Examining the relationship between Herbal Medicine use and Blood Pressure control in individuals on Antihypertensive therapy across two Regional Health Facilities in Trinidad.

Examining the relationship between Herbal Medicine use and Blood Pressure control in individuals on Antihypertensive therapy across two Regional Health Facilities in Trinidad. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Examining the relationship between Herbal Medicine use and Blood Pressure control in individuals on Antihypertensive therapy across two Regional Health Facilities in Trinidad. Arlene F. Williams-Persad, Graham Carvalho, Alexia Brereton, Shivanand Baboolal, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4331036/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Self-medication with herbal medicine (HM) to manage hypertension is an expanding trend worldwide. Still there is very little evidence to substantiate the motives for use in the control of blood pressure (BP). This study aims to ascertain the relationship between HM and antihypertensive treatment to manage hypertension across two regional health facilities in Trinidad. Methods This cross-sectional investigation surveyed hypertensive patients aged 35–64 from the North-Central and Eastern Regional Health facilities across Trinidad. Consent was obtained from 139 participants through convenience sampling. Data included a self-reporting questionnaire and patient medical records. Analysis using Chi-square, Mann-Whitney U tests for data not normally distributed and statistical significance at the 95% confidence interval. Results HM-users were either hypertensive stage 1 or 2 with no significant correlation between BMI and hypertensive stage ( p -value = -0.053, p -value = 0.537). Garlic, Allium sativum L (57%) most used as a tea, was taken daily ‘to control BP’. Current systolic and diastolic BP was higher among HM-users, compared to non-users with no statistical significance. Controlled-BP, HM-users (15.7%) showed statistical significance (p < 0.05), a negative association (Phi = -0.175) and an OR (95% CI) of 0.426 (0.187–0.969). Non-compliance to prescribed antihypertensives was greater among HM-users, 40% compared to non-users, 29.6%. Antihypertensives included calcium channel blockers (70.1%), ACE inhibitors (46.3%), and angiotensin-II receptor blockers (40.6%). Patient non-compliance to conventional medication was found to be higher among HM-users identified by the negative association among patients with uncontrolled BP. The most commonly used herb, A. sativum , was preferred for BP control, however, this study showed no significant changes in BP compared to non-users. Conclusion Patient medication concordance is imperative. Herb-drug interactions may be associated with the higher prevalence of patients at hypertensive stages 1 and 2 that are uncontrolled in this study. Herbal medicines dietary and herbal supplements hypertension Figures Figure 1 INTRODUCTION Hypertension exhibits a global rise in prevalence, solidifying its position as the primary etiological factor for cardiovascular disease and premature mortality ( 1 ). As of 2019, the World Health Organization (WHO) stated a 42% prevalence rate of hypertension among adults aged 30 to 79 years in Trinidad and Tobago (T&T), surpassing the global average ( 2 ). This trend is consistent with other studies which report that low and middle income countries have experienced a significant rise in hypertension prevalence within the past two decades ( 1 , 2 ). Despite these rising numbers, only 21% of those diagnosed with hypertension in T&T are reported to be controlled ( 2 ). Inadequate blood pressure control has been shown to be associated with increased risk of cardiovascular disease, of which mortality rates are higher in T&T than in North America ( 3 , 4 ). Approximately 80% of patients use herbal medicine (HM) in combination with antihypertensive medications (AHM) or alone for the treatment of hypertension ( 5 ). Herbal medicines, as defined by the WHO includes ‘herbs, herbal materials, herbal preparations and finished herbal products (FHP), that contain as active ingredients parts of plants, or other plant materials, or combinations’ ( 6 ). There are several studies examining the relationship between blood pressure control and herbal medicine use in relation to medication adherence. Nagawa CS et al (2021) demonstrated that there was no significant association between medication adherence and blood pressure control ( 7 ). This study also found that patients who used herbal or dietary supplements (HDS) that were reported in the literature to improve hypertension were associated with improved blood pressure control compared to those who did not ( 7 ). However, studies that examined herbal medicine use irrespective of the specific herb found no association between its use and blood pressure control ( 8 , 9 ). Amira OC and Okubadejo NU (2007) also found that there was no difference in clinical characteristics or socio-economic status of complementary and alternative medicine (CAM) users compared to non-users ( 8 ). Herbal medicine has been reported to be used in combination with standard antihypertensive medication due to their perceived safety and high efficacy ( 5 ). Clement YN et al (2007) examined the perceived efficacy of herbal remedies in T&T and found that 86.6% of participants believed that herbs had equal or greater efficacy than standard conventional medication ( 10 ). This study also found that hypertension was the most commonly managed condition with herbal remedies, whereby garlic ( Allium sativum ) was used by almost half of the sample and in 20% of hypertensive patients ( 10 ). Other medicinal plants reported to be commonly used in the management of chronic diseases in Trinidad and Tobago include orange rind ( Citrus sinensis ), ginger ( Zingiber officinale ), and lemongrass ( Cymbopogon citratus ) ( 10 ). Clement YN et al highlights the need for further research to determine the efficacy of herbal medicine in the management of chronic disease ( 10 ). While the reasons for use and perceived efficacy of herbal remedies in Trinidad and Tobago has been studied, none have yet examined the impact of herbal medicine use and blood pressure control in the management of hypertension. Considering this, the aims of this study were to determine: The impact of herbal medicine use on blood pressure control. The frequency and characteristics of herbal medicine usage in our hypertensive population. If an association exists between herbal medicine use and medication adherence. METHODS Design and Setting This cross-sectional study was conducted to examine the relationship between herbal medicine use and blood pressure control in hypertensive patients who were prescribed conventional antihypertensive medication. Data was collected from patients across two regional health authorities (RHA) in Trinidad and Tobago. Patients were surveyed over a one-month period at health centres within the North Central Regional Health Authority (NCRHA) and Eastern Regional Health Authority (ERHA) at the chronic disease clinic. Study Participants A convenience sampling of patients attending their clinic appointment who were ages 35 to 64 with diagnosed essential hypertension and on prescribed antihypertensive medications (AHM) were invited to participate in this study. Patients who were diagnosed with comorbid cardiovascular disease including coronary artery disease, heart failure, and stroke as well as patients with normal blood pressure (≤ 120 / ≤80 mmHg) according to the Eighth Joint National Committee (JNC 8) recommendations were excluded from the study ( 11 , 12 ). All patients provided written informed consent. This study was approved by the research ethics committee of The University of the West Indies, St. Augustine (ref: CREC-SA.1923/12/2022). All participants involved in this study provided written informed consent. A total of 151 patients were interviewed and 139 were included in the final analysis. Twelve (7.9%) patients were omitted as two of them had normal blood pressure readings recorded, four had no blood pressure readings recorded, two had a history of comorbid cardiovascular disease, and four had missing data that prevented further analysis. Assuming a power of 80% and an alpha value of 0.05, the estimated target sample size was 127. The calculation was conducted based on the following equation: \(\:N\:=\frac{{{{p}_{0}{q}_{0}\left\{{z}_{1-a/2}+{z}_{1-B}\sqrt{\frac{p1q1}{p0q0}}\right\}}^{2}}^{}}{{({p}_{1}-{p}_{0})}^{2}}\) ( 13 ). Data Collection Data was collected from patients in two ways: ( 1 ) self-administered questionnaires, and ( 2 ) past medical history obtained from medical records. The questionnaires were used to collect data relating to socio-demographics, history of hypertension, medication compliance, and herbal medicine use. Patients who used herbal medicine were classified as ‘herbal medicine users’. Medical records were used to gather data consisting of prior and current blood pressure readings, body mass index, and current prescribed medications. Current blood pressure readings were obtained at the time of the interview. Previous blood pressure readings were termed as ‘initial’ were recorded at least 3 to 6 months prior to when patients were surveyed. The stage of hypertension was defined according to the JNC 8 recommendations ( 11 , 12 ). Blood pressure control was defined as a current blood pressure of ≤ 140 / ≤90 mmHg according to the Pan American Health Organization HEARTS protocol that is currently employed by the Ministry of Health in Trinidad and Tobago ( 14 ). The protocol utilises this target blood pressure for all hypertensive patients who are not defined as high risk. Medication compliance was determined by asking patients whether they follow their prescribed medication regime (yes, no, or most of the time). Patients who answered ‘yes’ were categorised as compliant, while patients who answered ‘no’ or ‘most of the time’ were categorised as non-compliant. Statistical Analysis Data analysis was conducted using IBM SPSS Statistics, version 29.0.0.0. Chi-square was used to analyse sociodemographic factors, blood pressure control, and medication compliance. The Mann-Whitney U test was used to compare mean values of blood pressure and BMI between herbal medicine users and non-users. This statistical test was utilised as the data for these variables were non-normally distributed and contained outliers. Confidence intervals of 95% were used and statistical significance was assumed at a p -value < 0.05. RESULTS Among the patients surveyed, herbal medicine use exhibited a prevalence of