Plants used for treating hypertension in Suriname.
Hypertension is the most important modifiable risk factor for cardiovascular, cerebrovascular, and renal diseases which are together among the most frequent causes of morbidity and mortality in the world. Despite the availability of a wide range of effective medicines, many individuals suffering from hypertension use plant-derived preparations for treating their disease. The choice for these alternatives is often associated with the closer relationship of such approaches to specific social, cultural, and religious perceptions about health and disease. However, in most cases, the scientific evidence for clinical efficacy of such medications is scant. The Republic of Suriname is a middle-income country in South America with a relatively high prevalence of hypertension and other cardiovascular diseases. This country harbors descendants of all continents, all of whom have preserved their cultural customs including their ethnopharmacological traditions. As a result, many Surinamese are inclined to treat their diseases including hypertension as they have done for centuries, that is, with plant-based preparations. This chapter has compiled the plants used for treating hypertension in Suriname; extensively evaluates 15 commonly used plants for potential efficacy on the basis of available phytochemical, mechanistic, preclinical, and clinical literature data; and closes with conclusions about their potential usefulness against the disease.
- medicinal plants
- preclinical studies
- clinical studies
- phytochemical composition
- mechanism of action
Blood pressure is the force exerted by the heart and the arteries to maintain the flow of blood through the body in order to supply all cells with oxygen and nutrients and remove waste products. This normally occurs at average systolic and diastolic pressures of 120 and 80 mm Hg, respectively . High blood pressure or arterial hypertension (or hypertension for short) is present when these values are persistently above 140 and 90 mm Hg, respectively . This condition initially does not cause symptoms . However, in the long-term, it is one of the most important predisposing factors for potentially fatal coronary artery disease, heart failure, stroke, peripheral vascular disease, vision loss, and chronic kidney disease .
Hypertension is classified as primary (or essential) hypertension and secondary hypertension . Primary hypertension accounts for 90–95% of cases, typically begins in the fifth or sixth decade of life, and is associated with nonspecific lifestyle factors such as excess salt intake, obesity and a sedentary lifestyle, cigarette smoking, high alcohol intake, stress, and a family history suggesting the involvement of genetic factors in its etiology . In the remaining 5–10% of cases categorized as secondary hypertension, the elevated blood pressure has an identifiable cause such as renal artery stenosis, chronic kidney disease, sleep apnoea, hyperthyroidism, pheochromocytoma, the use of oral contraceptives, or pregnancy .
In both situations, the elevated blood pressure is caused by an increase in the total peripheral resistance, that is, the total resistance to the flow of blood in the systemic circulation. The increased peripheral resistance is most often attributable to abnormalities in the sympathetic nervous system  and the renin-angiotensin-aldosterone system . In the former case, the excessive release of adrenaline and noradrenaline leads to overstimulation of β1- and α1-adrenoreceptors, contraction of arterial smooth muscles, constriction of the arterioles, and an increased peripheral resistance . In the latter case, excess secretion of renin by juxtaglomerular cells following stimulation of β1-adrenergic receptors on their surface, along with glomerular underperfusion, leads to the reabsorption of salt and water and the release of renin, enlarging vascular volume and further increasing peripheral resistance . Impairments in the functioning of vasorelaxing factors such as nitric oxide due to endothelial dysfunction as well as that of vasoactive substances such as endothelin, bradykinin, and atrial natriuretic peptide may further contribute to and/or maintain the hypertension .
Lifestyle modifications such as dietary changes can lower blood pressure and decrease the risk of health complications. Examples of such alterations are diets low in sodium, high in potassium, rich in vegetables, fruits, and low-fat dairy products (the so-called Dietary Approaches to Stop Hypertension (DASH) diet, as well as vegetarian diets . Lifestyle modifications other than dietary changes shown to reduce hypertension are increased physical exercise, weight loss, and stress reduction . The potential effectiveness of these modifications is similar to, and may even exceed the effects of a single medication . Notably, several randomized controlled trials have demonstrated that even a slight blood pressure decrease of 10 mm Hg reduces the risk of death due to cardiovascular disease by 25% and the risk of stroke-related mortality by 40% .
