Open access peer-reviewed chapter

Plant-Based Ethnopharmacological Remedies for Hypertension in Suriname

Written By

Dennis R.A. Mans, Angela Grant and Nicholaas Pinas

Submitted: 03 August 2017 Reviewed: 31 October 2017 Published: 20 December 2017

DOI: 10.5772/intechopen.72106

From the Edited Volume

Herbal Medicine

Edited by Philip F. Builders

Chapter metrics overview

2,195 Chapter Downloads

View Full Metrics


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.


  • hypertension
  • medicinal plants
  • Suriname
  • preclinical studies
  • clinical studies
  • phytochemical composition
  • mechanism of action

1. Introduction

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 [1]. High blood pressure or arterial hypertension (or hypertension for short) is present when these values are persistently above 140 and 90 mm Hg, respectively [1]. This condition initially does not cause symptoms [1]. 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 [1].

Hypertension is classified as primary (or essential) hypertension and secondary hypertension [2]. 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 [3]. 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 [2].

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 [4] and the renin-angiotensin-aldosterone system [5]. 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 [4]. 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 [5]. 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 [6].

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 [7]. Lifestyle modifications other than dietary changes shown to reduce hypertension are increased physical exercise, weight loss, and stress reduction [8]. The potential effectiveness of these modifications is similar to, and may even exceed the effects of a single medication [9]. 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% [10].

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 [12].

Currently, close to 1 billion adults or over 20% of the world population suffer from hypertension [13]. 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 [14]. 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 [15].

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 [17]. 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 [19]. By 2030, low-income countries are even expected to have eight times more deaths due to these ailments than high-income countries [19].


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 [20].

Figure 1.

Map of Suriname depicting the administrative districts (from: The insert (from: indicates the location of Suriname in South America.

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. [20]. 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 [20]. All ethnic groups have largely preserved their own specific identity [21], making Suriname one of the culturally most diverse countries in the world [22].

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 [23]. 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 [24]. Suriname’s most important economic means of support are crude oil drilling, bauxite and gold mining, agriculture, fisheries, forestry, and ecotourism [24]. These activities contributed substantially to the gross domestic income in 2014 of USD 5.21 billion and the average per capita income in that year of USD 9325 [24]. This positions Suriname on the World Bank’s list of upper-middle income economies [25].

2.2. Non-communicable diseases

At the same time, as observed in many low- and middle-income countries [19], 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) [26]; 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 [27]; and the average tobacco and alcohol consumption per capita in individuals of 15 years and older was unacceptably high [28].

As a result, in 2008, 25.1% of Surinamese was obese [28, 29]; 7.4% had prediabetes and 13.0% diabetes mellitus [30]; the overall estimated prevalence of the metabolic syndrome was 39.2% [31]; 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 [19], 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% [29]. 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 [29]. 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 [33].

2.3. Hypertension

The comprehensive, nation-wide Suriname Health Study on non-communicable diseases found an overall prevalence of hypertension of 26.2% [32]. This was in the range of values reported for many other developing countries [34] as well as the relatively large Surinamese diaspora in The Netherlands [35]. 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 [32]. The prevalence of hypertension in demographic risk factor subgroups differed between ethnic groups, as did the associations of ethnic groups with hypertension [32], implying the need of tailor-made intervention programs to control hypertension in Suriname [32].

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 [36]), and in an urban middle-income population (31 and 41%, respectively [37]). 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 [36] and after adjusting for age, urban African-Surinamese had significantly higher odds of having hypertension than their Asian counterparts [36].

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 [32]), 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 [43].

In 2014, the Ministry spent 5.7% of the country’s gross domestic product for health expenditures which corresponded to an average per capita sum of USD 589. The costs of those who cannot afford these expenses are covered by the Ministry of Social Affairs. Government employees and employees of government-related companies are mandatory insured at the State Health Foundation. Essential pharmaceuticals including those for treating hypertension are imported, stocked, and distributed by the National Pharmaceutical Import and Distribution Company and are in general readily available. These medicines are identified by the Board for Essential Pharmaceuticals that consists of various players in the field of pharmacy and pharmacology in Suriname.

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 [23]. 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 [45], 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) usedMode of preparation
AcanthaceaeJusticia pectoralis Jacq.
(Freshcut; tonkawiwiri)
AcanthaceaeRuellia tuberosa L.
(Minnieroot; watrakanu)
Roots and leavesInfusion
AmaranthaceaeAlternanthera brasiliana (L.) Kuntze
(Brazilian joyweed; weti ede)
Whole plantInfusion
AnacardiaceaeMangifera indica L.
(Mango; manya)
AnacardiaceaeSpondias dulcis L.
(Ambarella; pomme cythère)
Fresh fruits; fresh peelsPressed to obtain juice to drink; infusion
AnnonaceaeAnnona muricata L.
(Soursop; zuurzak)
Fresh leavesInfusion
ApiaceaeApium graveolens L.
(Celery; soepgroenten)
Fresh leavesInfusion
ApocynaceaeCatharanthus roseus (L.) G.Don, 1837
(Rosy periwinkle; kotomisi)
Whole plantInfusion
ApocynaceaeGeissospermum laeve (Vell.).Miers
(Pao-pereira bark; bergi bita)
Fresh stem barkDecoction
ArecaceaeCosos nucifera L.
(Coconut tree; kronto)
Dried husk fibersInfusion
AsteraceaeAyapana triplinervis (Vahl) R.M. King & H. Rob
(Water hemp; sekrepatuwiwiri)
Fresh or dried leavesInfusion
AsteraceaeCyanthillium cinereum (L.) H. Rob
(Little ironweed; doifiwiwiri)
Whole plantInfusion
AsteraceaeMelampodium camphoratum (L.F.) Baker
(Sand bitters; kanfrubita)
Whole plantInfusion
BignoniaceaeMansoa alliacea (Lam.) A.H. Genry
(Garlic vine; konofrukutetey)
Leaves and hardwoodInfusion
BoraginaceaeCordia schomburgkii DC.
(Canalette; blaka uma)
Fresh leavesInfusion
BoraginaceaeCordia tetrandra Aubl.
(Clammy cherry; tafrabon)
Dried leavesInfusion
CaricaceaeCarica papaya L.
(Papaya; papaya)
Fresh fruitsNone; fresh fruit eaten
CecropiaceaeCecropia peltata L.
(Trumpet tree; uma busipapaya)
Dried leavesInfusion
CecropiaceaeCecropia sciadophylla Mart.
(Congo pump; man busipapaya)
Dried leavesInfusion
CombretaceaeTerminalia catappa L.
(Tropical almond; zoete amandel)
CommelinaceaeTripogandra serrulata (Vahl.) Handlos.
(Pink trinity; redi gado dede)
Dried leavesInfusion
ConvolvulaceaeIpomoea aquatica Forssk.
(Water spinach; dagublad)
Young leaves and stemCooked and eaten as a vegetable
CucurbitaceaeCucumis sativus L.
(Cucumber; komkommer)
Fresh fruitsPressed to obtain juice to drink
CucurbitaceaeCucurbita moschata Duchesne
(Squash; pompoen)
Dried flowersInfusion
CucurbitaceaeMomordica charantia L.
(Bitter melon; sopropo)
Dried whole plantInfusion
DilleniaceaeDavilla nitida (Vahl.) Kubizki
(Sandpaper tree; schuurpapier)
StemPressed to obtain sap to drink
EuphorbiaceaeAcalypha hispida Burm. f.
(Red hot cat’s tail; pus’pusitere)
FabaceaeCopaifera guyanensis Desf.
(Copaiba; hoepelhout)
Fresh stem barkInfusion
FabaceaeDesmodium adscendens (Sw.) DC.
(Beggar lice; toriman)
RootsPressed to obtain sap to drink
FabaceaeHymenaea courbaril L.
(West Indian locust; loksi)
Stem barkInfusion
FabaceaeMachaerium lunatum (L.f.) Ducke
(Manatee bush; brantimaka)
FabaceaeMimosa pudica L.
(Shy plant; Sing sing tap yu koto)
Whole plantInfusion
FabaceaeSenna alata (L.) Roxb.
(Candle bush; slabriki)
FabaceaeTamarindus indica L.
(Tamarind; tamarinde)
LamiaceaeOcimum campechianum Mill.
(Amazonian basil; smeriwiwiri)
Whole plantMacerated for herbal bath
LauraceaePersea americana Mill.
(Avocado; advocaat)
Dried leavesInfusion
MalvaceaeGossypium barbadense L.
(Sea island cotton; redi katun)
MalvaceaeHibiscus sabdariffa L.
(Roselle; syuru)
MalvaceaeWaltheria indica L.
(Sleepy morning; malva)
MeliaceaeAzadirachta indica A. Juss.
(Neem; nim)
MeliaceaeCarapa guianensis Aubl.
(Crabwood; witte krapa)
Dried stem barkDecoction
MeliaceaeCarapa procera D.C.
(African crabwood; rode krapa)
Dried stem barkDecoction
MusaceaeMusa sp., Musa x paradisiaca
(Banana; banaan)
OxalidaceaeAverrhoa bilimbi L.
(Bilimbi; birambi)
Fresh fruitsPressed to obtain juice to drink
PassifloraceaePassiflora cocciea Aubl.
(Scarlet passion flower; sneki markusa)
Leaves and stemInfusion
PhyllanthaceaePhyllanthus amarus Schumach. & Thonn.
(Stonebreaker; finibita)
Whole plantInfusion
PhytolaccaceaeMicrotea debilis Sw.
(Weak jumby pepper; eiwitblad)
Fresh or dried whole plant or leavesInfusion
PiperaceaePeperomia pellucida (L.) Kunth.
(Pepper elder; konsakawiwiri)
Fresh leaves or whole plantPressed to obtain sap to drink
PiperaceaePeperomia rotundifolia (L.) Kunth.
(Swan spice; tinsensiwiwiri)
Fresh leaves or whole plantPressed to obtain sap to drink
PiperaceaePiper betle L.
(Betel; pahnblad)
PiperaceaePiper marginatum Jacq.
(Marigold pepper; aneysiwiwiri)
PoaceaeEleusine indica L.
(Indian goosegrass; mangrasi)
PoaceaeZea mais L.
(Maize; karu)
Ripe earsDecoction
RhamnaceaeZiziphus jujuba L.
(Jujube; olijf)
RubiaceaeSipanea pratensis Aubl.
(Water lagaga; wetibaka)
SapindaceaePaullinia pinnata L.
(Bread and cheese; feyfifingawiwiri)
LeavesPressed to obtain sap to drink
SapotaceaeChrysophyllum cainito L.
(Star apple; sterappel)
Dried leavesInfusion
ScrophulariaceaeScoparia dulcis L.
(Licorice weed; sibiwiwiri)
Aerial partsInfusion
SimarubaceaeQuassia amara L.
(Bitter wood; kwasibita)
Hard woodInfusion
SiparunaceaeSiparuna guianensis Aubl.
(Ant bush; yarakopi)
Aerial partsMacerated for herbal bath
SolanaceaePhysalis angulata L.
(Angular winter cherry; batotobita)
Dried leavesInfusion
SolanaceaeSolanum leucocarpon Dual.
(Bitayouli; uma parabita)
LeavesMacerated for herbal bath
SolanaceaeSolanum macrocarpum L.
(African eggplant; antruwa)
Fresh fruitsCooked and eaten as a vegetable
SolanaceaeSolanum stramoniifolium Jacq.
(Coconilla; makadroyfi)
Fresh fruitsNone; fresh fruit eaten
SolanaceaeSolanum subinerme Jacq.
(Juhuna; droyfimaka)

Table 1.