approximately 60%. Table 1 shows the sociodemographic characteristics of patients by herbal medicine use. Participants were more likely to be above the age of 60 years (48.9%), of East-Indian ethnicity (37.2%), retired (46.8%), married (51.8%), and have primary education be the highest form of education attained. The association between herbal medicine use and any sociodemographic characteristics did not achieve statistical significance ( p -value > 0.05). Table 1 Sociodemographic characteristics of hypertensive patients aged 35–64 according to herbal medicine use. Characteristics Overall population n = 139 (%) HM users n = 83 (%) HM non-users n = 56 (%) X 2 p -value Age (years) 35–50 51–55 56–60 61–64 19 (13.7) 18 (12.9) 34 (24.5) 68 (48.9) 10 ( 12 ) 10 ( 12 ) 18 (21.7) 45 (54.2) 9 (16.1) 8 (14.3) 16 (28.6) 23 (41.1) 2.354 0.502 Ethnicity African East-Indian Mixed 43 (31.4) 51 (37.2) 43 (31.4) 25 (30.9) 28 (34.6) 28 (34.6) 18 (32.1) 23 (41.1) 15 (26.8) 1.032 0.597 Employment status Employed Unemployed Retired 49 (35.3) 25 ( 18 ) 65 (46.8) 25 (30.1) 13 (15.7) 45 (54.2) 24 (42.9) 12 (21.4) 20 (35.7) 4.605 0.1 RHA ERHA NCRHA 81 (58.3) 58 (41.7) 51 (61.4) 32 (38.6) 30 (53.6) 26 (46.4) 0.853 0.356 Highest level of education Primary Secondary Tertiary 60 (45.1) 50 (37.6) 23 (17.3) 39 (48.1) 25 (30.9) 17 (21) 21 (40.4) 25 (48.1) 6 (11.5) 4.554 0.103 Marital status Single Married Divorced Widowed 34 (24.5) 72 (51.8) 14 (10.1) 19 (13.7) 18 (21.7) 43 (51.8) 10 ( 12 ) 12 (14.5) 16 (28.6) 29 (51.8) 4 (7.1) 7 (12.5) 1.541 0.673 HM, herbal medicine; RHA, regional health authority; ERHA, Eastern Regional Health Authority; NCRHA, North Central Regional Health Authority Table 2 shows the clinical characteristics of participants by herbal medicine use. HM non-users had a slightly higher average BMI compared to HM users. As demonstrated in Fig. 1 , HM users had higher average systolic blood pressure readings compared to non-users. This trend was also observed for the average current diastolic blood pressure, however, the initial diastolic blood pressure of HM users were slightly lower compared to non-users. The association between blood pressure readings, BMI, and herbal medicine use did not achieve statistical significance ( p -value > 0.05). Spearman’s rank analysis found no significant correlation between BMI stage and stage of hypertension for the sample population ( p = -0.053, p- value = 0.537). The majority (48.9%) of patients in this study were classified as having stage 1 hypertension. HM users were found to fall within stage 1 (54.2%) or stage 2 (31.3%) classification more often than non-users. Among the total sample, 30 (21.6%) patients exhibited controlled blood pressure and within the two groups examined, 15.7% of patients who used herbal medicine achieved control compared to 30.4% for non-users. Individuals using herbal medicine (84.3%) were more likely to have uncontrolled blood pressure ( p -value < 0.05) compared with HM non-users (69.6%). This was further supported by a negative correlation (phi = -0.175) and an odds ratio (95% CI) of 0.426 (0.187–0.969). Almost all (96.4%) participants reported using their prescribed antihypertensive medications, with 70.9% of them being prescribed combination drug therapy and 64.2% of patients reporting compliance with their antihypertensive medications. Among herbal medicine users, 40% were non-compliant compared with 29.6% of non-users. The most prescribed class of antihypertensive was calcium channel blockers (70.1%), followed by ACE inhibitors (46.3%), and angiotensin-II receptor blockers (40.6%). Other classes of medications prescribed included cholesterol lowering agents (63.2%), followed by antidiabetic agents (48.1%), and antiplatelet agents (42.5%). Table 2 Clinical characteristics of hypertensive patients according to herbal medicine use. Characteristics Overall population n = 139 (%) HM users n = 83 (%) HM non-users n = 56 (%) Test statistic a p -value Mean BMI (kg/m 2 ) (SD) 30.5 (7.4) 30.2 (6.7) 31 (8.5) 2283 0.86 Mean initial systolic BP (mmHg) (SD) 151.9 (20.9) 153.2 (20.1) 150.1 (22.1) 2079 0.293 Mean initial diastolic BP (mmHg) (SD) 85.1 (13.3) 84.6 ( 14 ) 85.9 (12.2) 2125 0.393 Mean current systolic BP (mmHg) (SD) 151.5 (17.2) 153.5 (16.7) 148.6 (17.7) 1931.5 0.092 Mean current diastolic BP (mmHg) (SD) 82.4 (10.8) 83 (11.4) 82 (9.9) 2142.5 0.435 Stage of hypertension Elevated Stage 1 Stage 2 29 (20.9) 68 (48.9) 42 (30.2) 12 (14.5) 45 (54.2) 26 (31.3) 17 (30.4) 23 (41.1) 16 (28.6) 5.312 0.07 Blood pressure control Controlled Uncontrolled 30 (21.6) 109 (78.4) 13 (15.7) 70 (84.3) 17 (30.4) 39 (69.6) 4.266 0.039* Duration of hypertension (years) (SD) 10.4 (8.9) 11.3 (9.8) 9.1 (7.2) 2046 0.231 Compliance with prescribed antihypertensive medication Compliant Non-compliant n = 134 86 (64.2) 48 (35.8) n = 80 48 (60) 32 (40) n = 54 38 (70.4) 16 (29.6) 1.508 0.219 Prescribed antihypertensive therapy Monotherapy Combination therapy n = 134 39 (29.1) 95 (70.9) n = 79 25 (31.6) 54 (68.4) n = 55 14 (25.5) 41 (74.5) 0.602 0.438 a Test statistics derived from Mann-Whitney U test comparing mean values, and X 2 test comparing proportions. *Significant p-value < 0.05 HM, herbal medicine; SD, standard deviation; BMI, body mass index; BP, blood pressure Table 3 shows the reported herbs used among patients compared to blood pressure control. A total of 30 herbs were cited in this study, with the most common being garlic (57%), followed by ginger (41.8%), and turmeric (30.4%). A greater number of patients reporting use of these herbs were found to have uncontrolled blood pressure. The herbs associated with controlled blood pressure, reported in this study, included wonder of the world (23.1%), moringa (15.4%), vervine (15.4%), mango leaf (7.7%), saffron (15.4%), bay leaf (7.7%), berberine (7.7%), orange rind (7.7%), seed-under-leaf (7.7%), ashwagandha (7.7%), pawpaw leaf (7.7%), and rosemary leaf (7.7%). Table 3 Commonly used herbal medicines among hypertensive patients, ranked by prevalence and blood pressure control status. Common name Scientific name Family n (%) Blood pressure control Controlled n = 13 (%) Uncontrolled n = 66 (%) Garlic Allium sativum L. Amaryllidaceae 45 (57) 6 (46.2) 39 (59.1) Ginger Zingiber officinale Roscoe Zingiberaceae 33 (41.8) 3 (23.1) 30 (45.5) Turmeric Curcuma longa Zingiberaceae 24 (30.4) 2 (15.4) 22 (33.3) Wonder-of-the-world Bryophyllum pinnatum (Lam.) Oken Crassulaceae 10 (12.7) 3 (23.1) 7 (10.6) Lemongrass Cymbopogon citratus (D.C.) Stapfl Poaceae 9 (11.4) 1 (7.7) 8 (12.1) Moringa Moringa oleifera Lam. Moringaceae 7 (8.9) 2 (15.4) 5 (7.6) Cinnamon Cinnamomum verum Lauraceae 7 (8.9) 0 (0) 7 (10.6) Vervine Stachytarpheta jamaicensis (L.) Vahl Verbenaceae 6 (7.6) 2 (15.4) 4 (6.1) Mango leaf Mangifera indica L. Anacardiaceae 5 (6.3) 1 (7.7) 4 (6.1) Saffron Curcuma longa L. Zingiberaceae 4 (5.1) 2 (15.4) 2 ( 3 ) Soursop leaf Annona muricata L. Annonaceae 4 (5.1) 0 (0) 4 (6.1) Bay leaf Pimenta racemosa (Mill.) Myrtaceae 4 (5.1) 1 (7.7) 3 (4.5) Berberine Coptidis rhizoma Berberidaceae 4 (5.1) 1 (7.7) 3 (4.5) Orange (rind) Citrus sinensis (L.) Osbeck Rutaceae 3 (3.8) 1 (7.7) 2 ( 3 ) Seed-under-leaf Phyllanthus urinaria L. Phyllanthaceae 3 (3.8) 1 (7.7) 2 ( 3 ) Ashwagandha Withania somnifera (L.) Dunal Solanaceae 2 (2.5) 1 (7.7) 1 (1.5) Pawpaw leaf Carica papaya L. Caricaceae 2 (2.5) 1 (7.7) 1 (1.5) Tambran Tamarindus indica L. Leguminosae 2 (2.5) 0 (0) 2 ( 3 ) Rosemary leaf Rosemarinus officinalis Lamiaceae 2 (2.5) 1 (7.7) 1 (1.5) Guava leaf Psidium guajava L. Myrtaceae 2 (2.5) 0 (0) 2 ( 3 ) Caraille Momordica charantia L. Cucurbitaceae 2 (2.5) 0 (0) 2 ( 3 ) Neem Azadirachta indica A.Juss. Meliaceae 2 (2.5) 0 (0) 2 ( 3 ) Unspecified “greens” / “bush” N/A N/A 2 (2.5) 0 (0) 2 ( 3 ) Shining bush Peperomia pellucida (L.) Kunth Piperaceae 1 (1.3) 0 (0) 1 (1.5) Avocado leaf Persea americana Mill. Lauraceae 1 (1.3) 0 (0) 1 (1.5) Olive bush Bontia daphnoides L. Myoporaceae 1 (1.3) 0 (0) 1 (1.5) Timarie Mimosa pudica L. Leguminosae 1 (1.3) 0 (0) 1 (1.5) Stinging nettle Urtica dioica L. Urticaceae 1 (1.3) 0 (0) 1 (1.5) Wild senna Senna alata (L.) Roxb. Leguminosae 1 (1.3) 0 (0) 1 (1.5) Black sage Cordia curassavica (Jacq.) Boraginaceae 1 (1.3) 0 (0) 1 (1.5) Table 4 shows the characteristics of herbal medicine use according to blood pressure control. Most patients (42.3%) used herbal medicine for a duration of between 1 to 5 years, with the average time of use being 8.8 years. Those with controlled blood pressure were observed to have used herbal medicine for less time on average (5.1 years) compared to those with uncontrolled blood pressure (9.5 years). HM users were more likely to prepare their HM at home (76.5%), consume HM in the form of tea (89%), and consume HM daily (53.3%). Of HM-users with controlled blood pressure, 87.5% used HM daily and 69.2% were compliant with their antihypertensive medications. There were 25.6% of patients who did not report the frequency at which they use HM. Table 4 Characteristics of herbal medicine use according to blood pressure control. Characteristic Overall n (%) Controlled BP n (%) Uncontrolled BP n (%) Duration of time using HM 20 n = 78 11 (14.1) 33 (42.3) 22 (28.2) 6 (7.7) 6 (7.7) n = 13 2 (15.4) 6 (46.2) 5 (38.5) 0 (0) 0 (0) n = 65 9 (13.8) 27 (41.5) 17 (26.2) 6 (9.2) 6 (9.2) Mean duration of time using HM (SD) 8.8 (13.5) 5.1 (4.1) 9.5 (14.6) Preparation of HM Homemade Commercially made Both n = 81 62 (76.5) 2 (2.5) 17 (21) n = 13 10 (76.9) 0 (0) 3 (23.1) n = 68 52 (76.5) 2 (2.9) 14 (20.6) Method of consumption Tea Combination tea and capsules n = 73 65 (89) 8 ( 11 ) n = 11 8 (72.7) 3 (27.3) n = 62 57 (91.9) 5 (8.1) Frequency of use Daily 2–3 times per week Once per week Once per month n = 60 32 (53.3) 13 (21.7) 8 (13.3) 7 (11.7) n = 8 7 (87.5) 0 (0) 1 (12.5) 0 (0) n = 52 25 (48.1) 13 (25) 7 (13.5) 7 (13.5) Compliance with prescribed antihypertensive medication Compliant Non-compliant n = 83 48 (57.8) 35 (42.2) n = 13 9 (69.2) 4 (30.8) n = 70 39 (55.7) 31 (44.3) HM, herbal medicine; BP, blood pressure; SD, standard deviation The most cited reason for herbal medicine use was blood pressure control (73.4%), followed by ‘feeling better’ with use (25.3%), general health and wellness (20.3%), recommendations from family (8.9%), and the belief that HM has less side effects compared to conventional medicine (7.6%). DISCUSSION Approximately 60% of our study population reported using herbal medicine alongside their prescribed conventional antihypertensive medications. The use of herbal medicine has been increasing globally and the WHO estimates the prevalence of herbal medicine use to have increased from 80% in 2008 to 88% in 