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.
Highlights
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
After removing 37 duplicates, 49 articles were excluded based on screening the titles and abstracts. rough the full-text evaluation, 11 articles, five case reports, one review article, two non-Randomized controlled trials (RCTs), two non-SYM-related articles, and one article comparing two different Herbal medicine (HM), were excluded. erefore, seven articles [29,30,31,32,33,34,35] with 711 participants were included in the qualitative and quantitative synthesis (Figure 1)
As symptoms are related to hypertension, anxiety was assessed in two studies using the Zung self-rating anxiety score (SAS) [30] and Hamilton anxiety rating scale (HAMA) [35]
Summary
Hypertension is a major public health challenge worldwide. It is strongly associated with potentially severe conditions including cardiovascular disease and premature death [1]. According to the 2012 National Health Interview Survey and the Adult Alternative Medicine supplement, a combination of hypercholesterolemia, hypertension, diabetes, and obesity as dyads and triads was significantly related to the increased use of CAM such as mind-body interventions, manipulative methods, and energy therapies [10]. Herbal medicine (HM) has been used as a treatment approach in East Asian traditional medicine (EATM) to treat various medical conditions including hypertension-related symptoms for thousands of years in East Asia. Erefore, we aimed to synthesize the available evidence related to the effectiveness and safety of SYM as a monotherapy or adjunctive therapy for patients with hypertension and to assess the methodological quality of these studies to help clinicians establish evidence-based treatment strategies. Publication date, and publication status restrictions were imposed. e following search terms were used in PubMed: Hypertension [MH] OR hypertens ∗ [TIAB] OR “blood pressure” [MH] OR “blood pressure” [TIAB] OR blood pressure [TIAB] AND Chai-Hu-Jia-Long-Gu-Mu-Li-Tang [TIAB] OR Chai-Hu-Jia-Long-Gu-Mu-Li-Wan [TIAB] OR Chai-Hu-Jia-Long-Gu-Mu-Li-Pian [TIAB] OR Saiko-karyukotsu-borei-to [TIAB] OR Saiko-ka-ryukotsu-borei-to [TIAB] OR Sihogayonggolmoryeo-tang [TIAB] (Supplement 1)
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