CAM407A Complementary and Alternative Medicine Assignment Sample

• Subject Code : CAM407A
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• Subject Name : Nursing

Integrative Complementary Medicine

Table of Contents

Introduction.

Pathophysiology, aetiology & medical treatments.

Proposed herbal/ nutritional therapeutic.

Literature review..

Conclusion.

References.

Introduction to Integrative Complementary Medicine

Hypertension is the severe medical condition of heart that is characterised by elevated blood pressure in heart arteries (Fuchs & Whelton, 2019). The elevated blood pressure may cause serious effect on heart, kidney, and brain. Blood pressure is created due to the force exerted by the moving blood against the walls of the blood vessel, the force generated is high then it leads to hypertension condition and if it is low than it leads to hypotension condition. Both the conditions are responsible for degrading the health of heart and forcing heart to work under pressure. According to World Health Organisation (2018), 1.13 billion people around the globe are suffering from hypertension condition. Physiologists prescribe angiotensin converting enzyme (ACE) inhibitors to treat high blood pressure condition.

Rather than this, many people use complementary medication for the treatment of hypertension. Complementary medicines provide the promising benefit to the people such as low toxicity, reduced cost, no or negligible side effects, herbal and natural in nature. The adoption of the complementary medicine among people is due to the fact of cultural beliefs, people perception, societal overview, and knowledge of natural products on health of people (Ibrahim et al, 2016). The report will provide information on complementary medicine treatments specific for the hypertensive patient. It will also provide insight on the pathophysiology condition of the patients suffering with the hypertensive cardiac disease. In hypertensive patients, the vascular tone elevated because of increased level of alpha-adrenoceptor stimulation and higher release of peptides like angiotensin, endothelins, and others in the body.

Pathophysiology, Aetiology & Medical Treatments

Hypertension is a cardiac condition that occurs because of increase in blood pressure, thus it cause a load to heart as it has to pump harder for efficient work. The normal blood pressure of the human is 120 mmHg systolic and 80 mm Hg diastolic However, the hypertensive patients shows the pressure 140 mmHg systolic & 90 mmHg diastolic or sometime more than 160 mmHg systolic and more than 110 mmHg diastolic (Batool et al, 2018). The contributing risk factors associated with development of hypertension are smoking, obesity, unhealthy lifestyle, eating habits, increase salt intake, alcohol consumption, stress, and physical inactivity. The pathogenesis of the hypertension is a multifactorial and a highly complex as the disease involves the interaction of multiple organ system with involvement of various metabolic independent and dependent pathways. The systematic vascular resistance and the cardiac output are responsible for the flow of blood and creating pressure on the vessel. In, hypertensive patients both of these issues are high.

The underlying cause of the development of disease is currently unknown. However there are many factors which may directly or indirectly associate with development of disease condition. The development of hypertension disease initiate from the primary hypertension. The primary hypertension arises because of increase in blood plasma volume, hormone, and growth factors. Along with this, other growth factors are responsible for increasing vascular smooth muscle mass and thus lead to the vascular remodelling. The higher systematic vascular resistance and vascular stiffness impose the load and pressure on the left ventricle. These conditions are responsible for left ventricular hypertrophy induction and dysfunction of left ventricular diastolic (Hamrahian, 2017). 

The unmet requirement of controlling and reducing blood pressure in high risk patients overcome through the usage of novel drugs. The drugs associated with hypertension are generally of the inhibitor class. These drugs are designed in such a way that it reduces the comorbidities associated with hypertension such as chronic kidney disease, diabetes mellitus, heart failure, heart attack and elevated blood pressure. The drugs associated with the treatment include anti-aldosterone, mineralocorticoid receptor antagonists, aldosterone synthase inhibitors, and renin angiotensin system (Oparil & Schmieder, 2015). Other than this, some of the marketed drugs for the treatment of hypertension are based on anti-hypertensive model include angiotensin converting enzyme, diuretics, beta-blockers, angiotensin II receptor blockers, calcium channel blockers, alpha agonist, and alpha blockers (Wright, Musini, & Gill, 2018).

The risk factors associated with the hypertension are modifiable and non-modifiable (Pinto, & Martins, 2017). The modifiable factors are those that can be adjusted according to the lifestyle of the person. Genetic factor, higher sodium intake, and bad habits of eating such as drinking, smoking, and drug addiction are responsible for the increasing the blood pressure in an individual. Moreover obesity, diseased condition, overweight, obesity, renal disease, family history, and sedentary lifestyle are some of the contributory factors responsible for the development of hypertension (Pinto & Martins, 2017).

