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Medicinal plants use in Nigeria for the management of hypertension and diabetes
Abstract
Worldwide, people constantly embrace alternative and/or complementary therapies, which include traditional medicinal plants (TMPs), for management of their health conditions. Two non-communicable diseases, hypertension and diabetes, evoke growing concerns over the escalating health threat which they pose to humanity globally. Over the past decade these conditions have become two of the biggest healthcare issues in Africa, rivalling communicable diseases. This study focuses on the use of TMPs for the management of hypertension and diabetes in Nigeria, Africa’s most populous country. The aim is to determine using questionnaire, the extent of the usage of these TMPs. The high prevalence of hypertension and diabetes in Nigeria is a national health problem. The impact of poor management due mainly to unaffordable healthcare costs makes it more burdensome on the patients. These factors, combined with disease complications, exacerbate the financial plight of individual families. Hence the search for alternatives. This study considers the drive behind TMP use. A survey among HTN and DM patients in two South Eastern Nigeria hospitals was run based on a structured/semi-structured questionnaire administered over 600 patients. The results of this study show high prevalence in the use of TMPs for the management of hypertension and diabetes. Approximately, 75% of the participants use TMPs. All of them use TMPs concurrently with their prescription medicines, predisposing them to severe hypotension or hypoglycaemia, possibilities of drug interactions, direct toxicities, as well as adulteration with active pharmaceutical agents. Also, the poor quality of herbal medicines raises safety concerns. Directions for use of these TMPs are scanty or anecdotal. Consequently, fifty (50) plants commonly used by these patients were recorded with known pharmacokinetic parameters. Most of these TMPs have been proven to possess therapeutic properties and pharmacological effects, thus providing a baseline for investigation into their uses by patients. Vernonia amygdalina (bitter leaf), Ocimum gratissimum (sweet basil/scent leaf) and Gongronema latifolium (bush buck) were three of the most commonly used medicinal plants identified from this work. Quantitative statistical cross-analysis was used to make statistical inferences using data from this study. It was ascertained that there were some associations between the use of TMPs by patients, their conditions and demographics. This study is important as it forms the basis of a future study - survey to be conducted on Nigerian doctors – to ascertain their views on alternative medicine and its integration into the national healthcare system. Keywords: Hypertension; Diabetes mellitus; Traditional medicines; Medicinal plants; Nigeria; South Eastern Nigeria; CAM; ethnobotany; ethnopharmacology; Antihypertensive, herbs, herbal remedies; hypertension/diabetes and medicinal plant.
... The practice is more common in developing countries where the cost of synthetic drug is unaffordable to a large size of the populace (Agrawal et al., 2010). A hospital based study conducted in Nigeria puts the frequency of utilization of medicinal plants among hypertensive patients to treat their ailment at 70.9% (Sylver-Francis, 2022). The exorbitant drug price, coupled with recent economic challenges probably forced these people to resort to using plants they believe to have antihypertensive activity due to their affordability and availability without proper knowledge of their function and toxicity to the body, where some have the idea that combining it with conventional treatment works better (Abubakar et al., 2015). ...
Hypertension is one of the diseases that require long-term therapy and most of the drugs used for the treatment of hypertension in Nigeria are expensive. The exorbitant drug price, coupled with recent economic challenges, forced many people in Nigeria to resort to using plants they believe to have antihypertensive activity due to their affordability and availability without proper knowledge of their functions and toxicity to the body. The study aimed to identify and document plant species, plant products and method of preparations used by people in Northern Nigeria to control hypertension with the view of preserving the knowledge and providing basis for pharmacological investigations. Data for the study were generated from scientific databases using specific keywords such as “medicinal plants”, “hypertension” and “Northern Nigeria”. The data generated were collated and analyzed in Microsoft Excel spreadsheet. A total of 59 medicinal plant species belonging to 39 families used by the people of Northern Nigeria to manage hypertension were documented. Out of the 39 families, Fabaceae (7), Apocynaceae (3), Lamiaceae (3), and Malvaceae (3) were the most represented. Among the 59 plant species documented Allium sativum (5), Hibiscus sabdariffa (4) and Carica papaya (4) were the most reported. The most used plant parts are leaves (36) and the least used are rhizomes (1), fruit water (1), kernel and gel (1). Decoction (46) was the most common method of preparation while the least was powder used in food (2). In addition, the antihypertensive properties of 50 of the 59 medicinal plants were previously experimentally tested and confirmed. Though the antihypertensive activity of most of the plants used were experimentally verified and validated, further studies are required to identify toxicity and appropriate dosage regimen of the plants
... Only 2.5% of the surveyed sample mentioned this as a reason. In contrast, in other populations, such as in North Sumatra, Indonesia, 5% of 200 people interviewed considered the economic factor important, and in Nigeria, 75% of the population uses medicinal plants to treat conditions like hypertension and diabetes due to economic reasons [48,49] . The difference in preference for medicinal plants based on the economic variable between countries like Nigeria and Costa Rica can be largely attributed to the presence of a universal health system in Costa Rica. ...
