Phytotherapy and nutraceuticals can represent—alongside a proper lifestyle that includes a balanced diet and the physical activity you need—a valuable resource for the health of the cardiovascular system, both in preventive contexts and in cases of mild hypertension (defined as “borderline”), where a physician may not yet deem classical pharmacological therapy appropriate. Improved control of the condition and blood pressure readings can also be achieved in chronic hypertension, with the aim of optimally managing medication dosing and sometimes reducing it.
Thanks to certain plants and targeted nutraceuticals, it is possible not only to promote the normalization of blood pressure values but also to contribute to the management of concomitant and aggravating factors such as dyslipidemias or stress, addressing the problem from every angle and, where possible, postponing the need to undertake a conventional pharmaceutical therapy.
The Role of Plants
Among the best-known and most used herbal remedies, we should mention Hawthorn (Biancospino), a plant with sedative effects on the heart and the central nervous system, whose hypotensive effect manifests by slowing the heart rate and by reducing stress that can trigger mild hypertension and sensations such as the so-called “heart in the throat.” The Olive tree, capable of providing a hypotensive effect through peripheral vasodilation, and Garlic, which beyond aiding blood pressure control also contributes to atherosclerosis prevention.
The antihypertensive efficacy of olive (Olea europaea) appears to rest on the ability of the active constituents in the phytocomplex to tackle the hypertension issue on multiple fronts (1): there is the direct hypotensive action of the oleoside and oleuropeoside, and the indirect hepato-renal diuretic effect, all paired with a peripheral vasodilatory effect—due to oleuropein (which moreover increases coronary blood flow)—with an overall decrease in both systolic and diastolic blood pressure.
At high doses, both olive derivatives and oleuropein itself have demonstrated a positive inotropic effect and a negative chronotropic effect. For the most encouraging clinical studies in terms of efficacy, the dry extract (ethanol 80% v/v extraction solvent) titrated to oleuropein 18–26% and total polyphenols 30–40% at a dosage of 500 mg twice daily has been used.
Lowering Blood Pressure
Regarding Garlic (Allium sativum), beyond its peripheral vasodilatory effect—which is useful for reducing systolic and diastolic blood pressure—it can produce diuretic and natriuretic effects, thereby reinforcing the antihypertensive action achieved via vasodilation. It can therefore be recommended as an adjunct in the treatment of essential hypertension, thanks to the plant’s synergistic effect with other antihypertensive drugs, which might allow a reduction in dosage for improved tolerability and patient acceptance of the therapy.
The antihypertensive effects are effectively complemented by garlic’s other cardiovascular actions, such as lipid-lowering, fibrinolytic, and antiplatelet effects, which intervene on the multiple aspects that contribute to atherosclerosis, making garlic a useful remedy even in the presence of metabolic syndrome.
In the Case of Mild Hypertension
The Hawthorn (Crataegus spp., including Crataegus monogyna or Crataegus oxyacantha) ultimately represents the ideal choice for treating mild hypertension related to stress. This plant provides protection for the entire cardio-vascular system, acting as a heart “sedative,” with its hypotensive effect not only by calming the heart rate but also by exerting calming effects on the central nervous system (3).
At the level of the heart, Hawthorn exerts a positive inotropic action, increasing the contractile force of the heart, while being negative inotropy in terms of excitability and rhythm, due to inhibition of the Na+/K+-ATPase pump. It can contribute to improved coronary circulation, promoting blood flow to the heart and modestly dilating the coronary vessels. Consequently, it reduces peripheral resistance and produces a modest lowering of blood pressure, aided by a mild diuretic effect. Proanthocyanidins simultaneously provide protective effects on the vascular endothelium. Dry extracts are usually used 2–3 times daily, for a total daily dose of about 900 mg.
Do not overlook the importance of diuretic plants like couch grass (gramigna) or mouse-ear hawkweed (pilosella) for a comprehensive 360-degree intervention on the hypertensive picture. The role of natural remedies with lipid-lowering activity is also fundamental, as they positively impact aggravating factors of cardiovascular damage such as hyperlipidemia. It is common to see, in therapy as well as in the formulation of phytotherapies and nutraceuticals, a synergistic combination of functional substances that can enhance each other, especially when each component’s efficacy rests on different mechanisms of action.
The Role of Fatty Acids
Among the useful nutraceuticals, now recognized internationally (EFSA, American Heart Association, Food Standards Australia and New Zealand) for their key role in cardiovascular health, prevention, and control of hypertension, are Omega-3s—from dietary sources (such as olive oil within the Mediterranean diet) or from supplements at various dosages (generally between 2,000 and 4,000 mg/day)—that is, polyunsaturated fatty acids (PUFAs) containing a double bond at the third carbon of the chain. The intake of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) can reduce systemic systolic and diastolic blood pressure.
According to EFSA, consuming at least 2 g/day of DHA and EPA can help maintain normal triglyceride levels in the blood (6), through several action mechanisms. Among these, increased production and bioavailability of nitric oxide (NO) at the endothelial level via activation of endothelial nitric oxide synthase (eNOS), as well as a favorable shift in prostaglandin synthesis toward vasodilatory prostaglandins.
The Polyunsaturated Fats
Underlying the efficacy of PUFAs is also their capacity to reduce insulin resistance and regulate vascular tone (through stimulation of the parasympathetic nervous system and suppression of the renin-angiotensin-aldosterone system) (7). Krill (Euphausia superba), a small Antarctic crustacean, is among the most interesting sources of omega-3 PUFAs, thanks to the exceptional bioavailability of its EPA and DHA, which are absorbed in the intestines to a greater extent than those found in fish oil (8).
For a vegetarian or vegan-friendly supplementation, an option is the omega-3s from many vegetable oils rich in alpha-linolenic acid (ALA), such as olive oil and flaxseed oil; the latter has shown cholesterol-lowering effects, particularly in postmenopausal women and in individuals with high baseline cholesterol (9).
Even Tea Has Its Role
Several meta-analyses and clinical studies indicate that regular use of tea (Camellia sinensis) can produce a significant reduction in diastolic blood pressure (DBP) (4) and can impact cardiovascular mortality risk (5). The catechin EGCG (epigallocatechin gallate) can inhibit the angiotensin-converting enzyme; thus, weekly consumption of black tea extract has a blood-pressure-lowering effect on systolic blood pressure (SBP).
Green tea appears to lower blood pressure through several mechanisms, for instance by maintaining a balance among vasoconstrictors, vasodilators, and hyperpolarizing factors (4), and it also promotes nitric oxide production, improving ventricular function and thus modulating reactive oxygen species (ROS).
Melatonin for Nocturnal Hypertension
For individuals who experience hypertensive peaks mainly at night, it may be useful to consider the adjunctive use of nutraceuticals based on melatonin (2 mg and up)—the hormone secreted at night by the pineal gland—preferably slow-release.
Melatonin, responsible for circadian rhythms of sleep, would act on blood pressure through both central and peripheral mechanisms: it improves nitric oxide (NO) metabolism and endothelial function, and it protects vessels from oxidative damage (10).
Melatonin supplementation can also help improve sleep quality in hypertensive patients undergoing pharmacological treatment with beta-blockers, drugs that suppress the physiological secretion of this hormone.
From the June 2025 issue of Integrative Medicine
Bibliography
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Abbonati a Karla Miller