If lifestyle changes are not sufficient to reduce the elevated blood pressure, antihypertensive medications are prescribed. Still, lifestyle changes are recommended in conjunction with medication [6, 11]. Among the commonly used antihypertensives are thiazide-diuretics such as chlorthalidone and hydrochlorothiazide, calcium channel blockers such as nifedipine and amlodipine, β-blockers such as atenolol and metoprolol, angiotensin-converting enzyme (ACE) inhibitors such as captopril and enalapril, and angiotensin receptor blockers such as losartan and candesartan [6, 11]. These medications may be used either alone or at certain combinations [6, 11]. β-blockers are widely used as a first-line treatment for hypertension, but their efficacy may be inferior to those of other antihypertensive drugs .
Currently, close to 1 billion adults or over 20% of the world population suffer from hypertension . This leads to enormous medical, economic, and human costs. In the USA alone, the total economic burden of hypertension in terms of healthcare services, medications, and absent workforce was estimated at USD 47 billion to USD 73.4 billion between the years 2009 and 2011 . And management of hypertension accounts for 30% of office visits for individuals of 45–64 years, and for more than 40% of visits in those aged 60–74 years and over 75 years .
Hypertension occurs slightly more often in males, individuals of low socioeconomic status, and those of older age [13, 16]. It is correspondingly common in high-, medium-, and low-income countries [13, 17], but prevalence rates vary widely throughout the world, with values as low as 3.4–6.8% in rural India and as high as 68.9–72.5% in Poland . There are also large differences in prevalence rates within certain countries. For instance, African American adults in the USA have among the highest rates in the world at 44% but hypertension is less common in US whites and Mexican Americans [16, 18]. Still, deaths due to non-communicable diseases including those related to hypertension occur more frequently and at earlier stages in low- and middle-income countries when compared to industrialized countries . By 2030, low-income countries are even expected to have eight times more deaths due to these ailments than high-income countries .
2. Background on Suriname
2.1. Geography, people, and economy
The Republic of Suriname is located on the north-east coast of South America and borders the Atlantic Ocean to the north, French Guiana to the east, Brazil to the south, and Guyana to the west (Figure 1). The country’s land area of roughly 165,000 km2 can be distinguished into a northern narrow low-land coastal area that harbors the capital city Paramaribo as well as other urbanized areas, a broad but sparsely inhabited savannah belt, and a southern forested area that comprises about three-quarters of its surface area and largely consists of dense, pristine, and highly biodiverse tropical rain forest. Roughly 80% of the population of about 570,000 lives in the urbanized northern coastal zone while the remaining 20% populates the rural and interior savannas and hinterlands .
Suriname is renowned for its ethnic, religious, and cultural diversity, harboring various Amerindian tribes, the original inhabitants of the country; descendants from runaway enslaved Africans brought in between the sixteenth and the nineteenth century (called Maroons); those from mixed Black and White origin (called Creoles); descendants from contract workers from China, India (called Hindustanis), and Java, Indonesia (called Javanese) who arrived between the second half of the nineteenth century and the first half of the twentieth century; descendants from a number of European countries; and more recently, immigrants from various Latin American and Caribbean counties including Brazil, Guyana, French Guiana, Haiti, etc. . The largest ethnic groups in the country are the Hindustanis, Maroons, Creoles, and Javanese, accounting for 27.4, 21.7, 17.0, and 15.7%, respectively, of the total population . All ethnic groups have largely preserved their own specific identity , making Suriname one of the culturally most diverse countries in the world .
Suriname is situated on the Guiana Shield, a Precambrian geological formation estimated to be 1.7 billion years old and one of the regions with the largest expanse of undisturbed tropical rain forest in the world with a very high animal and plant biodiversity . The high mineral density of Suriname’s soil contributes to its ranking as the 17th richest country in the world in terms of natural resources and development potential . Suriname’s most important economic means of support are crude oil drilling, bauxite and gold mining, agriculture, fisheries, forestry, and ecotourism . These activities contributed substantially to the gross domestic income in 2014 of USD 5.21 billion and the average
2.2. Non-communicable diseases
At the same time, as observed in many low- and middle-income countries , more and more Surinamese are adapting a Western lifestyle. For instance, only about half of the country’s overall population met the levels for physical activity recommended by the World Health Organization (WHO) ; almost three-quarters of school children aged 13–15 years had less than 1 hour of physical activity per day and 81% had a high calorie intake ; and the average tobacco and alcohol consumption
As a result, in 2008, 25.1% of Surinamese was obese [28, 29]; 7.4% had prediabetes and 13.0% diabetes mellitus ; the overall estimated prevalence of the metabolic syndrome was 39.2% ; and more than 25% of adults had a raised blood pressure [29, 32]. These observations indicate that Suriname, similarly to many other economically developing countries , is facing increasing public health threats of lifestyle-related non-communicable diseases including cardiovascular disease.