... Vernonia amygdalina is a perennial shrub that belong to the Asteraceae family and is popularly called bitter leaf in English. Ewuro in Yoruba (Southwest Nigeria) and Chusar-doki in Hausa (Northern part of Nigeria) [19,20]. The leaves are green with a characteristic odour and bitter taste [21]. ...
Indigenous vegetables have gained attention due to their dietary fibre, mineral, amino acids, phytochemicals, and antioxidant activities. Bitter leaf (BL); Efinrin leaf (EF); Koro owu or cotton seed leaf (KO); Marugbo leaf (MA); Ewedu leaf (EW) and Ira leaf (IR) are common Nigeria indigenous vegetables. These vegetables were processed into soup and analysed for proximate, mineral, amino acids, phytochemicals, and antioxidant activities. The crude fibre content of the vegetable ranged from 2.70 g/100 g in BL to 8.63 g/100 g in MA. It was observed that MA soup had the highest calcium content (42.89 mg/100 g) while the phytochemicals (mg/g) - tannin, phytate, oxalate, total phenol and total flavonoids values ranged as follows: 0.80–7.30; 2.00–32.76; 0.63–5.77; 1.06–9.12 and 0.61–19.50 respectively. The branch chain amino acid content ranged from 10.75 in MA to 14.67 in BL, total non-essential amino acids (35.32 in BL – 57.97 g/100 g in KO) and total essential amino acid (25.70 in MA – 32.34 g/100 g in KO) respectively. The DPPH ranged between 32.32 – 97.24%. Hence, consumption of these processed Nigerian indigenous vegetables soups may be beneficial in prevention and treatment of diet related diseases.
This paper argues that indigenous knowledge systems' emergence via Zimbabwe as an example is more than a case of a sudden realisation on the part of the international community (especially from Western scholars of the former colonised people's knowledge systems), which instead asserts that the indigenous people themselves have, and continue to bring forth new insights and 'new' knowledge systems and thus beyond just a quest of a people who want to bring their knowledge to the attention of the global membership. Hence, it is a case of peoples who are reclaiming their identity as well as asserting their visibility begun by reclaiming their national freedoms and curving nations out of former colonial empires that were largely dominated by the United Kingdom, France and Portugal. The paper also notes that indigenous knowledge systems (IKS) are a movement not only against the vestiges of colonialism, but also of neo-colonialism. Finally, the paper argues that IKS is also in some way, some form of the former colonised getting back at the former colonial powers and their knowledge systems, and asserts that the world today is in the grips of global warming and other calamities because of the practices of the West that are driven by greed, and not the need for living within one's means.
Traditional medicine is typically the most accessible primary healthcare for a large proportion of the people in Nigeria. However, its potential remains under-explored, especially with regards to their documentation. This research investigated and documented the use of medicinal plants in the management of various health conditions/diseases among local populations in Lagos State. This study was conducted in five (5) locations of Lagos State i.e., Alimosho, Badagry, Eti-Osa, and Epe (including Ijebu and Imota). Ethnobotanical information from 100 participants was obtained using semi-structured questionnaires. Frequency of citation (FC), relative frequency of citation (RFC), fidelity level (FL), and informant consensus factor (ICF) were used to assess the importance of plants utilised for various health conditions/diseases. We identified 183 plants from 61 plant families with the highest number (24) of plants belonging to Fabaceae. Based on the high FC, the top-five popular plants used for managing health conditions/diseases in the study areas were Mangifera indica (95%), Waltheria indica (93%), Zingiber officinale (87%), Alchornea cordifolia (83%) and Ipomoea involucrata (81%). Furthermore, Rauvolfia vomitoria, Urena lobata and Waltheria indica were recognised as the most adaptable plants, as they were used to treat five different health conditions/diseases. The most commonly used life-forms were herbs (34%) and woody species (shrubs; 30%, and trees; 22%). The most regularly used plant parts were leaves. The calculated RFC values for all medicinal plant species ranged from 0.01 to 0.95, while FL values ranged from 7.14 to 100%. We found 14 health conditions/diseases, with ICF values ranging from 0.88 to 0.95. Insomnia, insanity, convulsion, nervousness, and muscle relaxants had the lowest (ICF = 0.88) agreement, while malaria/fevers, stomach, and respiratory-related diseases had the most (ICF = 0.95) agreement. The documented therapeutic uses of the plants provide basic data for further research aimed at pharmacological and conservation studies of the most important flora existing in the study areas.