Plants used for treating hypertension in Suriname.


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.

FamilyPlant species
(Vernacular name in English; Surinamese)
Preclinical evidenceClinical evidencePresumed key active constituent(s)Presumed mechanism of action
AcanthaceaeRuellia tuberosa L.
(Minnieroot; watrakanu)
NoNoUnknownDecreased blood lipid levels
AnacardiaceaeMangifera indica L.
(Mango; manya)
YesNoMangiferinVasodilation; stimulated diuresis
AnnonaceaeAnnona muricata L.
(Soursop; zuurzak)
YesNoAlkaloids, essential oilsVasodilation
ApiaceaeApium graveolens L.
(Celery; soepgroente)
YesYes3-n-butylphthalideVasodilation, stimulated diuresis
ArecaceaeCocos nucifera L.
(Coconut; kronto)
YesYesPhenolics, flavonoidsVasodilation; decreased blood lipid levels; stimulated diuresis
CaricaceaeCarica papaya L.
(Papaya; papaya)
YesNoUnknownVasodilation; stimulated diuresis
CucurbitaceaeCucumis sativus L.
(Cucumber; komkommer)
YesYesUnknownStimulated diuresis
FabaceaeDesmodium adscendens (Sw.) DC.
(Beggar lice; toriman)
FabaceaeHymenaea courbaril L.
(West Indian locust; loksi)
FabaceaeTamarindus indica L.
(Tamarind; tamarinde)
decreased blood lipid levels
LauraceaePersea americana Mill.
(Avocado; advocaat)
YesNoUnknownVasodilation; decreased blood lipid levels
MalvaceaeGossypium barbadense L.
(Sea island cotton; redi katun)
MalvaceaeHibiscus sabdariffa L.
(Roselle; syuru)
YesNoPolyphenolics, flavonoidsVasodilation; stimulated diuresis; decreased blood lipid levels
MeliaceaeAzadirachta indica A. Juss.
(Neem; nim)
YesNoAzadirachtin, nimbininVasodilation
OxalidaceaeAverrhoa bilimbi L.
(Bilimbi; birambi)
YesNoUnknownVasodilation; decreased cardiac output; stimulated diuresis

Table 2.

Preclinical and clinical evidence for blood pressure-lowering activity of 15 commonly used plants in Suriname for treating hypertension, the presumed key active constituent(s) in these plants, and their presumed mechanism of action.

3.1. Acanthaceaea – Ruellia tuberosa L.

The minnie root R. tuberosa (Figure 2) is probably native to Central America but has spread to various other tropical regions in South America as well as South and South east Asia. Both the English vernacular name ‘cracker plant’ and the Surinamese vernacular name watrakanu (‘water canon’) are probably derived from the loud crack emitted when the ripe fruits in a pod with seven to eight seeds burst open on contact with water, hurdling the seeds away. The whole plant, the leaves, and/or the roots are used in various traditional medicinal systems including those in Suriname as an antidiabetic, antipyretic, analgesic, diuretic, antihypertensive, gastroprotective, anthelmintic, antigonorrheal, antioxidant, blood-purifying, and abortifacient agent [46, 48, 49, 55, 56]. Some of these activities were supported by the results from pharmacological studies [57, 58] and could be associated with certain alkaloids, triterpenoids, saponins, sterols, and flavonoids in the plant [59].

Figure 2.

Acanthaceaea – Ruellia tuberosa L. (from:

So far, no formal experimental evaluations on the presumed antihypertensive activity of R. tuberosa have been reported. However, crude extracts from the leaves of the closely related species R. patula and R. brittoniana as well as n-butanolic extracts and the aqueous layers of both plant extracts displayed cardiotonic effects in isolated rabbit hearts [60]. More importantly, a preparation from R. patula elicited a clear blood pressure-lowering effect in pentothal sodium-anesthetized rats [61]. This effect may be attributed, at least partially, to the blood lipid-lowering actions of Ruellia preparations [57, 58].

3.2. Anacardiaceae – Mangifera indica L.

The mango tree M. indica is indigenous to Bangladesh, India, and Pakistan where it is found in the wild. It has been domesticated in India around 2000 BC, and many cultivated varieties have been produced in other tropical countries including Suriname. Both sour, unripe, and sweet, ripe mangoes are widely used in cuisine, among others, in chutneys, curries, pickles, or side dishes, and to prepare juices, smoothies, nectars, jams, and as a flavoring in ice creams, sorbets, fruit bars, and pies.

Preparations from flowers, unripe fruits, stone, leaves, stembark, and roots of M. indica also have many traditional medicinal uses, among others, to treat certain parasitic infections, uterus disorders, gastrointestinal problems, and syphilis; strengthen the blood vessels; cure varicose veins; and lower an elevated blood pressure [46, 62, 63, 64]. Several of these properties have been attributed to a number of bioactive substances in leaves and stem bark of the plant including the polyphenolic compound mangiferin [65]. This compound also displayed notable blood pressure-lowering effects in in vitro models and laboratory animals [66].

The apparent antihypertensive effect of M. indica preparations and constituents may be attributed to at least two mechanisms, namely the induction of vasodilation and the stimulation of diuresis. Indications for the former possibility are provided by the inhibition of noradrenaline-induced contractions of mesenteric arteries isolated from spontaneously hypertensive rats by a M. indica stem bark extract (called ‘Vimang’ from ‘vida del mango’ meaning ‘life of the mango’) [62]. Support for the second possibility comes from the diuretic effect of ‘Vimang’ in laboratory rats [67].

3.3. Annonaceae – Annona muricata L.

The exact origin of the soursop or graviola A. muricata (Figure 3) is unknown, but it is believed to be native to the Caribbean and the tropical regions of the Americas. It is now widely cultivated for its fruit, the pulp of which contains substantial amounts of vitamin C, vitamin B1, and vitamin B2 and is used to make fruit juice drinks, smoothies, as well as candies, sorbets, and ice cream flavorings. Relatively recently, A. muricata fruit and graviola capsules have been promoted as an alternative treatment for cancer. However, there is no medical evidence for such an activity, even though preclinical studies have shown cytotoxic effects of A. muricata extracts against cultured cancer cells [68].

Figure 3.

Annonaceae – Annona muricata L. (from:

Importantly, Annona species including A. muricata are a rich source of annonaceous acetogenins such as annonacin and annonamine, potent neurotoxins that inhibit mitochondrial complex I, thereby shutting down cellular respiration [69]. These compounds have been associated – although not conclusively – with the unusually high incidence of atypical parkinsonism in the Caribbean island of Guadeloupe where relatively large amounts of A. muricata fruits as well as infusions and decoctions from the leaves of the plant are consumed [70].

Nevertheless, all parts of A. muricata are extensively used – also in Suriname – as traditional medicines against a wide diversity of conditions, among others, insomnia; nervousness, anxiety, and depression; a hangover; epilepsy; parasitic and helminth infections; diabetes mellitus; cancer; and hypertension [45, 48, 49, 55, 71]. Pharmacological studies with preparations from leaves, bark, and roots of the plant have indeed shown sedative, anxiolytic, smooth muscle-relaxant, antispasmodic, and antihypertensive effects [71, 72, 73]. Some of these effects may be attributed to the presence in the plant of bioactive constituents such as alkaloids, flavonol triglycosides, phenolics, and essential oils [71].

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 A. muricata [74]. Furthermore, the extract decreased the phenylephrine-induced contractions of isolated rat and guinea pig aortic rings [74, 75], and relaxed the contractions of isolated rat aortic rings caused by high K+ while apparently blocking Ca2+ channels [74]. These findings suggest that the hypotensive effects of the A. muricata leaf extract may involve vasodilation mediated through peripheral mechanisms involving antagonism of Ca2+ [74]. This effect has been attributed to alkaloids such as coreximine, anomurine, and reticulin, and some essential oil components such as β-caryophyllene [74].

However, in light of the affinity of both crude extracts and isoquinoline alkaloids isolated from Annona species to 5-HT1A receptors in vitro [72], and the well-known decreasing effect of 5-HT1A receptor agonists on blood pressure and heart rate [76], it is also possible that the antihypertensive effect of these plants occurs through a central mechanism that causes peripheral vasodilation and stimulates the vagus nerve.

3.4. Apiaceae – Apium graveolens L.

The celery A. graveolens (Figure 4) originates from the Mediterranean region, but many cultivars are now grown throughout the world. This plant has been cultivated since ancient times, initially only for its medicinal qualities, but later also as a vegetable to counter the salt-sickness of winter diets based on salted meats without green vegetables. Today, A. graveolens stalks, leaves, and hypocotyl are eaten raw or as an ingredient in salads, cooked as a vegetable, or as a flavoring – either fresh or dried – in soups, stews, and pot roasts.

Figure 4.

Apiaceae – Apium graveolens L. (from:

A. graveolens seeds – which are in fact very small fruits – yield a valuable volatile oil that is used in perfumes and, when ground and mixed with salt, to produce celery salt for enhancing the flavor of, for instance, Bloody Mary cocktails [77]. However, celery seeds contain relatively high levels of the phenylpropene apiole that can cause abortion – sometimes with fatal consequences [78] – as well as liver and kidney damage [79] and severe allergic reactions including potentially fatal anaphylactic shock [80].

Nevertheless, A. graveolens is extensively used in traditional medicinal systems – including those in Suriname-against numerous diseases ranging from respiratory ailments and liver diseases to menstrual problems and hypertension [45, 81, 82].

Support for an antihypertensive effect of preparations from A. graveolens came from the decreased blood pressure and heart rate in salt-induced hypertensive rats, normotensive rats, and normotensive rabbits following intraperitoneal administration of extracts from seeds, stalks, or roots of the plant [83, 84, 85, 86]. The results from studies with isolated rat aortic rings suggested that these effects occurred through vasodilation [83] or the stimulation of muscarinic receptors [84]. However, extracts from celery leaves, stalks, and roots have also been reported to stimulate diuresis in several experimental models [87, 88], providing an alternative explanation for their blood pressure-lowering effects.

The antihypertensive effects of A. graveolens have been attributed to the presence in the plant of the benzofuran 3-n-butylphthalide [86, 89] that, along with sedanolide, is also primarily responsible for the aroma and taste of celery. Clinical studies indeed showed a reduction in blood pressure of patients who had been given celery juice [90, 91]. These and other clinical data first led to the approval in China of 3-n-butylphthalide for the treatment of cerebral ischemia, and the preparation of clinical studies to assess n-butylphthalide formulated as softgel capsules for its safety in patients with mild to moderate acute ischemic stroke [92].

