EMERGING ROLE OF NUTRACEUTICALS IN THE MANAGEMENT OF HYPERTENSION: A SYSTEMATIC REVIEW

EMERGING ROLE OF NUTRACEUTICALS IN THE MANAGEMENT OF HYPERTENSION: A SYSTEMATIC REVIEW

Rita Saini *, Anupriya Nautiyal and Shivanand Patil

Department of Pharmacy, Shree Dev Bhoomi Institute of Education, Science and Technology, Poundha, Dehradun, Uttarakhand, India.

ABSTRACT: Nutraceutical is a word obtained from Nutrition and Pharmaceuticals. Nutrients are a feed constituent that helps to support the life of human beings or animals. Pharmaceutical components are non-toxic food constituents, including prevention and treatment of disease. They commonly inhabit the disorders associated with oxidative stress, for instance, cardiovascular disease, Diabetes, and Hypertension. Nutraceuticals possess substantial importance because of their expected safety and possible nutritional and therapeutic effects. Hypertension is the most frequent risk factor for cardiovascular disease involving coronary heart disease and stroke. There is a crucial role in utilizing single and integral nutraceutical supplements, vitamins, antioxidants, and minerals in the treatment of hypertension. These food supplements rein huge demand because they are less toxic and have long life treatment with dietary food. We have done a face-to-face survey on 33 medical stores. The survey results found that the most demanding nutraceutical is Mactotal, and the least demanding nutraceuticals are Beryl tone and Allvell-Z graph seed extract. The survey study also shows a list of Nutraceuticals that are available in drug stores, including Mactotal, Omega fatty acids grape seed extract, Advanced BP support, Natural formula BP complex, Blood pressure formula, BP rescue, Cholbiome, Zeovita- 4G, Super B complex, Alpha-linolenic acid, Allvell-Z grape seed extract tablet, Antioxidant support, Vegifruit syrup, Beet juice and Beryl tone.

Keywords: Nutrition, Pharmaceutical, Hypertension, Cardiovascular disease, Diabetes

INTRODUCTION: Hypertension is not a disease it is a condition in which the force of blood against the artery walls is high. According to the 2017 American college of cardiology/ American heart association hypertension recommendations, hypertension is defined as systolic blood pressure above 130mmHg or diastolic blood pressure above 80mm Hg ¹.

Usually, hypertension occurs when the blood pressure is above 140/90mm Hg, considering if the pressure is above 180/120mm Hg. The Hong Kong cardiovascular prevalence population investigated of healthy people randomly selected; the popularity of hypertension was below 2% in young subjects aged 25-34, but the prevalence rises to around 50% in those 65-75 years of age ².

Research has recommended that the blood vessels naturally harden with age, losing their compliance. This may clarify why older people are more likely to modify high blood pressure ³. Hypertension disorders in pregnancy are among the most common medical complications, affecting 5% to 10% of pregnancies worldwide ⁴. The hypertension is divided into two types. Essential or primary hypertension when the condition has no known cause. When another condition causes hypertension, it is known as secondary hypertension ⁵. The factors of hypertension are shown in Table 1.

TABLE 1: FACTORS OF HYPERTENSION

Medication of Hypertension: There are some medications which are used in the condition of hypertension:

• Antihypertensive Drug: Antihypertensive drugs may decrease cardiac output by either inhibiting myocardial contractility or reducing ventricular filling pressure ⁶.
• Non-Pharmacological Management of hypertension: It is a harmless treatment and helpful either to eliminate the drug requirement or reduce the dose. Non-pharmacological approaches to reducing blood pressure generally treat patients with diastolic blood pressure in the range of 90 to 95mmHg ⁷.
• Reduction of Body Weight: Obesity and hypertension are closely associated, and obese hypertensive may lower their blood pressure by losing weight regardless of a change in salt consumption ⁸.
• Sodium Restriction: Severe salt restriction will lower the blood pressure in most hospitalized hypertensive patients; this treatment method was advocated before developing effective antihypertensive drugs ⁹.
• Physical Exercise: Lake of physical activity is associated with a higher incidence of hypertension ¹⁰.
• Diet: Natural vegetables and dietary products contain high potassium levels, which lower the BP by increasing sodium excretion, decreasing sympathetic activity, and renin-angiotensin secretion ¹¹.

Nutraceuticals: A nutraceuticals word combines ‘Nutrient’ and ‘Pharmaceutical’. According to AAFCO, 1996, ‘nutrient’ means a feed component in the form and at an extent that will assist or support of the life of a human being or animal occupy ‘nutraceutical’ means any non-toxic food constituent that has scientifically demonstrated health welfare, including the treatment of disease ¹². Nutraceuticals are defined as-, according to Dr. Stephen De Felice- a “food, or parts of a food, that contribute medical or health welfare including the prevention and treatment of disease ¹³. It is also known as “Functional food”. The nutraceuticals components elaborated on the other components like dietary supplements, herbal components, vitamins, and nutrients ¹⁴.

