South African Journal of Botany: Muhammad Zakariyyah Aumeeruddy, Mohamad Fawzi Mahomoodally

South African Journal of Botany 0 0 0 (2020) 1–18
Contents lists available at ScienceDirect
South African Journal of Botany

journal homepage: www.elsevier.com/locate/sajb
Traditional herbal therapies for hypertension: A systematic review of

global ethnobotanical field studies
Muhammad Zakariyyah Aumeeruddy a, Mohamad Fawzi Mahomoodally a,b,∗
a
Department of Health Sciences, Faculty of Science, University of Mauritius, 230 Réduit, Mauritius
b
Institute of Research and Development, Duy Tan University, Da Nang 550000, Viet Nam
a r t i c l e i n f o a b s t r a c t
Article history: The worldwide burden of hypertension and its associated cardiovascular diseases have urged researchers
Received 21 June 2020 to explore for alternative therapies. Together with laboratory studies, field surveys on the documenta-
Revised 20 August 2020
tion of traditional antihypertensive therapies have expanded across the world. However, a compilation
Accepted 2 September 2020
and analysis of these field studies has not been done so far. This review aim to document all traditional
Available online xxx
medicinal plants used globally for the management of hypertension. Field studies were retrieved from
Keywords: main databases including Sciencedirect, Medline/PubMed, and Google Scholar. 433 surveys were obtained
Cardiovascular diseases which dated from 1970 to 2019. A total of 1329 traditionally used plant species (823 genera and 176
Ethnomedicine families) were reported across 90 countries against hypertension. Compositae (Genera: 68; Species:103)
Hypertension and Lamiaceae (Genera:39; Species:103) were the families with the most used species. The main species
Hypotensive (in order of number of reports) were Allium sativum L., followed by Olea europaea L., Allium cepa L., An-
Medicinal plants
nona muricata L., Persea americana Mill., Citrus aurantiifolia (Christm.) Swingle, Catharanthus roseus (L.)
Traditional
G.Don, Moringa oleifera Lam., Cymbopogon citratus (DC.) Stapf, and Carica papaya L. Pakistan (Family:81;
Species:246) reported the highest number of plant species followed by Mexico, Nigeria, India, Algeria,
Morocco, Thailand, Suriname, Benin, and Iran. Leaf (35%), fruit (12%), and root (10%) were the most pre-
ferred plant parts while the main methods of preparation were decoction (50%) and infusion (22%). This
study is the first of its kind to compile all traditionally used hypotensive medicinal plants across the
world. It is recommended that another systematic review be conducted on the biological properties of all
identified species in our review to identify those which have been scientifically validated in in vitro, in
vivo, and clinical studies before they can be considered as alternative or complementary antihypertensive
therapies.
© 2020 SAAB. Published by Elsevier B.V. All rights reserved.
1. Introduction is termed as prehypertension. Patients with this condition have an

