**2. Background on Suriname**

present when these values are persistently above 140 and 90 mm Hg, respectively [1]. This condition initially does not cause symptoms [1]. However, in the long-term, it is one of the most important predisposing factors for potentially fatal coronary artery disease, heart fail-

Hypertension is classified as primary (or essential) hypertension and secondary hypertension [2]. Primary hypertension accounts for 90–95% of cases, typically begins in the fifth or sixth decade of life, and is associated with nonspecific lifestyle factors such as excess salt intake, obesity and a sedentary lifestyle, cigarette smoking, high alcohol intake, stress, and a family history suggesting the involvement of genetic factors in its etiology [3]. In the remaining 5–10% of cases categorized as secondary hypertension, the elevated blood pressure has an identifiable cause such as renal artery stenosis, chronic kidney disease, sleep apnoea, hyper-

In both situations, the elevated blood pressure is caused by an increase in the total peripheral resistance, that is, the total resistance to the flow of blood in the systemic circulation. The increased peripheral resistance is most often attributable to abnormalities in the sympathetic nervous system [4] and the renin-angiotensin-aldosterone system [5]. In the former case, the

adrenoreceptors, contraction of arterial smooth muscles, constriction of the arterioles, and an increased peripheral resistance [4]. In the latter case, excess secretion of renin by juxtaglomer-

merular underperfusion, leads to the reabsorption of salt and water and the release of renin, enlarging vascular volume and further increasing peripheral resistance [5]. Impairments in the functioning of vasorelaxing factors such as nitric oxide due to endothelial dysfunction as well as that of vasoactive substances such as endothelin, bradykinin, and atrial natriuretic

Lifestyle modifications such as dietary changes can lower blood pressure and decrease the risk of health complications. Examples of such alterations are diets low in sodium, high in potassium, rich in vegetables, fruits, and low-fat dairy products (the so-called Dietary Approaches to Stop Hypertension (DASH) diet, as well as vegetarian diets [7]. Lifestyle modifications other than dietary changes shown to reduce hypertension are increased physical exercise, weight loss, and stress reduction [8]. The potential effectiveness of these modifications is similar to, and may even exceed the effects of a single medication [9]. Notably, several randomized controlled trials have demonstrated that even a slight blood pressure decrease of 10 mm Hg reduces the risk of death due to cardiovascular disease by 25% and the risk of stroke-

If lifestyle changes are not sufficient to reduce the elevated blood pressure, antihypertensive medications are prescribed. Still, lifestyle changes are recommended in conjunction with medication [6, 11]. Among the commonly used antihypertensives are thiazide-diuretics such as chlorthalidone and hydrochlorothiazide, calcium channel blockers such as nifedipine and amlodipine, β-blockers such as atenolol and metoprolol, angiotensin-converting enzyme (ACE) inhibitors such as captopril and enalapril, and angiotensin receptor blockers such as losartan and candesartan [6, 11]. These medications may be used either alone or at certain



ure, stroke, peripheral vascular disease, vision loss, and chronic kidney disease [1].

thyroidism, pheochromocytoma, the use of oral contraceptives, or pregnancy [2].

excessive release of adrenaline and noradrenaline leads to overstimulation of β1

peptide may further contribute to and/or maintain the hypertension [6].

ular cells following stimulation of β1

152 Herbal Medicine

related mortality by 40% [10].
