Jurnal Garlic for Hipertensive

7/25/2019 Jurnal Garlic for Hipertensive

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BMC Cardiovascular Disorders

Open AccessResearch article

Efect o garlic on blood pressure: A systematic reviewandmeta-analysis

Karin Ried* , Oliver R Frank , Nigel P Stocks , Peter Fakler and1 1 1 1ho!as Sullivan"

#ddress$ Disci%line o& 'eneral Practice, he (niversit) o& #delaide, #delaide, South #ustralia and Disci%line o& Pulic +ealth,he (niversit) o&

1 "

#delaide, #delaide, South #ustralia

!ail$ Karin Ried* - karin.ried/adelaide.edu.au0 Oliver R Frank - oliver.&rank/adelaide.edu.au0 Nigel P Stocks -nigel.stocks/adelaide.edu.au0Peter Fakler - %&akler/ig%ond.net.au0 ho!as Sullivan - tho!as.sullivan/adelaide.edu.au

* Corres%onding author

Abstract

Background: Non-pharmacological treatment options or hypertension have the potenreduce the risk o& cardiovascular disease at a %o%ulation level. #ni!al studies have suggested thgarlic reduces lood %ressure, ut %ri!ar) studies in hu!ans and non-s)ste!atic revies havere%orted !i2ed results. 3ith interest in co!%le!entar) !edicine &or h)%ertension increasing, it

is ti!el) to u%date a s)ste!atic revie and !eta-anal)sis &ro! 1445 o& studies investigating thee6ect o& garlic %re%arations on lood %ressure.

Methods: e searched the Medline and Embase databases or studies published betw!"##and Octoer "778. Rando!ised controlled trials ith true %laceo grou%s, using garlic-onl)%re%arations, and re%orting !ean s)stolic and9or diastolic lood %ressure :SBP9DBP; and standardeviations ere included in the !eta-anal)sis. 3e also conducted sugrou% !eta-anal)sis )aseline lood %ressure :h)%ertensive9nor!otensive;, &or the ".? !! +g &or SBP in the garlic grouco!%ared to %laceo :n @ 170 % @ 7.771;, hile the !ean decrease in the h)%ertensive sugrou%

as ?.5 > ".? !! +g &or SBP :n @ 50 % A 7.771;, and 8. > 1. !! +g &or DBP :n @ 0 % A 7.771Regression anal)sis revealed a signi


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BMC Cardiovascular Disorders 2008, 8:13 http://www.biomedcentral.com/1471-221/8/13


Background+)%ertension :s)stolic lood %ressure :SBP; 157 !!+g0 diastolic lood %ressure :DBP; 47 !! +g; is aknon risk &actor &or cardiovascular !oridit) and !or-talit), a6ecting an esti!ated 1 illion individuals orld-

ide G1H. Recentl) u%dated guidelines &or the treat!ent o&high lood %ressure stress the i!%ortance o& %reventivestrategies, and reco!!end e2tending the !anage!ent o&lood %ressure to include %re-h)%ertensive individuals:SBP 1"7I149DBP ?7I?4 !! +g; G1H. Pri!ar) !anage-!ent should include relevant li&est)le !odi


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)able !: 'haracteristics o randomised controlled trials included in meta-analysis e*amining the efect ogarlic on blood pressure+ource +tudy design,

ntervention.control groups

)ype o garlicpreparation/0osage/ 0uration

Number oparticipants inintervention vscontrol group

Mean +B1 2+03 atstart.end ointervention vscontrol in mm 4g

Mean 0B1 2+03 atstart.end ointervention vscontrol in mm 4g

KandJiora 14??:Stud) 1;, G11H

Parallel, 'arlic %oder :Kai;,"79"7 'arlic$ 185 :5;91?:17;

'arlic$ 44 :;9? :5;

Diuretic drug :D)tide+; garlic9drug onl)

=77 !g9d, :standing; Control$ 18 :?;91=4:=;

Control$ 4? :;947 :;

1" ks

#uer et al. 1447, G1"HParallel, Kai, "59" 'arlic$ 181 :"1.=;91":14.=;

'arlic$ 17" :1;9?4:5.5;

'arlic9%laceo =77 !g9d, Control$ 1=1 :14;91:14;

Control$ 48 :1".4;94:17.=;

1" ks

Torerg U Schneider1447, G1H

Parallel, Kai, "79"7 'arlic$ 155. :1.5;91?. :5.;

'arlic$ 41 :.4;9?8:.8;

'arlic9%laceo 477 !g9d, Control$ 155 :17.5;9158 :8.1;

Control$ ?? :=.1;947:.8;

1= ks

+olJgartner et al.144", G15H

Parallel, Kai, 58958 'arlic$ 15.5 :1.5;91.5 :15.=;

'arlic$ ?".? :17.;98?.= :4.;

i%id-loering drug:BenJa


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:details on &unding in ales " and ;. Regression anal)-ses ere conducted using Stata version 4 G1H.