increased risk for progression to hypertension. Hypertension is de-
Hypertension, also known as high blood pressure, is a major fined as a systolic blood pressure ≥140 mmHg or a diastolic blood
contributor to cardiovascular diseases. It is a condition in which pressure ≥90 mmHg (Khatib and El-Guindy, 2005).
blood vessels have a persistent raised pressure. Blood pressure is From 1975 to 2015, the number of adults with hypertension
induced by the force of blood pushing against the walls of arter- has increased from 594 million to 1.13 billion, with the increase
ies as it is pumped by the heart. A high pressure indicates that the seen largely in low- and middle-income countries (WHO, 2019).
heart has to pump harder than normal (WHO, 2019). Normal blood The highest prevalence of hypertension is found in the African Re-
pressure is defined as levels <120/80 mmHg. Systolic blood pres- gion at 46% of adults aged 25 and above, while the prevalence is
sure of 120–139 mmHg or a diastolic blood pressure 80–89 mmHg lowest in the Americas at 35% (WHO, 2013). National surveys con-
tinue to show that hypertension is often not detected and, where
diagnosed, is often inefficiently treated (Foëx and Sear, 2004).
Abbreviations: ACE, angiotensin-converting enzyme; DPB, diastolic blood pres- Hypertension is estimated to be responsible for 70% heart at-
sure; Fam, family; L-NAME, NG-nitro-L-arginine methyl ester; Gen, genera; SBP, sys- tacks, strokes, and chronic heart failure, causing 13.5% of cardio-
tolic blood pressure; Spc, species.
∗
vascular deaths globally (Ried and Fakler, 2014). Among the Non-
Corresponding author at: Department of Health Sciences, Faculty of Science,
University of Mauritius, 230 Réduit, Mauritius. communicable diseases, cardiovascular diseases are responsible for
most annual deaths (17.9 million), followed by cancers (9.0 mil-
E-mail addresses: f.mahomoodally@uom.ac.mu, mohamadfawzimahomoodally@duytan.edu.vn
(M.F. Mahomoodally).
https://doi.org/10.1016/j.sajb.2020.09.008
0254-6299/© 2020 SAAB. Published by Elsevier B.V. All rights reserved.
2 M.Z. Aumeeruddy and M.F. Mahomoodally / South African Journal of Botany 000 (2020) 1–18
lion), respiratory diseases (3.9 million), and diabetes (1.6 million) 2.3. Data extraction
(WHO, 2018).
Treatment for hypertension involves a change in lifestyle and Two plant databases were used for validation of species names:
medicines. Lifestyle changes include cessation of tobacco and al- The Plant List (http://www.theplantlist.org/) and The International
cohol use, improvements in diet and exercise, managing men- Plant Names Index (IPNI) (www.ipni.org). In case the names of
tal stress, and regular check of blood pressure (WHO, 2019). plants were misspelled, google search was performed to recheck
Currently used drugs include diuretics (sometimes called “water the names followed by validation with the two databases listed
pills”), angiotensin-converting enzyme (ACE) inhibitors, beta block- above. Synonyms of species names were taken into consideration
ers, calcium channel blockers, peripherally acting alpha-adrenergic to avoid repetition in the counting process.
blockers, angiotension II antagonists, vasodilators, centrally-acting For species which are unresolved in The Plant List but found in
alpha adrenergics, renin inhibitors, and combination medicines IPNI, a single asterisk ∗ was placed besides the names.
(FDA, 2019). However, the side-effects associated with antihyper- For species which were reported as “sp.” but the species were
tensive drugs including dizziness, tiredness, headache, upset stom- not specified, two asterisks ∗∗ were placed besides the names.
ach, and swelling (FDA, 2019), have motivated researchers to find These species were included but were counted only if no such
new medicines in metabolites or extracts from plants to control species has been recorded in their respective genera, e.g. “Aspara-
hypertension. gus sp.” was not counted because other Asparagus species such
Medicinal plants have been used since ancient times for the as Asparagus racemosus Willd. and Asparagus capensis L. were also
management of various ailments. Such remedies have now spread listed, while “Lasia sp.”, “Arnebia sp.”, “Cnestis sp.”, “Mollugo sp.”,
all through the global markets and both consumers and medi- “Stenocalyx sp.”, “Bistorta sp.”, and “Aquilaria sp.” were counted be-
cal professionals have started to entrust and rely on these phy- cause they were the only species listed in their genera.
tomedicines (Aziz et al., 2014; Saleem et al., 2019a). Currently, For species which were not found in these two databases but
the application of modern scientific techniques have proved to were included, three asterisks ∗∗∗ were placed besides the names,
be efficient in the isolation, purification, and characterization of including Teucrium rogleanom L. and Crataegus sericea Dzekov.
a plethora of plant bioactive compounds, and also provided key
insights into their mechanisms of action and therapeutics effects 2.4. Data representation
(Saleem et al., 2019b).
So far, the use of traditional medicinal plants against noncom- Table A, showing the detailed list of plants along with their
municable diseases has been documented by field studies con- country reported, parts and method of preparation used was in-
ducted across the world. Nonetheless, a compilation and analysis serted in Supplementary file A. "NI" (not indicated) was written
of these surveys for specific ailment, such as hypertension, is still when no information was specified on parts and method of prepa-
lacking. According to data scrutinized from literature, a previous ration used. A hyphen was inserted in the column of plant parts
review (Baharvand-Ahmadi and Asadi-Samani, 2017) on the medic- and method because in some surveys many parts and methods
inal plants of Iran revealed the use of 40 species against hyperten- of preparation were reported for several ailments and the specific
sion while another review by Meresa et al. (2017) listed 66 plants plant part and method used only for hypertension were not spec-
used as hypotensive in Ethiopia. However, a global documentation ified. Table A was reorganised into four tables (1–4) to summarize
of traditionally used medicinal plants in the management of hyper- the findings.
tension has not been done so far. Consequently, the objectives of
this study were to (i) list all medicinal plants used against hyper- 2.5. Study selection
tension worldwide, (ii) highlight the countries where these species
were reported, and (iii) report the main plant parts and method of 638 relevant articles were obtained from the screening of
preparation used. databases, of which 192 were duplicates. 13 were excluded after
analysis of our inclusion and exclusion criteria, and 433 surveys
2. Methodology were included (see selection process in Fig. 1.).
2.1. Search strategy 3. Results
Surveys were identified from main scientific databases such as 3.1. Traditional medicinal plant families and species used against
Sciencedirect, Medline/PubMed, and Google Scholar. We used spe- hypertension
cific keywords including “Ethnomedicinal + hypertension”, “Eth-
nomedicine + hypertension”, “Ethnobotanical + hypertension”, A total of 1329 species (Spc) belonging to 823 genera (Gen)
“Ethnomedical + hypertension”, “Ethnopharmacological + hyper- under 176 families (Fam) were identified as traditionally used
tension”, “Folk + hypertension”, “Traditional + hypertension”, “In- plants to treat hypertension (Table 1). Compositae was the fam-
digenous + hypertension”, “Plants + hypertension”, “Herbal + hy- ily with the most used genera and species (see Fig. 2) (Gen:68;
pertension”, and “Natural products + hypertension”. A hyphen (-) Spc:103). The other familes with high number of species used to
was inserted after the word "ethno" during the searching process manage hypertension were Lamiaceae (Gen:39; Spc:103), Legumi-
in order not to miss any articles which made use of this symbol in nosae (Gen:66; Spc:98), Rosaceae (Gen:18; Spc:54), Apocynaceae
their title e.g. ethno-medicinal, ethno-botanical, and so on. (Gen:30; Spc:42), Malvaceae (Gen:20; Spc:33), Rubiaceae (Gen:23;
Spc:31), Rutaceae (Gen:13; Spc:30), Solanaceae (Gen:11; Spc:29)
2.2. Inclusion and exclusion criteria and Poaceae (Gen:25; Spc:29). The twenty families reported in the
present review (in order of highest number of species reported)
Our inclusion criteria were that (i) articles should be published are displayed in Fig. 2.
in English language, (ii) articles should be field studies (surveys), With regards to the plant species, Allium sativum L. was mostly
(iii) all articles identified until 2019 were included. We also used reported (n = 113), followed by Olea europaea L. (n = 46), Al-
the following exclusion criteria: (i) articles with no study areas or lium cepa L. (n = 34), Annona muricata L. (n = 32), Persea ameri-
scientific plant names, (ii) articles with only abstract, and (iii) arti- cana Mill. (n = 27), Citrus aurantiifolia (Christm.) Swingle (n = 25),
cles in non-English language. Catharanthus roseus (L.) G.Don (n = 23), Moringa oleifera Lam.
M.Z. Aumeeruddy and M.F. Mahomoodally / South African Journal of Botany 000 (2020) 1–18 3
3.2. Regional wise plant utilization for the treatment of hypertension
The traditional use of plants against hypertension has been