Background
Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories.
Methods
We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age.
Findings
The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran.
Interpretation
Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings.
Funding
WHO.
Background: The rising burden of non-communicable diseases (NCDs) is a threat to India. Increasingly, individuals interested in improving their health and making healthy lifestyle
changes are turning to complementary and alternative medicine
(CAM) as a health-care option.
Design and Methods: The objective of this study was to determine the prevalence, pattern, and predictor of alternative medicine
use among NCDs patients undergoing allopathic treatment in an
urban health centre. The study design was a hospital-based crosssectional study, which was done in a government hospital,
Srinagar, Pauri District, Uttarakhand, India among adult males
and females aged above 20 years. The patients having NCDs were
systematically sampled.
Result: Among 233 studied patients 57.1% were males. The
mean age of the patients was 55.8 years (SD 13.5). Of the total
studied patients 46.8% were diagnosed with DM, and 43.8% of
HTN. Nearly one-fifth of the patients were known to have a CVD
or COPD. A total of 49.8% of the studied NCD patients reported
use of both allopathic and alternative medicine treatment and nearly 3.4% of the studied NCD patients in the last one year to seek
exclusive alternative medicine treatment. The overall use of exclusive alternative medicine was low that is 3.7%, 1.0%, and 5% in
diabetes, hypertension, and chronic lung disease patients, respectively. The most common form of alternative medicine used by
studied patients was medicinal herbs/biological-based medicine
(MB) (62.9%). Among MB commonly used were a bitter gourd,
aloe vera, and others. 29.8% of the patients used Indian/Ayurveda
medicine in total.
Conclusions: The use of exclusive alternative medicine is low
in adult patients with NCD. However, medical pluralism is prevalent. A better understanding of practices especially that focuses on
alternative medicine needs a qualitative study, which was beyond
the scope of this study
Metabolic syndrome as a clustering disorder includes excess abdominal fat distribution, abnormal insulin and glucose metabolism, disturbed blood lipids, pro-inflammatory state, and hypertension. Regarding to the adverse effects of synthetic medicines, the identification of appropriate healthcare approaches, such as herbal medicines, with fewer side effects is more favorable. Allium cepa L. (onion) is a culinary and medicinal herb belonging to the family of Amaryllidaceae. Flavonoids such as quercetin and kaempferol, alk(en)yl cysteine sulfoxides including S-methyl cysteine sulfoxide and S-propyl cysteine sulfoxide, cycloalliin, thiosulfinates, and sulfides are main compounds existing in the plant. A. cepa and its pharmacologically active constituents display broad-spectrum activities including anti-oxidant, anti-inflammatory, lipid-modifying, anti-obesity, antihypertensive, and antidiabetic effects. Our objective in this review was to find out the role of A. cepa and its bioactive phytochemicals as cardiovascular protective agents in different metabolic syndrome risk factors, including hyperlipidemia, high blood glucose, obesity, and hypertension.
Epidemiological studies have documented a high incidence of diabetes in hypertensive patients.Insulin resistance is defined as a less than expected biologic response to a given concentration of the hormone and plays a pivotal role in the pathogenesis of diabetes. However, over the last decades, it became evident that insulin resistance is not merely a metabolic abnormality, but is a complex and multifaceted syndrome that can also affect blood pressure homeostasis. The dysregulation of neuro-humoral and neuro-immune systems is involved in the pathophysiology of both insulin resistance and hypertension. These mechanisms induce a chronic low grade of inflammation that interferes with insulin signalling transduction. Molecular abnormalities associated with insulin resistance include the defects of insulin receptor structure, number, binding affinity, and/or signalling capacity. For instance, hyperglycaemia impairs insulin signalling through the generation of reactive oxygen species, which abrogate insulin-induced tyrosine autophosphorylation of the insulin receptor. Additional mechanisms have been described as responsible for the inhibition of insulin signalling, including proteasome-mediated degradation of insulin receptor substrate 1/2, phosphatase-mediated dephosphorylation and kinase-mediated serine/threonine phosphorylation of both insulin receptor and insulin receptor substrates. Insulin resistance plays a key role also in the pathogenesis and progression of hypertension-induced target organ damage, like left ventricular hypertrophy, atherosclerosis and chronic kidney disease. Altogether these abnormalities significantly contribute to the increase the risk of developing type 2 diabetes.
