Complementary Alternative Cardiovascular Medicine

Chapter 3 / Botanical Medicine and CVD 41
ity of the root was noted as early as 1918. The isolated alkaloid, reserpine,
revolutionized the management of hypertension in Western medicine
in the 1950s. Reserpine depletes adrenergic neurons of
norepinephrine, resulting in decreased sympathetic tone and vasodilation.
These effects occur in the central nervous system (CNS), peripheral
nervous system, and adrenal glands. Rauwolfia’s depletion of
selected neurotransmitters in the CNS likely explain its traditional use
in the treatment of certain psychiatric illnesses.
The antihypertensive effects of reserpine may take up to 2 wk to be
observed. Smaller doses of reserpine should be used if a diuretic is
concomitantly prescribed. In comparative studies, low doses of reserpine
(0.25 mg/d) given concurrently with thiazide were as effective as
sustained-release nifedipine (20 mg/d) in a study of black African patients
who were with diagnosed hypertension (84). Other studies comparing
low-dose reserpine (0.1 mg/d) plus a diuretic show that this combination
is as effective as calcium channel blockers (85). A study in Germany
found that low-dose reserpine (0.1 mg/d) given concurrently with
clopamide (5 mg/d) was significantly more effective in reducing blood
pressure than enalapril (5 mg/d). After 3 wk of treatment, mean systolic
and diastolic blood pressure reduction from baseline (24 h after last
medication intake) in the reserpine/diuretic group was –19.6/–17.0
mmHg and –6.1/–9.5 mmHg for the enalapril group (between-group
comparison: p < 0.01 for both parameters). The normalization rates for
diastolic blood pressure (