3.5. Arecaceae – Cocos nucifera L.

The coconut tree C. nucifera is believed to originate from the South East Asian peninsular region. It has probably spread to many other parts of the world by sea-faring traders and through marine currents, and is now cultivated in many subtropical and tropical countries. Refrigerated coconut water or coconut juice is a much appreciated refreshing drink all over the world; the fleshy coconut ‘meat’ is used fresh or dried in confections and desserts; coconut milk is frequently added to curries and other spicy dishes; and coconut oil is used for frying and preparing margarine and in various cosmetics [93].

Almost all parts of C. nucifera have long been used in traditional medicine for treating many disease conditions, among others, diarrhea, fever and malaria, renal diseases, asthma, diabetes mellitus, hair loss, menstrual disorders, venereal diseases, as an oral contraceptive, and against hypertension [45, 94]. Pharmacological studies with extracts, fractions, and isolated compounds from parts of C. nucifera indeed showed a variety of activities ranging from antimicrobial and antiparasitic activities to vasodilatory and antihypertensive effects [95]. Some of these observations may be related to the presence in the plant of polyphenols, tannins, flavonoids, triterpenes, saponins, steroids, alkaloids, and/or fatty acids [94].

Evidence for an antihypertensive activity from C. nucifera came from the relaxation of isolated rat aortic rings by an ethanolic extract of C. nucifera endocarp and the reduced blood pressure in salt-induced hypertensive rats treated with this preparation [96]; the decreased blood pressure in a rat model of insulin resistance and acquired systolic hypertension following administration of tender coconut water [97]; and the decrease in heart rate of hypertensive Wistar rats which were given coconut water [98]. Notably, in a small clinical study, coconut water given for 2 weeks reportedly lowered the blood pressure in 71% of hypertensive individuals [99], while the fresh vascular sap from the immature, unopened inflorescence given once per day for 5 consecutive weeks led to a decrease in blood pressure as well as a reduction in total serum cholesterol in women with stage one hypertension [100].

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 [96]; inhibition of lipid peroxidation, upregulation of antioxidant status, and improved insulin sensitivity [97]; a decreased cardiac beating frequency [98]; and/or a (potassium-sparing) diuretic activity [99].

3.6. Caricaceae – Carica papaya L.

The papaya plant C. papaya probably has its origin in Mexico and the northern parts of South America and has subsequently become naturalized throughout other tropical and subtropical regions. Various cultivars are grown for their edible ripe fruits which are usually consumed raw. The juice from ripe papayas is a popular low-calorie beverage and is also added as a flavoring in candies, jellies, and ice cream; the unripe fruit is incorporated in various dishes; the young leaves and flower buds may be consumed as vegetables; and the ground black seeds are sometimes used as a substitute for black pepper.

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 [101]. Based on this practice, papain is now included as a component in some powdered meat tenderizers [102]. A few other important contemporary uses of papain are its medical use against dyspepsia and other digestive disorders and disturbances of the gastrointestinal tract [103], and its addition to beer as a clarifying agent [104].

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 [101].

Support for the alleged antihypertensive effect of C. papaya was provided by the decrease in blood pressure in renal and salt-induced hypertensive Wistar rats treated with a crude ethanol extract from the unripened fruit [106]. This preparation, as well as a pentane extract from papaya seeds and an aqueous extract from papaya leaves relaxed vascular muscle tone of isolated rabbit arterial strips [106], strips of dog carotid artery precontracted with phenylephrine [107], and rat aortic ring preparations [108]. The relaxing effect of the fruit preparation was counteracted by phentolamine, suggesting that C. papaya contains (an) antihypertensive substance(s) that mainly exhibits α-adrenoceptor activity [108]. C. papaya preparations may also exert a blood pressure-lowering effect by stimulating diuresis, as suggested by the diuretic action of an aqueous root extract in laboratory rats, accomplishing similar effects on electrolyte excretion as hydrochlorothiazide [109].

3.7. Cucurbitaceae – Cucumis sativus L.

The cucumber plant C. sativus is originally from South Asia, most probably India, where it has been cultivated for more than 3000 years. Nowadays, hundreds of cultivars are grown throughout the world and traded on the global market. The mature fruit contains about 90% water and is relatively low in nutrients, and many enjoy its appetizing flavor and texture, making it a popular ingredient of fresh salads as well as pickles and relishes. Cucumber extracts are also widely used in facial tonics and moisturizers, presumably because their high water and antioxidant content would protect the skin from aging [93].

Preparations from C. sativus leaves, seeds, flowers, and fruits are also used in various traditional medicines for treating, among others, bacterial and parasitic infections, kidney and gall stones, as well as thrombosis and hypertension [45, 50, 52, 56, 110]. Preclinical evaluation of the plant parts showed various pharmacological activities including blood pressure-lowering effects [111, 112]. Some of these effects may be associated with the presence in the plant of bioactive compounds such as cucurbitacins, cucumegastigmanes I and II, cucumerin A and B, vitexin, and orientin [111, 112].

Importantly, a Chinese study found a significant reduction in blood pressure and a marked increase in coronary blood flow of patients receiving C. sativus vine compound tablets, as well as improved myocardial contraction in laboratory animals while no toxic effects were noted [113]. Furthermore, a relatively recent study conducted in Indonesia reported a reduction in mean blood pressure in elderly patients receiving 100 g of cucumber in juice form for 7 days [114].

The antihypertensive effects of these preparations may be associated with the stimulation of diuresis. Indeed, an ethanolic extract from the leaves of C. sativus, either alone or as part of a polyherbal formulation, had a moderately stimulatory effect on diuresis in laboratory rats when compared to furosemide [115]. Also, an ether extract from the seeds of C. melo increased diuresis in anesthetized dogs [116], and an aqueous extract from the leaves of C. trigonuscaused a comparable diuretic effect as hydrochlorothiazide in conscious albino rats [117]. In the former study, urinary chloride excretion was increased suggesting that the extract had decreased tubular reabsorption [116].

3.8. Fabaceae – Desmodium adscendens (Sw.) DC.

The glue sticks D. adscendens is commonly encountered in forests, grasslands, secondary/disturbed vegetation, old cultivated fields, and roadsidesin tropical areas. The leaves and stems have probably been used for thousands of years by native peoples for a variety of health issues, including liver ailments, respiratory diseases, backache, rheumatism, gonorrhea, ovarian inflammation, and epilepsy [118, 119].

Main compounds in D. adscendens are flavonoids, triterpenes, saponins, amines, and alkaloids [120]. Pharmacological studies with D. adscendens leaf extracts showed, among others, spasmolytic effects in isolated guineas pig trachea and ilei precontracted with histamine [121, 122].

In Suriname, D. adscendens is generally known as ‘konkruman’ (‘informer’) or ‘toriman’ (‘story teller’) because the sticky pods stay clinging to clothing, betraying the unapproved presence of the bearer ‘in the field’, that is, away from home. Indigenous folklore believes that preparations from the plant attract and hold fortune and prosperity while at the same capturing and removing bad luck and disease [45]. A tea prepared from the macerated roots is also used as an antihypertensive [46]. This effect may be attributable to the above-mentioned relaxing effect of certain constituents of the plant on smooth muscle cells [121, 122] – possibly including those in blood vessel walls – but there are no scientific indications to support this presumption.

3.9. Fabaceae – Hymenaea courbaril L.

The courbaril, West Indian locust, or jatoba H. courbaril (Figure 5) is a common tree in the Caribbean, Central America, and South America. The hardwood is very durable and is used for manufacturing furniture, flooring, window frames, staircases, as well as canoes. The seeds are situated in a hard pod and are surrounded by an edible dry pulp that has an unpleasant scent reminiscent of foot odor. For this reason, the tree is also known as ‘stinking toe’ and ‘old man’s toe’. However, the pulp has a high content of starches and proteins and a sweet taste. It is often eaten raw; may be dried and powdered for making snacks; and may also be mixed with water to prepare a drink called ‘atole’.

Figure 5.

Fabaceae – Hymenaea courbaril L. (from:

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 [123]. Animé has a pleasant fragrance and is used for the production of incense, perfume, and varnish [123]. Interestingly, the indigenous peoples of the Amazon have used H. courbaril resin for centuries to preserve the colors on their pottery [45]. Preparations from this substance, along with those from several other parts of the plant, have traditionally also been used in various South American and African countries for treating a variety of conditions such as anemia, kidney problems, dysfunctions of the respiratory system, and abdominal ailments [45, 123, 124].

Many bioactive compounds have been identified in leaves, seeds, and trunk resin of H. courbaril, including flavonoids, terpenoids, phenolic acids, steroids, and coumarins [124, 125]. Some of these compounds have been related to the myorelaxant, anti-inflammatory, and antimicrobial effects including activity against dengue virus type-2 observed in pharmacological studies with H. courbaril preparations [124, 126, 127]. In Suriname, the stembark is used to prepare a tea that would treat a similar variety of ailments as well as hypertension [45]. Whether the latter activity may be associated with vasodilation following relaxation of the smooth muscles [126] including those in the blood vessel walls remains to be determined.

3.10. Fabaceae – Tamarindus indica L.

The tamarind T. indica is probably indigenous to tropical Africa where it grows in the wild. It has been cultivated for centuries on the Indian subcontinent, and has been introduced in South America including Suriname by Spanish and Portuguese colonists in the sixteenth century. The fruit is a pod with a hard, brown shell that contains up to 12 seeds surrounded by a sweet and sour pulp that is used in cooking, to flavor foods, in refreshing drinks, and as a key ingredient of Worcestershire sauce.

Preparations from T. indica leaves, seeds, fruits, and roots are extensively used in folk medicine, among others, for treating abdominal discomfort, microbial and parasitic infestations, as an aphrodisiac, and against hypertension [48, 128, 129]. These parts of the plant contain various phenolic compounds, terpenes, sugars, as well as mucilage and pectin [128, 129]. Some of these constituents have been associated with, among others, antioxidant, anti-hyperlipidemic, and cardioprotective effects of the plant in laboratory models [130].

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 [131]. 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 [132]. The blood pressure-lowering effects of the T. indica preparations have been suggested to occur through direct sympatho-inhibition [131], protection of the body against oxidative assault that could initiate the development of hypertension [131, 133], and/or lowering of blood lipid levels [133, 134].

3.11. Lauraceae – Persea americana Mill.

The avocado tree P. americana probably originates from Central America and the western parts of South America and was presumably domesticated as early as 5000 BC. Today, avocados are a successful cash crop with a high commercial value. Avocado is mostly eaten raw; (prolonged) cooking makes it inedible, causing a chemical reaction that confers a bitter taste to it. It is an ingredient of many servings and dishes and is often used in vegetarian cuisine as a substitute for meats because of its relatively high content of monounsaturated fats [135]. The rather expensive oil extracted from avocados is mostly used for salads or dips and in cosmetics and toiletries [136].

