Herbal Medicine (Sihogayonggolmoryeo‐Tang or Chai‐Hu‐Jia‐Long‐Gu‐Mu‐Li‐Tang) for Treating Hypertension:A Systematic Review and Meta‐Analysis

Abstract

Introduction. For situations in which effective and safe natural-derived products to treat hypertension are needed, recent studies suggest that an herbal medicine, Sihogayonggolmoryeo-tang (SYM), can improve both hypertension and concurrent mood symptoms. We aimed to evaluate the effectiveness and safety of SYM in treating hypertension. Methods. Thirteen English, Korean, and Chinese databases were comprehensively searched from their inception to May 2020. Randomized controlled trials (RCTs) using SYM as a monotherapy or adjunctive therapy for hypertension were evaluated. The primary outcome was the systolic and diastolic blood pressure (BP). Descriptive analyses of the relevant data were conducted, and where appropriate data were available, a meta-analysis was performed, and the results were presented as a risk ratio or mean difference with 95% confidence intervals. The risk of bias was assessed using the Cochrane risk of bias tool, and the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results. Seven RCTs with 711 participants were included. Compared with placebo, SYM significantly lowered systolic and diastolic BP and concurrent depression. SYM significantly lowered systolic and diastolic BP compared with active controls; however, subgroup analysis revealed no differences between SYM and antihypertensives. In addition, SYM significantly decreased the level of concurrent depression compared with antidepressants. There was no consistent difference in BP reduction between SYM combined with antihypertensives and antihypertensives alone. No serious adverse events were reported following SYM administration. Most of the included studies had an unclear risk of bias, and the quality of evidence was generally rated “low.” Conclusion. Current evidence suggests that SYM may have the potential to lower hypertension and concurrent depressive symptoms without serious adverse events. Additional high-quality, placebo-controlled RCTs should be conducted to confirm the efficacy of SYM.

Methodological Aspects of Meta-Analyses Assessing the Effect of Blood Pressure–Lowering Treatment on Clinical Outcomes

“…4 Depending on the research question, however, the search strategy should be expanded. For example, if the research question concerns the effect of herbal medicine on BP, it may be wise to consult non-English language databases to avoid what is sometimes referred to as the “Tower of Babel bias.” 27,28 Indeed, while previously relying on foreign colleagues to assess articles in other languages, it is our experience that online translation services, like Google translate, work well to assess eligibility and even extract data from non-English language studies.…”

Preference between Chinese and Western medicines for hypertension treatment: Evidences based on Chinese population aged ≥ 45 years

“…[7] With oral medication, western antihypertensives are used more commonly, including thiazide diuretic, angiotensin converting enzyme inhibitor, beta blocker, and long-acting calcium channel blocker. [8] Chinese herbal medicines are also somewhat efficacious in treating hypertension, [9] such as Sihogayonggolmoryeo-Tang [10] and Shenqi pill. [11] Non-medication treatments, on the other hand, mainly advocate lifestyle improvements (e.g., weight loss, smoking cessation, alcohol restriction, and low-salt diet), which also include surgical treatment.…”