Abstract
The development of risk factors associated with cardiovascular disorders present a major public health challenge in both developed countries and countries with emerging economies. Hypertension and associated complications including stroke and myocardial infarction have reached pandemic levels. Current management strategies of hypertension predominantly include the utilization of pharmaceutical drugs which are often associated with undesirable side effects. Moreover, the drugs are often too expensive for populations from resource-limited Southern African rural, and some urban, communities. As a result, most patients rely on ethno-medicinal plants for the treatment of a variety of diseases including cardiovascular and metabolic disorders. The effectiveness of these plants in managing several cardiovascular diseases has been attributed to the presence of bioactive phytochemical constituents. In this review, the treatment options that target the renin–angiotensin system (RAS) in the management of hypertension were summarized, with special emphasis on ethno-medicinal plants and their influence on the ACE1 RAS pathway. The dearth of knowledge regarding the effect of ethno-medicinal plants on the ACE2 pathway was also highlighted.
Highlights
Corner Beit and Siemert Streets, Doornfontein, Johannesburg 2000, South Africa; Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa
Evidence to support the potential beneficial role of ACE2 in cardiovascular diseases (CVDs) comes from the fact that: (i) ACE2 activity and expression increase in the initial stages of heart failure, but decrease with the progression of the disease [65], (ii) over-expression of ACE2 in hypertensive rats infused with Ang II prevents cardiac hypertrophy [66], (iii) lower levels of ACE2 are shown to be associated with cardiac and renal pathologies in animal models [67] and (iv) over-expressed ACE2 gene transfer after neonatal development protects against elevated blood pressure and cardiac pathology in spontaneously hypertensive (SHR) models [59]
Pharmaceutical drugs currently used in the treatment of hypertension often target the renin angiotensin system
Summary
The worldwide incidence of cardiovascular and metabolic diseases is on the increase, as evidenced by the growing prevalence of hypertension, type 2 diabetes (T2DM), and obesity. Connor, et al [14] reported that ethnicity affects the overall prevalence of hypertension in South Africa, with a higher incidence in the black population compared to other ethnic groups. Controlled hypertension contributes majorly to the general burden of diseases in the adult population and can lead to cerebrovascular diseases, myocardial infarctions, kidney disease or failure, as well as left ventricular hypertrophy, which could predispose to congestive heart failure. This can, be avoided by both prompt detection and cost-effective management of the condition [5]. It is widely accepted that there is a dire need to improve the diagnosis and management of hypertension [8]
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