Prevalence and Determinants of Complementary and Alternative Medicine Use in Subjects with Hypertension in a Tertiary Centre in South East Nigeria
Published: 2024-03-30
Page: 183-193
Issue: 2024 - Volume 7 [Issue 1]
Michael Chinweuba Abonyi *
Department of Internal Medicine, College of Medicine, Enugu State University, Enugu, Nigeria.
Theophilus Ejiofor Ugwu
Department of Internal Medicine, College of Medicine, Enugu State University, Enugu, Nigeria.
Chidiebele Malachy Ezeude
Department of Internal Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi, Nigeria.
Valentine Chidiebere Ugwueze
Endocrine, Diabetes and Metabolism Unit, Department of Internal Medicine, Alex Ekwueme Federal University, Abakaliki, Ebonyi State, Nigeria.
Ngozi Ijeoma Okoro
Department of Chemical Pathology (Endocrinology), College of Medicine Enugu State University, Enugu, Nigeria.
Christian Chukwuemeka Eze
Department of Ophthalmology, College of Medicine, Enugu State University, Enugu, Nigeria.
Uzoma Chukwunonso Okechukwu
Department of Internal Medicine, College of Medicine, Enugu State University, Enugu, Nigeria.
Fintan Chinweike Ekochin
Department of Internal Medicine, College of Medicine, Enugu State University, Enugu, Nigeria.
Gesiye Esimamidida Bozimo
Department of Internal Medicine, Federal Medical Centre, Yenagoa, Nigeria.
Kariba Akhidue
Department of Internal Medicine, University of Port Harcourt Teaching Hospital Port Harcourt, Nigeria.
Chidinma Brenda Nwatu
Department of Internal Medicine, University of Nigeria, Nsukka, Nigeria.
Ekenechukwu Esther Young
Department of Internal Medicine, University of Nigeria, Nsukka, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Objective: To study the prevalence and determinants of the use of complementary and alternative medicine (CAM) in patients with hypertension (HTN).
Methods: Two hundred and fifty patients visiting the medical outpatient Clinic at Enugu State University Teaching Hospital in Southeast Nigeria were interviewed. Information was obtained on the patients' demographics, type(s), duration, pattern and disclosure of CAM use, sources of recommendation and reasons for using CAM.
Results: The prevalence of CAM use was 4.4%. The most commonly used CAM was biologic-based therapy; bitter leaf (Vernonia amigdalina) (90.9%), Ginger (90.9%), garlic (72.7%), Cinnamon (45.5%), bitter kola (Garcinia kola) (36.4%), lemon grass (9.1%), green tea (9.1%), guava (9.1%) and mango leaves (9.1%). This was followed by manipulative and body-based (exercise and relaxation), and then spiritual method (fasting and prayer). Most subjects used CAM concurrently with orthodox medicine (63.6%), and neither knew the constituent of what they were taking (72.7%) nor revealed to their healthcare provider (HCP) that they were on CAM (81.8%). The most common reason for the non-disclosure is that the HCP will discourage them (66.7%). Most subjects used CAM to manage hypertension (54.5%).
Conclusion: A proportion of patients receiving orthodox medication for HTN also use CAM. A better treatment outcome would emanate from education of HCP and the general public on CAM use, legislation on the control of unwholesome and harmful use of CAM, and well-funded research on proven and potential CAM modalities for the benefit of humanity.
Keywords: Hypertension, complementary and alternative medicine, prevalence
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Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223-237. DOI: 10.1038/s41581-019-0244-2
Lenfant C, Chobanian AV, Jones DW, Roccella EJ. Joint National Committee on the prevention, detection, evaluation, and treatment of high blood pressure. seventh report of the joint national committee on the prevention, detection, evaluation, and treatment of high blood pressure (JNC 7): resetting the hypertension sails. Hypertension. 2003;41(6):1178-9. DOI: 10.1161/01.HYP.0000075790.3389 AE. Epub 2003 May 19. PMID: 12756222.
Iqbal AM, Jamal SF. Essential Hypertension. 2023 Jul 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 30969681
Tedla YG, Bautista LE. Drug side effect symptoms and adherence to antihypertensive medication. Am J Hypertens. 2016;29(6):772-9. DOI: 10.1093/ajh/hpv18 Epub 2015 Dec 7. PMID: 26643686; PMCID: PMC5863783.