Plotting of blood pressure changes over time3e integrated additional lood %ressure data &ro! studiesincluded in the s)ste!atic revie in BP9ti!e %lots &or vis-ual assess!ent o& BP trends de%ending on BP at start o&treat!ent :!ean9!edian SBP at start or A 17 !! +g,!ean9!edian DBP or A ? !! +g;. 3e included in the%lots data o& %laceo and non-%laceo controlled trialsusing garlic-onl) %re%arations, and re%orting !ean or

!edian SBP and9or DBP.

$esultsleven o& " studies included in our s)ste!atic revie andinvestigating the e6ect o& garlic on lood %ressure !et theinclusion criteria &or !eta-anal)sis :ale 1; G11-"1H.Fourteen studies ere e2cluded &ro! !eta-anal)sis$ si2had no %laceo control grou% G"5,","?,",5,H,another si2 re%orted inco!%lete data &or !ean SBP, DBPor SD G","=,"8,7,1,H, and another to ecause the)used garlic co!ination su%%le!ents containing other

%otentiall) h)%otensive agents G"","4H :#dditional File1;. 3e ere ale to contact the authors o& &our studiesith suitale stud) design ut inco!%letel) re%orted dreuired &or !eta-anal)sis G"7,"=,"8,H, and otainedco!%lete data &ro! one stud) G"7H.

en o& the eleven studies included in the !eta-anal)sisre%orted co!%lete SBP and SD data reuired &or !eta-anal)sis, and eleven studies re%orted DBP and SD data:ale 1; :DBP data onl) G1H;. Nine studies co!%aredgarlic %re%arations to %laceo, and to studies co!%arthe e6ect o& garlic on lood %ressure in addition to a drco!%ared to drug %lus %laceo G11$ diuretic, antih)%ertensive, acts on sodiu! chloride reasor%tion, 15$ li%idloering drugH. Nine studies used garlic %oder :!ainlKai, a standardised garlic su%%le!ent G"H;, one stuused aged garlic e2tract G14H and another used distilledgarlic oil G"1H. Dosage o& garlic %oder ranged etee

=77 and 477 !g %er da), and duration o& interventionranged &ro! 1" to " eeks. # total o& "" individualsallocated to a garlic intervention grou% and "1 individals allocated to a control grou% ere included in the !anal)sis on SBP, and "? :garlic; versus "?" :control; oDBP. Mean lood %ressure at start o& intervention varie!arkedl), ith &our studies re%orting !ean SBP in theh)%ertensive range :157 !! +g; and three studiesre%orting !ean DBP in the h)%ertensive range47 !!+g; e&ore treat!ent.

Meta-anal)sis o& ten studies o& the e6ect o& garlic on Sshoed a signi


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+eterogeneit) as !oderate &or !eta-anal)sis o& SBP o&

all ten studies : @ 8.1;. +oever, e &ound no heter-"ogeneit) in the sugrou% anal)sis o& studies ith h)%er-tensive individuals at start o& intervention : @ 7;. he"

sa!e trend as oserved &or !eta-anal)sis o& DBP ith "

@ ?." &or %ooled anal)sis o& all ten studies and @ 7"

&or sugrou% anal)sis o& studies ith h)%ertensive su-Lects at start o& intervention.

Regression anal)sis as conducted to test hether hetero-geneit) eteen the studies could e e2%lained ) one or!ore o& the &olloing continuous variales$ dosage :onl)studies using garlic %oder ere included, n @ ?94 :SBP9DBP;, range =77I477 !g9d;, duration o& intervention

:SBP9DBP$ n @ 17911, range 1"I" ks;, and SBP or DBPat start o& intervention :SBP9DBP$ n @ 17911, range 18I174 SBP917"-=5 DBP;. SBP or DBP at start o& intervention%roved to e a signi


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!ean DBP loer than ? !! +g at start o& intervention:Figure and d;.

