Phytotherapy in the Management of Diabetes and Hypertension

Hypertension remains one of the most common forms of cardiovascular diseases affecting and plaguing both developing and developed countries. Hypertension, despite its ever-increasing prevalence across all age-groups, sex and race is often associated with potent debilitating complications that constitute huge financial and social burdens to both its sufferers and the society at large. Thus, hypertension and other related cardiovascular diseases are considered public menace. Effective management of hypertension requires a holistic and multidisciplinary approach, based on the identification of patients at highest cardiovascular risk and the use of multifactorial interventions, targeting not only the high blood pressure but all modifiable cardiovascular risk factors. Despite, remarkable and landmark progress and success recorded with the use of conventional pharmacotherapies in the management of hypertension and its complications, therapeutic failures still remain a major clinical concern. Thus, the current chapter defines, highlights and discusses the epidemiology, classification, aetiopathophysiology and risk factors, and complications of hypertension, conventional treatment strategies and alternative therapies (particularly with herbal therapies) employed in the local management of this disease. In addition, an in-depth insight into the recent development in the therapeutic/clinical use of herbal therapies in the local management of hypertension with the view of providing evidence-based preclinical and clinical data that are geared towards promoting the therapeutic use of these alternatives as alternative/adjuvant therapy in the effective management of hypertension.

Diabetes mellitus (DM) is an endocrine disorder affecting more than 100 million people worldwide. It is exemplified by hyperglycemia caused by imperfect functioning of insulin, abnormal insulin secretion or sometimes the combination of both. The long-term persistence of high glucose concentrations in the blood leads to the generation of abnormally high level of free radicals and reactive oxygen species (ROS), change of various oxidative stress biomarker levels, simultaneous decline of antioxidant defense mechanisms and thereby causes a variety of diabetic complications in the body. Increasing evidence in both experimental and clinical studies suggests that oxidative stress plays a major role in the pathogenesis of both types of diabetes mellitus. Abnormally increased production of free radicals and the simultaneous decline of antioxidant defense mechanisms can lead to damage of cellular organelles and enzymes, enhanced lipid peroxidation, and development of insulin resistance, creating complicacies. Changes in oxidative stress biomarkers and their consequences are discussed in this chapter. In vivo studies of the effects of various conventional and alternative drugs on these biomarkers are surveyed. There is a need to continue to explore the relationship between free radicals, diabetes, and its complications, and to elucidate the mechanisms by which increased oxidative stress accelerates the development of diabetic complications, in an effort to expand treatment options. Many ethnobotanically important herbal plants possessing antihyperglycemic potential are known to exist in nature. Moreover, a large number of polyherbal formulations (PHFs) derived from these plants are presently being prescribed as medicinal/dietary supplements for the management of DM. It has become very much essential to explore the hidden active principles present in the traditionally used antidiabetic herbal plants in order to standardize the formulations of various herbal drugs for the betterment of both types of DM treatment. This chapter would well indicate about how oxidative stress is involved in the pathogenesis of diabetes and its complications. The experimental validations and biochemical aspects of traditionally used antidiabetic plants in phytotherapy of DM are discussed to understand and elucidate the antidiabetic as well as associated antioxidative potentials.

Diabetes and hypertension are the two major global public health problems and are associated with each other. The number of diabetic and hypertensive patients is increasing all over the world at an alarming rate rapidly in developing countries due to a number of reasons. Conventional anti-diabetic and antihypertensive drugs are usually associated with many side effects such as severe hypoglycemia, lactic acidosis, idiosyncratic liver cell injury, permanent neurological deficit, digestive discomfort, headache, dizziness and even death. On the other hand, about 75 to 80% of the world population use herbal medicines, particularly in the developing countries, for primary health care not only due to their better acceptability by human body and lesser side effects but also due to lower cost compared to conventional drugs. This chapter is aimed at providing an in-depth information about the antidiabetic herbs such as Ficus religiosa, Pterocarpus marsupium, Gymnema sylvestre, Allium sativum, Eugenia jambolana, Momordica charantia, Tinospora cordifolia, Trigonella foenum-graecum and antihypertensive herbs such as Ginkgo biloba, Passiflora nepalensis, Zingiber officinale which have shown considerable protective effects in the recent studies. The chapter will also provide some directions for future studies which may be aimed at isolation, purification, and characterization of bioactive antidiabetic and antihypertensive compounds present in these plants. Apart from antidiabetic and antihypertensive activities, the possible mechanisms of actions of the above-mentioned plants are also discussed in this chapter.

