Effect of Red Ginseng on Blood Pressure in Patients with Essential Hypertension and White Coat Hypertension Assessed by Twenty-Four-Hour Ambulatory Blood Pressure Monitoring

24시간 혈압변동양상에 대한 고려홍삼의 효과

Background : Hypertension is one of the leading causes of death in elderly and one of major risk factors of both coronary artery disease and ischemic cerebrovascular disease. Therefore, effective control of hypertension without any complications from antihypertensive drug itself is crucial. Red ginseng has been used as an antihypertensive agent in Korea, but its antihypertensive effect is not clear in spite of several in vivo and in vitro experimental studies. The objective of this study is to evaluate 1) the antihypertensive effect of red ginseng in patients with essential hypertension, 2) the change in diurnal blood pressure pattern with red ginseng medication and 3) any possible side effects of red ginseng during the study. Method : To all patients with mild to moderate essential hypertension, every antihypertensive medication was discontinued for at least four weeks. After drug-free interval, the office-based blood pressure levels were checked and if the diastolic blood pressure(DBP) level was between 90 mmHg and 110 mmHg, 'basal' 24 hour ambulatory blood pressure monitoring(ABPM) was done. By that result mild-to-moderate essential hypertension (24 hour mean DBP > 90 mmHg . group B1, n=12) or white coat hypertension (24 hour mean DBP < 90 mmHg ; group A, n=8) could be diagnosed and included in this study. If the DBP level was above 110 mmHg after drug free interval, either beta blocker (atenolol 50 mg q.d.) or calcium channel blocker (nicardipine 40 mg b.i.d.) was given for. four weeks and office-based blood pressure levels were checked again. Only subjects whose DBP level were between 90 mmHg to 110 mmHg included this study and the 'basal' 24 hour ABPM was done. for those who were medicated with beta blocker, they were grouped as B2 (n=8) and if with calcium channel blocker, they were pooped as B3 (n=6). B1, B2 and B3 groups were taken together as 'hypertensive group' (group B, n=26). After 'basal' 24 hour ABPM, all subjects were given placebo for four weeks and then second 24 hour ABPM was done ('placebo'). Red ginseng was medicated to all subjects for. eight weeks and then final 24 hour ABPM ('medication') was done. The dose of red ginseng was 4.5 grams per day (1.5 gram t.i.d., $8{\sim}9pm$ am, $1{\sim}2$pm, $6{\sim}7$pm respectively). Results : 1) 24 hour mean systolic blood pressure(SBP) level had reduced significantly ( p=0.03 ) in hypertensive group ( group B : 149.3 / 12.1 vs. 143.6 / 10.3 mmHg ) and also in group Bl, B2 and B3. The degree of SBP reduction was about 5%. 2) 24 hour mean DBP level tended to reduce in hypertensive group (group B ; ,91.3 / 6.8 vs. 87.8 / 5.7 mmHg, p=0.173). 3) 24 hour mod heart rate had reduced significantly (p=0.048) in all study subjects (67.1 / 7.4 vs. 62.9 / 8.4 / min). But that finding was not found in white coat hypertension or hypertensive group. 4) Either significant BP reduction or heart rate change were not observed in white coat hypertension group (group A). 5) Both systolic and diastolic pressure load tended to be reduced in hypertensive group and in group B1, B2 and B3. 6) Systolic and diastolic BP reduction mostly occured at daytime ($8\;am{\sim}6\;pm$) and at dawn ($5\;am{\sim}7\;pm$) whereas little changes at night time $(6\;am{\sim}4\;pm)$). 7) Two subjects stopped the study due to abdominal discomfort and constipation during the study period. The other possible side effects of red ginseng were sweating(n=3), somnolence(n=4), or excessive appetite(n=2). Conclusion : Red ginseng might be useful as a relatively safe adjuvant to any antihyper-tensives though exact mechanisms of red ginseng upon the blood pressure is not clear. Further studies should be made to evaluate the long-term effect of red ginseng treatment and to elucidate pharmacophysiologic mechanisms .