0iscussionOur !eta-anal)sis suggests that garlic su%%le!entatione2erts a h)%otensive e6ect co!%ared to %laceo, in %artic-ular in individuals ith high lood %ressure :SBP 157!! +g, DBP 47 !! +g;. Meta-anal)sis o& all studiesshoed a !ean decrease o& 5.= > ".? !! +g &or SBP in

the garlic grou% co!%ared to %laceo :% @ 7.771;, hilethe !ean decrease in the h)%ertensive sugrou% as ?.5 >".? !! +g &or SBP and 8. > 1. !! +g &or DBP :% A7.77771;. o heterogeneit) in the sugrou% anal)ses inaddition to regression anal)sis con


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ages eteen =77 and 477 !g %er da) o& Kai %oder.On the other hand, detection o& an association eteenduration o& garlic intake and lood %ressure change !a)have een li!ited ecause the !aLorit) o& studies :8 outo& 11; took


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Sugrou% !eta-anal)sis on the e6ect o& garlic on s)stolic lood %ressure o& h)%ertensive suLects :157 !! +g at start o&intervention; :#; or nor!otensive suLects :A157 !! +g at start o& intervention; :B;0 on diastoliclood %ressure o& h)%er-tensive suLects :

47 !! +g; :C; or nor!otensive suLects :A47 !! +g; :D;5igure 8+ubgroup meta-analysis on the efect o garlic on systolic blood pressure o hypertensivesub9ects 2

!;mm4g at start o intervention3 2A3 or ain 1663 20 1.00(12.55) 22 -1.00(9.00) 12.24 2.00 [-4.66, 8.66]

*aradeth 1664 25 2.40(13.23) 27 -1.80(11.58) 11.82 4.20 [-2.58, 10.98]

*imon% 166! 28 -8.00(10.57) 28 -5.00(10.28) 18.22 -3.00 [-8.46, 2.46]

*teiner 166 41 -8.00(11.20) 41 -4.40(9.25) 27.49 -3.60 [-8.05, 0.85]

;dler 1667 12 -4.80(10.64) 11 1.30(8.23) 9.07 -6.10 [-13.84, 1.64]

?hang 2000 14 -3.50(5.94) 13 0.90(7.36) 21.16 -4.40 [-9.47, 0.67]

(otal 6! ' 140 142 100.00 -2.28 [-4.61, 0.05]

(e%t for heterogeneit": 'hi@ 7.11, df ! P 0.21, @ 26.

(e%t for o#erall effect: ? 1.62 P 0.0

-10 -! 0 ! 10

Aa#o$r% t reatment Aa#o$r% control

-1!

ean ifference * ean ifference *

*t$d" (reatment 'ontrol fied eight fied

5 5 6! ' 6! '

>ain 1663 20 1.00(12.55) 22 -1.00(9.00) 12.24 2.00 [-4.66, 8.66]

*aradeth 1664 25 2.40(13.23) 27 -1.80(11.58) 11.82 4.20 [-2.58, 10.98]

*imon% 166! 28 -8.00(10.57) 28 -5.00(10.28) 18.22 -3.00 [-8.46, 2.46]

*teiner 166 41 -8.00(11.20) 41 -4.40(9.25) 27.49 -3.60 [-8.05, 0.85]

;dler 1667 12 -4.80(10.64) 11 1.30(8.23) 9.07 -6.10 [-13.84, 1.64]

?hang 2000 14 -3.50(5.94) 13 0.90(7.36) 21.16 -4.40 [-9.47, 0.67]

(otal 6! ' 140 142 100.00 -2.28 [-4.61, 0.05]

(e%t for heterogeneit": 'hi@ 7.11, df ! P 0.21, @ 26.

(e%t for o#erall effect: ? 1.62 P 0.0

-10 -! 0 ! 10

Aa#o$r% t reatment Aa#o$r% control

-1!


' +P h"perten%i#e %$bgro$p


5 5 6! ' 6! '

9andiora-%1 1688 20 -16.00(2.95) 20 -8.00(3.69) 53.01 -8.00 [-10.07, -5.93]

;$er 1660 24 -13.00(10.52) 23 -4.00(9.65) 6.83 -9.00 [-14.77, -3.23]

ain 1663 20 -1.00(7.38) 22 -1.00(5.89) 10.40 0.00 [-4.06, 4.06]

9ie%ewetter 1663 32 -3.00(10.42) 32 -1.60(8.80) 7.69 -1.40 [-6.13, 3.33]

*aradeth 1664 25 1.90(7.43) 27 -0.70(7.48) 10.44 2.60 [-1.46, 6.66]

*imon% 166! 28 -4.00(5.88) 28 -4.00(5.89) 18.07 0.00 [-3.08, 3.08]

*teiner 166 41 -1.70(7.05) 41 -3.30(6.18) 20.85 1.60 [-1.27, 4.47]

;dler 1667 12 -3.20(6.60) 11 1.30(5.60) 6.90 -4.50 [-9.49, 0.49]

?hang 2000 14 -3.80(6.92) 13 -1.20(5.17) 8.16 -2.60 [-7.19, 1.99]

(otal 6! ' 219 221 100.00 -0.06 [-1.37, 1.25]

