Roselle (Hibiscus sabdariffa L.) extract as an adjunct to valsartan in patients with mild chronic kidney disease: A double-blind randomized controlled clinical trial

Abstract

Objective: The objective of this study was to evaluate theeffectiveness of Hibiscus sabdariffa L. extract (HS) as an adjunctto valsartan in the treatment of high blood pressure in patients withmild chronic kidney disease (CKD).Materials and Methods: This trial was conducted in Gorgan,Iran. Seventy-two participants with CKD and high blood pressurewere randomly assigned to either the HS group, receiving a 350mg pill every 12 hr for 90 days along with 40 mg of valsartanevery 12 hr, or the control group (40 mg valsartan + 12.5 mghydrochlorothiazide). The primary objective was to assess theimprovement of hypertension, while secondary objectives includedthe evaluation of proteinuria, albuminuria, kidney function, lipidprofile, and electrolyte levels. Molecular docking analysis wasperformed to examine the mechanisms of action of the isolatedcomponents of HS.Results: Out of 80 initial participants, 72 were included in theanalysis. Both groups showed a significant reduction in bloodpressure (p<0.001). The HS group demonstrated a statisticallysignificant decrease in lipid profile (p<0.001). There were nostatistically significant differences between the groups regardingthe reduction of renal markers. Molecular docking analysisrevealed that the compounds present in HS, particularly itsanthocyanins and flavonoids, exhibited greater angiotensinconverting enzyme (ACE) inhibitory potential thanhydrochlorothiazide in both domains. Moreover, the compoundsmet the criteria for drug likeness and Lipinski rules.Conclusion: Adjunctive therapy with HS showed promisingresults in reducing hypertension and improving lipid profile inpatients with CKD.

Keywords

• chronic kidney disease
• hypertenstion
• valsartan
• hibiscus sabdariffa
• antocyanidin
• hydrochlorothiazide
• lipid profile
• molecular docking