Berberine for the treatment of hypertension: A systematic review

• Published in: Complementary therapies in clinical practice 2021-02, Vol.42, p.101287-101287, Article 101287
• Main Authors: Suadoni, Marco Tullio, Atherton, Iain
• Format: Article
• Language: English
• Subjects: Alternative medicine; Antihypertensive Agents - therapeutic use; Barberry; Berberine; Berberine - pharmacology; Berberine - therapeutic use; Berberis; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiovascular diseases; Critical incidents; Drug therapy; Herbal medicine; Humans; Hypertension; Hypertension - drug therapy; Intervention; Medical diagnosis; Medical screening; Meta-analysis; Metformin; Quality assessment; Risk factors; Software; Systematic review
• ISSN: 1744-3881; 1873-6947
• DOI: 10.1016/j.ctcp.2020.101287

Hypertension is the highest risk factor for disease globally. When prescription of drug therapy is recommended, patients might decline treatment due to hypertension asymptomatic nature, sometimes turning to alternative therapies. One popular therapy is berberine, a plant alkaloid that has been used in eastern medicine for millennia to treat several ailments, including cardiovascular diseases and their risk factors. Through a transparent and pragmatic approach towards searching, synthesising, assessing, and reporting the available clinical evidence, the present review aimed to investigate berberine effect on blood pressure and cardiovascular disease risk. It also intended to provide guidance for clinician when advising their patients, and to highlight gaps in the research along offering suggestions to fill them. The review was conducted following the protocol PRISMA-P, and reported according to the related PRISMA statement. The PICO framework was used to define the scope of the review, and to arrive at a database search strategy. The strategy was run on the databases Medline, CINAHL, AMED, Embase, and Cochrane Library through the platforms EBSCOhost and Ovid. Citations were exported to Mendeley citation manger for screening. Relevant studies were selected based on specified inclusion and exclusion criteria. Data from included studies was extracted in the form of a detailed table of characteristics of studies, and summarised in an evidence table. Quality of studies was assessed using the SIGN methodology checklist for controlled trials. The results from the quality assessment were summarised through an adaptation of the Robvis tool software package output. Effect estimates and their precision were calculated with RevMan 5 computer program from the extracted study outcomes. Five randomised controlled trials and two non-randomised controlled trials were included with 614 participants. All provided data on blood pressure, but none measured cardiovascular events or long-term adverse events. The group of studies was highly heterogeneous in terms of experimental intervention, comparator intervention, length to follow-up, participants’ diagnosis, and setting. The heterogeneity prevented a meaningful meta-analysis. Berberine plus amlodipine was not significantly better than amlodipine alone at reducing systolic and diastolic blood pressure. Compared to metformin, berberine provided a statistically significant moderate reduction effect on systolic blood pressure (−11