Hippocrates stressed in the certified means, “Let food be the medicine and medicine be food”, concerning 2000years previously ^{15, 16}. Nutraceutical components are the product in which the combination of nutrients and functional food are also used as medicine. Nutraceutical products are physiologically useful for the protection against in case of chronic disease, diabetes, cancer, high blood pressure, and Alzheimer's disease ¹⁷. The concept of nutraceuticals was started from the survey in U.K., Germany, and France, and its consumer then exercises hereditary factors to achieve an adequate health ¹⁸. Nutraceuticals are food derivatives that give therapeutic and health welfare, as well as the obstruction, Management, and treatment of disease, and involve a class the nutrient, encapsulated dietary additives, and frozen food.

Benefits of Nutraceuticals ^{19, 20}:

FIG. 1: BENEFITS OF NUTRACEUTICALS

Nutraceuticals are physiologically health beneficial in many diseases like cancer, heart disease and the treatment of hypertension, diabetes, arthritis, and nutraceuticals may offer many benefits in human health ^{13, 14}. Some benefits of nutraceuticals in human life are shown in Fig. 1.

• It increases the value of the diet.
• It may help us live longer.
• It helps us to avoid any particular long-term medical condition.
• It may be more natural than traditional medicine and helps produce less side effect in the body.
• It fulfills the deficiency of nutrients in our body.
• These are easily available in market and market and they are economically affordable.

Types of Nutraceuticals ^{21, 22}: The nutraceuticals are mainly divided in two types:

1. Traditional Nutraceuticals: This is the class which we get directly from nature without changing any natural form. Many constituents such as lycopene in tomatoes, saponins in soy are present and ingested for health benefits. Traditional nutraceuticals can be classified on the basis of:

(a) Chemical constituents: Based on chemical constituents the, nutraceuticals can divide into three types:

• Nutrients: Plant and animal products with a vitamin have many health welfares and are pleasant in curing heart, kidney, lung disease, etc. The nutrients elaborated the minerals, vitamins, and amino acids, with granted nutritional functions.
• Herbals: Nutraceuticals and herbs have a worthy influence on preventing many chronic diseases and producing healthier lives. Peppermint (Mentha piperita) carries several terpenoids, mainly menthol, a bioactive component and cures a cold and aches. Tannins contents of lavender assist issuing stress and blood pressure and are convenient for lung disorders.
• Phytochemicals: Phytochemicals are the nutrients based on plants with specific biological occupations that encourage human health. They are further mentioned as phytonutrients. Ex- Flavonoids, Phenolic acids, curcumin.

(b) Nutraceutical Enzyme: Some enzymes are obtained from plants, animals, and microbial origin. Enzymes are a crucial part of life, without which our body is authorized to come to an end of the function.

(c) Probiotic Microorganism: Probiotics manners ‘for life’. They are described as live microorganisms, which, when ingested in tolerable aggregates, consult a health effect on the host. Ex- Insulin.

2. Non-traditional Nutraceuticals are food enhanced with additives or biotechnologically designed crops to improve the nutrients. Such as Rice and Broccoli are well off beta-carotene and vitamins. Non-traditional nutraceuticals are classified as follows:

• Fortified Nutraceuticals are enhanced with vitamins and minerals, generally at a range up to 100% of the dietary supplements gaining for the nutrient. These are nutraceuticals from agricultural procreation or added nutrients and constituents.
• Recombinant Nutraceuticals: Biotechnology implements have been well applied between an agitation process in several food substances such as cheese and bread to extract the enzyme convenient for providing essential nutrients at best level.

Nutraceuticals in Management of Cardiovascular disease Hypertension]: Cardiovascular diseases (CVD) are chronic diseases using disorders of the heart and blood vessels which generally include hypertension [high blood pressure], coronary heart disease [heart attack], stroke, etc. ²³.

The nutraceuticals reduce the possibility of cardiovascular by regulating several possible factors such as oxidative strain, and renin-angiotensin structure hyperactivity. Nutraceutical derivatives, antioxidants, vitamins, and natural components in food produce effects that are a class of medications that reduce blood pressure ²⁴.

High blood pressure is one of the most relevant independent risk factors of CVDs and the most prevalent all over the world.

Reduction in nitric oxide bioavailability, increase in angiotensin-II and endothelin coupled with endothelial activation initiate the vascular and cardiac dysfunction and hypertension ²⁵.

Dietary folate and plasma ascorbic acid has been found to be inversely associated with blood pressure. Lower risk of elevated blood pressure in the multiple supplement groups suggests that there was a relationship between these nutrients and blood pressure ²⁶.

Nutraceuticals or the supplements of the nutrients of the nutraceuticals reduces the hypertensive condition by lowering blood pressure and increasing antioxidant enzymes.

“Antihypertensive” Foods, Nutrients and Nutraceuticals: The European society of hypertension [ESH] specialists board has published a paper on nutraceuticals and BP control that assorted the natural compounds with clinically measurable consequences on BP in foods, nutrients, and non- nutrient nutraceuticals ²⁷.

“Antihypertensive” Food: It is a food supplement that is used to reduce high blood pressure. Antihypertensive food is a dietary supplement that fulfills the deficiency in the body, which is the biggest cause of hypertension.