recorded in 90 countries; 24 from the African continent, 26
from Asia, 20 from Europe, 7 from North America, 10 from
South America, 2 from Oceania, and 1 (Marquesas Islands) which
is far from any continent (see all countries in Table 2). The
country with the most number of species reported is Pakistan
(Fam:81; Spc:246), followed by Mexico (Fam:75; Spc:184), Nige-
ria (Fam:59; Spc:144), India (Fam:59; Spc:137), Algeria (Fam:40;
Spc:97), Morocco (Fam:40; Spc:90), Thailand (Fam:47; Spc:83),
Suriname (Fam:47; Spc:80), Benin (Fam:42; Spc:79), and Iran
(Fam:31; Spc:73).
With regards to the countries where the main plant families
were reported, the use of the Lamiaceae family was observed in
48 countries, Compositae in 48 countries, Leguminosae in 39 coun-
tries, Rosaceae in 35 countries, and Apocynaceae in 31 countries
(Table 3). The common countries where at least 3 of these 5 fam-
ilies were reported are Algeria, Argentina, Benin, Brazil, Bulgaria,
China, Congo, Greece, India, Iran, Italy, Jordan, Kenya, Korea, Mada-
gascar, Malaysia, Mauritius, Mexico, Morocco, Nicaragua, Nigeria,
Pakistan, Philippines, Portugal, Reunion, Singapore, South Africa,
Suriname, Tanzania, Thailand, Togo, and Turkey. As for the main
plant species reported (see Table 4), Allium sativum L. was re-
ported in 41 countries, Allium cepa L. in 18 countries, Olea europaea
Fig. 1. Flow chart used for design of current review.
L. in 17 countries, Catharanthus roseus (L.) G.Don in 15 countries,
Moringa oleifera Lam. in 15 countries, Persea americana Mill. in 14
countries, Annona muricata L. and Carica papaya L. in 13 coun-
tries, Citrus aurantiifolia (Christm.) Swingle and Cymbopogon citra-
(n = 22), Cymbopogon citratus (DC.) Stapf (n = 22), and Carica pa- tus (DC.) Stapf in 11 countries. The common countries where at
paya L (n = 21). The twenty species recorded in the present review
(in order of highest number of reports) are shown in Fig. 3.
Fig. 2. Twenty traditionally used plant families with highest number of genera and species reported against hypertension.
Fig. 3. Twenty traditionally used medicinal plant species with highest number of reports against hypertension.
least 6 of these 10 species were reported are Benin, Mauritius, 4. Discussion