The stem bark, fruits, seeds, and leaves of P. americana are used in traditional medicine in Africa, the West Indies, as well as South and Central America including Suriname for treating, among others, menstrual problems, gastrointestinal ailments, bronchitis, diabetes mellitus, hypercholesterolemia, and hypertension [45, 46, 49, 52, 55, 137, 138]. Pharmacological evaluations with animal models provided some support for these ethnopharmacological claims [139]. These effects may partially be associated with the aliphatic acetogenins, terpenoid glycosides, furan ring-containing derivatives, flavonoids, and coumarins in various parts of the plant [140].

Evidence for an antihypertensive effect of P. americana leaf and seed preparations came from the relaxing effects they produced in isolated guinea pig atrial muscle strips, rat portal veins, and rat thoracic aortic rings precontracted with noradrenaline [141] and the blood pressure-lowering effects they produced in laboratory animals [141, 142, 143].

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 [144], modulation of ACE activity [145], 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 [147].

3.12. Malvaceae – Gossypium barbadense L.

The sea island cotton or Egyptian cotton G. barbadense (Figure 6) is believed to have emerged in Peru as a cross between G. herbaceum L. and G. raimondii Ulbrich or G. gossypioides (Ulbrich) Standley. It is now widely cultivated in the warmer parts of the world, and is an important industrial and export product of Egypt, the West Indies, Sudan, Peru, and the USA.

Figure 6.

Malvaceae – Gossypium barbadense L. (from:

Cotton is the soft white fibrous substance that surrounds the seeds of the plant and helps in the dispersal of the seeds [148]. It consists of 88–96% α-cellulose, 3–6% hemicellulose, and 1–2% lignin [148]. 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 [148]. The seed oil can be incorporated in, among others, margarine and mayonnaise, but also in soaps, cosmetics, lubricants, and protective coatings [148]. The oil as well as other parts of Gossypium species contains the triterpenoid aldehyde gossypol that causes infertility in males [149]. Other constituents of G. barbadense are alkaloids, flavonoids, total phenols, cyanogenic glycosides, and saponins [148, 150].

G. barbadense preparations are widely used in traditional medicine. In many African countries as well as the Guianas including Suriname, preparations from leaves, roots, and seed oil are used for treating a multitude of diseases ranging from eye affections, otitis media, bronchitis, and menstrual problems to malaria, convulsions, gonorrhea, leprosy, and hypertension [45, 51, 52, 55, 151]. Pharmacological studies have supported some of these folk medicinal uses [151, 152].

The presumption of a blood pressure-lowering effect of G. barbadense was supported by the dose-dependent hypotensive effect of a fraction of a crude leaf extract in laboratory rats [153]. The results from parallel studies with several agonists and antagonists of acetylcholine receptors suggested that this occurred through an action on the central nervous system comparably to that of the centrally acting α2-adrenergic agonist clonidine [153]. On the other hand, an aqueous extract from G. barbadense leaves decreased the tension of isolated guinea pig aorta rings stimulated with phenylephrine (a selective α1-adrenergic receptor agonist) by 15–35% [75], suggesting that it may lower an elevated blood pressure by decreasing the peripheral vascular resistance.

3.13. Malvaceae – Hibiscus sabdariffa L.

The roselle H. sabdariffa (Figure 7) probably originates from Africa and is presumably domesticated in Sudan about 6000 years ago. It was initially cultivated for its seed and later for its leaves and bright red colored calyces which are particularly in the USA and Germany processed to give food colorings. The seed oil can be used for cooking and the seeds are eaten roasted as a snack. However, H. sabdariffa seeds probably contain toxic substances and may be better used for manufacturing soaps and shrubs [154]. Young shoots, leaves, and calyces can be included in certain dishes, and fresh or dried calyces are used to prepare flavorful and slightly acidic herbal teas, refreshing beverages that may be carbonated, cocktails with rum, as well as jams.

Figure 7.

Malvaceae – Hibiscus sabdariffa L. (from:

Preparations from H. sabdariffa leaves, calyces, and roots are widely used in traditional medicines because of their presumed antimicrobial, antioxidant, anticancer, hepatoprotective, hypocholesterolemic, antidiabetic, diuretic, and antihypertensive properties [45, 155, 156]. Phytochemical and pharmacological studies supported some of these uses [155, 156].

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 [157], 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 [160]. Quercetin caused the release of NO from vascular endothelium, increasing renal vasorelaxation and kidney filtration, stimulating diuresis and decreasing blood pressure [161]. And the anthocyanins may exert antioxidant effects which inhibit LDL oxidation, impeding atherosclerosis, an important cardiovascular risk factor [162]. Alternatively, anthocyanins may decrease blood pressure by inhibiting ACE activity [163]. 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 [164].

However, comprehensive reviews and a meta-analysis suggest that the evidence for the use of H. sabdariffa preparations against hypertension is insufficient and recommend more high-quality animal and human studies to demonstrate benefit from these substances in this condition [162, 165, 166].

3.14. Meliaceae – Azadirachta indica A. Juss.

The neem tree A. indica is originally from the Asian subcontinent and is now grown in various tropical and semi-tropical regions. The bitter-tasting shoots and flowers are incorporated into various dishes, while preparations from leaves, bark, and fruits are consumed during many Hindu ceremonies, festivals, and commemorations.

A. indica leaves and seeds contain potent antiparasitic, insecticidal, and antimicrobial compounds such as the limonoids azadirachtin and nimbinin [167]. For this reason, dried neem leaves are placed in cupboards and storage facilities for grains to prevent damage from insects and burned to keep away mosquitoes, while the seed oil is used as a key ingredient of non-synthetic ecofriendly pesticides in agriculture, acting as an antifeedant, repellent, and egg-laying deterrent for insects [168]. The seed cake that remains after oil extraction is used as a fertilizer, enriching the soil with organic matter, and at the same time reducing nitrogen loss by inhibiting nitrification and averting damage to crops by termites and nematodes [168]. Neem oil is also a valuable ingredient of a large variety of cosmetics such as soaps, shampoos, balms, creams as well as toothpastes and nail polishes [169].

Parts of A. indica have been used for centuries in traditional and alternative medicinal systems in India and Suriname against a wide variety of diseases ranging from microbial infections and malaria to diabetes mellitus and hypertension [45, 170]. Some of these applications are supported by the results from pharmacological studies and may be related to the actions of, among others, azadirachtin and nimbinin [167, 171].

Indications for a potential antihypertensive effect of A. indica preparations were provided by the inhibitory effect of A. indica yogurt on ACE activity in vitro [172], and the blood pressure-lowering effect of leaf extracts in (salt-induced) rat models [173, 174]. Studies with laboratory rabbits suggested that these effects might also be due to vasodilation mediated through a combination of Ca2+ channel blockade, NO-inhibitory mechanisms, and cardiac depressant activity [175].

3.15. Oxalidaceae – Averrhoa bilimbi L.

The bilimbi A. bilimbi (Figure 8) presumably originates from Indonesia. It has been introduced in several Southeast Asian countries, and has spread to Australia as well as the Caribbean, Central America, and South America. The fruits can be eaten raw with salt and spice, pickled to obtain sweet and sour side dishes, incorporated in certain dishes as a souring agent, made into jams, or squashed to obtain a cooling beverage. However, A. bilimbi fruits (as well as leaves) contain high levels of oxalate [176] which may cause tubular necrosis and acute kidney failure when the concentrated juice is drunk on a daily basis [177].

Figure 8.

Oxalidaceae – Averrhoa bilimbi L. (from:

Parts of A. bilimbi have been important sources of medicines since antiquity. Decoctions, infusions, powders, and pastes have been used in several traditional medicinal systems including those in Suriname for preventing and treating many diseases such as skin eruptions, cough, cold, syphilis, diarrhea, obesity, diabetes mellitus, microbial infections, and hypertension [46, 178]. Physicochemical and pharmacological studies supported some of these uses [179].

Indications for efficacy against hypertension of A. bilimbi came from the decreased contractility of isolated guinea pig atria precontracted with norepinephrine upon exposure to an aqueous extract from the leaves [180]. Such an extract also produced a substantial antihypertensive effect in an in vivo study with cats [181]. The mechanisms underlying these observations may be associated with a decrease in cardiac output following alterations in intracellular calcium metabolism and/or phenomena involving the muscarinic receptor [180]. It is also possible that the relatively high levels of oxalate in these preparations [176] promote diuresis. A third possible mechanism involves inhibition of ACE activity, as suggested by the in vitro ACE-inhibitory effect of an A. bilimbi leaf ethanol extract which was comparable to that of captopril [182].


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]; Table 1), indicating both the high need of antihypertensive medications and the high demand for traditional plant-derived for treating this condition in the country. As mentioned above, the prevalence of hypertension and other cardiovascular diseases is relatively high in Suriname [32, 36, 37], while most Surinamese have a long tradition of using ethnopharmacological preparations for treating their diseases [21, 44].

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 (A. graveolens, C. nucifera, and C. sativus) had undergone preclinical as well as clinical evaluation against hypertension and turned out positive in at least some of the clinical studies. However, the clinical studies merely comprised a handful, although those with 3-n-butylphthalide in A. graveolens were sufficiently encouraging to prepare larger scale clinical evaluations [90, 91, 92].

Nine other plants (M. indica, A. muricata, C. papaya, T. indica, P. americana, G. barbadense, H. sabdariffa, A. indica, and A. bilimbi) have only been tested in preclinical models of hypertension (Table 2), relatively few of which involved animal studies. And three of the plants (R. tuberosa, D. adscendens, and H. courbaril) have never been assessed for potential antihypertensive effects, not even in preclinical models (Table 2). On the bright side, with the exception of H. courbaril, there were in all cases suggestions about the mechanisms that may be involved in the antihypertensive effects (Table 2). Then again, the chemical substances responsible for these effects were only provided for 6 plants (M. indica, A. muricata, A. graveolens, C. nucifera, H. sabdariffa, and A. indica; Table 2).

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 [183].