There is a long history of using traditional Chinese medicines (TCM) for the treatment of diabetes mellitus (DM) and hypertension (HTN). However, their functioning mechanisms are still unknown. In this chapter, we summarize some common Chinese herbs that have been applied to treat DM and/or HTN since ancient times. Their active ingredients and the underlying mechanisms have been expounded. This may provide us a better understanding of the functions of these TCM for the treatment of DM and HTN, as well as a clue to unveil their possible efficacies for these chronic diseases. Nevertheless, further studies are needed to more accurately represent TCM in this field.

The genus Senna belongs to the family Leguminosae in the major group of flowering plants (Angiosperms). Members of this genus are widely distributed in different parts of the world and are mostly used for the traditional treatment of diabetes mellitus. Scientific investigations have confirmed the anti-diabetic effects. In this chapter, all the in vitro and in vivo anti-diabetic studies conducted on members of Senna genus are critically reviewed with emphasis on the pharmacology, mechanism of antidiabetic action and identified bioactive anti-diabetic agents in the plants. Among the members of the genus, Senna auriculata, S. fistula and S. tora are perhaps the most investigated. Other members of the genus investigated for anti-diabetic effects are S. occidentalis, S. surratensis, S. angustifolia, S. singueana and S. siamae. Most of the plants demonstrated potent anti-diabetic activity which is mediated via mechanisms similar to conventional anti-diabetic drugs. Unfortunately, only few studies were reported on the pure bioactive anti-diabetic agents but groups of phytochemicals were postulated (as bioactive agents) for most of the studies. Findings from the in vitro and in vivo anti-diabetic studies would be of interest for further research and subsequent standardization (and commercialization) of anti-diabetic herbal remedy from some members of Senna genus.

Diabetes is a disease with widespread prevalence; it adversely affects human health and contributes to the development of various chronic diseases, including hypertension, adipose tissue dysfunction, cardiovascular and liver diseases, and diabetic neuropathies and nephropathies. Diabetes is categorized as type 1 or type 2 diabetes. Type 1 is caused by autoimmune-mediated destruction of pancreatic β-cell islets, resulting in insulin deficiency, whereas type 2 diabetes is characterized by insulin resistance and/or abnormal insulin secretion. It is known that insulin resistance also leads to hypertension or high blood pressure. Both diabetes and hypertension are risk factors for cardiovascular disease and share a common pathophysiology, including insulin resistance, obesity, inflammation, and oxidative stress. The use of phytochemicals to treat diabetes and hypertension is of great interest. Curcumin is a biphenolic compound that has been used for the treatment and prevention of diabetes and hypertension in traditional Ayurvedic medicine. Dietary curcumin inhibits several cell signaling pathways known to be dysregulated in diabetes and hypertension. In addition, it can prevent diabetes and hypertension through antioxidant and anti-inflammatory mechanisms. Curcumin can normalize sugar levels through the modulation of tumor necrosis factor α, free fatty acids, nuclear factor κB (NF-κB), lipid peroxidation, and lysosomal enzymes. Furthermore, it decreases thiobarbituric acid reactive substances and succinate dehydrogenase, while activating peroxisome proliferator-activated receptor γ. Curcumin reduces insulin resistance through the activation of lipoprotein lipase, NF-E2-related factor 2, and liver enzymes participating in metabolic process. Thus, the interaction of curcumin with several signal transduction pathways reverses insulin resistance, hyperglycemia, hyperlipidemia, and other inflammatory symptoms associated with diabetes and hypertension.