Nigeria, Pakistan, Philippines, and Togo.
From the compiled data, a huge amount of traditionally used
medicinal plants against hypertension was reported. However, we
3.3. Plant parts observed few key points which need to be discussed.
Firstly, it was observed that Lamiaceae and Compositae were
Analysis of the plant parts revealed that leaf (n = 1004) was the families of plants with most number of reports. The most prob-
mostly used, followed by fruit (n = 353), root (n = 293), aerial able reason for their high usage could be due to their large num-
parts (n = 244), flower (n = 168), seed (n = 157), whole plant ber of species distributed worlwide and thus have a higher prob-
(n = 151), stem, (n = 141), bark (stem/root) (n = 135), bulb ability of being used by the global population. As per The Plant
(n = 100), rhizome (n = 33), tuber (n = 23), shoot (n = 19), ex- List, the Compositae family consists of 32,913 accepted species
udates (resin, sap, latex) (n = 13), wood (n = 11), bud (n = 9), names while Lamiaceae consists of 7886 accepted species names
branch (n = 7), clove (n = 6), pod (n = 5), corm (n = 3), sprouts (http://www.theplantlist.org/).
(n = 2), and gum (n = 1). The percentage use of the different plant Another reason for their high reports could be because species
parts are shown in Fig. 4. of these families are potent hypotensive agents, but it could also be
certain native plants from specific regions with less number of re-
ports possess high antihypertensive properties. However these as-
3.4. Methods of preparation sumptions have to be systematically analysed by reviewing the bi-
ological properties of each species to compare their potency.
The most preferred methods of preparation of formulations Furthermore, the high use of leaves, as observed in the present
were decoction (n = 1136) and infusion (n = 507) (see per- review, is a general trend in herbal medicine, most likely due to
centage of use in Fig. 5). Other less reported methods were in- their high abundancy and availability compared to other parts of
gested (eaten/drunk) raw (n = 131), juice (n = 118), macera- plant (Rao et al., 2015). As for conservation, the use of leaves indi-
tion (n = 108), powdered followed by ingestion directly or with cate a more sustainable practice in comparison to root harvesting
water/pap/honey/juice/tea (n = 107), cooked/vegetable/flavouring processes which could be a threat for the survival of some species.
(n = 87), tincture/essence/alcohol extract (n = 24), paste (n = 17), In addition, using too much fruits and seeds may cause adverse
fermented/vinegar/brewing (n = 15), bath/massage (n = 9), effect on plant genetic diversity and distribution due to their role
burn/smoked (n = 8), ingested directly with water (n = 7), oil in sexual reproduction and dispersal (Rao et al., 2015). Moreover, it
(n = 5), pill/capsule (n = 2), syrup (n = 2), lyophilisate (n = 2), was observed that decoction was the main method used for prepa-
poultice (n = 1), mash (n = 1), and hydrodistilled (n = 1). The ration of various formulations. This could be due to the fact that
various methods of preparation are displayed in Table A in Supple- decoction is more rapid compared to other methods such as infu-
mentary file A.
sion and maceration which may take hours for the extraction pro- the use of traditional and complementary medicine against hyper-
cess. The use of heat in herbal preparations is known to accelerate tension. It is also recommended that future field studies properly
biological reactions and increase the availability of bioactive con- document specific information of the method of preparation, dose
ponents (Homervergel et al., 2018). taken, duration of treatment, conventional treatment undergoing,
and whether improvement in health or side effects are experienced
5. Conclusion and future perspectives with the use of these medicinal plant species.
As the next and most important step, it is highly recommended
To sum up, this study is the first of its kind to document the that another systematic review be conducted on the biological
global use of traditional medicinal plants against hypertension. A properties of all identified species in our review to identify those
vast number of species have been identified in various countries which have been scientifically validated as antihypertensive in
with different methods of preparation. This study is a big step vitro, in vivo, and clinical trials. The effectiveness of different sol-
in providing base line information for the scientific community. vents and extraction techniques on the hypotensive properties of
Nonetheless, several research gaps have been identified that war- plant extracts should be critically analysed to develop optimum ex-
rants due attention in future studies. tracting procedures.The bioactivity of isolated phytochemical from
Firstly, field studies on the documentation of traditional medic- the listed plants should be systematically reviewed including their
inal plants against hypertension are lacking in a lot of countries. mechanism of actions by which they exert their therapeutic effects,
It could also be that many surveys have been carried out and and their potentiating effects on conventional hypotensive drugs,
published in local languages and could not be reviewed in the thereby serving as valuable starting points for drug discovery and
present study. More field studies should also be conducted among developments.
hypertensive patients in regions with high prevalence of hyperten-
sion because of a higher probability of obtaining useful data on
Table 3
Countries where the five main plant families have been reported against hypertension.
Lamiaceae Compositae Leguminosae Rosaceae Apocynaceae
Algeria Afghanistan Algeria Albania Argentina