  1. 1. Beevers G, Lip GY, O’Brien E. ABC of hypertension: The pathophysiology of hypertension. British Medical Journal. 2001;322:912-916
  2. 2. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community – A statement by the American Society of Hypertension and the International Society of Hypertension. Journal of Clinical Hypertension (Greenwich, Conn.). 2014;16:14-26. DOI: 10.1111/jch.12237
  3. 3. Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community. A statement by the American Society of Hypertension and the International Society of Hypertension. Journal of Hypertension. 2014;32:3-15. DOI: 10.1097/HJH.0000000000000065
  4. 4. Esler M, Lambert E, Schlaich M, Schlaich L. Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension. Journal of Applied Physiology (1985). 2010;109:1996-1998; discussion 2016. DOI: 10.1152/japp-lphysiol.00182.2010
  5. 5. Navar LG. Counterpoint: Activation of the intrarenal renin-angiotensin system is the dominant contributor to systemic hypertension. Journal of Applied Physiology (1985). 2010;109:1998-2000; discussion 2015. DOI: 10.1152/japplphysiol.00182.2010a
  6. 6. Delacroix S, Chokka RG, Worthley SG. Hypertension: Pathophysiology and treatment. Journal of Neurology & Neurophysiology. 2014;5:250. DOI: 10.4172/2155-9562.1000250
  7. 7. Yokoyama Y, Nishimura K, Barnard ND, Takegami M, Watanabe M, Sekikawa A, et al. Vegetarian diets and blood pressure: A meta-analysis. JAMA Internal Medicine. 2014;174:577-587. DOI: 10.1001/jamainternmed.2013.14547
  8. 8. Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, et al. Beyond medications and diet: Alternative approaches to lowering blood pressure: A scientific statement from the American Heart Association. Hypertension. 2013;61:1360-1383. DOI: 10.1161/HYP.0b013e318293645f
  9. 9. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the Management of Arterial Hypertension: The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal. 2013;34:2159-2199. DOI: 10.1093/eurheartj/eht151
  10. 10. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: Meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. British Medical Journal. 2009;338:b1665. DOI: 10.1136/bmj.b1665
  11. 11. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Journal of the American Medical Association. 2014;311:507-520. DOI: 10.1001/jama.2013.284427
  12. 12. Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH. Beta-blockers for hyper-tension. Cochrane Database of Systematic Reviews. 2017;1:CD002003. DOI: 10.1002/14651858.CD002003.pub5
  13. 13. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control: A systematic analysis of population-based studies from 90 countries. Circulation. 2016;134:441-450. DOI: 10.1161/CIRCULATIONAHA.115.018912
  14. 14. Cohen JD. Hypertension epidemiology and economic burden: Refining risk assessment to lower costs. Managed Care. 2009;18:51-58
  15. 15. Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2006 summary. National Health Statistics Reports. 2008;3:1-39
  16. 16. Kearney PM, Whelton M, Reynolds K, Whelton PK, He J. Worldwide prevalence of hypertension: A systematic review. Journal of Hypertension. 2004;22:11-19
  17. 17. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: Analysis of worldwide data. Lancet. 2005;365:217-223
  18. 18. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics-2011 update: A report from the American Heart Association. Circulation. 2011;123:e18-e209. DOI: 10.1161/CIR.0b013e3182009701
  19. 19. Chan KY, Adeloye D, Grant L, Kolčić I, Marušić A. How big is the ‘next big thing’? Estimating the burden of non-communicable diseases in low- and middle-income countries. Journal of Global Health. 2012;2:020101. DOI: 10.7189/jogh.02.020101
  20. 20. Algemeen Bureau voor de Statistiek/Censuskantoor. Suriname in cijfers 2013/05. Resultaten achtste (8ste) volks- en woningtelling in Suriname (volume 1) (General Bureau of Statistics/Census office. Suriname in numbers 2013/05. Results of the Eight General Census of Suriname). Demografische en sociale karakteristieken en migratie (Demographic and social characteristics and migration). Paramaribo: Algemeen Bureau voor de Statistiek; 2013
  21. 21. Mans DRA, Ganga D, Kartopawiro J. Meeting of the minds: Traditional herbal medicine in multiethnic Suriname (chapter 6). In: El-Shemy H, editor. Aromatic and Medicinal Plants – Back to Nature. Rijeka: InTech; 2017. pp. 111-132. DOI: 10.5772/66509
  22. 22. Helman A. Cultureel mozaïek Van Suriname. Bijdrage Tot Onderling Begrip (Cultural Mosaic of Suriname. A Contribution to Mutual Understanding). De Walburg Pers: Zutphen; 1977
  23. 23. Hammond DS. Forest conservation and management in the Guiana shield (chapter 1). In: Hammond DS, editor. Tropical Rainforests of the Guiana Shield. Wallingford: CABI Publishing; 2005. pp. 1-14
  24. 24. Algemeen Bureau voor de Statistiek. Suriname in cijfers 303-2014-04 (General Bureau of Statistics. Suriname in numbers 303-2014-04). Basis indicatoren (Basic indicators). Paramaribo: Algemeen Bureau voor de Statistiek; 2014
  25. 25. The World Bank. Suriname overview [Internet]. 2014. Available from: [Accessed: Sep 23, 2017]
  26. 26. Baldew SS, Krishnadath IS, Smits CC, Toelsie JR, Vanhees L, Cornelissen V. Self-reported physical activity behavior of a multi-ethnic adult population within the urban and rural setting in Suriname. BMC Public Health. 2015;15:485. DOI: 10.1186/s12889-015-1807-1
  27. 27. Suriname Ministry of Health. Global School-Based Student Health Survey. Paramaribo: Suriname Ministry of Health; 2009
  28. 28. Suriname Ministry of Health Suriname. National Action Plan for the Prevention and Control of Noncommunicable Diseases 2012-2016. Paramaribo: Suriname Ministry of Health; 2009
  29. 29. World Health Organization. Noncommunicable Diseases (NCD) Country Profiles. Suriname. Geneva: World Health Organization; 2014
  30. 30. Krishnadath ISK, Nahar-van Venrooij LM, Jaddoe VWV, Toelsie JR. Ethnic differences in prediabetes and diabetes in the Suriname. Health Study. BMJ Open Diabetes Research & Care. 2016;4:e000186. DOI: 10.1136/bmjdrc-2015-000186
  31. 31. Krishnadath ISK, Toelsie JR, Hofman A, Jaddoe VWV. Ethnic disparities in the prevalence of metabolic syndrome and its risk factors in the Suriname Health Study: A cross-sectional population study. BMJ Open. 2016;6:e013183. DOI: 10.1136/bmjopen-2016-013183
  32. 32. Krishnadath ISK, Jaddoe VWV, Nahar-van Venrooij LM, Toelsie JR. Ethnic differences in prevalence and risk factors for hypertension in the Suriname Health Study: A cross sectional population study. Population Health Metrics. 2016;14:33. eCollection 2016
  33. 33. Punwasi W. Doodsoorzaken in Suriname 2009-2011 (Causes of Daeth in Suriname 2009-2011). Ministerie van Volksgezondheid, Bureau Openbare Gezondheidszorg: Paramaribo; 2012
  34. 34. Ibrahim MM, Damasceno A. Hypertension in developing countries. Lancet. 2012;380:611-619. DOI: 10.1016/S0140-6736(12)60861-7
  35. 35. Agyemang C, Bindraban N, Mairuhu G, Montfrans G, Koopmans R, Stronks K, et al. Prevalence, awareness, treatment, and control of hypertension among Black Surinamese, South Asian Surinamese and White Dutch in Amsterdam, The Netherlands: The SUNSET study. Journal of Hypertension. 2005;23:1971-1977
  36. 36. Diemer F, Baldew SM, Van Montrans GA, Oehlers GP, Brewster LM. Prehypertension and hypertension in urban Suriname. Journal of Hypertension. 2016;34:e358. DOI: 10.1097/
  37. 37. Karamat F, Diemer F, Baldew S, Oehlers G, Van Montfrans G, Brewster L. Prehypertension and hypertension in urban Suriname: The HELISUR study. Journal of Hypertension. 2016;34:e551. DOI: 10.1097/01.hjh.0000501508.90665.63
  38. 38. Van den Born BJ, Koopmans RP, Groeneveld JO, van Montfrans GA. Ethnic disparities in the incidence, presentation and complications of malignant hypertension. Journal of Hypertension. 2006;24:2299-2304
  39. 39. Agyemang C, van Valkengoed I, van den Born BJ, Stronks K. Prevalence and determinants of prehypertension among African Surinamese, Hindustani Surinamese, and White Dutch in Amsterdam, the Netherlands: The SUNSET study. European Journal of Cardiovascular Prevention and Rehabilitation. 2007;14:775-781
  40. 40. Agyemang C, Kunst AE, Bhopal R, Zaninotto P, Unwin N, Nazroo J, et al. Hypertension in Dutch and English ethnic minorities. Blood pressure better controlled in English groups than in Dutch groups. Nederlands Tijdschrift voor Geneeskunde. Dutch. 2011;155:A3318
  41. 41. Van Beune EJ, Haafkens JA, Schuster JS, Bindels PJ. ‘Under pressure’: How Ghanaian, African-Surinamese and Dutch patients explain hypertension. Journal of Human Hypertension. 2006;20:946-955
  42. 42. Van Beune EJ, Haafkens JA, Agyemang C, Schuster JS, Willems DL. How Ghanaian, African-Surinamese and Dutch patients perceive and manage antihypertensive drug treatment: A qualitative study. Journal of Hypertension. 2008;26:648-656
  43. 43. Ministry of Health. Report of the Director of Health 2005-2007. Paramaribo: Ministry of Health Republic of Suriname; 2008
  44. 44. Mans DRA. “Nature, green in leaf and stem”. Research on plants with medicinal properties in Suriname. Clinical and Medical Investigations. 2016;2:1-10. DOI: 10.15761/CMI.1000121
  45. 45. Van Andel TR, Ruysschaert S. Medicinale en rituele planten van Suriname (Medicinal and Ritual Plants of Suriname). Amsterdam: KIT Publishers; 2011
  46. 46. Raghoenandan UPD. Etnobotanisch onderzoek bij de Hindoestaanse bevolkingsgroep in Suriname (An Ethnobotanical Investigation among Hindustanis in Suriname). [thesis]. Paramaribo: Anton de Kom Universiteit van Suriname; 1994