(e%t for heterogeneit": 'hi@ 7.48, df 7 P 0.38, @ .4(e%t for o#erall effect: ? 0.06 P 0.63

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Aa#o$r% t reatment Aa#o$r% contro l



5 5 6! ' 6! '

=olgartner 1662 47 -4.20(8.00) 47 -4.00(7.49) 17.49 -0.20 [-3.33, 2.93]

>ain 1663 20 -1.00(7.38) 22 -1.00(5.89) 10.40 0.00 [-4.06, 4.06]

9ie%ewetter 1663 32 -3.00(10.42) 32 -1.60(8.80) 7.69 -1.40 [-6.13, 3.33]

*aradeth 1664 25 1.90(7.43) 27 -0.70(7.48) 10.44 2.60 [-1.46, 6.66]

*imon% 166! 28 -4.00(5.88) 28 -4.00(5.89) 18.07 0.00 [-3.08, 3.08]

*teiner 166 41 -1.70(7.05) 41 -3.30(6.18) 20.85 1.60 [-1.27, 4.47]

;dler 1667 12 -3.20(6.60) 11 1.30(5.60) 6.90 -4.50 [-9.49, 0.49]

?hang 2000 14 -3.80(6.92) 13 -1.20(5.17) 8.16 -2.60 [-7.19, 1.99]

(otal 6! ' 219 221 100.00 -0.06 [-1.37, 1.25]

(e%t for heterogeneit": 'hi@ 7.48, df 7 P 0.38, @ .4(e%t for o#erall effect: ? 0.06 P 0.63

-10 -!


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0 ! 10

Aa#o$r% t reatment Aa#o$r% contro l



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Funnel %lots o& studies included in !eta-anal)sis on the e6ect o& garlic on s)stolic lood %ressure :#;and diastolic lood %res-sure :B;Figure 55unnel plots o studies included in meta-analysis on the efect o garlic on systolic bloodpressure 2A3 anddiastolic blood pressure 2B3 & )he vertical line o Begge/ the dotted linesthe 4 con


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*

*

*

*

') Mean 'BP at start % 8( mm Hg

* *

*

*

**

!

70

7!

80

8!

60

6!

100

10!

0 ! 10 1! 20 2! 30

Weeks

Mean"

astolc!l

oo"pr

ess#re$

mm Hg)

*6paraD

;67D

>0!%wall

04norm

=62D

*6cro%%

>63D

*64D

*6!D

>04norm

9i61

(04

?00D

') Mean 'BP at start % 8( mm Hg

* *

*

*

**

!

70

7!

80

8!

60

6!

100

10!

0 ! 10 1! 20 2! 30

Weeks

Mean"

astolc!l

oo"pr

ess#re$

mm Hg)

* *

*

*

**

!

70

7!

80

8!

60

6!

100

10!

0 ! 10 1! 20 2! 30

Weeks

Mean"

astolc!l

oo"pr

ess#re$

mm Hg)

*6paraD

;67D

>0!%wall

04norm

=62D

*6cro%%

>63D

*64D

*6!D

>04norm

9i61

(04

?00D

*6paraD

;67D

>0!%wall

04norm

=62D

*6cro%%

>63D

*64D

*6!D

>04norm

9i61

(04

?00D


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hich !a) hel% to &orestall %rogression to h)%ertensionG1,=7H.

'onclusionhis s)ste!atic revie and !eta-anal)sis suggests that gar-

lic %re%arations are su%erior to %laceo in reducing lood%ressure in individuals ith h)%ertension. Future largescale long-ter! trials are needed to investigate hetherstandardised garlic %re%arations could %rovide a sa&e alter-native or co!%le!entar) treat!ent o%tion &or h)%erten-sion in clinical %ractice.

7ist o AbbreviationsBP$ lood %ressure0 C$ con


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"=. Kieseetter +, ung F, Pindur ', ung M, MroietJ C, 3enJel $Efect o gar l ic on thrombocyte aggregation/ microcircula-tion/ and other risk actors& nt Clin Phar!acol her o2icol !""!/%"23: !#!-!##&

"8. De#Santos O, 'ruenald $ 6ect o& garlic %oder talets onblood lipids and blood pressure: a si*-month placebo-con-trolled/ double-blind study& Br Clin Res !""8/ : 8-&

"?. De#Santos O, ohns R$ 6ects o& garlic %oder and garlic oilpreparations on blood lipids/ blood pressure and well-being&Br = Clin es 1, =$1100.

"4. CJern) B, Sa!ochoiec $ Klinische (ntersuchungen !it eine!Dnoblauch-7e>ithin-1rparat&=

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Jurnal Garlic for Hipertensive