Belarus Algeria Argentina Algeria Bangladesh
Benin Argentina Benin Belarus Benin
Bhutan Benin Brazil Brazil Bhutan
Brazil Bolivia China Bulgaria Bulgaria
China Brazil Congo Cyprus China
Colombia Bulgaria Eritrea Georgia Congo
Congo China Ethiopia Greece French Guiana
Cuba Congo French Guiana India Guyana
Cyprus Cuba Ghana Iran India
Egypt Egypt Greece Italy Iran
Eritrea Greece Guinea Jordan Italy
Ethiopia Guatemala Guyana Kenya Kenya
Georgia India India Kosovo Korea
Germany Indonesia Iran Lebanon Laos
Ghana Iran Kenya Macedonia Madagascar
Greece Iraq Korea Mauritius Malaysia
India Italy Madagascar Mexico Martinique
Indonesia Jordan Malaysia Montenegro Mexico
Iran Kenya Martinique Morocco Myanmar
Iraq Korea Mauritius Pakistan Nepal
Italy Lebanon Mexico Palestine Nigeria
Jordan Madagascar Morocco Portugal Pakistan
Kenya Malaysia Nicaragua Romania Philippines
Kosovo Martinique Nigeria Russia Reunion Island
Libya Mauritius Pakistan Sardinia South Africa
Malaysia Mexico Philippines Serbia Suriname
Mauritius Morocco Reunion Island South Africa Tanzania
Mexico Myanmar Sierra Leone Spain Thailand
Morocco Nepal Singapore Syria Togo
Nicaragua Nicaragua South Africa Turkey Vietnam
Nigeria Nigeria Spain Ukraine
Pakistan Pakistan Sudan United Kingdom
Peru Panama Suriname United States
Philippines Philippines Tanzania Uzbekistan
Portugal Portugal Thailand
Rodrigues Reunion Island Togo
Russia Rodrigues Uganda
Singapore Sierra Leone Vietnam
South Africa Singapore
Suriname South Africa
Tanzania Sudan
Thailand Suriname
Togo Thailand
Turkey Togo
Ukraine Turkey
United Kingdom Uganda
Uzbekistan Zimbabwe
Fig. 4. Percentage use of different plant parts against hypertension.
Fig. 5. Percentage of use of various methods of preparations of plants against hypertension.
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Table 2
Number of traditional plant families and species reported against hypertension in different coun-
tries.
Continent Country Number of families Number of species
Africa Algeria 40 97
Benin 42 79
Central African Republic 8 10
Congo 22 29
Egypt 8 9
Eritrea 9 9
Ethiopia 13 22
Ghana 13 15
Guinea 10 15
Kenya 16 23
Libya 2 4
Madagascar 19 22
Mauritius 23 37
Morocco 40 90
Nigeria 59 144
Reunion 23 26
Rodrigues 17 22
Sierra Leone 9 13
South Africa 33 60
Sudan 10 15
Tanzania 14 18
Togo 27 49
Uganda 6 7
Zimbabwe 1 1
Asia Afghanistan 7 10
Bangladesh 4 4
Bhutan 9 9
China 33 48
India 59 137
Indonesia 33 45
Iran 31 73
Iraq 7 8
Jordan 8 10
Korea 11 12
Laos 2 2
Lebanon 5 7
Malaysia 42 61
Myanmar 11 13
Nepal 15 16
Pakistan 81 246 (1 unknown)
Palestine 8 8
Philippines 33 52
Russia 7 10
Saudi Arabia 1 1
Singapore 9 12
Sri Lanka 2 2
Syria 3 4
Thailand 47 83
Uzbekistan 10 15
Vietnam 3 3
Europe Albania 4 4
Belarus 8 12
Bolivia 7 7
Bulgaria 7 9
Georgia 4 5
Germany 4 7
Greece 18 30
Italy 24 44
Kosovo 10 18
Macedonia 3 5 (1 unknown)
Montenegro 1 1
Netherlands 4 4
Portugal 6 8
Romania 10 13
Sardinia 3 3
Serbia 2 2
Spain 12 16
Turkey 31 73
Ukraine 2 2
United Kingdom 10 14
North America Guatemala 4 4