2018 ( 19 ). Findings from other studies that evaluated the prevalence of simultaneous HM and conventional antihypertensive drug use varied greatly. According to a systematic review conducted in 2021 by Azizah N et al , the reported frequencies of simultaneous HM and conventional antihypertensive use among different parts of the world include 6.2% in West Africa, 10% in Jamaica, 22.1% in Tanzania, 30.6% in T&T, 37.1% in South Africa, and 47.5% in Nigeria ( 5 ). This almost 30% rise in HM utilisation for the management of hypertension in T&T since 2007 underscores the importance for further evaluation of its effectiveness in the management of hypertension. In our study, the use of herbal medicine was independent of any sociodemographic factors. This is consistent with a similar study performed in Nigeria by Amira O and Okubadejo N (2007) who also found no relationship ( 8 ). In contrast, a study done by Nagawa C et al (2021) found that HDS use was related to age, gender, and level of education ( 7 ). Nagawa C et al found the following: patients who reported HDS use were older than non-users, women used HDS more compared to males, and that patients taking HDS were more likely to have some college level education or an associates degree ( 7 ). This discordance may be explained by the disparity of demographic characteristics of our study population in comparison to other studies. While data for gender was not collected in our study, a systematic review performed by Azizah N et al found that the majority of patients who utilise herbal medicine are female ( 5 ). Specifically, Amira O and Okubadejo N reported that 63.6% of patients in Nigeria who use CAM were female, while in Tanzania, Liwa A et al (2017) cited that females made up 59.6% of herbal medicine users ( 8 , 20 ). In addition, Clement et al reported that in Trinidad and Tobago, the number of female patients (73.2%) who utilised HM for the management of hypertension was greater than that of male patients ( 10 ). Tabassum N and Ahmad F (2011), reported the need for coupling ayurveda and conventional therapy for the treatment of hypertension and went on to highlight scientific evidence to support the antihypertensive effects of herbs such as, A. sativum and Z. officinale . They emphasised the need to explore the components of the extracts to potentially unlock pure effective antihypertensives agents with higher efficacy and fewer side effects for the treatment of HTN in the future ( 15 ). The most commonly used herbal medicines reported in this study in highest order included, A. sativum, Z. officinale and C.longa for use to manage hypertension. Randomised clinical trials were consolidated to support the use of A. sativum (garlic) and support its effectiveness in reducing blood pressure by 8–10 mmHg systolic and by 5–6 mmHg diastolic ( 16 ). Less evidence was found for the hypotensive effects of Z. officinale and C.longa with greater evidence reported on the hypotensive effect of other herbals such as Hibiscus Sabdariffa ( 17 ). We found that while participants reported herbal medicine use, no significant changes in BP was calculated similar to the study conducted by James P.B. et al (2018) ( 18 ). The patient non-compliance to conventional medication was found to be higher among HM-users identified by the negative association among patients with uncontrolled BP. This is as a result of an observed 21% of patients being considered controlled-hypertensive with 30% not using herbal medicines and showing a 70% compliance rating. In addition, the observed 21% of controlled-hypertensive patients was consistent with the WHO 2023 report for Trinidad and Tobago ( 2 ). This study substantiated the veracious adherence to treatment of hypertension by the regional healthcare facilities in Trinidad outlined in the PAHO 2023 clinical pathway guidelines for T&T ( 14 ). There are limitations to this study. This was a cross-sectional study, therefore, a temporal or causal relationship between herbal medicine use, medication compliance, and blood pressure control could not be assessed. The study design also limits the generalizability of the results. Valid measures such as the Morisky Medication Adherence Research scale were not used to assess antihypertensive medication compliance. Implementation of this scale could have been useful in conducting this study similar to Thankgsuk P et al (2012), which would have provided statistical evidence to confirm the association between herbal medicine use and poor medication adherence resulting in poor blood-pressure control ( 9 ). Another limitation of this study involves the duration of time between the measurements of the initial and current blood pressures, which was between 3 to 6 months. This length of time may not allow for a significant change in blood pressure to be observed. In addition, variations may exist in how the general public defines herbal medicine, potentially influencing the results of this study. CONCLUSION In conclusion, patient medication concordance is imperative. Herb-drug interactions may be associated with the higher prevalence of patients regressing to hypertensive stages 1 and 2 that are uncontrolled which may lead to progressive chronic-non-communicable disease. Understanding what drives the patient to use herbal medicines is of great importance and patient education about the risks associated with self-medication in hypertension must be highlighted. Declarations Ethics approval and consent to participate This study was approved by the research ethics committee of The University of the West Indies, St. Augustine (ref: CREC-SA.1923/12/2022). All participants involved in this study provided written informed consent. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Fundings No funding was obtained for the conduct of this study Author Contribution A.F.W.P. - Principal investigator, study design, data collection, upload and analysis. Manuscript preparation and review.G.C. - Independent data analysis and manuscript preparation.A.B., S.B., K.C., M.P., R.R., A.R., P.R., T.S. - proposal development and field data collection. Acknowledgement The University of the West Indies, Graduate Studies & Research (ORC). Trinidad and Tobago West IndiesThe five participating health centers under the Eastern Regional and North-Central Regional Health Authorities (ERHA and NCRHA) and the Ministry of Health, Trinidad and Tobago, West Indies Availability of data and materials Password protected electronically and stored with the principal investigator. References Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37. Hypertension Trinidad and Tobago. 2023 country profile. https://www.who.int/publications/m/item/hypertension-tto-2023-country-profile . Accessed 14 April 2024. Chadee D, Seemungal T, Pinto Pereira LM, Chadee M, Maharaj R, Teelucksingh S. Prevalence of self-reported diabetes, hypertension and heart disease in individuals seeking State funding in Trinidad and Tobago, West Indies. J Epidemiol Glob Health. 2013;3(2):95–103. Yusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease and mortality in 155,722 individuals from 21 high-, middle-, and low-income countries. Lancet Lond Engl. 2020;395(10226):795–808. Azizah N, Halimah E, Puspitasari IM, Hasanah AN. Simultaneous Use of Herbal Medicines and Antihypertensive Drugs Among Hypertensive Patients in the Community: A Review. J Multidiscip Healthc. 2021;14:259–70. Traditional. Complementary and Integrative Medicine. https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine . Accessed 14 April 2024. Nagawa CS, Palakshappa JA, Sadasivam RS, Houston TK. Herbal or Dietary Supplement Use and Hypertensive Medications: Does the Combination Relate to Medication Adherence and Blood Pressure Control? J Altern Complement Med. 2021;27(2):168–75. Amira OC, Okubadejo NU. Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria. BMC Complement Altern Med. 2007;7:30. Thangsuk P, Pinyopornpanish K, Jiraporncharoen W, Buawangpong N, Angkurawaranon C. Is the Association between Herbal Use and Blood-Pressure Control Mediated by Medication Adherence? A Cross-Sectional Study in Primary Care. Int J Environ Res Public Health. 2021;18(24):12916. Clement YN, Morton-Gittens J, Basdeo L, Blades A, Francis MJ, Gomes N, et al. Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad. BMC Complement Altern Med. 2007;7:4. 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). JAMA. 2014;311(5):507–20. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52. Sample Size Calculator. https://clincalc.com/stats/samplesize.aspx . Accessed 19 April 2024. Clinical pathways - Trinidad and Tobago - PAHO/WHO. https://www.paho.org/en/documents/clinical-pathways-trinidad-and-tobago . Accessed 14 April 2024. Tabassum N, Ahmad F. Role of natural herbs in the treatment of hypertension. Pharmacogn Rev. 2011;5(9):30–40. Ried K. Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis. Exp Ther Med. 2020;19(2):1472–8. Ellis LR, Zulfiqar S, Holmes M, Marshall L, Dye L, Boesch C. A systematic review and meta-analysis of the effects of Hibiscus sabdariffa on blood pressure and cardiometabolic markers. Nutr Rev. 2022;80(6):1723–37. James PB, Kamara H, Bah AJ, Steel A, Wardle J. Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone. Complement Ther Clin Pract. 2018;31:7–15. Organization WH. WHO Global Report on Traditional and Complementary Medicine 2019. World Health Organization; 2019. p. 228. Liwa A, Roediger R, Jaka H, Bougaila A, Smart L, Langwick S, et al. Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study. Int J Hypertens. 2017;2017:5692572. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4331036","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":337006696,"identity":"8088122b-7059-481a-baad-7d4f0ba60a08","order_by":0,"name":"Arlene F. Williams-Persad","email":"data:image/png;base64,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","orcid":"","institution":"University of the West Indies","correspondingAuthor":true,"prefix":"","firstName":"Arlene","middleName":"F.","lastName":"Williams-Persad","suffix":""},{"id":337006698,"identity":"c5f71ea1-ad17-4f77-90b8-63e2f119d8be","order_by":1,"name":"Graham Carvalho","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Graham","middleName":"","lastName":"Carvalho","suffix":""},{"id":337006701,"identity":"9fce8f2d-65bc-4a99-9ae7-76254405bef0","order_by":2,"name":"Alexia Brereton","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Alexia","middleName":"","lastName":"Brereton","suffix":""},{"id":337006702,"identity":"af809ffb-13a8-467d-8793-14609e26bef5","order_by":3,"name":"Shivanand Baboolal","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Shivanand","middleName":"","lastName":"Baboolal","suffix":""},{"id":337006703,"identity":"3ebabda0-ecb6-4d86-9cf3-05ff92297ce7","order_by":4,"name":"Kelsea Chinemilly","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Kelsea","middleName":"","lastName":"Chinemilly","suffix":""},{"id":337006704,"identity":"7b0cce65-87b7-41dc-aed9-46465e3aaa47","order_by":5,"name":"Mikhail Premchand","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Mikhail","middleName":"","lastName":"Premchand","suffix":""},{"id":337006705,"identity":"5d537aa4-3da2-4f24-a58c-181c47db1ebf","order_by":6,"name":"Renissa Ramdial","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Renissa","middleName":"","lastName":"Ramdial","suffix":""},{"id":337006706,"identity":"d18500a5-13dc-4cbd-b087-713a03caa002","order_by":7,"name":"Angelina Ramroop","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Angelina","middleName":"","lastName":"Ramroop","suffix":""},{"id":337006707,"identity":"f5c12d68-3cf1-4580-a601-4a244eb61981","order_by":8,"name":"Patrice Richards","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Patrice","middleName":"","lastName":"Richards","suffix":""},{"id":337006708,"identity":"b818b698-e38e-4915-9a11-bd3f5c2ccb6e","order_by":9,"name":"Tyneil Seepersad","email":"","orcid":"","institution":"University of the West Indies","correspondingAuthor":false,"prefix":"","firstName":"Tyneil","middleName":"","lastName":"Seepersad","suffix":""}],"badges":[],"createdAt":"2024-04-26 17:29:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4331036/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4331036/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62656863,"identity":"a665fb58-4058-4b18-b072-898c46b75a85","added_by":"auto","created_at":"2024-08-17 02:04:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78301,"visible":true,"origin":"","legend":"\u003cp\u003eBox plot showing blood pressure readings of patients according to herbal medicine use.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4331036/v1/3015611aa7cdf8d395313864.png"},{"id":62657865,"identity":"de570b15-9712-4ce1-ab8d-e58ab7d5fa02","added_by":"auto","created_at":"2024-08-17 02:12:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1069992,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4331036/v1/7a2d2a95-d2ce-44e8-9a71-58cee0c253b5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Examining the relationship between Herbal Medicine use and Blood Pressure control in individuals on Antihypertensive therapy across two Regional Health Facilities in Trinidad.","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eHypertension exhibits a global rise in prevalence, solidifying its position as the primary etiological factor for cardiovascular disease and premature mortality (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As of 2019, the World Health Organization (WHO) stated a 42% prevalence rate of hypertension among adults aged 30 to 79 years in Trinidad and Tobago (T\u0026amp;T), surpassing the global average (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This trend is consistent with other studies which report that low and middle income countries have experienced a significant rise in hypertension prevalence within the past two decades (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Despite these rising numbers, only 21% of those diagnosed with hypertension in T\u0026amp;T are reported to be controlled (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Inadequate blood pressure control has been shown to be associated with increased risk of cardiovascular disease, of which mortality rates are higher in T\u0026amp;T than in North America (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eApproximately 80% of patients use herbal medicine (HM) in combination with antihypertensive medications (AHM) or alone for the treatment of hypertension (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Herbal medicines, as defined by the WHO includes \u0026lsquo;herbs, herbal materials, herbal preparations and finished herbal products (FHP), that contain as active ingredients parts of plants, or other plant materials, or combinations\u0026rsquo; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). There are several studies examining the relationship between blood pressure control and herbal medicine use in relation to medication adherence. Nagawa CS \u003cem\u003eet al\u003c/em\u003e (2021) demonstrated that there was no significant association between medication adherence and blood pressure control (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This study also found that patients who used herbal or dietary supplements (HDS) that were reported in the literature to improve hypertension were associated with improved blood pressure control compared to those who did not (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, studies that examined herbal medicine use irrespective of the specific herb found no association between its use and blood pressure control (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Amira OC and Okubadejo NU (2007) also found that there was no difference in clinical characteristics or socio-economic status of complementary and alternative medicine (CAM) users compared to non-users (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHerbal medicine has been reported to be used in combination with standard antihypertensive medication due to their perceived safety and high efficacy (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Clement YN \u003cem\u003eet al\u003c/em\u003e (2007) examined the perceived efficacy of herbal remedies in T\u0026amp;T and found that 86.6% of participants believed that herbs had equal or greater efficacy than standard conventional medication (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). This study also found that hypertension was the most commonly managed condition with herbal remedies, whereby garlic (\u003cem\u003eAllium sativum\u003c/em\u003e) was used by almost half of the sample and in 20% of hypertensive patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Other medicinal plants reported to be commonly used in the management of chronic diseases in Trinidad and Tobago include orange rind (\u003cem\u003eCitrus sinensis\u003c/em\u003e), ginger (\u003cem\u003eZingiber officinale\u003c/em\u003e), and lemongrass (\u003cem\u003eCymbopogon citratus\u003c/em\u003e) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClement YN \u003cem\u003eet al\u003c/em\u003e highlights the need for further research to determine the efficacy of herbal medicine in the management of chronic disease (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While the reasons for use and perceived efficacy of herbal remedies in Trinidad and Tobago has been studied, none have yet examined the impact of herbal medicine use and blood pressure control in the management of hypertension. Considering this, the aims of this study were to determine:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe impact of herbal medicine use on blood pressure control.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe frequency and characteristics of herbal medicine usage in our hypertensive population.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIf an association exists between herbal medicine use and medication adherence.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and Setting\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted to examine the relationship between herbal medicine use and blood pressure control in hypertensive patients who were prescribed conventional antihypertensive medication. Data was collected from patients across two regional health authorities (RHA) in Trinidad and Tobago. Patients were surveyed over a one-month period at health centres within the North Central Regional Health Authority (NCRHA) and Eastern Regional Health Authority (ERHA) at the chronic disease clinic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Participants\u003c/h2\u003e \u003cp\u003eA convenience sampling of patients attending their clinic appointment who were ages 35 to 64 with diagnosed essential hypertension and on prescribed antihypertensive medications (AHM) were invited to participate in this study. Patients who were diagnosed with comorbid cardiovascular disease including coronary artery disease, heart failure, and stroke as well as patients with normal blood pressure (\u0026le;\u0026thinsp;120 / \u0026le;80 mmHg) according to the Eighth Joint National Committee (JNC 8) recommendations were excluded from the study (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). All patients provided written informed consent. This study was approved by the research ethics committee of The University of the West Indies, St. Augustine (ref: CREC-SA.1923/12/2022). All participants involved in this study provided written informed consent.\u003c/p\u003e \u003cp\u003eA total of 151 patients were interviewed and 139 were included in the final analysis. Twelve (7.9%) patients were omitted as two of them had normal blood pressure readings recorded, four had no blood pressure readings recorded, two had a history of comorbid cardiovascular disease, and four had missing data that prevented further analysis. Assuming a power of 80% and an alpha value of 0.05, the estimated target sample size was 127. The calculation was conducted based on the following equation: \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:N\\:=\\frac{{{{p}_{0}{q}_{0}\\left\\{{z}_{1-a/2}+{z}_{1-B}\\sqrt{\\frac{p1q1}{p0q0}}\\right\\}}^{2}}^{}}{{({p}_{1}-{p}_{0})}^{2}}\\)\u003c/span\u003e\u003c/span\u003e (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003eData was collected from patients in two ways: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) self-administered questionnaires, and (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) past medical history obtained from medical records. The questionnaires were used to collect data relating to socio-demographics, history of hypertension, medication compliance, and herbal medicine use. Patients who used herbal medicine were classified as \u0026lsquo;herbal medicine users\u0026rsquo;. Medical records were used to gather data consisting of prior and current blood pressure readings, body mass index, and current prescribed medications. Current blood pressure readings were obtained at the time of the interview. Previous blood pressure readings were termed as \u0026lsquo;initial\u0026rsquo; were recorded at least 3 to 6 months prior to when patients were surveyed.