Indeed, WHO assessments from 2014 attributed 68% of total deaths in Suriname to the four main non-communicable diseases (cardiovascular, neoplastic, diabetic, and chronic respiratory diseases) and estimated that the probability of dying between age 30 and 70 years from these conditions was 14% . Notably, in all approximations and previsions, cardiovascular disease was the most important cause of morbidity and mortality in Suriname. For instance, in 2012, stroke (11%), ischemic heart disease (9.1%), diabetes mellitus (7.3%), and hypertensive heart disease (4.5%) were among the leading causes of mortality, together accounting for about 800 or almost one-third of the total number of deaths in that year . Indeed, with 864 fatalities in 2013 (or more than one-quarter of the total number of 3260 deaths in that year), cardiovascular disease was by far the leading cause of mortality in Suriname, ahead of death due to malignant neoplasms, external causes, perinatal complications, diabetes mellitus, and acute respiratory infections .
The comprehensive, nation-wide Suriname Health Study on non-communicable diseases found an overall prevalence of hypertension of 26.2% . This was in the range of values reported for many other developing countries  as well as the relatively large Surinamese diaspora in The Netherlands . Mean values for systolic and diastolic blood pressure were higher in males than in females; increased with older age; and were highest in Creoles Hindustanis, and Javanese, and lowest in Maroons and Amerindians . The prevalence of hypertension in demographic risk factor subgroups differed between ethnic groups, as did the associations of ethnic groups with hypertension , implying the need of tailor-made intervention programs to control hypertension in Suriname .
The findings from two other Surinamese studies suggest that an urban lifestyle may also contribute to the development of prehypertension and hypertension in Suriname, reporting higher prevalence rates in the urban areas of the country (39 and 41%, respectively ), and in an urban middle-income population (31 and 41%, respectively ). These studies found neither gender differences nor racial/ethnic differences in the prevalence of hypertension in their participants [36, 37], but prehypertension was more common in urban males than in urban females  and after adjusting for age, urban African-Surinamese had significantly higher odds of having hypertension than their Asian counterparts .
An apparent ethnic/racial predilection of hypertension was also observed in several Dutch epidemiological studies that included Surinamese migrants. These studies reported a higher incidence of prehypertension, hypertension, malignant hypertension, and related renal complications in participants from Afro-Surinamese and Hindustani descent compared to white individuals [35, 38, 39, 40]. These differences were tentatively explained by ethnic disparities in the perception of hypertension (supporting one of the findings of the Suriname Heath Study ), as well in drug adherence, blood pressure control, and/or insurance status [38, 40, 41, 42].
2.4. Health care system
Suriname’s healthcare system is coordinated by the Ministry of Health which is headed by the Minister of Health and the Director of Health (the Chief Medical Officer). The main responsibilities of the ministry are the planning, coordination, inspection, and monitoring and evaluation of, as well as policy development and setting standards to the country’s health system .
In 2014, the Ministry spent 5.7% of the country’s gross domestic product for health expenditures which corresponded to an average
Primary healthcare in Suriname’s coastal area and hinterlands is provided by the government-subsidized Regional Health Service and Medical Mission, respectively, each operating about 40 clinics which also dispense medicines. In 2004, Suriname had 0.45 physicians per 1000 population. Secondary care and specialist care including that for patients suffering from complications of hypertension are provided by two private and two government-supported hospitals in Paramaribo and one public hospital in the western district of Nickerie.
The Academic Hospital Paramaribo also functions as training facility for both general practitioners and medical specialists, and has to its disposal a Thorax Center for specialized cardiology care and cardiothoracic surgery. Patients with kidney failure are treated by the government-supported Kidney Dialysis Center. Cases of hypertensive crisis and other medical emergencies can get help around-the-clock from the First-aid Stations of the Academic Hospital Paramaribo and the Sint Vincentius Hospital Suriname.
Patients who need specialized therapy that is not available in Suriname (particularly those suffering from certain malignancies) are sent abroad – in general to the Netherlands or Colombia – for treatment. All expenses are covered by the Ministry of Health that has reserved a special budget for these cases.