Martinique 19 25
Mexico 75 184
Nicaragua 10 14
Jamaica 1 1
Panama 5 5
United States 5 5
, Egypt, Eritrea, Ethiopia, Germany, Greece, India, Indonesia, Iran, Iraq, Italy, Jamaica, Kosovo, Macedonia, Madagascar, Malaysia, Martinique, Mauritius, Mexico, Morocco, Myanmar, Nicaragua, Nigeria, Pakistan, Palestine, Philippines, Rodrigues, Romania, Sau
Panyaphu et al., 2011; Papp et al., 2014; Pascaline et al., 2010;

Peltzer et al., 2016; Picking et al., 2015; Pieroni, 2017; Amel, 2013;
Pieroni et al., 2014; Pieroni and Giusti, 2009; Pieroni et al.,
2016; Pieroni et al., 2015a; Pieroni et al., 2005; Pieroni et al.,
2015b; Pieroni and Sõukand, 2017; Polat, 2019; Polat et al., 2015;
Polat et al., 2013; Amini and Hamdam, 2017; Polat and Satil, 2012;
Polat et al., 2012; Pöll, 2005; Popoola and Obembe, 2013;
Putri et al., 2016; Rabearivony et al., 2015; Rai and Lalramnghin-
glova, 2010; Rajaei and Mohamadi, 2012; Rajamanoharan, 2014;
Rajendran et al., 2003; Amjad et al., 2017; Rakotondrafara et al.,
2018; Ramli et al., 2015; Randriamiharisoa et al., 2015;
Razafindraibe et al., 2013; Regassa, 2013; Rehecho et al., 2011;
Rehman et al., 2017; Riondato et al., 2019; Amri and Kisan-
gau, 2012; Ripen and Noweg, 2016; Rout et al., 2009; Sabeen et al.,
Countries where the ten main plant species have been reported against hypertension. (Note: The species in the first column are arranged in order of number of reports (see Fig. 3)).
2009; Sadat-Hosseini et al., 2017; Sadeghia and Mahmood, 2014;