\u003c/p\u003e \u003cp\u003eThe stage of hypertension was defined according to the JNC 8 recommendations (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Blood pressure control was defined as a current blood pressure of \u0026le;\u0026thinsp;140 / \u0026le;90 mmHg according to the Pan American Health Organization HEARTS protocol that is currently employed by the Ministry of Health in Trinidad and Tobago (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The protocol utilises this target blood pressure for all hypertensive patients who are not defined as high risk. Medication compliance was determined by asking patients whether they follow their prescribed medication regime (yes, no, or most of the time). Patients who answered \u0026lsquo;yes\u0026rsquo; were categorised as compliant, while patients who answered \u0026lsquo;no\u0026rsquo; or \u0026lsquo;most of the time\u0026rsquo; were categorised as non-compliant.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted using IBM SPSS Statistics, version 29.0.0.0. Chi-square was used to analyse sociodemographic factors, blood pressure control, and medication compliance. The Mann-Whitney U test was used to compare mean values of blood pressure and BMI between herbal medicine users and non-users. This statistical test was utilised as the data for these variables were non-normally distributed and contained outliers. Confidence intervals of 95% were used and statistical significance was assumed at a \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAmong the patients surveyed, herbal medicine use exhibited a prevalence of approximately 60%. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the sociodemographic characteristics of patients by herbal medicine use. Participants were more likely to be above the age of 60 years (48.9%), of East-Indian ethnicity (37.2%), retired (46.8%), married (51.8%), and have primary education be the highest form of education attained. The association between herbal medicine use and any sociodemographic characteristics did not achieve statistical significance (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic characteristics of hypertensive patients aged 35\u0026ndash;64 according to herbal medicine use.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;139 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHM users\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;83 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHM non-users\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;56 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003cp\u003e35\u0026ndash;50\u003c/p\u003e \u003cp\u003e51\u0026ndash;55\u003c/p\u003e \u003cp\u003e56\u0026ndash;60\u003c/p\u003e \u003cp\u003e61\u0026ndash;64\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (13.7)\u003c/p\u003e \u003cp\u003e18 (12.9)\u003c/p\u003e \u003cp\u003e34 (24.5)\u003c/p\u003e \u003cp\u003e68 (48.9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e10 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e18 (21.7)\u003c/p\u003e \u003cp\u003e45 (54.2)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (16.1)\u003c/p\u003e \u003cp\u003e8 (14.3)\u003c/p\u003e \u003cp\u003e16 (28.6)\u003c/p\u003e \u003cp\u003e23 (41.1)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.354\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.502\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003cp\u003eAfrican\u003c/p\u003e \u003cp\u003eEast-Indian\u003c/p\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (31.4)\u003c/p\u003e \u003cp\u003e51 (37.2)\u003c/p\u003e \u003cp\u003e43 (31.4)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (30.9)\u003c/p\u003e \u003cp\u003e28 (34.6)\u003c/p\u003e \u003cp\u003e28 (34.6)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (32.1)\u003c/p\u003e \u003cp\u003e23 (41.1)\u003c/p\u003e \u003cp\u003e15 (26.8)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.032\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.597\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (35.3)\u003c/p\u003e \u003cp\u003e25 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e65 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (30.1)\u003c/p\u003e \u003cp\u003e13 (15.7)\u003c/p\u003e \u003cp\u003e45 (54.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (42.9)\u003c/p\u003e \u003cp\u003e12 (21.4)\u003c/p\u003e \u003cp\u003e20 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRHA\u003c/b\u003e\u003c/p\u003e \u003cp\u003eERHA\u003c/p\u003e \u003cp\u003eNCRHA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (58.3)\u003c/p\u003e \u003cp\u003e58 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (61.4)\u003c/p\u003e \u003cp\u003e32 (38.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (53.6)\u003c/p\u003e \u003cp\u003e26 (46.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (45.1)\u003c/p\u003e \u003cp\u003e50 (37.6)\u003c/p\u003e \u003cp\u003e23 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (48.1)\u003c/p\u003e \u003cp\u003e25 (30.9)\u003c/p\u003e \u003cp\u003e17 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (40.4)\u003c/p\u003e \u003cp\u003e25 (48.1)\u003c/p\u003e \u003cp\u003e6 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSingle\u003c/p\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (24.5)\u003c/p\u003e \u003cp\u003e72 (51.8)\u003c/p\u003e \u003cp\u003e14 (10.1)\u003c/p\u003e \u003cp\u003e19 (13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (21.7)\u003c/p\u003e \u003cp\u003e43 (51.8)\u003c/p\u003e \u003cp\u003e10 (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e12 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (28.6)\u003c/p\u003e \u003cp\u003e29 (51.8)\u003c/p\u003e \u003cp\u003e4 (7.1)\u003c/p\u003e \u003cp\u003e7 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.673\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHM, herbal medicine; RHA, regional health authority; ERHA, Eastern Regional Health Authority; NCRHA, North Central Regional Health Authority\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the clinical characteristics of participants by herbal medicine use. HM non-users had a slightly higher average BMI compared to HM users. As demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, HM users had higher average systolic blood pressure readings compared to non-users. This trend was also observed for the average current diastolic blood pressure, however, the initial diastolic blood pressure of HM users were slightly lower compared to non-users. The association between blood pressure readings, BMI, and herbal medicine use did not achieve statistical significance (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Spearman\u0026rsquo;s rank analysis found no significant correlation between BMI stage and stage of hypertension for the sample population (\u003cem\u003ep\u003c/em\u003e = -0.053, \u003cem\u003ep-\u003c/em\u003evalue\u0026thinsp;=\u0026thinsp;0.537).\u003c/p\u003e \u003cp\u003eThe majority (48.9%) of patients in this study were classified as having stage 1 hypertension. HM users were found to fall within stage 1 (54.2%) or stage 2 (31.3%) classification more often than non-users. Among the total sample, 30 (21.6%) patients exhibited controlled blood pressure and within the two groups examined, 15.7% of patients who used herbal medicine achieved control compared to 30.4% for non-users. Individuals using herbal medicine (84.3%) were more likely to have uncontrolled blood pressure (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared with HM non-users (69.6%). This was further supported by a negative correlation (phi = -0.175) and an odds ratio (95% CI) of 0.426 (0.187\u0026ndash;0.969).\u003c/p\u003e \u003cp\u003eAlmost all (96.4%) participants reported using their prescribed antihypertensive medications, with 70.9% of them being prescribed combination drug therapy and 64.2% of patients reporting compliance with their antihypertensive medications. Among herbal medicine users, 40% were non-compliant compared with 29.6% of non-users.\u003c/p\u003e \u003cp\u003eThe most prescribed class of antihypertensive was calcium channel blockers (70.1%), followed by ACE inhibitors (46.3%), and angiotensin-II receptor blockers (40.6%). Other classes of medications prescribed included cholesterol lowering agents (63.2%), followed by antidiabetic agents (48.1%), and antiplatelet agents (42.5%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical characteristics of hypertensive patients according to herbal medicine use.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;139 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHM users\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;83 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHM non-users\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;56 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest statistic\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean BMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e) (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.5 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.2 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean initial systolic BP (mmHg) (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151.9 (20.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153.2 (20.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150.1 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean initial diastolic BP (mmHg) (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.1 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.6 (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.9 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean current systolic BP (mmHg) (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151.5 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153.5 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148.6 (17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1931.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean current diastolic BP (mmHg) (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.4 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2142.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStage of hypertension\u003c/b\u003e\u003c/p\u003e \u003cp\u003eElevated\u003c/p\u003e \u003cp\u003eStage 1\u003c/p\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (20.9)\u003c/p\u003e \u003cp\u003e68 (48.9)\u003c/p\u003e \u003cp\u003e42 (30.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (14.5)\u003c/p\u003e \u003cp\u003e45 (54.2)\u003c/p\u003e \u003cp\u003e26 (31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (30.4)\u003c/p\u003e \u003cp\u003e23 (41.1)\u003c/p\u003e \u003cp\u003e16 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood pressure control\u003c/b\u003e\u003c/p\u003e \u003cp\u003eControlled\u003c/p\u003e \u003cp\u003eUncontrolled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (21.6)\u003c/p\u003e \u003cp\u003e109 (78.