Kretchy IA, Owusu-Daaku FT, Danquah SA, Asampong E. A psychosocial perspective of medication side effects, experiences, coping approaches and implications for adherence in hypertension management. Clin Hypertens. 2015;21:19 DOI: 10.1186/s40885-015-0028- PMID: 26893929; PMCID: PMC4750803.
Hamrahian SM, Maarouf OH, Fülöp T. A critical review of medication adherence in hypertension: Barriers and facilitators clinicians should consider. Patient Prefer Adherence. 2022;16:2749-2757.
DOI: 10.2147/PPA.S36878 PMID: 36237983; PMCID: PMC9552797.
Cohen JS. Adverse drug effects, compliance, and initial doses of antihypertensive drugs recommended by the Joint National Committee vs the Physicians' Desk Reference. Arch Intern Med. 2001;161(6):880–885 DOI: 10.1001/archinte.161.6.880
Tangkiatkumjai M, Boardman H, Walker DM. Potential factors that influence usage of complementary and alternative medicine worldwide: A systematic review. BMC Complement Med Ther. 2020;20:363 Available:https://doi.org/10.1186/s12906-020-03157-2
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993;328(4):246-52 DOI: 10.1056/NEJM19930128328040 PMID: 8418405.
Hughes EF, Jacobs BP, Berman BM: Complementary and alternative medicine. Current Medical Diagnosis and Treatment. Edited by: Tierney LM, McPhee SJ, Papadakis MA. 2005, New York, McGraw-Hill, 1696-1719.
Ezeome ER, Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complementary and Alternative Medicine. 2007;7(1):1-8.
Okoronkwo I, Onyia-pat J, Okpala P, Agbo M, Ndu A. Patterns of complementary and alternative medicine use, perceived benefits, and adverse effects among adult users in Enugu Urban, Southeast Nigeria. Evidence-Based Complementary and Alternative Medicine. 2014;6:Article ID 239372.
DOI: 10.1155/2014/239372
Abonyi MC, Ezeude CM, Ugwueze VC, Nwatu CB, Nkpozi MO, Young EE. Prevalence and determinants of complementary and alternative medicine (cam) use among subjects with Diabetes Mellitus (DM) in a Tertiary Institution in South East Nigeria. JDDT. 2024;13(12): 15-1.
Osamor PE, Owumi BE Complementary and alternative medicine in the management of hypertension in an urban Nigerian community. BMC Complement Altern Med 2010;10:36.
DOI: 10.1186/1472-6882-10-36
Liwa AC, Smart LR, Frumkin A, Epstein HA, Fitzgerald DW, Peck RN. Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: A systematic review. Curr Hypertens Rep. 2014;16(6):437. DOI: 10.1007/s11906-014-0437-9 PMID: 24764197; PMCID: PMC4076776.
Thompson AE, Anisimowicz Y, Miedema B, Hogg W, Wodchis WP, Aubrey-Bassler K. The influence of gender and other patient characteristics on health care-seeking behaviour: A QUALICOPC study. BMC Fam Pract. 2016;17:38 DOI: 10.1186/s12875-016-0440-0
Oke DA, Bandele EO. Misconceptions of hypertension. J Natl Med Assoc. 2004; 96(9):1221-4. PMID: 15481752; PMCID: PMC2568468.
Olisa NS, Oyelola FT. Evaluation of use of herbal medicines among ambulatory hypertensive patients attending a secondary health care facility in Nigeria. Int J Pharm Pract. 2009;17(2):101-5.
PMID: 20214258.
Amira OC, Okubadejo NU. Frequency of complementary and alternative medicine utilization in hypertensive patients attending an urban tertiary care centre in Nigeria. BMC Complement Altern Med. 2007;7:30 DOI: 10.1186/1472-6882-7-3 PMID: 17903257; PMCID: PMC2045097
Kretchy IA, Owusu-Daaku F, Danquah S. Patterns and determinants of the use of complementary and alternative medicine: A cross-sectional study of hypertensive patients in Ghana. BMC Complementary an Alternative Medicine. 2014;14 DOI: 10.1186/1472-6882-14-44
Hughes GD, Aboyade OM, Clark BL, Puoane TR. The prevalence of traditional herbal medicine use among hypertensives living in South African communities. BMC Complementary and Alternative Medicine. 2013;13 DOI: 10.1186/1472-6882-13-38
Eddouks M, Maghrani M, Lemhadri A, Ouahidi ML, Jouad H. Ethno-pharmacological survey of medicinal plants used for the treatment of diabetes mellitus, hypertension and cardiac diseases in the south-east region of Morocco. Journal of Ethnopharmacology. 2002;82(2-3):97–103.