2.5. Use of traditional medicines against hypertension in Suriname
Despite the broad availability of affordable and accessible modern health care throughout the entire country, the use of traditional medicines is deeply rooted in all ethnic groups in Suriname [21, 44]. This is probably for an important part attributable to the fact that all ethnic and cultural groups in the country have preserved much of their original cultural and ethnopharmacological practices as a means of strengthening the ethnic identity during the secluded lifestyle the former colonial authorities had forced them into [21, 22]. Furthermore, Suriname’s large biodiversity provides ample and readily available raw material that can be processed into traditional medicines . As a result, many disease conditions including hypertension are often treated with traditional plant-based medicines and may be used instead of, or in conjunction with prescription drugs.
The medicinal plants used throughout the country have extensively been discussed in the literature , and those used more commonly by Hindustanis, Maroons, and Javanese have also been reviewed [46, 47, 48]. Less comprehensive accounts of these plants have been presented as well [49, 50, 51, 52, 53, 54, 55]. Together, these publications have compiled 789 Surinamese medicinal plants, 65 of which (roughly 8%) are used for treating hypertension. The latter plants, plant parts, and methods of processing are given in Table 1. They belong to 38 different families, the most represented of which are the Fabaceae with 7 species, the Solanaceae with 5 species, the Malvaceae and the Piperaceae with 4 species each, and the Asteraceae and the Cucurbitaceae with 3 species each (Table 1). In 31 cases the leaves are used, in 9 cases the whole plant, in 6 cases the fruits, in 5 cases the bark, and in 1–3 cases other plant parts such as roots and flowers (Table 1).
(Vernacular names in English; Surinamese)
|Part(s) used||Mode of preparation|
|Roots and leaves||Infusion|
(Brazilian joyweed; weti ede)
(Ambarella; pomme cythère)
|Fresh fruits; fresh peels||Pressed to obtain juice to drink; infusion|
(Rosy periwinkle; kotomisi)
(Pao-pereira bark; bergi bita)
|Fresh stem bark||Decoction|
(Coconut tree; kronto)
|Dried husk fibers||Infusion|
(Water hemp; sekrepatuwiwiri)
|Fresh or dried leaves||Infusion|
(Little ironweed; doifiwiwiri)
(Sand bitters; kanfrubita)
(Garlic vine; konofrukutetey)
|Leaves and hardwood||Infusion|
(Canalette; blaka uma)
(Clammy cherry; tafrabon)
|Fresh fruits||None; fresh fruit eaten|
(Trumpet tree; uma busipapaya)
(Congo pump; man busipapaya)
(Tropical almond; zoete amandel)
(Pink trinity; redi gado dede)
(Water spinach; dagublad)
|Young leaves and stem||Cooked and eaten as a vegetable|
|Fresh fruits||Pressed to obtain juice to drink|
(Bitter melon; sopropo)
|Dried whole plant||Infusion|
(Sandpaper tree; schuurpapier)
|Stem||Pressed to obtain sap to drink|
(Red hot cat’s tail; pus’pusitere)
|Fresh stem bark||Infusion|
(Beggar lice; toriman)
|Roots||Pressed to obtain sap to drink|
(West Indian locust; loksi)
(Manatee bush; brantimaka)
(Shy plant; Sing sing tap yu koto)
(Candle bush; slabriki)
(Amazonian basil; smeriwiwiri)
|Whole plant||Macerated for herbal bath|
(Sea island cotton; redi katun)
(Sleepy morning; malva)
(Crabwood; witte krapa)
|Dried stem bark||Decoction|
(African crabwood; rode krapa)
|Dried stem bark||Decoction|
|Fresh fruits||Pressed to obtain juice to drink|
(Scarlet passion flower; sneki markusa)
|Leaves and stem||Infusion|
(Weak jumby pepper; eiwitblad)
|Fresh or dried whole plant or leaves||Infusion|
(Pepper elder; konsakawiwiri)
|Fresh leaves or whole plant||Pressed to obtain sap to drink|
(Swan spice; tinsensiwiwiri)
|Fresh leaves or whole plant||Pressed to obtain sap to drink|
(Marigold pepper; aneysiwiwiri)
(Indian goosegrass; mangrasi)
(Water lagaga; wetibaka)
(Bread and cheese; feyfifingawiwiri)
|Leaves||Pressed to obtain sap to drink|
(Star apple; sterappel)
(Licorice weed; sibiwiwiri)
(Bitter wood; kwasibita)
(Ant bush; yarakopi)
|Aerial parts||Macerated for herbal bath|
(Angular winter cherry; batotobita)
(Bitayouli; uma parabita)
|Leaves||Macerated for herbal bath|
(African eggplant; antruwa)
|Fresh fruits||Cooked and eaten as a vegetable|
|Fresh fruits||None; fresh fruit eaten|
3. Scientific rationale for using Surinamese plants against hypertension
In this section, 15 plants that are commonly used against hypertension in Suriname, as well as preclinical and clinical indications for their blood pressure-lowering effect and their presumed bioactive constituent(s) and mechanism(s) of action are in detail addressed. The plants are most frequently mentioned as traditional treatments for hypertension in the above-mentioned publications [45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55]. The data are summarized in Table 2.