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (15.7)\u003c/p\u003e \u003cp\u003e70 (84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (30.4)\u003c/p\u003e \u003cp\u003e39 (69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.039*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of hypertension (years) (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.4 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.3 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1 (7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCompliance with prescribed antihypertensive medication\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCompliant\u003c/p\u003e \u003cp\u003eNon-compliant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;134\u003c/b\u003e\u003c/p\u003e \u003cp\u003e86 (64.2)\u003c/p\u003e \u003cp\u003e48 (35.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;80\u003c/b\u003e\u003c/p\u003e \u003cp\u003e48 (60)\u003c/p\u003e \u003cp\u003e32 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;54\u003c/b\u003e\u003c/p\u003e \u003cp\u003e38 (70.4)\u003c/p\u003e \u003cp\u003e16 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrescribed antihypertensive therapy\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMonotherapy\u003c/p\u003e \u003cp\u003eCombination therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;134\u003c/b\u003e\u003c/p\u003e \u003cp\u003e39 (29.1)\u003c/p\u003e \u003cp\u003e95 (70.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;79\u003c/b\u003e\u003c/p\u003e \u003cp\u003e25 (31.6)\u003c/p\u003e \u003cp\u003e54 (68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;55\u003c/b\u003e\u003c/p\u003e \u003cp\u003e14 (25.5)\u003c/p\u003e \u003cp\u003e41 (74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003eTest statistics derived from Mann-Whitney U test comparing mean values, and X\u003csup\u003e2\u003c/sup\u003e test comparing proportions.\u003c/p\u003e \u003cp\u003e*Significant p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003cp\u003eHM, herbal medicine; SD, standard deviation; BMI, body mass index; BP, blood pressure\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the reported herbs used among patients compared to blood pressure control. A total of 30 herbs were cited in this study, with the most common being garlic (57%), followed by ginger (41.8%), and turmeric (30.4%). A greater number of patients reporting use of these herbs were found to have uncontrolled blood pressure. The herbs associated with controlled blood pressure, reported in this study, included wonder of the world (23.1%), moringa (15.4%), vervine (15.4%), mango leaf (7.7%), saffron (15.4%), bay leaf (7.7%), berberine (7.7%), orange rind (7.7%), seed-under-leaf (7.7%), ashwagandha (7.7%), pawpaw leaf (7.7%), and rosemary leaf (7.7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommonly used herbal medicines among hypertensive patients, ranked by prevalence and blood pressure control status.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCommon name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eScientific name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eBlood pressure control\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eControlled\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;13 (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUncontrolled\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;66 (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGarlic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAllium sativum\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmaryllidaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (59.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGinger\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eZingiber officinale\u003c/em\u003e Roscoe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZingiberaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTurmeric\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCurcuma longa\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZingiberaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (30.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (33.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWonder-of-the-world\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBryophyllum pinnatum\u003c/em\u003e (Lam.) Oken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrassulaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLemongrass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCymbopogon citratus\u003c/em\u003e (D.C.) Stapfl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMoringa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMoringa oleifera\u003c/em\u003e Lam.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMoringaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (7.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCinnamon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCinnamomum verum\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLauraceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (10.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVervine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eStachytarpheta jamaicensis\u003c/em\u003e (L.) Vahl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVerbenaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMango leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMangifera indica\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnacardiaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaffron\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCurcuma longa\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eZingiberaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSoursop leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAnnona muricata\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnnonaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (6.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBay leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePimenta racemosa (Mill.)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMyrtaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBerberine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCoptidis rhizoma\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBerberidaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrange (rind)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCitrus sinensis\u003c/em\u003e (L.) Osbeck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRutaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeed-under-leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePhyllanthus urinaria L.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePhyllanthaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAshwagandha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eWithania somnifera\u003c/em\u003e (L.) Dunal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSolanaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePawpaw leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCarica papaya L.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCaricaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTambran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTamarindus indica L.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeguminosae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRosemary leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRosemarinus officinalis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLamiaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuava leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePsidium guajava\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMyrtaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaraille\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMomordica charantia\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCucurbitaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eAzadirachta indica A.Juss.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMeliaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnspecified \u0026ldquo;greens\u0026rdquo; / \u0026ldquo;bush\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShining bush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePeperomia pellucida\u003c/em\u003e (L.) Kunth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePiperaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvocado leaf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003ePersea americana Mill.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLauraceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlive bush\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBontia daphnoides\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMyoporaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTimarie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eMimosa pudica L.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeguminosae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStinging nettle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eUrtica dioica\u003c/em\u003e L.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUrticaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWild senna\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSenna alata (L.) Roxb.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeguminosae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack sage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eCordia curassavica (Jacq.)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoraginaceae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the characteristics of herbal medicine use according to blood pressure control. Most patients (42.3%) used herbal medicine for a duration of between 1 to 5 years, with the average time of use being 8.8 years. Those with controlled blood pressure were observed to have used herbal medicine for less time on average (5.1 years) compared to those with uncontrolled blood pressure (9.5 years). HM users were more likely to prepare their HM at home (76.5%), consume HM in the form of tea (89%), and consume HM daily (53.3%). Of HM-users with controlled blood pressure, 87.5% used HM daily and 69.2% were compliant with their antihypertensive medications. There were 25.6% of patients who did not report the frequency at which they use HM.