DOI: 10.1016/s0378-8741(02)00164-2
Kifle ZD, Yimenu DK, Kidanu BB. Complementary and alternative medicine use and its associated factors among hypertensive patients in Debre Tabor General Hospital, Ethiopia. Metabol Open. 2021;12:100132. DOI: 10.1016/j.metop.2021.100132 PMID: 34632358; PMCID: PMC8493576.
Peninah Jelagat K. Prevalence and factors associated with complementary and alternative medicine use among patients with hypertension in Turbo, Kenya. Moi University Open Access Repository; 2019 Available:http://ir.mu.ac.ke:8080/jspui/handle/123456789/2740
Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA. 1998;280(18): 1569-75. DOI: 10.1001/jama.280.18.1569 PMID: 9820257
MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of alternative medicine in Australia. The Lancet. 1996; 347(9001):569–573.
DOI: 10.1016/s0140-6736(96)91271-4
Ali-Shtayeh MS, Jamous RM, Jamous RM, Salameh NMY. Complementary and Alternative Medicine (CAM) use among hypertensive patients in Palestine. Complementary Therapies in Clinical Practice. 2013;19(4): 256–263 DOI: 10.1016/j.ctcp.2013.09.001
Nailwal D, B VR, Gupta A. Patterns and predictors of complementary and alternative medicine use in people presenting with the non-communicable disease in an urban health facility, North India. J Public Health Res. 2021;10:2109
Marstedt G, Moebus S. Inanspruchnahme alternativer Methoden in der medizin. Gesundheitsberichterstattung des Bundes. Berlin: Robert Koch Institut. 2002;7.
Klein SD, Torchetti L, Frei-Erb M, Wolf U. Usage of complementary medicine in Switzerland: Results of the Swiss Health Survey 2012 and Development Since 2007. PLoS One. 2015;10(10):e0141985.
DOI: 10.1371/journal.pone.0141985
Erratum in: PLoS One. 2015;10(12): e0144676. PMID: 26513370; PMCID: PMC4626041.
Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: A systematic review and metaanalysis. Integr Cancer Ther. 2012;11(3):187-203. DOI: 10.1177/1534735411423920 Epub 2011 Oct 21. PMID: 22019489.
Foley H, Steel A, Cramer H. Wardle J, Adam J. Disclosure of complementary medicine use to medical providers: A systematic review and meta-analysis. Sci Rep. 2019;9:1573 Available:https://doi.org/10.1038/s41598-018-38279-8
Edo GI, Samuel PO, Jikah AN, Onoharigho FO, Idu LI, Obasohan P, et al. Biological and bioactive components of bitter leaf (Vernonia amygdalina leaf): Insight on health and nutritional benefits. A review, Food Chemistry Advances. 2023;3: 100488. ISSN 2772-753 DOI: 10.1016/j.focha.2023.100488
Shirzad F, Morovatdar N, Rezaee R, Tsarouhas K, Abdollahi Moghadam A. Cinnamon effects on blood pressure and metabolic profile: A double-blind, randomized, placebo-controlled trial in patients with stage 1 hypertension. Avicenna J Phytomed. 2021;11(1):91-100. PMID: 33628723; PMCID: PMC7885002.
Ried K. Garlic lowers blood pressure in hypertensive subjects, improves arterial stiffness and gut microbiota: A review and meta-analysis. Exp Ther Med. 2020;19(2): 1472-1478.
DOI: 10.3892/etm.2019.8374 Epub 2019 Dec 27. PMID: 32010325; PMCID: PMC6966103
Hasani H, Arab A, Hadi A, Pourmasoumi M, Ghavami A, Miraghajani M. Does ginger supplementation lower blood pressure? A systematic review and meta-analysis of clinical trials. Phytother Res. 2019;33(6): 1639-1647. DOI: 10.1002/ptr.6362. Epub 2019 Apr 11. PMID: 30972845.