In the hypertensive patient, left ventricle (LV) diastolic dysfunction is accounted during the initial phase of hypertension. Cardiac remodelling creates predominant pressure cause the hypertrophy development. This overloading cause increase in cardiac mass and chamber volume. When the pressure increases the diastolic dysfunction continues to increase and cause blood pressure to elevate. Other than this there are several biomarkers such as nitric oxide, complementary proteins, neutrophils, and cytophils that contribute additional increase in blood pressure. These factors if not treated properly may cause cardiac myopathy and diastolic dysfunction with reduced fraction (Messerli, Rimoldi, and Bangalore, 2017). The adrenergic activity through beta-receptor is responsible for the stimulation of heart rate and alpha receptor. These stimulations increase the peripheral arteriol constrictor. These constrictions cause the blood vessel to shrink and thus elevate the pressure of blood in the heart. Sometime, the elevated pressure can cause the damage of inner lining of arterioles. The damage further releases a vasoconstriction polypeptide endothelium that again causes the constriction of blood vessel. These factors contribute to the rise in blood pressure and also leakage of micro-albuminuria.

Proposed Herbal/ Nutritional Therapeutic

According to National Institute of Health, complementary and alternative medicines are defined as the group of diverse treatments that is ascertain toward implementing care (Lulebo et al, 2017). These treatments may be drugs, phytochemical, meditation, yoga or any other home-made remedies.

Ginko bilobe extract is a herbal, natural and a dietary supplement that are extracted from maidenhair tree and belongs to Ginkgophyta plantae division (Tsalamandris et al, 2018). These extract has been used therapeutically in traditional chines medicine. The extracts are responsible for showing reduce effect of free radicle in hypertensive patient. Moreover, the natural extract of Ginkgo biloba is known for its antihypertensive, antithrombotic, antiplatelet, and vasodilator properties. Thus, the extract is in demand for the treatment of hypertension in patient (Tsalamandris et al, 2018).

Garlic or Allium sativum is belong to Lilliceae family and is one of the versatile medicinal plants. Garlic is shown to have many medicinal values such as anti-bacterial, anti-fungal, antioxidant, anti-cancerous, anti-hypertensive, anti-atherosclerotic, and immune boosting characteristic (Bhardwaj et al, 2015).

Literature Review of Integrative Complementary Medicine

Paper 1: “Advanced perspectives of beneficial role of Ginkgo biloba in neurological, cardiac and cerebrovascular disorders”

• Critical review – the Ginkgo biloba is the form of alternative medicine that has a therapeutic mechanism that contributes to pharmacological activity in the hypertensive patients. The extract also shows a promising result in cardiovascular, neurological, ischemic stroke, dementia, and cerebrovascular disease (Nash & Shah, 2015). The natural extracts are safe for human use and shows minimal side effects. The extract comprises of various phytochemicals that are responsible for the therapeutic action of disease. The phytochemicals present in the extract includes gingolides, bilobalide, and flavonoids (Nash & Shah, 2015).

• Result and discussion – In the paper, author have provide the insight information on Ginkgo bilobe. The author has also provides the evidences for the clinical trials that are going on around the world foe determining the efficacy and efficiency of the extract on various disease. According to author, the extract can act as alternative mechanism to conventional treatment of hypertension as in the pre-clinical trial; the extract shows lowered blood pressure in pre-clinical models. The decrease in blood pressure is due to inhibition action on angiotensin converting enzyme (ACE) activity. The extract also shows to regulatory effect on nitric oxide level and preserving the vascular reactivity through endothelium-dependent and endothelium –independent vasodilators. According to author, extract shows a minimal toxicity and in older adults with a dose of 240 mg per day. The author opined that the extracts of ginkgo biloba are widely accepted by Chinese institute of Health (CIH) for the treatment of cardio associated disease. However, there is a need of future research to ensure the reliable and definitive clinical data.

Paper 2: “Phytochemicals and natural plant products indicated for the treatment of pulmonary arterial hypertension”

• Critical review – In this paper, the author has focussed on the qualitative aspects of plant extracts including Ginkgo biloba. The author has summarised the therapeutic properties of the natural compounds on pulmanorary arterial hypertension. Author opined that ginkgo biloba has clinical efficiency in treating atherosclerosis, thrombus and platelet aggregation, hypertension, and ischemia-reperfusion injury (Xiang et al, 2018).