Saha et al., 2014; Saikia, 2006; Saltos et al., 2016; Anderson and
The, 1999; Samar et al., 2015; Samoisy and Mahomoodally, 2015;
Samuel et al., 2010; Sankaranarayanan et al., 2010; Saqib and
Janbaz, 2016; Sargin et al., 2013; Sargin et al., 2015a, 2015b;
Sarri et al., 2012; Savo et al., 2011; Andrade-Cetto, 2009;
Scherrer et al., 2005; Semenya et al., 2012; Semenya and Pot-
gieter, 2015; Sen et al., 2011; Seyoum and Zerihun, 2014;
Sezik et al., 2004; Shah and Khan, 2006; Shah et al., 2016;
Sher et al., 2015; Sher and Alyemeni, 2011; Angmo et al.,
2012; Shin et al., 2018; Shrestha et al., 2015; Shuaib et al.,
2019; Siew et al., 2014; Silalahi et al., 2015; Singh, 2015;
Singh, 2018; Song and Kim, 2011; Song et al., 2014; Sõukand
et al., 2017a; Ari et al., 2015; Sõukand et al., 2017b; Ssegawa and
Kasenene, 2007; Stryamets et al., 2015; Suárez, 2019; Subedi, 2017;
Sudarmono, 2018; Sujarwo and Caneva, 2015; Sujarwo et al.,
2015; Suleiman, 2015; Sureshkumar et al., 2017; Arquion et al.,
2015; Suroowan and Mahomoodally, 2013; Susalit et al., 2011;
Sydara et al., 2014; Tahraoui et al., 2007; Tantengco et al., 2018;
Tareau et al., 2017; Tchicaillat-Landou et al., 2018; Teklay et al.,
2013; Temam and Dillo, 2016; Tetik et al., 2013; Adeniran, 2015;
Aston Philander, 2011; Thring and Weitz, 2006; Tiţǎ et al.,
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2014c; Ullah et al., 2014; Upadhyay et al., 2010; Uysal, 2010;
Atawodi et al., 2014; Uzun and Kaya, 2016; van Andel and
Westers, 2010; Vázquez et al., 1997; Vijayakumar et al., 2015;
Vitalini et al., 2013; Vitalini et al., 2015; Vokou et al., 1993;
Waay-Juico et al., 2018; Wangchuk et al., 2008; Wanzala et al.,
vo, Martinique, Mexico, Morocco, Nigeria, Pakistan, Peru, Philippines, Romania, Spain, Togo, Turkey
, Ghana, Guyana, Malaysia, Marquesas Islands, Mauritius, Nigeria, Pakistan, Philippines, Suriname
2016; Aththorick and Berutu, 2018; Waruruai et al., 2011;

ysia, Martinique, Nigeria, Pakistan, Philippines, South Africa, Suriname, Tanzania, Togo, Vietnam
ius, Morocco, Pakistan, Palestine, Portugal, Reunion, Rodrigues, Sardinia, Spain, Syria, Turkey
Wassie et al., 2015; World Health Organization (WHO) 2018;

s, Myanmar, Nigeria, Pakistan, Philippines, Reunion, Rodrigues, Sierra Leone, Thailand, Togo
Yaoitcha et al., 2015; Yaovi-Gameli et al., 2018; Yirga, 2010;

donesia, Mauritius, Mexico, Nigeria, Panama, Philippines, South Africa, Suriname, Togo
Youssef, 2013; Zenebe et al., 2012; Au et al., 2008; Augustino et al.,

2011; Awang et al., 2018; Ayeni and Aliyu, 2018; Aziz et al.,
nesia, Malaysia, Mauritius, Philippines, Reunion, Rodrigues, Suriname, Thailand
2017; Azizi and Keshavarzi, 2015; Adsersen and Adsersen, 1997;

Azliza et al., 2012; Baharvand-Ahmadi et al., 2016; Balangcod and
Balangcod, 2011; Balangcod and Balangcod, 2015; Baleta et al.,
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Siswanto, 2017; Baydoun et al., 2015; Afolayan and Mbaebie, 2010;
Bekoe et al., 2017; Benarba et al., 2015; Benatrehina et al., 2018;
Benítez et al., 2010; Bertsch, 2011; Bhuyan and Baishya, 2013;
Bieski et al., 2015; Blasco et al., 2014; Boggan et al., 1997;
Bouasla and Bouasla, 2017; Agiel and Mericli, 2017; Bouyahya et al.,
2017; Bradacs et al., 2011; Bruni et al., 1997; Bulut et al.,
2017; Bulut and Tuzlaci, 2013; Buochuama and Akhabue, 2018;
xico, Nigeria, Pakistan, Philippines, Thailand
Nigeria, Pakistan, Rodrigues, Thailand, Togo
Bussmann et al., 2017; Bussmann et al., 2014; Bussmann et al.,