Chitra Devi R, Sim SM, Ismail R. Effect of Cymbopogon citratus and Citral on Vascular Smooth Muscle of the Isolated Thoracic Rat Aorta. Evid Based Complement Alternat Med. 2012;2012: 539475.
DOI: 10.1155/2012/539475
Peng X, Zhou R, Wang B, Yu X, Yang X, Liu K. et al. Effect of green tea consumption on blood pressure: a meta-analysis of 13 randomized controlled trials. Sci Rep. 2014; 4: 6251. DOI: 10.1038/srep06251
Braga DC, Gomes PM, Carlos Batista MA, Souza JA, Almeida Bastos JC, Rodrigues-das-Dôres RG et al Effects of Psidium guajava L. leaves extract on blood pressure control and IL-10 production in salt-dependent hypertensive rats, Biomedicine & Pharmacotherapy, Volume 155, 2022, 113796, ISSN 075 3322, https://doi.org/10.1016/j.biopha.2022.113796.
Silva H, Bárbara R. Exploring the Anti-Hypertensive Potential of Lemongrass-A Comprehensive Review. Biology (Basel). 2022; 11(10): 1382. doi: 10.3390/biology11101382. PMID: 36290288; PMCID: PMC9598547
Kamyab R, Namdar H, Torbati M, Ghojazadeh M, Araj-Khodaei M, Fazljou SMB. Medicinal Plants in the Treatment of Hypertension: A Review. Adv Pharm Bull. 2021; 11(4): 601-617. doi: 10.34172/apb.2021.090. Epub 2020 Nov 1. PMID: 34888207; PMCID: PMC8642800
Li S, Odedina S, Agwai I, Ojengbede O, Huo D, Olopade OI. Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. BMC Complement Med Ther. 2020; 20(1): 93.
Santaella DF, Araújo EA, Ortega KC, Tinucci T, Mion D Jr, Negrão CE, de Moraes Forjaz CL. Aftereffects of exercise and relaxation on blood pressure. Clin J Sport Med. 2006; 16(4): 341-7. doi: 10.1097/00042752-200607000-00010. PMID: 16858219.
Pescatello LS, Franklin BA, Fagard R, Farquhar WB, Kelley GA, Ray CA; American College of Sports Medicine. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc. 2004;36(3):533-53. DOI:10.1249/01.mss.0000115224.88514.3 PMID: 15076798.
Asfaw Erku D, Basazn Mekuria A. Prevalence and correlates of complementary and alternative medicine use among hypertensive patients in Gondar Town, Ethiopia. Evid Based Complement Alternat Med. 2016;2016: 6987636. DOI: 10.1155/2016/6987636 Epub 2016 Oct 23. PMID: 27843480; PMCID: PMC5097805.
Robles B, Upchurch DM, Kuo T. Comparing complementary and alternative medicine use with or without including prayer as a modality in a local and diverse united states jurisdiction. Front Public Health. 2017;5:56. DOI: 10.3389/fpubh.2017.00056 PMID: 28377918; PMCID: PMC5359242
Stoewen DL. Dimensions of wellness: Change your habits, change your life. Can Vet J. 2017;58(8):861-862. PMID: 28761196; PMCID: PMC5508938.
Singh V, Raidoo DM, Harries CS. The prevalence, patterns of usage and people's attitude towards Complementary and Alternative Medicine (CAM) among the Indian community in Chatsworth, South Africa. BMC Complement Altern Med. 2004;4:3. DOI: 10.1186/1472-6882-4-3 PMID: 15018622; PMCID: PMC356921
Goldstein MS, Brown ER, Ballard-Barbash R, Morgenstern H, Bastani R, Lee J, Gatto N, Ambs A. The use of complementary and alternative medicine among California adults with and without cancer. Evid Based Complement Alternat Med. 2005;2(4):557-65. DOI: 10.1093/ecam/neh138 Epub 2005 Oct 25. PMID: 16322814; PMCID: PMC1297511.
Abonyi MC, Ezeude CM, Ugwueze VC, Nwatu CB, Nkpozi MO, Young EE. Prevalence and Determinants of Complementary and Alternative Medicine (CAM) use among subjects with Diabetes Mellitus (DM) in a Tertiary Institution in South East Nigeria. Journal of Drug Delivery and Therapeutics. 2023;13(12): 15-21.