• Result and discussion – The author state that ginkgo biloba leaf extract has shown to protect the person from hypertension with hypercholesterocolemia induced renal injury. The reduction is found due to the contributory factors of vasopasm reduction, relaxation, suppression of renal oxidative stress, reduction of inflammation due to reactive oxygen, and stress induction of nitrosative commodities (Xiang et al, 2018). The ginkgo biloba leaf extract also shows promising activities in reducing intima-media ratio, decrease proliferation and migration of vasodilator cells. Thus, this characteristics feature shows the positive response of the natural extract on hypertensive patients.

Paper 3: “Garlic lower pressure of blood in hypertensive subjects and also improves arterial stiffness and gut microbiota.

• Critical review – Garlic, garlic cloves and its supplements shows a contributing therapeutic effect on the hypertensive patients. The author opined the beneficial, contributing, and clinical finding on the cardiovascular health of the patients. The garlic supplements show a reduction in arterial stiffness, blood stickiness, and higher cholesterol level (Reid, 2019). The signalling pathways associated with influence of garlic are nitric oxide and hydrogen sulphide production. Garlic and its supplements belong to sulphur donor class, and participate in trans-sulphuration pathway and influence the efficiency of hydrogen sulphide production. Thus, play an important role in susceptibility to develop hypertension.

• Result and discussion - The author stated that its second trial found that the dose of two capsules per day to the person suffering from hypertension is sufficient in lowering the blood pressure by 10mmHg systolic and 5mmHg diastolic. Moreover, the garlic capsules found to show an effective impact in reducing peripheral blood pressure, pulse pressure, central blood pressure, pulse wave, and arterial stiffness. Thus, these factors show a contributing effect on heart health, aerobic fitness, and cardiac health and reduce the risk of cardiovascular disease development. The author has provided the evidence on the clinical trials to identify the beneficial effect of garlic on hypertensive patient. The total of 553 participants was included in the clinical study who is suffering from hypertension. The trial were of high quality with the minimum bias and found that garlic supplements reduce the risk of cardiovascular disease and help in rejuvenating blood arteries (Reid, 2019).

Paper 4: “Garlic and heart disease”

• Critical review – In this paper, author has reviewed the beneficial, therapeutic, and clinical outcome of garlic and its supplements on patients suffering from hypertension (Varshney & Budoff, 2016). The contributory risk factors associated with cardiac disease are stroke, hypertension, arterial fibro genesis, cardiac myopathy, atherosclerosis-related disease (ARD), ischemic heart disease (IHD), stroke, and peripheral vascular disease. Garlic and its supplements are being majorly used as a complementary therapy among patients suffering from hypertension. The author has also summarises the effect of garlic on the cardiac risk factors such as coronoray artery calcium (CAC), inflammatory biomarkers such as C-reactive protein (CRP), and vascular function of pulse wave velocity.

• Result and discussion - The author has provided the evidence of clinical trial to support the therapeutic effect of garlic on cardiac health. The findings from the trial includes that the antihypertensive therapy shows 20% to 25% reduction in IHD incidence, 30% to 40% reduction in stroke and contributory reduction of blood pressure in patients suffering from hypertension. These studies also reveille that with the administration of garlic, the blood pressure reduced by 7 to 16 mm Hg and 5 to 9 mm Hg SBP and SBP respectively (Varshney & Budoff, 2016). The reduction in blood pressure is because of the presence of sulphur component in garlic. These sulphur component transformed into hydrogen sulphide (H2S), which further act as signalling molecules for smooth muscle relaxation, vasodilator, and reduction blood pressure. The author also confined that the aged garlic extract provide more beneficial effects on the health of heart.

Paper 5: “The systematic review, meta analysis, and critical analysis of the effects of garlic and its supplements on the blood pressure in people suffering from hypertension”

• Critical review – The author has provided an analysis of the effect of garlic and its supplement on reducing the blood pressure. The author opined that garlic preparations and its supplements are the complementary alternative medicines and are great herbal supplements in providing beneficial effect to patient. Garlic and its supplement showed a considerable blood pressuring lowering effect in aged individual as well (Rohner et al, 2015).

• Result and discussion – The author has opined that the study was conducted with the individual having hypertension of more than 140 mm Hg systolic and 90 mm Hg diastolic. The author stated that the dosage and type of garlic used in the study includes 600 to 2400 mg per day, 3.6 to 13.6 mg of allicin. However, the fresh garlic used for the treatment comprise of 5 to 9 mg of allicin. The type, treatment induced, and quantity of the garlic determine the effect and efficacious treatment approach. As the heat treated garlic provide the limited benefit as compared to raw garlic. The author provide an insight on the mechanism of action in the fact that, the garlic comprises of S-allylcysteine that help in increasing nitric oxide production within the endothelial cells and thus help in increasing, enhancing, dilating the blood vessel (Rohner et al, 2015).