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of herbal medicine use according to blood pressure control.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControlled BP n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUncontrolled BP n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of time using HM\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;78\u003c/p\u003e \u003cp\u003e11 (14.1)\u003c/p\u003e \u003cp\u003e33 (42.3)\u003c/p\u003e \u003cp\u003e22 (28.2)\u003c/p\u003e \u003cp\u003e6 (7.7)\u003c/p\u003e \u003cp\u003e6 (7.7)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;13\u003c/p\u003e \u003cp\u003e2 (15.4)\u003c/p\u003e \u003cp\u003e6 (46.2)\u003c/p\u003e \u003cp\u003e5 (38.5)\u003c/p\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;65\u003c/p\u003e \u003cp\u003e9 (13.8)\u003c/p\u003e \u003cp\u003e27 (41.5)\u003c/p\u003e \u003cp\u003e17 (26.2)\u003c/p\u003e \u003cp\u003e6 (9.2)\u003c/p\u003e \u003cp\u003e6 (9.2)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean duration of time using HM (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.8 (13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1 (4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5 (14.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreparation of HM\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHomemade\u003c/p\u003e \u003cp\u003eCommercially made\u003c/p\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;81\u003c/b\u003e\u003c/p\u003e \u003cp\u003e62 (76.5)\u003c/p\u003e \u003cp\u003e2 (2.5)\u003c/p\u003e \u003cp\u003e17 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;13\u003c/b\u003e\u003c/p\u003e \u003cp\u003e10 (76.9)\u003c/p\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003cp\u003e3 (23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;68\u003c/b\u003e\u003c/p\u003e \u003cp\u003e52 (76.5)\u003c/p\u003e \u003cp\u003e2 (2.9)\u003c/p\u003e \u003cp\u003e14 (20.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMethod of consumption\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTea\u003c/p\u003e \u003cp\u003eCombination tea and capsules\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;73\u003c/b\u003e\u003c/p\u003e \u003cp\u003e65 (89)\u003c/p\u003e \u003cp\u003e8 (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;11\u003c/b\u003e\u003c/p\u003e \u003cp\u003e8 (72.7)\u003c/p\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;62\u003c/b\u003e\u003c/p\u003e \u003cp\u003e57 (91.9)\u003c/p\u003e \u003cp\u003e5 (8.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFrequency of use\u003c/b\u003e\u003c/p\u003e \u003cp\u003eDaily\u003c/p\u003e \u003cp\u003e2\u0026ndash;3 times per week\u003c/p\u003e \u003cp\u003eOnce per week\u003c/p\u003e \u003cp\u003eOnce per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;60\u003c/b\u003e\u003c/p\u003e \u003cp\u003e32 (53.3)\u003c/p\u003e \u003cp\u003e13 (21.7)\u003c/p\u003e \u003cp\u003e8 (13.3)\u003c/p\u003e \u003cp\u003e7 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;8\u003c/b\u003e\u003c/p\u003e \u003cp\u003e7 (87.5)\u003c/p\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003cp\u003e1 (12.5)\u003c/p\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;52\u003c/b\u003e\u003c/p\u003e \u003cp\u003e25 (48.1)\u003c/p\u003e \u003cp\u003e13 (25)\u003c/p\u003e \u003cp\u003e7 (13.5)\u003c/p\u003e \u003cp\u003e7 (13.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCompliance with prescribed antihypertensive medication\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCompliant\u003c/p\u003e \u003cp\u003eNon-compliant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;83\u003c/b\u003e\u003c/p\u003e \u003cp\u003e48 (57.8)\u003c/p\u003e \u003cp\u003e35 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;13\u003c/b\u003e\u003c/p\u003e \u003cp\u003e9 (69.2)\u003c/p\u003e \u003cp\u003e4 (30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003en\u0026thinsp;=\u0026thinsp;70\u003c/b\u003e\u003c/p\u003e \u003cp\u003e39 (55.7)\u003c/p\u003e \u003cp\u003e31 (44.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHM, herbal medicine; BP, blood pressure; SD, standard deviation\u003c/p\u003e \u003cp\u003eThe most cited reason for herbal medicine use was blood pressure control (73.4%), followed by \u0026lsquo;feeling better\u0026rsquo; with use (25.3%), general health and wellness (20.3%), recommendations from family (8.9%), and the belief that HM has less side effects compared to conventional medicine (7.6%).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eApproximately 60% of our study population reported using herbal medicine alongside their prescribed conventional antihypertensive medications. The use of herbal medicine has been increasing globally and the WHO estimates the prevalence of herbal medicine use to have increased from 80% in 2008 to 88% in 2018 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Findings from other studies that evaluated the prevalence of simultaneous HM and conventional antihypertensive drug use varied greatly. According to a systematic review conducted in 2021 by Azizah N \u003cem\u003eet al\u003c/em\u003e, the reported frequencies of simultaneous HM and conventional antihypertensive use among different parts of the world include 6.2% in West Africa, 10% in Jamaica, 22.1% in Tanzania, 30.6% in T\u0026amp;T, 37.1% in South Africa, and 47.5% in Nigeria (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This almost 30% rise in HM utilisation for the management of hypertension in T\u0026amp;T since 2007 underscores the importance for further evaluation of its effectiveness in the management of hypertension.\u003c/p\u003e \u003cp\u003eIn our study, the use of herbal medicine was independent of any sociodemographic factors. This is consistent with a similar study performed in Nigeria by Amira O and Okubadejo N (2007) who also found no relationship (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In contrast, a study done by Nagawa C \u003cem\u003eet al\u003c/em\u003e (2021) found that HDS use was related to age, gender, and level of education (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Nagawa C \u003cem\u003eet al\u003c/em\u003e found the following: patients who reported HDS use were older than non-users, women used HDS more compared to males, and that patients taking HDS were more likely to have some college level education or an associates degree (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This discordance may be explained by the disparity of demographic characteristics of our study population in comparison to other studies. While data for gender was not collected in our study, a systematic review performed by Azizah N \u003cem\u003eet al\u003c/em\u003e found that the majority of patients who utilise herbal medicine are female (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Specifically, Amira O and Okubadejo N reported that 63.6% of patients in Nigeria who use CAM were female, while in Tanzania, Liwa A \u003cem\u003eet al\u003c/em\u003e (2017) cited that females made up 59.6% of herbal medicine users (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). In addition, Clement \u003cem\u003eet al\u003c/em\u003e reported that in Trinidad and Tobago, the number of female patients (73.2%) who utilised HM for the management of hypertension was greater than that of male patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTabassum N and Ahmad F (2011), reported the need for coupling ayurveda and conventional therapy for the treatment of hypertension and went on to highlight scientific evidence to support the antihypertensive effects of herbs such as, \u003cem\u003eA. sativum\u003c/em\u003e and \u003cem\u003eZ. officinale\u003c/em\u003e. They emphasised the need to explore the components of the extracts to potentially unlock pure effective antihypertensives agents with higher efficacy and fewer side effects for the treatment of HTN in the future (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most commonly used herbal medicines reported in this study in highest order included, \u003cem\u003eA. sativum, Z. officinale\u003c/em\u003e and \u003cem\u003eC.longa\u003c/em\u003e for use to manage hypertension. Randomised clinical trials were consolidated to support the use of \u003cem\u003eA. sativum\u003c/em\u003e (garlic) and support its effectiveness in reducing blood pressure by 8\u0026ndash;10 mmHg systolic and by 5\u0026ndash;6 mmHg diastolic (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Less evidence was found for the hypotensive effects of \u003cem\u003eZ. officinale\u003c/em\u003e and \u003cem\u003eC.longa\u003c/em\u003e with greater evidence reported on the hypotensive effect of other herbals such as \u003cem\u003eHibiscus Sabdariffa\u003c/em\u003e (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe found that while participants reported herbal medicine use, no significant changes in BP was calculated similar to the study conducted by James P.B. \u003cem\u003eet al\u003c/em\u003e (2018) (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The\u003c/p\u003e \u003cp\u003epatient non-compliance to conventional medication was found to be higher among HM-users identified by the negative association among patients with uncontrolled BP. This is as a result of an observed 21% of patients being considered controlled-hypertensive with 30% not using herbal medicines and showing a 70% compliance rating. In addition, the observed 21% of controlled-hypertensive patients was consistent with the WHO 2023 report for Trinidad and Tobago (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This study substantiated the veracious adherence to treatment of hypertension by the regional healthcare facilities in Trinidad outlined in the PAHO 2023 clinical pathway guidelines for T\u0026amp;T (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are limitations to this study. This was a cross-sectional study, therefore, a temporal or causal relationship between herbal medicine use, medication compliance, and blood pressure control could not be assessed. The study design also limits the generalizability of the results. Valid measures such as the Morisky Medication Adherence Research scale were not used to assess antihypertensive medication compliance. Implementation of this scale could have been useful in conducting this study similar to Thankgsuk P \u003cem\u003eet al\u003c/em\u003e (2012), which would have provided statistical evidence to confirm the association between herbal medicine use and poor medication adherence resulting in poor blood-pressure control (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Another limitation of this study involves the duration of time between the measurements of the initial and current blood pressures, which was between 3 to 6 months. This length of time may not allow for a significant change in blood pressure to be observed. In addition, variations may exist in how the general public defines herbal medicine, potentially influencing the results of this study.