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Complementary and alternative medicine (CAM) is widely used by people in the United States and other countries for the treatment of health conditions that include hypertension (HTN), cardiovascular disease (CVD), heart failure, hyperlipidemia and other condtions. The visits to CAM practitioners result in significant out-of-pocket expenses, as CAM is not covered by health insurance in the majority of cases. The reasons for this are that the products used are not closely regulated by governmental regulatory agencies and lack scientific evidence about their effectiveness and safety. The people regard these products as being ‘natural’ and, consequently, safe. However, there is evidence that these products can be contaminated and adulterated with other substances and could cause harm to the persons who take them. The responsibility falls on the health professionals, who should become familiar with the various CAM products, inquire their patients whether they taking any of these products and advise them accordingly. This review is based on a recent statement issued by the American Medical for the use of CAM for the treatment of HTN. For its preparation, a Medline search of the English language literature was performed between 2010 and 2014 restricted in the use of CAM for CVD and HTN, and from the 88 abstracts reviewed, 23 pertinent papers were selected. These papers together with collateral literature will be discussed in this review regarding CAM and CAM products on their effectiveness and safety for the treatment of CVD and HTN.

The antihypertensive effects of moexipril, a new angiotensin converting enzyme inhibitor, and verapamil-SR as add-on therapy to hydrochlorothiazide (HCTZ) were investigated in patients with moderate to severe (stages II and III) essential hypertension. Of 147 patients treated for 4 weeks with 25 mg/day HCTZ, 108 whose sitting diastolic blood pressure (SDBP) was 100 to 114 mm Hg inclusive were randomized to 7.5 mg/day moexipril (56 patients) and 180 mg/day verapamil-SR (52 patients) in addition to 25 mg/day HCTZ. If after 4 weeks of treatment the SDBP was > or = 90 mm Hg, the dose of moexipril was increased to 15 mg/day and that of verapamil-SR increased to 240 mg/day; the patients were followed for an additional 8 weeks. Blood chemistries, plasma renin activity, and plasma aldosterone were done during the study. Both moexipril and verapamil-SR were safe and well tolerated and decreased the sitting and standing blood pressure similarly (P < .001). This study demonstrated that the addition of moexipril and verapamil-SR to low dose HCTZ is effective for the treatment of moderate to severe hypertension.

1. The effects of prolonged high sodium intake (duration 3 months) and meclofenamate were studied in two groups of male spontaneously hypertensive (SH) rats. 2. Group 1 (eight rats) received 1% NaCl in water and served as controls, and group 2 received 1% NaCl in water plus meclofenamate (3·5–4·0 mg daily). 3. Group 2 rats developed higher arterial pressure, renal vascular resistance and left ventricular weight and greater renal histological changes, with lower effective renal plasma flow, renal blood flow and glomerular filtration rate, than group 1. No differences were observed between the two groups in heart rate, body weight, fluid intake, urine volume, UNaV, UKV and right ventricular weight. 4. The results suggest that the combination of high sodium intake and meclofenamate exerts a greater damaging effect on the arterial pressure and renal function of SH rats than salt alone.

The efficacy and safety of different doses of a new controlled release formulation of isradipine (isradipine-CR, ICR) were evaluated in patients with mild to moderate (stages 1 and 2) essential hypertension in a placebo-controlled study. Of 402 randomized patients, 384 completed the study (placebo = 77, 5 mg ICR = 76, 10 mg ICR = 76, 15 mg ICR = 78, 20 mg ICR = 77). All doses of ICR decreased the blood pressure and the effect was greater with doses of 10, 15, and 20 mg once daily (P < .001). The most common clinical side effect was mild ankle edema, which was dose dependent, occurring in 35.5% of the patients taking the 20-mg ICR dose. This study showed that ICR is long acting, effective, and well tolerated.

This was a randomized, double-blind, parallel-group, starting-dose study comparing the efficacy of 20 mg CS-866, a new angiotensin receptor blocker (ARB), with three other ARBs. During the last 2 weeks of a 4-week single-blind placebo run-in period, hypertension was confirmed by a sitting diastolic blood pressure (BP) =100 and =115 mm Hg as measured by office cuff. Eligible patients were randomly assigned to 1 of the 4 treatment groups and treated for 8 weeks. BP was measured at the end of Weeks 2, 4, and 8. Data for 578 randomized patients were included; 61% of patients were male, and the mean age was 51.9 years. There were no significant differences in baseline BP values or demographic characterictics among treatment groups. The comparison of the change in sitting cuff diastolic BP from baseline to Week 8 (primary efficacy variable) is summarized below for CS-866 and each comparator drug (Intent-to-treat population). (See Table) Drug/DoseN(Change Baseline-Week 8[a,b]P-ValueCS-866/20 mg145-11.5 mm Hg---Losartan/50 mg146- 8.2 mm Hg0.0002Valsartan/80 mg142- 7.9 mm Hg0.0000Irbesartan/150 mg145- 9.9 mm Hg0.0412[a] Least-squares mean; [b] Last observation carried forward The magnitude of the effect of CS-866 in lowering sitting diastolic BP was statistically greater than that of losartan, valsartan, or irbesartan at the starting doses of these drugs. Although the magnitude of the systolic BP lowering effect of CS-866 was numerically greater as compared to the other ARBs, the differences were not statistically significant. There were no differences in the safety profile between all drugs, which were extremely well tolerated. We conclude that CS-866 is more effective than other ARBs tested at the starting doses for reducing office cuff diastolic BP in patients with essential hypertension. Dr. Suzanne Oparil is the recipient of grants in aid from Astra Merck, Berlex, Boehringer, Bristol Myers-Squibb, Hoffman La-Roche, Novartis (Ciba), Merck & Co., Pfizer, Sanofi/BioClin, Searle, SmithKline Beecham/Bayer, SmithKline Beecham/Boehringer Manneheim, Wyeth-Ayerst, Parke-Davis. She is a consultant for Astra Merck, BMS/Sanofi Winthrop, Eli-Lilly, the Salt Institute, Novartis, Solvay Pharmaceuticals, Wyeth-Ayerst. She is a member of the Board of Directors for the Texas Biotechnology Corporation.