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ISSN: 1734-3402
Family Medicine & Primary Care Review
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vol. 22
Review paper

A review and update on the use of Hibiscus sabdariffa (karkadeh) in the treatment of essential hypertension

Taqi Hashmi
Miaaz Zidan
Hanan Khudadad
Yahyaa Hashmi

Primary Health Care Corporation, Qatar
RCSI, Bahrain
Family Medicine & Primary Care Review 2020; 22(3): 240–243
Online publish date: 2020/10/16
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Essential hypertension is a common, significant worldwide disease whose adequate treatment requires a multidrug regime in 70% of patients, where adherence to treatment ranges from low to very low (72.7% to 19.7%), and where each additional medication used causes a decrease in adherence by up to 85%. Hibiscus sabdariffa L. (HS) is a widely used herb which has been used for its antihypertensive effect, which may offer to play a useful synergistic role to pharmacotherapy.

This review sought to identify relevant basic laboratory studies, human randomised controlled studies (RCTs), meta-analysis and reviews studying the safety, mechanism and/or effect of HS on blood pressure.

Material and methods
A search was done, ending on the 1st of October 2019, of the following databases: Medline, COCHRANE and EMBASE. RCTs were assessed for quality using the Jadad scale.

Basic laboratory studies have shown that HS is rich in bioactive anthocyanins, which inhibit angiotensin-converting enzyme (ACE) in a dose-dependent manner, and HS extracts also have a direct vasodilator effect. 13 safety studies have found HS to be safe at normal doses with minimal clinically important drug-herb interaction. Very high doses (> 300 mg/kg/day) are associated with liver enzyme abnormalities and raised uric acid in rat studies. 14 RCTs show that HS causes a significant reduction in systolic blood pressure (-6.3 to -31.9 mm Hg) and diastolic blood pressure (-1.1 to -19.7 mm Hg).

HS is a widely available, acceptable, cheap and effective synergistic agent in the management of essential hypertension.


essential hypertension, Hibiscus sabdariffa, therapy

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