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, patient medication concordance is imperative. Herb-drug interactions may be associated with the higher prevalence of patients regressing to hypertensive stages 1 and 2 that are uncontrolled which may lead to progressive chronic-non-communicable disease. Understanding what drives the patient to use herbal medicines is of great importance and patient education about the risks associated with self-medication in hypertension must be highlighted.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThis study was approved by the research ethics committee of The University of the West Indies, St. Augustine (ref: CREC-SA.1923/12/2022). All participants involved in this study provided written informed consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFundings\u003c/h2\u003e \u003cp\u003eNo funding was obtained for the conduct of this study\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.F.W.P. - Principal investigator, study design, data collection, upload and analysis. Manuscript preparation and review.G.C. - Independent data analysis and manuscript preparation.A.B., S.B., K.C., M.P., R.R., A.R., P.R., T.S. - proposal development and field data collection.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe University of the West Indies, Graduate Studies \u0026amp; Research (ORC). Trinidad and Tobago West IndiesThe five participating health centers under the Eastern Regional and North-Central Regional Health Authorities (ERHA and NCRHA) and the Ministry of Health, Trinidad and Tobago, West Indies\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003ePassword protected electronically and stored with the principal investigator.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHypertension Trinidad and Tobago. 2023 country profile. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/publications/m/item/hypertension-tto-2023-country-profile\u003c/span\u003e\u003cspan address=\"https://www.who.int/publications/m/item/hypertension-tto-2023-country-profile\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 14 April 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChadee D, Seemungal T, Pinto Pereira LM, Chadee M, Maharaj R, Teelucksingh S. Prevalence of self-reported diabetes, hypertension and heart disease in individuals seeking State funding in Trinidad and Tobago, West Indies. J Epidemiol Glob Health. 2013;3(2):95\u0026ndash;103.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYusuf S, Joseph P, Rangarajan S, Islam S, Mente A, Hystad P, et al. Modifiable risk factors, cardiovascular disease and mortality in 155,722 individuals from 21 high-, middle-, and low-income countries. Lancet Lond Engl. 2020;395(10226):795\u0026ndash;808.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzizah N, Halimah E, Puspitasari IM, Hasanah AN. Simultaneous Use of Herbal Medicines and Antihypertensive Drugs Among Hypertensive Patients in the Community: A Review. J Multidiscip Healthc. 2021;14:259\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraditional. Complementary and Integrative Medicine. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/traditional-complementary-and-integrative-medicine\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 14 April 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNagawa CS, Palakshappa JA, Sadasivam RS, Houston TK. Herbal or Dietary Supplement Use and Hypertensive Medications: Does the Combination Relate to Medication Adherence and Blood Pressure Control? J Altern Complement Med. 2021;27(2):168\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmira OC, Okubadejo NU. Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria. BMC Complement Altern Med. 2007;7:30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThangsuk P, Pinyopornpanish K, Jiraporncharoen W, Buawangpong N, Angkurawaranon C. Is the Association between Herbal Use and Blood-Pressure Control Mediated by Medication Adherence? A Cross-Sectional Study in Primary Care. Int J Environ Res Public Health. 2021;18(24):12916.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClement YN, Morton-Gittens J, Basdeo L, Blades A, Francis MJ, Gomes N, et al. Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad. BMC Complement Altern Med. 2007;7:4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames 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). JAMA. 2014;311(5):507\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSample Size Calculator. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clincalc.com/stats/samplesize.aspx\u003c/span\u003e\u003cspan address=\"https://clincalc.com/stats/samplesize.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 19 April 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClinical pathways - Trinidad and Tobago - PAHO/WHO. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.paho.org/en/documents/clinical-pathways-trinidad-and-tobago\u003c/span\u003e\u003cspan address=\"https://www.paho.org/en/documents/clinical-pathways-trinidad-and-tobago\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 14 April 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTabassum N, Ahmad F. Role of natural herbs in the treatment of hypertension. Pharmacogn Rev. 2011;5(9):30\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRied K. Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis. Exp Ther Med. 2020;19(2):1472\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEllis LR, Zulfiqar S, Holmes M, Marshall L, Dye L, Boesch C. A systematic review and meta-analysis of the effects of \u003cem\u003eHibiscus sabdariffa\u003c/em\u003e on blood pressure and cardiometabolic markers. Nutr Rev. 2022;80(6):1723\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJames PB, Kamara H, Bah AJ, Steel A, Wardle J. Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone. Complement Ther Clin Pract. 2018;31:7\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. WHO Global Report on Traditional and Complementary Medicine 2019. World Health Organization; 2019. p. 228.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiwa A, Roediger R, Jaka H, Bougaila A, Smart L, Langwick S, et al. Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study. Int J Hypertens. 2017;2017:5692572.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Herbal medicines, dietary and herbal supplements, hypertension","lastPublishedDoi":"10.21203/rs.3.rs-4331036/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4331036/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSelf-medication with herbal medicine (HM) to manage hypertension is an expanding trend worldwide. Still there is very little evidence to substantiate the motives for use in the control of blood pressure (BP). This study aims to ascertain the relationship between HM and antihypertensive treatment to manage hypertension across two regional health facilities in Trinidad.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional investigation surveyed hypertensive patients aged 35\u0026ndash;64 from the North-Central and Eastern Regional Health facilities across Trinidad. Consent was obtained from 139 participants through convenience sampling. Data included a self-reporting questionnaire and patient medical records. Analysis using Chi-square, Mann-Whitney U tests for data not normally distributed and statistical significance at the 95% confidence interval.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHM-users were either hypertensive stage 1 or 2 with no significant correlation between BMI and hypertensive stage (\u003cem\u003ep\u003c/em\u003e-value = -0.053, \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.537). Garlic, \u003cem\u003eAllium sativum L\u003c/em\u003e (57%) most used as a tea, was taken daily \u0026lsquo;to control BP\u0026rsquo;. Current systolic and diastolic BP was higher among HM-users, compared to non-users with no statistical significance. Controlled-BP, HM-users (15.7%) showed statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), a negative association (Phi = -0.175) and an OR (95% CI) of 0.426 (0.187\u0026ndash;0.969). Non-compliance to prescribed antihypertensives was greater among HM-users, 40% compared to non-users, 29.6%. Antihypertensives included calcium channel blockers (70.1%), ACE inhibitors (46.3%), and angiotensin-II receptor blockers (40.6%). Patient non-compliance to conventional medication was found to be higher among HM-users identified by the negative association among patients with uncontrolled BP. The most commonly used herb, \u003cem\u003eA. sativum\u003c/em\u003e, was preferred for BP control, however, this study showed no significant changes in BP compared to non-users.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003ePatient medication concordance is imperative. Herb-drug interactions may be associated with the higher prevalence of patients at hypertensive stages 1 and 2 that are uncontrolled in this study.\u003c/p\u003e","manuscriptTitle":"Examining the relationship between Herbal Medicine use and Blood Pressure control in individuals on Antihypertensive therapy across two Regional Health Facilities in Trinidad.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-17 02:04:43","doi":"10.21203/rs.3.rs-4331036/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-30T07:57:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-19T14:14:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-17T11:35:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Complementary Medicine and Therapies","date":"2024-04-26T17:28:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-complementary-medicine-and-therapies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcam","sideBox":"Learn more about [BMC Complementary Medicine and Therapies](https://bmccomplementmedtherapies.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Complementary Medicine and Therapies","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"66c99fa9-0ca0-4219-ac15-7aa60b05d8ff","owner":[],"postedDate":"August 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-15T12:23:41+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-17 02:04:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4331036","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4331036","identity":"rs-4331036","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}