Antihypertensive foods are often naturally obtained and used as nutraceuticals without any adulterations. Table 2 shows some food components which is showing antihypertensive properties:

TABLE 2: ANTIHYPERTENSIVE FOOD AND THEIR FUNCTIONS

Antihypertensive Nutrients ³⁵: Antihypertensive nutrients are the compounds that are naturally present in our diet with accepted nutritional levels, such as minerals, vitamins, fatty acids, and polysaccharides. Nutrients/minerals are an element that does not maintain blood pressure but prevents the occurrence of arterial hypertension. Table 3 shows the nutrients which are shown antihypertensive properties:

TABLE 3: ANTIHYPERTENSIVE NUTRIENTS/ MINERALS AND THEIR FUNCTIONS

MATERIAL AND METHOD: A small face-to-face survey has been done on different medical shops/ drug stores in the areas of Dehradun, like near kanwali road, Dharmpur, Premnagar, Ballupur, Rispana, Doon hospital, Jogiwala. We found that some of the drug stores prefer nutraceuticals.

This survey data includes various types of nutraceuticals that are revealed through an offline (face to face) survey from December 15, 2021 to January 10, 2022. In this survey, we have collected data from chemist’s responses.

Survey Report of Nutraceuticals used in Management of Hypertension: Survey is a procedure of convention data from a sample of people, regularly with the purpose of generalizing the effect to a larger population. A survey gives an analytical source of data and awareness for nearly everyone occupied in the particular’s economy, from business and the media to government and academics. There are 4 modes of survey data collection: face-to-face survey, Telephone survey, Self- administered paper and pencil survey, Self- administered computer survey. This face-to-face survey reveals which nutraceuticals are used in the market for the Management of hypertension. Nutraceuticals are often available in the market in the form of tablet; capsule and oral formulations (Syrup).

Most formulations are available in the nutraceuticals market in the form of soft gel capsules. These nutraceuticals also contain some nutrients that can decrease blood pressure, as well as the lack of nutrition in the body, such as due to lack of vitamins, calcium, and magnesium, phosphorous in the body and chronic disease due to lack of nutrients in the body. In this case, nutraceuticals or dietary supplements are also taken. This survey reveals which nutraceuticals are highly demanding in the market. As per the survey, some of the marketed formulations of nutraceuticals are as follows:

Marketed Formulations of Nutraceuticals for Hypertension: As per the survey, the marketed formulation of nutraceuticals is shown in Table 4:

TABLE 4: MARKETED FORMULATIONS OF NUTRACEUTICALS

FIG. 2: GRAPH OF MARKETED DEMAND OF NUTRACEUTICALS IN THE FORM OF TABLET

FIG. 3: GRAPH OF MARKETED DEMAND OF NUTRACEUTICALS IN THE FORM OF CAPSULE                 

FIG. 4: GRAPH OF MARKETED DEMAND FOR  NUTRACEUTICALS IN THE FORM OF LIQUID ORALS

These graphs displayed which nutraceutical is preferred for hypertension in the market and which nutraceutical is most demanding in the market. After surveying 33 drugstores, we found that the most demanding nutraceutical is Mac total. This graph shows that most preferred nutraceutical is Mactotal, and the least demanding nutraceuticals are Beryl tone and Allvell-Z grape seed extract.

Marketed Formulation, Ingredients & their Functions: These are some antihypertensive drugs that are used as a marketed formulation of nutraceuticals.

Table 5 includes the composition and the functions of these antihypertensive drugs.

TABLE 5: MARKETED FORMULATIONS OF NUTRACEUTICALS & THEIR FUNCTIONS

CONCLUSION: It is concluded that the above-studied nutraceuticals that is Mactotal, Omega fatty acids grape seed extract, Advanced BP support, Natural formula BP complex, Blood pressure formula, BP rescue, Cholbiome, Zeovita- 4G, Super B complex, Alpha-linolenic acid, Allvell-Z grape seed extract tablet, Antioxidant support, Vegifruit syrup, Beet juice, Beryl tone.

These nutraceuticals and functional foods reduce blood pressure, in which mactotal, this effect is most likely mediated by inhibiting ACE activity, modulating NO production, scavenging free radicals, and improving endothelial function. The most demanding nutraceutical is Mactotal and least demanding nutraceutical is Allvell- Z grape seed extract and Barytone. This surveyed nutraceutical is in huge demand due to their fewer toxic effects and having good self-life as well as long life treatment with dietary foods.

ACKNOWLEDGEMENT: We acknowledge Mr. S. N. Nautiyal (Chairman), Shree Dev Bhoomi Institute of Education, Science and Technology, Dehradun, for the encouragement to do this work.

CONFLICTS OF INTEREST: Authors declare that there is not any conflict of interest.

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    How to cite this article:

    Saini R, Nautiyal A and Patil S: Emerging role of nutraceuticals in the management of hypertension: a systematic review. Int J Pharm Sci & Res 2023; 14(1): 62-70. doi: 10.13040/IJPSR.0975-8232.14(1).62-70.

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