(Vernacular name in English; Surinamese)
|Preclinical evidence||Clinical evidence||Presumed key active constituent(s)||Presumed mechanism of action|
|No||No||Unknown||Decreased blood lipid levels|
|Yes||No||Mangiferin||Vasodilation; stimulated diuresis|
|Yes||No||Alkaloids, essential oils||Vasodilation|
|Yes||Yes||3-n-butylphthalide||Vasodilation, stimulated diuresis|
|Yes||Yes||Phenolics, flavonoids||Vasodilation; decreased blood lipid levels; stimulated diuresis|
|Yes||No||Unknown||Vasodilation; stimulated diuresis|
(Beggar lice; toriman)
(West Indian locust; loksi)
decreased blood lipid levels
|Yes||No||Unknown||Vasodilation; decreased blood lipid levels|
(Sea island cotton; redi katun)
|Yes||No||Polyphenolics, flavonoids||Vasodilation; stimulated diuresis; decreased blood lipid levels|
|Yes||No||Unknown||Vasodilation; decreased cardiac output; stimulated diuresis|
3.1. Acanthaceaea –
The minnie root
So far, no formal experimental evaluations on the presumed antihypertensive activity of
3.2. Anacardiaceae –
The mango tree
Preparations from flowers, unripe fruits, stone, leaves, stembark, and roots of
The apparent antihypertensive effect of
3.3. Annonaceae –
The exact origin of the soursop or graviola
Nevertheless, all parts of
Indications for an antihypertensive effect were provided by the decrease in blood pressure in normotensive Sprague-Dawley rats which were intravenously treated with an aqueous leaf extract of
However, in light of the affinity of both crude extracts and isoquinoline alkaloids isolated from
3.4. Apiaceae –
Support for an antihypertensive effect of preparations from
The antihypertensive effects of
3.5. Arecaceae –
The coconut tree
Almost all parts of
Evidence for an antihypertensive activity from
The antihypertensive effects have been attributed to vasodilation following the direct activation of the nitric oxide/guanylate cyclase pathway as well as stimulation of muscarinic receptors and/or the cyclooxygenase pathway which would be caused by phenolic compounds and flavonoids ; inhibition of lipid peroxidation, upregulation of antioxidant status, and improved insulin sensitivity ; a decreased cardiac beating frequency ; and/or a (potassium-sparing) diuretic activity .
3.6. Caricaceae –
The papaya plant
The relatively high amount of the protease papain in unripe fruits has been taken advantage of for centuries by the indigenous peoples of the Americans and Caribbean to tenderize meat . Based on this practice, papain is now included as a component in some powdered meat tenderizers . A few other important contemporary uses of papain are its medical use against dyspepsia and other digestive disorders and disturbances of the gastrointestinal tract , and its addition to beer as a clarifying agent .
Preparations from papaya leaves are traditionally used for treating a wide variety of diseases ranging from dengue fever and malaria to diabetes mellitus, hypercholesterolemia, and hypertension [51, 101, 105]. Some of these claims may be explained, at least partially, by the presence of carotenoids and polyphenols, benzyl isothiocyanates and benzyl glucosinolates, and/or the cyanogenic substance prunasin in papaya skin, pulp, and seeds .
Support for the alleged antihypertensive effect of
3.7. Cucurbitaceae –
The cucumber plant
Importantly, a Chinese study found a significant reduction in blood pressure and a marked increase in coronary blood flow of patients receiving
The antihypertensive effects of these preparations may be associated with the stimulation of diuresis. Indeed, an ethanolic extract from the leaves of
3.8. Fabaceae –
Desmodium adscendens(Sw.) DC.