Introduction: Hypertension is the leading preventable cause of premature death worldwide. We aimed to examine the global disparities of hypertension prevalence, awareness, treatment, and control in 2010 and compare secular changes in these disparities from 2000 to 2010.
Methods: We searched MEDLINE from January 1995 to December 2014 and supplemented with manual searches of references from retrieved articles. A total of 135 population-based studies with 968,419 individuals aged ≥20 years from 90 countries were included. Sex-age-specific prevalences of hypertension from each country were applied to population data to calculate the number of hypertensive adults in each region and globally. Proportions of awareness, treatment, and control from each country were applied to hypertensive populations to obtain regional and global estimates.
Results: An estimated 30.2% (95% confidence interval, 30.1-30.4%) of the world’s adult population in 2010 had hypertension; 28.6% (28.3-28.9%) in high-income countries and 30.3% (30.1-30.5%) in low- and middle-income countries. An estimated 1.35 billion (1.34-1.36 billion) people had hypertension in 2010; 349 million (339-359 million) in high-income and 1.00 billion (0.99-1.01 billion) in low- and middle-income countries. From 2000 to 2010, age-standardized prevalence of hypertension decreased by 2.3% in high-income countries but increased by 6.1% in low- and middle-income countries. During the same period, the proportions of awareness (56.6% vs 68.8%), treatment (42.9% vs 56.1%), and control (16.6% vs. 28.9%) increased substantially in high-income countries, whereas awareness (34.7% vs 35.1%), treatment (23.4% vs 26.4%), and control (7.0% vs 7.8%) increased only slightly in low- and middle-income countries.
Conclusions: Global disparities in hypertension prevalence, awareness, treatment, and control are large and increasing. Collaborative efforts from national and international stakeholders are urgently needed to combat the emerging hypertension burden in low- and middle-income countries.
This review is an updated and expanded version published in this journal in 2016. Warfarin pharmacotherapy is extremely complex, since in addition to being a low therapeutic index drug, it does not follow the dose-response pattern and has characteristics that predispose the occurrence of interactions, such as high binding rate to plasma proteins, metabolization by cytochrome P450 enzymes, further to acting in the complex process of blood coagulation, platelet activation, and inflammation. For these reasons, warfarin has great potential for interaction with drugs, foods, and herbal medicines. Herb-warfarin interactions, however, are still not very well studied; thus, the objective of this update is to present new information on the subject aiming to provide a scientific basis to help health professionals in the clinical management of these interactions. A literature review was performed from May to June 2021 in multiple databases and articles published in 2016 to 2021 were included. A total of 59 articles describing 114 herbal medicines were reported to interact with warfarin. Of the plants mentioned, 84% had the potential to increase warfarin effect and the risk of bleeding. Targets possibly involved in these interactions include the processes of blood coagulation, platelet activation, and inflammation, in addition to the pharmacokinetics and pharmacodynamics of warfarin. Despite these alarming numbers, however, the clinical management of interactions is known to be effective. Thus, it is important that the use of these herbal medicines be done with caution in anticoagulated patients and that studies of herb-drug interactions be encouraged in order to generate information to support the clinical management of patients.
Concurrent use of herbs may mimic, magnify, or oppose the effect of drugs. Plausible cases of herb-drug interactions include: bleeding when warfarin is combined with ginkgo ( Ginkgo biloba), garlic ( Allium sativum), dong qual ( Angelica sinensis), or danshen ( Salvia miltiorrhiza); mild serotonin syndrome in patients who mix St John's wort ( Hypericum perforatum) with serotonin-reuptake inhibitors; decreased bioavailability of digoxin, theophylline, cyclosporin, and phenprocoumon when these drugs are combined with St John's wort; induction of mania in depressed patients who mix antidepressants and Panax ginseng; exacerbation of extrapyramidal effects with neuroleptic drugs and betel nut ( Areca catechu); increased risk of hypertension when tricyclic antidepressants are combined with yohimbine ( Pausinystalla yohimbe); potentiation of oral and topical corticosteroids by liquorice ( Glycyrrhiza glabra); decreased blood concentrations of prednisolone when taken with the Chinese herbal product xaio chai hu tang (sho-saiko-to); and decreased concentrations of phenytoin when combined with the Ayurvedic syrup shankhapushpi. Anthranoid-containing plants (including senna [ Cassia senna] and cascara [ Rhamnus purshiana]) and soluble fibres (including guar gum and psyllium) can decrease the absorption of drugs. Many reports of herb-drug interactions are sketchy and lack laboratory analysis of suspect preparations. Health-care practitioners should caution patients against mixing herbs and pharmaceutical drugs.