Conclusion on Integrative Complementary Medicine

From the above it can be concluded that complementary and alternative medicine treatment may use along with standard medical treatment but cannot be considered as the standard treatment. People have greater perspective for the adoption of these medicines as they think these medicines are safe, natural, and highly effective. However, this cannot be sure because these medicines lack certification from the government regulation in terms of safety, efficiency, pharmacokinetics, and pharmacogenomics. The report has demonstrated the beneficial aspects of the herbs such as Ginkgo bilibo and garlic. The clinical and government regulation is needed for making the complementary medicine to be acceptable by most of the population. Thus, from the above it can be concluded that the complementary and alternate medicine provide a safe, contrasting and a therapeutic effect on the hypertension person. Ginkgo bilibo and garlic are well known for providing therapeutic benefit on hypertensive person.

References for Integrative Complementary Medicine

Batool, A., Sultana, M., Gilani, P., & Javed, T. (2018). International Journal of Pharma Sciences and Scientific Research, 4, 49-61

Bhardwaj, K., Verma, M., Verma, N., Bhardwaj, S., and Mishra, S. (2015). Effects of long term supplementation of active garlic allicin in reducing blood pressure in hypertensive subjects. International Journal of Advances in Medicine, 2, 231-234. DOI: http://dx.doi.org/10.18203/2349-3933.ijam20150550

Fuchs, F. & Whelton, P. (2019). High blood pressure and cardiovascular disease. American Heart Association, 75, 285-292. https://doi.org/10.1161/HYPERTENSIONAHA.119.14240 

Hamrahian, S. (2017). Pathophysiology of hypertension. American Heart Association, 1-5

Ibrahim, I., Hassali, M., Saleem, F., & Tukmagi, H. (2016). A qualitative insight on complementary and alternative medicines used by hypertensive patients. Journal of Pharmacy & Bioallied Sciences, 8, 284-288. doi: 10.4103/0975-7406.199349

Lulebo, A., Mapatano, M., Mutombo, P., Mafuta, E., Samba, G., and Coppieters, Y. (2017). Prevalence and determinants of use of complementary and alternative medicine by hypertensive patients attending primary health care facilities in Kinshasa, Democratic Republic of the Congo: A cross-sectional study. BMC Complementary and Alternative Medicine, 17, 1-10. doi: 10.1186/s12906-017-1722-3

Messerli, F., Rimoldi, S., and Bangalore, S. (2017). The transition from hypertension to heart failure. JACC Journal, 5, 1-7. DOI: 10.1016/j.jchf.2017.04.012

Nash, K. and Shah, Z. (2015). Current perspectives on the beneficial role of Gingo biloba in neurological and cerebrovascular disorder. SAGE Journals, 6, 1-10. doi: 10.4137/IMI.S25054

Oparil, S. and Schmieder, E. (2015). New approaches in the treatment of hypertension. Circulation Research, 116, 1074-1095. https://doi.org/10.1161/CIRCRESAHA.116.303603

Pinto, I., and Martins, D. (2017). Prevalence and risk factors of arterial hypertension: A literature review. Journal of Cardiovascular Medicine and Therapeutics, 1, 1-7.

Rohner, A., Reid, K., Sobenin, I., Bucher, H., & Nordmann, A. (2015). A systematic review and meta analysis on the effects of garlic preparations on blood pressure in individuals with hypertension. American Journal of Hypertension, 28, 1-10.

Reid, K. (2019). Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis. Experimental and Therapeutic Medicine, 19, 1472-1478. doi: 10.3892/etm.2019.8374

Tsalamandris, S., Oikonomou, E., Papamikroulis, A., Tousoulis, D. (2018). Coronary artery disease from Biology to clinical practice. ScienceDirect, 273-300. Academic Press, Greece.

Xiang, L., Li, Y., Deng, X., Kosanovic, D., Schermuly, R., and Li, X. (2018). Natural plant products in treatment of pulmonary arterial hypertension. SAGE Journal, 8, 1-20. https://doi.org/10.1177/2045894018784033

Varshney, R. and Budoff, M. (2016). Garlic and heart disease. The Journal of Nutrition, 146, 416-421. DOI: 10.3945/jn.114.202333

World Health Organisation. (2018). Retrieved from: https://www.who.int/health-topics/hypertension/#tab=tab_1

Wright, J., Musini, V., and Gill, R. (2018). First-line drugs for hypertension. The Cochrane Collaborations,2, 1-112. doi: 10.1002/14651858.CD001841.pub3.

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