2 nd para start with: The increasing use of herbs creates the..

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4 The use of complementary and alternative medicines is increasing worldwide. According to National Center for Complementary and Integrative Health the most common of these are herbs 2 nd para start with: The increasing use of herbs creates the.. 4

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7 Start with: Many writers share the common view of the increasing popularity of herbal preparations to manage hypertension. In their study End with due to their agreeability with human body and fewer side effects 7

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9 NB:Remember to click after each herb mentioned 9

10 Start with: Individuals may have different attitudes toward the use of herbal medicines. While some may favour herbal preparation mainly due to them being widely considered all-natural, others may disagree having the opinion that it may be less effective than conventional medicines. 10

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12 The information from this study will serve to inform pharmacists about patient's level of knowledge and attitudes towards herbal medicines. This will assist in counselling the patient regarding the selection and use of herbal substances for the management of HTN. 12

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16 Medical centers- convenience sampling based on centers that had HTN clinic days and saw a large variety of patients Rxcies- stratified random sampling Questionnaire to determine the patients knowledge and attitudes Questionnair to 6 physicians to determine their views on the extent of use of herbs among patients in their practice 16

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19 The majority of participants (86%) knew about herbal medicines to lower blood pressure whether or not they supported the use. 19

20 The most common herb that participants knew about was garlic (77). Other common include moringa, guinea wen weed, sour sop, cinnamon, ginger. This chart shows the total list of herbs patients believed had antihypertensive properties. (I will give you a second to look at it, Marijuana is even listed here, maybe Dr Williams can look at that in her research) 20

21 Most of the participants reported that they gained their knowledge about herbal medicines through word of mouth from either friend, family or peer. To note: participants could choose more than one option * add`key: CAM, HCP etc 21

22 There was a greater percentage of participants who used conventional medicines only (47%) compared to participants who used herbal only (3%). This opinion can also be supported by the results obtained from the medical practitioners, where all six physicians were opposed to the use of herbs in managing hypertension. None the less, the greater percentage of patients (50%) used both conventional and herbal medicines to reduce their blood pressure. 22

23 Patients that used only conventional med were asked if they would consider using herbal substances and why. Eighty percent (80%) of the respondents said that they would consider the use of herbs in managing their blood pressure while twenty percent (20%) would not consider using herbs. 23

24 Of the twenty participants that said they would not consider using herbs, majority(12) gave the reason as possible interaction with their current medications (five (5) patients said it was not recommended by their health care practitioner and three (3) said that herbal medicines needed to be researched more. ) 24

25 Majority of the participants reported that their reason for using herbal medicines and conventional medicine was due to the additive benefits in reducing their blood pressure. This is supported by the study that was done by Lakshmi et al. (2010). They discussed that majority of their participants reported that the main use of herbs was due to the additive benefits in lowering blood pressure 25

26 Of those who used both herbal and conventional, 50% preferred herbal preparation they used and 50% preferred conventional. Hence, there was no preferential superiority between herbal and conventional medicines according to our study. 26

27 The patients who preferred conventional medicines reported that the main reason was that they believed they were more effective when compared to herbal medicine. A percentage of 88% reported that conventional medicine was more effective and 12% reported that it was more trustworthy and proven. This is expected as conventional medicines are synthetically modified to be used in treating hypertension and are thus tried and proven. 27

28 The most popular conventional medicines obtained from our study include hydrochlorothiazide, losartan, enalapril, atenolol and nifedipine. (with HCTZ being most common) This is expected as the JNC 8 recommends thiazide diuretics such as hydrochlorothiazide, calcium channel blockers such as nifedipine and angiotensin converting enzyme inhibitors such as enalapril as first line therapies for the treatment of hypertension. 28

29 For the Participants that preferred herbal, most reported that the reason for this was that they experienced less side effects when compared to conventional medicines. This result obtained from our study agreed with research written by Kumar & Yogeshwer (2003), where they discussed that individuals used herbal medicines because they experienced less side effects. 29

30 The most common herb that was used in the management of hypertension among participants was garlic (35 participants) and 27 of these participants reported eating or swallowing the clove of the garlic. 30

31 The medical practitioners also listed garlic as the most common herb reported to be used by their patients 31

32 The most reported frequency of administration of these herbs was once daily with twenty-nine (29) participants confirmation. It is our estimation that the herbs taken once daily were done so to mimic the frequency of some conventional medicines also taken once daily. 32

33 Most of the participants (33 patients) reported that they mostly used the leaf of the herbs for administration and preparation in mostly tea form (40 patients). Note patients could choose more than one option 33

34 Majority of the patients either strongly agreed or agreed that their BP is better controlled with herbal medicines. Therefore, the perceived effectiveness of the herb correlates with a positive attitude toward the herb he/she is using. 34

35 the majority (69%) strongly agreed and agreed that they would willing recommend the use of herbal medicines to aid in the treatment of hypertension. Thus, it can be said that due to the willingness of participants to recommend herbal medicines to other individuals, they have a positive outlook and attitude towards the use of herbs to treat hypertension. 35

36 Lastly, to further confirm positive attitude towards the herbal medicines, majority of patients rated the herbs as very effective and effective in reducing their blood pressure. 36

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38 There was a general positive attitude as the overall majority of respondents used herbal substances along with their conventional medicines for the additive benefit to control their hypertension. 38

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40 We are grateful to them for facilitating us as this was a pertinent step in completion of this research. Co-ordinators and managers at the various sites where we administered the research questionnaires. we would like to thank all those who participated in our questionnaires. They were kind, patient and willing to complete the questionnaires. We could not complete this research without them. 40

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