  47. 47. Van’t Klooster C, van Andel T, Reis R. Patterns in medicinal plant knowledge and use in a Maroon village in Suriname. Journal of Ethnopharmacology 2016;189:319-330
  48. 48. Tjong AG. Het gebruik van medicinale planten door de Javaanse bevolkingsgroep in Suriname (The Use of Medicinal Plants by the Javanese in Suriname). Instituut voor de Opleiding van Leraren: Paramaribo; 1989
  49. 49. Stephen HJM. Geneeskruiden van Suriname: hun toepassing in de volksgeneeskunde en in de magie (Herbal Medicines from Suriname: Their Applications in Folk Medicine and Wizardry). Amsterdam: De Driehoek; 1979
  50. 50. May AF. Sranan oso dresi. Surinaams kruidenboek (Surinamese Folk Medicine. A Collection of Surinamese Medicinal Herbs). De Walburg Pers: Paramaribo; 1982
  51. 51. Titjari. Famiri-encyclopedia foe da natoera dresi-fasi. Gezinskruidenboek van de natuurgeneeswijzen. Natuurgeneeswijzen uit het zonnige Suriname (Encyclopedia of Plant-based Forms of Treatment. Folk Medicines from Sunny Suriname). Amsterdam: Sangrafoe; 1985
  52. 52. Heyde H. Surinaamse Medicijnplanten (Surinamese Medicinal Plants). 2nd ed. Westfort: Paramaribo; 1987
  53. 53. Slagveer JL. Surinaams Groot Kruidenboek: Sranan Oso Dresie (Surinamese Herbal Medicines). De West: Paramaribo; 1990
  54. 54. Veth B. Gebruiks- en Medicinale Planten Van de Wayana Indianen in Frans Guyana en Suriname (Useful and Medicinal Plants of the Wayana Indians in French Guiana and Suriname). Utrecht: Nationaal Herbarium Nederland, Universiteit Utrecht; 1990
  55. 55. Sedoc NO. Afrosurinaamse natuurgeneeswijzen: Bevattende meer dan tweehonderd meest gebruikelijke geneeskrachtige kruiden (Afro-Surinamese Natural Remedies: Over two hundred Commonly Used Medicinal Herbs). Paramaribo: Vaco Press; 1992
  56. 56. Chothani DL, Patel MB, Vaghasiya HU, Mishira SH. Review on Ruellia tuberosa (cracker plant). Pharmacognosy Journal. 2010;2:506-512
  57. 57. Chaitanya BK, Babu SR, Ramesh C, Ravella A, Vardhan J, Atigari DV. Hypolipidemic and anti-oxidant activity of Ruellia tuberosa Linn. International Journal of Pharmacy and Biological Sciences. 2012;2:63-72
  58. 58. Rajan M, Kumar VK, Kumar PS, Swathi KR, Haritha S. Antidiabetic, antihyperlipidaemic and hepatoprotective activity of methanolic extract of Ruellia tuberosa Linn leaves in normal and alloxan induced diabetic rats. Journal of Chemical and Pharmaceutical Research. 2012;4:2860-2868
  59. 59. Samy MN, Sugimoto S, Matsunami K, Otsuka H, Kamel MS. Chemical constituents and biological activities of genus Ruellia. International Journal of Pharmacognosy. 2015;2:270-279. DOI: 10.1007/s10600-013-0549-5
  60. 60. Akhtar MF, Rashid S, Ahmad M, Usmanghani K. Cardiovascular evaluation of Ruellia patula and Ruellia brittoniana. Journal of Islamic World Academy of Sciences. 1992;5:67-71
  61. 61. Ahmad M, Akhtar MF, Miyase T, Rashid S, Ghani KU. Studies on the medicinal herb Ruellia patula. International Journal of Pharmacognosy. 1993;31:121-129
  62. 62. Beltrán AE, Alvarez Y, Xavier FE, Hernanz R, Rodriguez J, Núñez AJ, et al. Vascular effects of the Mangifera indica L. extract (Vimang). European Journal of Pharmacology. 2004;499:297-305
  63. 63. Tharanathan RN, Yashoda HM, Prabha TN. Mango (Mangifera indica L.), the king of fruits – A review. Food Reviews International. 2006;22:95-123. DOI: 10.1080/87559120600574493
  64. 64. Bekoe EO, Kretchy IA, Sarkodie JA, Okraku A, Sasu C, Adjei D, et al. Ethnomedicinal survey of plants used for the management of hypertension sold in the Makola market, Accra, Ghana Emelia Oppong Bekoe. European Journal of Medicinal Plants. 2017;19:1-9. DOI: 10.9734/EJMP/2017/32342
  65. 65. Barreto JC, Trevisan MTS, Hull WE, Erben G, De Brito ES, Pfundstein B, et al. Characterization and quantitation of polyphenolic compounds in bark, kernel, leaves, and peel of mango (Mangifera indica L.). Journal of Agricultural and Food Chemistry. 2008;56:5599-5610. DOI: 10.1021/jf800738r
  66. 66. Parvez GMM. Pharmacological activities of mango (Mangifera indica): A review. Journal of Pharmacognosy and Phytochemistry. 2016;5:1-7
  67. 67. Shree Devi MS. Acute toxicity and diuretic activity of Mangifera indica L. bark extracts. International Journal of Pharma and Bio Sciences. 2011;2:141-146
  68. 68. Tundis R, Xiao J, Loizzo MR. Annona species (Annonaceae): A rich source of potential antitumor agents? Annals of the New York Academy of Sciences. 2017;1398:30-36. DOI: 10.1111/nyas.13339
  69. 69. Bermejo A, Figadere B, Zafra-Polo MC, Barrachina I, Estornell E, Cortes D. Acetogenins from Annonaceae: Recent progress in isolation, synthesis and mechanisms of action. Natural Product Reports. 2005;22:269-303
  70. 70. Lannuzel A, Ruberg M, Michel PP. Atypical parkinsonism in the Caribbean island of Guadeloupe: Etiological role of the mitochondrial complex I inhibitor annonacin. Movement Disorders. 2008;23:2122-2128. DOI: 10.1002/mds.22300
  71. 71. Moghadamtousi SZ, Fadaeinasab M, Nikzad S, Mohan G, Ali HM, Kadir HA. Annona muricata (Annonaceae): A review of its traditional uses, isolated acetogenins and biological activities. International Journal of Molecular Sciences. 2015;16:15625-15658. DOI: 10.3390/ijms160715625
  72. 72. Hasrat JA, De Bruyne T, De Backer JP, Vauquelin G, Vlietinck AJ. Isoquinoline derivatives isolated from the fruit of Annona muricata as 5-HTergic 5-HT1A receptor agonists in rats: Unexploited antidepressive (lead) products. The Journal of Pharmacy and Pharmacology. 1997;49:1145-1149
  73. 73. Saleem U, Ejaz-ul-Haq M, Chudary Z, Ahmad B. Pharmacological screening of Annona muricata: A review. Asian Journal of Agriculture and Biology. 2017;5:38-46
  74. 74. Nwokocha CR, Owu DU, Gordon A, Thaxter K, McCalla G, Ozolua RI, et al. Possible mechanisms of action of the hypotensive effect of Annona muricata (soursop) in normotensive Sprague-Dawley rats. Pharmaceutical Biology. 2012;50:1436-1441. DOI: 10.3109/13880209.2012.684690
  75. 75. Mans DRA, Sallevelt SCEH, Soekhoe R, Bipat R, Toelsie JR. Evaluation of plants with presumed antihypertensive properties for their potential to decrease peripheral resistance using isolated guinea pig aortic rings precontracted with phenylephrine. Academic Journal of Suriname. 2010;1:15-19
  76. 76. Dabiré H. Central 5-hydroxytryptamine (5-HT) receptors in blood pressure regulation. Thérapie. 1991;46:421-429
  77. 77. Sowbhagya HB. Chemistry, technology, and nutraceutical functions of celery (Apium graveolens L.): An overview. Critical Reviews in Food Science and Nutrition. 2014;54:389-398. DOI: 10.1080/10408398.2011.586740
  78. 78. Ciganda C, Laborde A. Herbal infusions used for induced abortion. Journal of Toxicology. Clinical Toxicology. 2003;41:235-239
  79. 79. Amerio A, de Benedictis G, Leondeff J, Mastrangelo F, Coratelli P. Nephropathy due to apiol. Minerva Nefrologica. 1968;15:49-70
  80. 80. Celestin J, Heiner DC. Food-induced anaphylaxis. The Western Journal of Medicine. 1993;158:610-611
  81. 81. Gharouni M, Sarkati A. Application of Apium graveolens in treatment of hypertension. Journal of Dentistry of Tehran University of Medical Sciences. 2000;3:67-69
  82. 82. Al-Asmari AK, Athar MT, Kadasah SG. An updated phytopharmacological review on medicinal plant of Arab region: Apium graveolens Linn. Pharmacognosy Reviews. 2017;11:13-18. DOI: 10.4103/phrev.phrev_35_16
  83. 83. Tang FF, Guo JX, Zhang J, Li J, Study SM. On hypotensive and vasodilatory effects of celery juice. Food Science. 2007;28:322-325
  84. 84. Branković S, Kitić D, Radenković M, Veljković S, Kostić M, Miladinović B, et al. Hypotensive and cardioinhibotory effects of the aqueous and ethanol extracts of celery (Apium graveolens, Apiaceae). Acta Medica Medianae. 2010;49:13-16
  85. 85. Chai LM, Tian L, Li Y, Liu CS, Wu LY. Antihypertensive effects of roots of Apium graveolens extract in renal hypertensive rats. Chinese Journal of Experimental Traditional Medical Formulae. 2010;16:101-103
  86. 86. Moghadam MH, Imenshahidi M, Mohajeri SA. Antihypertensive effect of celery seed on rat blood pressure in chronic administration. Journal of Medicinal Food. 2013;16:558-563. DOI: 10.1089/jmf.2012.2664
  87. 87. Al Jawad FH, Al Razzuqi RAM, Al Jeboori AA. Apium graveolens accentuates urinary Ca2+ excretions in experimental model of nephrocalcinosis. International Journal of Green Pharmacy. 2011;5:100-102. DOI: 10.4103/0973-8258.85160
  88. 88. Ur Rehman A, Ishaq H, Furqan M, Sheikh D, Raza ML, Naqvi BS, et al. Comparative study of ethanolic and aqueous extracts of Apium graveolens L. root with furosemide for its diuretic activity and excretion of urinary metabolites in Wistar rats. Science International (Lahore). 2016;28:2503-2507
  89. 89. Zhu J, Zhang Y, Yang C. Protective effect of 3-n-butylphthalide against hypertensive nephropathy in spontaneously hypertensive rats. Molecular Medicine Reports. 2015;11:1448-1454. DOI: 10.3892/mmr.2014.2791
  90. 90. Dewi K, Jasaputra DK, Litanto O. The effect of celery ethanol extract (Apium graveolens L.) on male adult’s blood pressure. Planta Medica Journal. 2010;1:27-34
  91. 91. Madhavi D, Kagan D, Rao V, Murray MT. A pilot study to evaluate the antihypertensive effect of a celery extract in mild to moderate hypertensive patients. Natural Medicine Journal. 2013;5:1-5
  92. 92. Abdoulaye IA, Guo YJ. A review of recent advances in neuroprotective potential of 3-n-butylphthalide and its derivatives. BioMed Research International. 2016;2016:5012341. DOI: 10.1155/2016/5012341
  93. 93. Mans DRA, Grant A. “A thing of beauty is a joy forever”. Plants and plant-based preparations for facial care in Suriname. Clinical and Medical Investigations. 2017;2:1-16. DOI: 10.15761/CMI.1000143