Silymarin (SMN) is a complex mixture of flavonolignans extracted from seeds of the milk thistle (Silybummarianum). Traditionally, SMN has been used as a natural remedy for digestive problems and in particular for diseases of the liver and the biliary tract, for menstrual disorders and varicose veins. Other potential indications of SMN are related to its anticancer and anti-inflammatory properties demonstrated predominantly in in vitro assays. During the last years there are increasing data indicating beneficial effects of SMN on diabetes-induced negative impacts on tissues including the liver, pancreas and kidneys. Moreover, since the liver and kidneys are acting as the major organs which are biotransforming the xenobiotic and endogenous compounds, therefore any disorder in the function of aforementioned organs could be critical in diabetic patients. Therefore, in this chapter, we introduced SMN, its physicchemical properties, pharmacological effects and traditional uses. Our results from the last ten years about SMN protective and regulatory effects on drug and xenobiotic biotransforming enzymes in experimentally-induced diabetic animals are also discussed. Influence of SMN on pharmacokinetics of other concurrently administered antidiabetic drugs will be highlighted. Ultimately, its beneficial effects on diabeticinduced oxidative and nitrosative stress, histopathological injuries and biochemical markers in the liver, pancreas and kidneys are updated.

Plants have been highly valued for their healing properties in all cultures around the world. The plant is widely used in food and traditional medicine from ancient time. Carum carvi L. (C. carvi) is commonly known as spice and medicinal plant in many cultures and several studies have reported that C. carvi possesses antidiabetic, diuretic, antibacterial, antimicrobial, antiulcerogenic, antiproliferative and antispasmodic activities. Phytochemical analyses have revealed that the main phytochemicals in C. carvi seeds were carvone, limonene, carvacrol, carvenone, γ- terpinene, and p-cymene. In this chapter, information about C. carvi including its pharmacognosy, phytochemistry and pharmacology is provided.

Millions of people all over the world are using herbal medicines from thousands of years, due to their great interest in traditional medicines and they believe that herbal medicines are effective for the treatment of certain diseases. Premna serratifolia L. is an important medicinal shrub used in traditional system of medicines as antidiabetic, cardio tonic, antibiotic, anti-coagulant, carminative, hepatoprotective, anti-tumor etc. The different parts of the plant like leaves, stem, stem barks, root, root barks and wood have been used for extraction purpose. The chemical constituents or secondary metabolites found are mainly alkaloids, terpenoids, phenolic compounds, flavanoids and amino acids. The study suggests that the plant Premna serratifolia L. is a potent source for phytomedicine development in the future.

Eugenia jambolana. Lam. (EJ) is a plant belonging to Myrtaceace family. Most of the plant parts of Eugenia jambolana are used in traditional system of medicine in India. According to Ayurvedic scriptures, its bark is acrid, sweet, digestive and astringent to the bowels. It is also anthelmintic and is good for sore throat, bronchitis, asthma, thirst, biliousness, dysentery, blood impurities and to cure ulcers. Its antidiabetic activity has been demonstrated both experimentally and clinically. In addition, EJ has been demonstrated to exhibit several pharmacological properties including anti-allergic, anti-oxidant, radioprotective, hepatoprotective, anti-ulcer, antibacterial, anti-diarrhoeal, anti-hyperlipidemic, anti-depressant, nephroprotective and chemopreventive activities. The health benefits of Eugenia jambolana are mainly attributed to the various phytoconstituents, such as tannins, alkaloids, steroids, flavonoids, terpenoids, fatty acids, phenols, minerals, carbohydrates and vitamins present in the fruit. This chapter discusses the pharmacological and phytochemical properties of this plant.

Coccinia indica Wight and Arn (CI) is a plant belonging to Cucurbitaceae family. Most of the plant parts of CI are used in traditional system of medicine in India. CI has been demonstrated to exhibit several pharmacological properties including antidiabetic, antioxidant, antimirobial, antidyslipidemic, anthelmintic, antiinflammatory, analgesic antipyretic, hepatoprotective, ovicidal, wound healing, antitussive, anticancer and antilithiatic activities.The health benefits of CIare mainly attributed to the various phytoconstituents such as cryptoxanthin, cucurbitacin, taraxerone, lupeol, taraxerol, xyloglucan, sitosterol, heptacosane, beta amyrin and beta amyrin acetate. This chapter discusses the pharmacological and phytochemical properties of this plant.