The glue sticks
Main compounds in
3.9. Fabaceae –
The courbaril, West Indian locust, or jatoba
The stembark of the tree produces an orange, soft, sticky resin called ‘animé’, French for ‘animated’, referring to the large numbers of insects that are entrapped in it . Animé has a pleasant fragrance and is used for the production of incense, perfume, and varnish . Interestingly, the indigenous peoples of the Amazon have used
Many bioactive compounds have been identified in leaves, seeds, and trunk resin of
3.10. Fabaceae –
Furthermore, an aqueous tamarind seed extract produced a decrease in blood pressure, heart rate, as well as serum LDL, cholesterol, and HDL levels in streptozotocin-induced diabetic and hypertensive rats . As well, administration of the dried and pulverized fruit pulp led to a decrease in diastolic blood pressure as well as total cholesterol and LDL-cholesterol levels in human subjects . The blood pressure-lowering effects of the
3.11. Lauraceae –
The avocado tree
The stem bark, fruits, seeds, and leaves of
Evidence for an antihypertensive effect of
The mechanisms responsible for these effects may involve vasorelaxation by substances that inhibit Ca2+ influx and stimulate the synthesis and release of endothelium-derived relaxing factors and vasoactive mediators , modulation of ACE activity , and/or lowering of total cholesterol, triglycerides, VLDL, and/or LDL [143, 145, 146]. However, a clinical study found no benefit with respect to body weight, BMI, and percentage body fat, and no difference in serum lipids, fibrinogen, blood flow, or blood pressure when avocados were substituted for mixed fats in an energy-restricted diet .
3.12. Malvaceae –
The sea island cotton or Egyptian cotton
Cotton is the soft white fibrous substance that surrounds the seeds of the plant and helps in the dispersal of the seeds . It consists of 88–96% α-cellulose, 3–6% hemicellulose, and 1–2% lignin . Since about 2500 BC, the fibers are used for making sewing thread, yarn, cordage, and fishing nets, and more recently also for making coffee filters, paper, surgical dressings, and nitrocellulose-based explosives . The seed oil can be incorporated in, among others, margarine and mayonnaise, but also in soaps, cosmetics, lubricants, and protective coatings . The oil as well as other parts of
The presumption of a blood pressure-lowering effect of
3.13. Malvaceae –
The results from preclinical studies have associated the potential antihypertensive (and cardioprotective) properties of particularly tea made from roselle calyces with its abundant content of polyphenolic compounds such as chlorogenic acids , as well as flavonoid compounds such as kaempferol, quercetin, and anthocyanins [156, 158]. Chlorogenic acids (modestly) reduced an elevated blood pressure [157, 159]. Kaempferol may have a protective effect in heart diseases . Quercetin caused the release of NO from vascular endothelium, increasing renal vasorelaxation and kidney filtration, stimulating diuresis and decreasing blood pressure . And the anthocyanins may exert antioxidant effects which inhibit LDL oxidation, impeding atherosclerosis, an important cardiovascular risk factor . Alternatively, anthocyanins may decrease blood pressure by inhibiting ACE activity . These compounds, along with the flavonoids and the chlorogenic acids, have also been suggested to decrease hypertension by stimulating diuresis following modulation of aldosterone activity .
However, comprehensive reviews and a meta-analysis suggest that the evidence for the use of
3.14. Meliaceae –
Azadirachta indicaA. Juss.
The neem tree
Indications for a potential antihypertensive effect of
3.15. Oxalidaceae –
Indications for efficacy against hypertension of
4. Concluding remarks
This chapter has addressed the plants that are used in Suriname for treating hypertension. About 60 of the approximately 800 medicinal plants in Suriname are used against this condition ([45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55];
However, an extensive evaluation of 15 plants that are commonly used against hypertension in Suriname indicates that there is little scientific evidence for clinical efficacy against this condition. As shown in Table 2, 3 of the 15 plants (
Nine other plants (
These data clearly indicate that the scientific evidence accumulated so far to support the use of plant-based traditional medicines in Suriname against hypertension is scant. This raises not only the possibility that patients treat their disease with substances that may be ineffective, but also that they may run the risk of unknown or unforeseen adverse effects. For these reasons, it is necessary to subject these plants to comprehensive phytochemical and pharmacological investigations, elaborate preclinical evaluations, and well-designed and well-executed clinical studies to definitely establish their roles in the treatment of hypertension. Obviously, these enterprises will require considerable efforts from both academia and industry, but may eventually payoff when considering the importance of ancient wisdom and folk medicine to drug discovery and development programs .