  94. 94. Lima EBC, Sousa CNS, Meneses LN, Ximenes NC, Santos Jr MA, Vasconcelos GS, et al. Cocos nucifera (L.) (Arecaceae): A phytochemical and pharmacological review. Brazilian Journal of Medical and Biological Research. 2015;48:953-964.
  95. 95. Aggarwal B, Lamba HS, Sharma PA, Ajeet. Various pharmacological aspects of Cocos nucifera – A review. American Journal of Pharmacological Sciences 2017;5:25-30. DOI: 10.12691/ajps-5-2-2
  96. 96. Bankar GR, Nayak PG, Bansal P, Paul P, Pai KS, Singla RK, et al. Vasorelaxant and antihypertensive effect of Cocos nucifera Linn. Endocarp on isolated rat thoracic aorta and DOCA salt-induced hypertensive rats. Journal of Ethnopharmacology. 2011;134:50-54. DOI: 10.1016/j.jep.2010.11.047
  97. 97. Bhagya D, Prema L, Rajamohan T. Therapeutic effects of tender coconut water on oxidative stress in fructose fed insulin resistant hypertensive rats. Asian Pacific Journal of Tropical Medicine. 2012;5:270-276. DOI: 10.1016/S1995-7645(12)60038-8
  98. 98. Syafriani R, Sukandar EY, Apriantono T, Sigit JI. The effect of coconut water (Cocos nucifera L.) and an isotonic drink on the change of heart rate frequency in the rats induced hypertension. Procedia Chemistry. 2014;13:177-180. DOI: 10.1016/j.proche.2014.12.023
  99. 99. Alleyne T, Roache S, Thomas C, Shirley A. The control of hypertension by use coconut water and Mauby; two tropical food drinks. The West Indian Medical Journal. 2005;54:3-8
  100. 100. Bhagya D, Gopan S. Effects of coconut neera (Cocos nucifera L.) on blood pressure among hypertensive adult women. International Journal of Applied and Pure Science and Agriculture. 2016;2:1-7
  101. 101. Ikrama EHK, Stanley R, Netzel M, Fanning K. Phytochemicals of papaya and its traditional health and culinary uses – A review. Journal of Food Composition and Analysis. 2015;4:201-211
  102. 102. Khanna N, Panda PC. The effect of papain on tenderization and functional properties of spent hen meat cuts. Indian Journal of Animal Research. 2007;41:55-58
  103. 103. Huet J, Looze Y, Bartik K, Raussens V, Wintjens R, Boussard P. Structural characterization of the papaya cysteine proteinases at low pH. Biochemical and Biophysical Research Communications. 2006;341:620-626
  104. 104. Fukal L, Kas J. The role of active and inactivated papain in beer chillproofing. Journal of the Institute of Brewing. 1984;90:247-249
  105. 105. Sivarajah N. Medicinal uses of Carica papaya. Int. Journal of Scientific Research. 2017;6:2770-2772
  106. 106. Eno AE, Owo OI, Itam EH, Konya RS. Blood pressure depression by the fruit juice of Carica papaya (L.) in renal and DOCA-induced hypertension in the rat. Phytotherapy Research. 2000;14:235-239
  107. 107. Wilson RK, Kwan TK, Kwan CY, Sorger GJ. Effects of papaya seed extract and benzyl isothiocyanate on vascular contraction. Life Sciences. 2002;71:497-507
  108. 108. Runnie I, Salleh MN, Mohamed S, Head RJ, Abeywardena MY. Vasorelaxation induced by common edible tropical plant extracts in isolated rat aorta and mesenteric vascular bed. Journal of Ethnopharmacology. 2004;92:311-316
  109. 109. Sripanidkulchai B, Wongpanich V, Laupattarakasem P, Suwansaksri J, Jirakulsomchok D.Diuretic effects of selected Thai indigenous medicinal plants in rats. Journal of Ethnopharmacology. 2001;75:185-190
  110. 110. Saboo SS, Thorat PK, Tapadiya GG, Khadabadi SS. Ancient and recent medicinal uses of Cucurbitaceae family. International Journal of Therapeutic Applications. 2013;9:11-19
  111. 111. Mukherjee PK, Nema NK, Maity N, Sarkar BK. Phytochemical and therapeutic potential of cucumber. Fitoterapia. 2013;84:227-236. DOI: 10.1016/j.fitote.2012.10.003
  112. 112. Sahu T, Sahu J. Cucumis sativus (cucumber): A review on its pharmacological activity. Journal of Applied Pharmaceutical Research. 2015;3:4-9
  113. 113. Lu G, Yuan WX, Fan YJ. Clinical and experimental study of tablet cucumber vine compound in treating essential hypertension. Zhong Xi Yi Jie He Za Zhi. 1991;11:274-276
  114. 114. Pertami SB. Budiono, Rahayu DYS. Effect of cucumber (Cucumis sativus) juice on lowering blood pressure in elderly. Public Health of Indonesia. 2017;3:30-36
  115. 115. Palanisamy V, Shanmugam S, Balakrishnan S. Evaluation of diuretic activity of polyherbal formulation. International Journal of Pharmaceutics. 2015;5:244-247
  116. 116. Singh RC, Sisodia CS. Pharmacodynamic investigations into the diuretic activity of Cucumis melo seed (ether extract). The Indian Journal of Medical Research. 1970;58:505-512
  117. 117. Naik VR, Agshikar NV, Abraham GJ. Cucumis trigonus Roxb. II. Diuretic activity. Journal of Ethnopharmacology. 1981;3:15-19
  118. 118. Adjanohoun E. Contribution to ethnobotanical and floristic studies in the People’s Republic of Congo. Traditional Medicine and Pharmacopoeia. 1988;3(Suppl):428
  119. 119. Rastogi S, Pandey MM, Rawat AKS. An ethnomedicinal, phytochemical and pharmacological profile of Desmodium gangeticum (L.) DC. And Desmodium adscendens (Sw.) DC. Journal of Ethnopharmacology. 2011;136:283-296. DOI: 10.1016/j.jep.2011.04.031
  120. 120. Muanda FN, Bouayed J, Djilani A, Yao C, Soulimani R, Dicko A. Chemical composition and, cellular evaluation of the antioxidant activity of Desmodium adscendens leaves. Evidence-based Complementary and Alternative Medicine. 2011;2011:620862. DOI: 10.1155/2011/620862
  121. 121. Addy ME, Burka JF. Effects of Desmodium adscendens fractions on antigen-and arachidonic acid-induced contractions of guinea pig airways. Canadian Journal of Physiology and Pharmacology. 1988;66:820-825
  122. 122. Addy ME. Several chromatographically distinct fractions of Desmodium adscendens inhibit smooth muscle contractions. International Journal of Crude Drug Research. 1989;27:81-91
  123. 123. Hussain H, Hussain J, Al Harrasi A, Krohn K. The chemistry and biology of bicoumarins. Tetrahedron. 2012;68:2553-2578. DOI: 10.1016/j.tet.2012.01.035
  124. 124. Boniface PK, Baptista Ferreira S, Roland Kaiser C. Current state of knowledge on the traditional uses, phytochemistry, and pharmacology of the genus Hymenaea. Journal of Ethnopharmacology. 2017;206:193-223. DOI: 10.1016/j.jep.2017.05.024
  125. 125. Nogueira RT, Shepherd GJ, Laverde A, Marsaioli AJ, Imamura PM. Clerodane-type diterpenes from the seed pods of Hymenaea courbaril var. stilbocarpa. Phytochemistry. 2001;58:1153-1157
  126. 126. Bezerra GP, Góis RW, de Brito TS, de Lima FJ, Bandeira MA, Romero NR, et al. Phytochemical study guided by the myorelaxant activity of the crude extract, fractions and constituent from stem bark of Hymenaea courbaril L. Journal of Ethnopharmacology. 2013;149:62-69. DOI: 10.1016/j.jep.2013.05.052
  127. 127. Zandi K, Teoh B, Sam S, Wong P, Mustafa MR, AbuBakar S. vitro antiviral activity of fisetin, rutin and naringenin against dengue virus type-2. Journal of Medicinal Plants Research. 2011;5:5534-5539
  128. 128. De Caluw E, Halamov K, van Damme P. Tamarindus indica L.: A review of traditional uses, phytochemistry and pharmacology. Afrika Focus. 2010;23:53-83
  129. 129. Bagul M, Sonawane SK, Arya SS. Tamarind seeds: Chemistry, technology, applications and health benefits: A review. Indian Food Industry Mag. 2015;34:28-35
  130. 130. Bhadoriya SS, Mishra V, Raut S, Ganeshpurkar A, Jain SK. Anti-inflammatory and antinociceptive activities of a hydroethanolic extract of Tamarindus indica leaves. Scientia Pharmaceutica. 2012;80:685-700
  131. 131. Sole SS, Srinivasan BP. Aqueous extract of tamarind seeds selectively increases glucose transporter-2, glucose transporter-4, and islets’ intracellular calcium levels and stimulates β-cell proliferation resulting in improved glucose homeostasis in rats with streptozotocin-induced diabetes mellitus. Nutrition Research. 2012;32:626-636. DOI: 10.1016/j.nutres.2012.06.015
  132. 132. Iftekhar AS, Rayhan I, Quadir MA, Akhteruzzaman S, Hasnat A. Effect of Tamarindus indica fruits on blood pressure and lipid-profile in human model: An in vivo approach. Pakistan Journal of Pharmaceutical Sciences. 2006;19:125-129
  133. 133. Lim CY, Junit SM, Abdulla MA, Aziz AA. In vivo biochemical and gene expression analyses of the antioxidant activities and hypocholesterolaemic properties of Tamarindus indica fruit pulp extract. PLoS One. 2013;8:e70058. DOI: 10.1371/journal.pone.0070058
  134. 134. Martinello F, Soares SM, Franco JJ, Santos AC, Sugohara A, Garcia SB, et al. Hypolipemic and antioxidant activities from Tamarindus indica L. pulp fruit extract in hypercholesterolemic hamsters. Food and Chemical Toxicology. 2006;44:810-818
  135. 135. Dreher ML, Davenport AJ. Hass avocado composition and potential health effects. Critical Reviews in Food Science and Nutrition. 2013;53:738-750. DOI: 10.1080/10408398.2011.556759
  136. 136. Swisher HE. Avocado oil: From food use to skin care. J. Amer oil. Chemical Society. 1988;65:1704-1706
  137. 137. Karou SD, Tchacondo T, Djikpo Tchibozo MA, Abdoul-Rahaman S, Anani K, Koudouvo K, et al. Ethnobotanical study of medicinal plants used in the management of diabetes mellitus and hypertension in the central region of Togo. Pharmaceutical Biology. 2011;49:1286-1297. DOI: 10.3109/13880209.2011.621959
  138. 138. Gbolade A. Ethnobotanical study of plants used in treating hypertension in Edo state of Nigeria. Journal of Ethnopharmacology. 2012;144:1-10. DOI: 10.1016/j.jep.2012.07.018
  139. 139. Anita BS, Okokon JE, Okon PA. Hypoglycemic activity of aqueous Persea americana mill. Indian Journal of Pharmacology. 2005;37:325-326. DOI: 10.4103/0253-7613.16858
