072 Egyptian public servants who answered a self-administered questionnaire, including hypertension history. We measured the participants’ blood pressure with standardized procedures. The logistic regression models were used to assess the associations between SDH and hypertension. Results: The prevalence of hypertension was 28.2% (34.2% in males and 22.5% in females). The prevalence of undiagnosed hypertension was 16.3% (23.9% and 9.2%, respectively); thus, 57.8% of the hypertensive subjects were unaware of their high blood pressure status. SDH were associated with the odds of having hypertension in the unadjusted analyses. Higher education, being single, and having minor family members were associated with low odds of hypertension. On the other hand, non-professional occupations, job hours, household income, total family members, and work-family conflicts were associated with higher odds of hypertension. However, in the multivariable analyses, which included all SDH and adjusted for age, gender, smoking, physical activity, body mass index, medical history of chronic diseases, and family history of hypertension, only job hours were associated with the odds of having hypertension and undiagnosed hypertension: odds ratio (95% CI) = 1.07 (1.01-1.14) and 1.11 (1.02-1.20), respectively. Conclusion: SDH contributed minimally to the odds of having hypertension among public officials in Minia, Egypt. Civil servants with long working hours should be tracked with regular blood pressure monitoring as a high-risk group for hypertension.