Complementary and alternative medicine for hypertension. What evidence is there for herbalist suggestions?

Objective: To evaluate the clinical consequences of recommendations from Italian herbalists of products that can help control high blood pressure. Design: A questionnaire was distributed to 720 Italian herbalists to obtain information about the main herbal remedies and dietary supplements that they recommend to patients who require a 'natural' treatment to control their high blood pressure. The questionnaire was distributed during 12 current practice update seminars given by teachers of the Italian Society for the Study of Phytotherapy and Phytopharmacology to herbalists working in different regions of Italy in 2003. We then compiled a short review on the efficacy and safety of the products that the herbalists recommended. Results: The more frequently suggested herbal remedies were olive leaf, hawthorn, garlic, evening primrose oil, borage, psyllium, stevia, mistletoe and eleuthero, and the frequently suggested dietary supplements were magnesium, calcium, fish oil, γ-linolenic acid, coenzyme Q10, potassium, vitamin B 6, arginine and taurine. Most of the products recommended by the herbalists could be efficacious in reducing blood pressure. If a patient with hypertension is already using natural products that reduce their blood pressure even slightly, this may lead their doctor to underestimate their level of hypertension. If the patient then stops the complementary treatment after beginning drug therapy, this could cause their doctor to underestimate the effect of the drug therapy. Conclusion: If doctors are to have a role in advising patients about complementary and alternative medicine, they need some familiarity with this type of medicine. If they choose not to advise patients about this, then it is likely that the provision of complementary and alternative medicine will continue to be largely outside the conventional care framework. Perhaps provision may be through a growing network of parallel care providers involving a large number of non-medically qualified practitioners, which patients will continue to access directly. © 2005 Adis Data Information BV. All rights reserved.