  140. 140. Yasir M, Das S, Kharya MD. The phytochemical and pharmacological profile of Persea americana mill. Pharmacognosy Reviews. 2010;4:77-84. DOI: 10.4103/0973-7847.65332
  141. 141. Ojewole JA, Kamadyaapa DR, Gondwe MM, Moodley K, Musabayane CT. Cardiovascular effects of Persea americana mill (Lauraceae) (avocado) aqueous leaf extract in experimental animals. Cardiovascular Journal of Africa. 2007;18:69-76
  142. 142. Adeboye JO, Fajonyomi MO, Makinde JM, Taiwo OB. A preliminary study on the hypotensive activity of Persea americana leaf extracts in anaesthetized normotensive rats. Fitoterapia. 1999;70:15-20. DOI: 10.1016/S0367-326X(98)00015-X
  143. 143. Anaka ON, Ozolua RI, Okpo SO. Effect of the aqueous seed extract of Persea americana mill. (Lauraceae) on the blood pressure of Sprague-Dawley rats. African Journal of Pharmacy and Pharmacology. 2009;3:485-490
  144. 144. Owolabi MA, Jaja SI, Coker HA. Vasorelaxant action of aqueous extract of the leaves of Persea americana on isolated thoracic rat aorta. Fitoterapia. 2005;76:567-573
  145. 145. Odubanjo VO, Oboh G, Makinde OA. Inhibitory effect of aqueuos extracts of avocado pear (Persea americana) leaf and seed on angiotensin 1-converting enzyme: a possible means in treating/managing hypertension. Journal of Applied Life Sciences International. 2016;4:1-9. DOI: 10.9734/JALSI/2016/21605
  146. 146. Nwaoguikpe RN, Braide W. The effect of aqueous seed extract of Persea americana (avocado pear) on serum lipid and cholesterol levels in rabbits. African Journal of Pharmacy and Pharmacological Research. 2011;1:23-29
  147. 147. Pieterse Z, Jerling JC, Oosthuizen W, Kruger HS, Hanekom SM, Smuts CM, et al. Substitution of high monounsaturated fatty acid avocado for mixed dietary fats during an energy-restricted diet: Effects on weight loss, serum lipids, fibrinogen, and vascular function. Nutrition. 2005;21:67-75
  148. 148. Riello G. Cotton: The Fabric that Made the Modern World. Cambridge: Cambridge University Press; 2013
  149. 149. Coutinho EM. Gossypol: A contraceptive for men. Contraception. 2002;65:259-263
  150. 150. Muhammad Z, Masanawa AA, Pyeng AK. Phytochemical and mineral analysis of methanolic extract of Gossypium barbadense L. (cotton leaves). Annals of Experimental Biology. 2014;2:11-15
  151. 151. Cecilia EO, Olalekan EO, Oluwafemi B, Tolulope OM. Possible in vitro antioxidant potential of Gossypium barbadense leaf aqueous extract and its effect on lipid profile and liver enzymes of albino rats. Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2014;5:129-136
  152. 152. Chaturvedi A, Nag TN. Medicinal value of cotton. International Journal of MediPharm Research. 2015;1:147-149
  153. 153. Hasrat JA, Pieters L, Vlietinck AJ. Medicinal plants in Suriname: Hypotensive effect of Gossypium barbadense. The Journal of Pharmacy and Pharmacology. 2004;56:381-387
  154. 154. Ismail A, Ikram EHK, Nazri HSM. Roselle (Hibiscus sabdariffa L.) seeds – nutritional composition protein quality and health benefits. Food. 2008;2:1-16
  155. 155. Da-Costa-Rocha I, Bonnlaender B, Sievers H, Pischel I, Heinrich M. Hibiscus sabdariffa L.– A phytochemical and pharmacological review. Food Chemistry 2014;165:424-443. DOI: 10.1016/j.foodchem.2014.05.002
  156. 156. Okereke CN, Iroka FC, Chukwuma MO. Phytochemical analysis and medicinal uses of Hibiscus sabdariffa. International Journal of Herbal Medicine. 2015;2:16-19
  157. 157. Zhao Y, Wang J, Ballevre O, Luo H, Zhang W. Antihypertensive effects and mechanisms of chlorogenic acids. Hypertension Research. 2011;35:370-374. DOI: 10.1038/hr.2011.195
  158. 158. Grajeda-Iglesias C, Figueroa-Espinoza MC, Barouh N, Baréa B, Fernandes A, de Freitas V,et al. Isolation and characterization of anthocyanins from Hibiscus sabdariffa flowers. Journal of Natural Products. 2016;79:1709-1718. DOI: 10.1021/acs.jnatprod.5b00958
  159. 159. Onakpoya IJ, Spencer EA, Thompson MJ, Heneghan CJ. The effect of chlorogenic acid on blood pressure: A systematic review and meta-analysis of randomized clinical trials. Journal of Human Hypertension. 2014;29:77-81. DOI: 10.1038/jhh.2014.46
  160. 160. Calderon-Montaño JM, Burgos-Moron E, Perez-Guerrero C, Lopez-Lazaro M. A review on the dietary flavonoid kaempferol. Mini Reviews in Medicinal Chemistry. 2011;11:298-344
  161. 161. Alarcón-Alonso J, Zamilpa A, Aguilar FA, Herrera-Ruiz M, Tortoriello J, Jimenez-Ferrer E.Pharmacological characterization of the diuretic effect of Hibiscus sabdariffa Linn (Malvaceae) extract. Journal of Ethnopharmacology. 2012;139:751-756. DOI: 10.1016/j.jep.2011.12.005
  162. 162. Hopkins AL, Lamm MG, Funk JL, Ritenbaugh C. Hibiscus sabdariffa L. in the treatment of hypertension and hyperlipidemia: A comprehensive review of animal and human studies. Fitoterapia. 2013;85:84-94. DOI: 10.1016/j.fitote.2013.01.003
  163. 163. Ojeda D, Jiménez-Ferrer E, Zamilpa A, Herrera-Arellano A, Tortoriello J, Alvarez L.Inhibition of angiotensin convertin enzyme (ACE) activity by the anthocyanins delphinidin- and cyanidin-3-O-sambubiosides from Hibiscus sabdariffa. Journal of Ethnopharmacology. 2010;127:7-10. DOI: 10.1016/j.jep.2009.09.059
  164. 164. Jiménez-Ferrer E, Alarcón-Alonso J, Aguilar-Rojas A, Zamilpa A, Jiménez-Ferrer CI, Tortoriello J, et al. Diuretic effect of compounds from Hibiscus sabdariffa by modulation of the aldosterone activity. Planta Medica. 2012;78:1893-1898. DOI: 10.1055/s-0032-1327864
  165. 165. Ngamjarus C, Pattanittum P, Somboonporn C. Roselle for hypertension in adults. Cochrane Database of Systematic Reviews. 2010;1:CD007894. DOI: 10.1002/14651858.CD007894.pub2
  166. 166. Wahabi HA, Alansary LA, Al-Sabban AH, Glasziuo P. The effectiveness of Hibiscus sabdariffa in the treatment of hypertension: A systematic review. Phytomedicine. 2010;17:83-86. DOI: 10.1016/j.phymed.2009.09.002
  167. 167. Djibril D, Mamadou F, Gérard V, Geuye MDC, Oumar S, Rigal L. Physical characteristics, chemical composition and distribution of constituents of the neem seeds (Azadirachta indica A. Juss) collected in Senegal. Research Journal of Chemical Sciences. 2015;5:52-58
  168. 168. Lokanadhan S, Muthukrishnan P, Jeyaraman S. Neem products and their agricultural applications. Journal of Biopesticides. 2012;5(Suppl):72-76
  169. 169. Mak-Mensah EE, Firempong CK. Chemical characteristics of toilet soap prepared from neem (Azadirachta indica A. Juss) seed oil. Asian Journal of Plant Science & Research. 2011;1:1-7
  170. 170. Kumar VS, Navaratnam V. Neem (Azadirachta indica): Prehistory to contemporary medicinal uses to humankind. Asian Pacific Journal of Tropical Biomedicine. 2013;3:505-514.DOI: 10.1016/S2221-1691(13)60105-7
  171. 171. Alzohairy MA. Therapeutics role of Azadirachta indica (neem) and their active constituents in diseases prevention and treatment. Evidence-based Complementary and Alternative Medicine. 2016;2016:7382506. DOI: 10.1155/2016/7382506
  172. 172. Shori AB, Baba AS. Antioxidant activity and inhibition of key enzymes linked to type-2 diabetes and hypertension by Azadirachta indica-yogurt. Journal of Saudi Chemical Society. 2013;17:295-301
  173. 173. Koley KM, Lal J. Pharmacological effects of Azadirachta indica (neem) leaf extract on the ECG and blood pressure of rat. Indian Journal of Physiology and Pharmacology. 1994;38:223-225
  174. 174. Obiefuna I, Young R. Concurrent administration of aqueous Azadirachta indica (neem) leaf extract with DOCA-salt prevents the development of hypertension and accompanying electrocardiogram changes in the rat. Phytotherapy Research. 2005;19:792-795
  175. 175. Shah AJ, Gilani AH, Hanif HM, Ahmad S, Khalid S, Bukhari IA. Neem (Azadirachta indica) lowers blood pressure through a combination of Ca++ channel blocking and endothelium-dependent muscarinic receptors activation. International Journal of Pharmacology. 2014;10:418-428
  176. 176. De Lima G, de Almeida ME, Dos Santos LL. Physicochemical characteristics of bilimbi (Averrhoa bilimbi). Revista Brasileira de Fruticultura 2011;23:421-423
  177. 177. Bakul G, Unni VN, Seethaleksmy NV, Mathew A, Rajesh R, Kurien G, et al. Acute oxalate nephropathy due to ‘Averrhoa bilimbi’ fruit juice ingestion. Indian Journal of Nephrology. 2013;23:297-300. DOI: 10.4103/0971-4065.114481
  178. 178. Alsarhan AN, Sultana N, Kadir MR, Aburjai T. Ethnopharmacological survey of medicinal plants in Malaysia, the Kangkar Pulai region. International Journal of Pharmacology. 2012;8:679-686. DOI: 10.3923/ijp.2012.679.686
  179. 179. Alhassan AM, Ahmed QU. Averrhoa bilimbiLinn.: A review of its ethnomedicinal uses, phytochemistry, and pharmacology. Journal of Pharmacy & Bioallied Sciences. 2016;8:265-271. DOI: 10.4103/0975-7406.199342
  180. 180. Bipat R, Toelsie JR, Joemmanbaks RF, Gummels JM, Klaverweide J, Jhanjan N, et al. Effects of plants popularly used against hypertension on norepinephrine-stimulated guinea pig atria. Pharmacognosy Magazine. 2008;4:12-19
  181. 181. Winarti C, Marwati T. Effect of bilimbi leaf extracts on decrease blood pressure. Jurnal Pascapanen Pertanian. 2009;6:54-61
  182. 182. Muthia R, Suganda AG, Sukandar EY. Angiotensin-1-converting enzyme (ACE) inhibitory activity of several Indonesian medicinal plants. Research Journal of Pharmaceutical, Biological and Chemical Sciences. 2017;8(Suppl.):192-199
  183. 183. Mans DRA. From forest to pharmacy: Plant-based traditional medicines as sources for novel therapeutic compounds Academia Journal of Medicinal Plants 2013;1:101-110. DOI:

Written By

Dennis R.A. Mans, Angela Grant and Nicholaas Pinas

Submitted: 03 August 2017 Reviewed: 31 October 2017 Published: 20 December 2017