2016; Cadena-González et al., 2013; Ahmad and Holdsworth, 1994;
Çakilcioǧlu et al., 2010; Camejo-Rodrigues et al., 2003; Cano and
Volpato, 2004; Cartaxo et al., 2010; Castillo-Espana et al., 2009;
Ceuterick et al., 2011; Chander et al., 2014; Chander et al., 2015;
Chassagne et al., 2016; Chermat and Gharzouli, 2015; Ahmad et al.,
Table 4
2015; Chetri et al., 2018; Chhabra et al., 1990a, 1990b;

Chima et al., 2013; Chintamunnee and Mahomoodally, 2012;
Chua-Barcelo, 2014; Cornara et al., 2009; Cornara et al., 2014; Akbulut, S., Bayramoglu, M.M., 2013. The trade and use of some medical and
Dalar et al., 2018; Dambatta and Aliyu, 2012. aromatic herbs in Turkey. Studies on Ethno-Medicine 7, 67–77. doi:10.1080/
09735070.2013.11886446.
Akdime, H., Boukhira, S., El Mansouri, L., El Youbi, A.H., Bousta, D., 2015. Ethnob-
Declaration of Competing Interest otanical study and traditional knowledge of medicinal plants in Ain Leuh Re-
gion (Middle-Atlas of Morocco). American Journal of Advanced Drug Delivery 3,
248–263.
The authors declare that they have no known competing finan- Akgül, G., Yılmaz, N., Celep, A., Celep, F., Çakılcıoǧlu, U., 2016. Ethnobotanical pur-
cial interests or personal relationships that could have appeared to poses of plants sold by herbalists and folk bazaars in the center of Cappadocica
influence the work reported in this paper. (Nevsşhir, Turkey. Indian Journal of Traditional Knowledge 15, 103–108.
Akhtar, N., Rashid, A., Murad, W., Bergmeier, E., 2013. Diversity and use of ethno-
medicinal plants in the region of Swat, North Pakistan. Journal of Ethnobiology
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Supplementary material associated with this article can be
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Contents lists available at ScienceDirect

South African Journal of Botany

Traditional herbal therapies for hypertension: A systematic review of

1. Introduction is termed as prehypertension. Patients with this condition have an

2.1. Search strategy 3. Results

3.2. Regional wise plant utilization for the treatment of hypertension

The traditional use of plants against hypertension has been

least 6 of these 10 species were reported are Benin, Mauritius, 4. Discussion

Lamiaceae Compositae Leguminosae Rosaceae Apocynaceae

Algeria Afghanistan Algeria Albania Argentina

Fig. 4. Percentage use of different plant parts against hypertension.

Fig. 5. Percentage of use of various methods of preparations of plants against hypertension.

Uncited references Egamberdieva and Jabborova, 2018; Egamberdieva et al., 2013;

Fortini et al., 2016; Fyhrquist et al., 2002; Gairola et al.,

Continent Country Number of families Number of species

North America Guatemala 4 4

Panyaphu et al., 2011; Papp et al., 2014; Pascaline et al., 2010;

2009; Sadat-Hosseini et al., 2017; Sadeghia and Mahmood, 2014;

2016; Aththorick and Berutu, 2018; Waruruai et al., 2011;

Wassie et al., 2015; World Health Organization (WHO) 2018;

Yaoitcha et al., 2015; Yaovi-Gameli et al., 2018; Yirga, 2010;

Youssef, 2013; Zenebe et al., 2012; Au et al., 2008; Augustino et al.,

2017; Azizi and Keshavarzi, 2015; Adsersen and Adsersen, 1997;

Bussmann et al., 2017; Bussmann et al., 2014; Bussmann et al.,

2015; Chetri et al., 2018; Chhabra et al., 1990a, 1990b;

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