Herbal Therapies for Improving Endothelial Function in Patients with Hypertension: A Systematic Review

Abstract

Introduction: Endothelial dysfunction is a key early event in the pathogenesis of hypertension and atherosclerosis. This review assesses the efficacy of various herbal medicines in improving endothelial function in hypertensive patients.

Methods: We searched for RCTs that measured endothelial function, typically via Flow-Mediated Dilation (FMD), following supplementation with herbal products like French maritime pine bark extract, beetroot juice, or cocoa flavanols in hypertensive subjects.

Results: The review included 18 RCTs. The strongest and most consistent evidence was for French maritime pine bark extract and high-flavanol cocoa, both of which significantly improved FMD compared to placebo. Beetroot juice also showed a strong positive effect, linked to its high nitrate content.

Discussion: These herbal interventions improve endothelial function primarily by increasing the synthesis and bioavailability of nitric oxide, a key vasodilator. This represents a foundational approach to managing hypertension.

Conclusion: Pine bark extract, cocoa flavanols, and beetroot juice are evidence-based interventions for improving endothelial function in hypertension.