INTRODUCTION

Throughout history, many different cultures have recognized the potential use of garlic for
prevention and treatment of different diseases. Recent studies have shown the effects of garlic and its
extracts in a wide range of applications. One of the currently studied effects of garlic is in the systolic
and diastolic blood pressure in patient with essential hypertension. Hypertension, or chronically elevated
blood pressure (BP) (systolic/diastolic BP [SBP/DBP] ≥140/90 mmHg at the brachial artery), is a
multifactorial condition implicated in the development and progression of cardiovascular disease.
Hypertension affects nearly 1 billion people globally and it is among the most important modifiable risk
factors for cardiovascular disease. This study aimed to evaluate the effects of garlic on blood pressure
with different doses and comparatively longer duration of 24 weeks in patients with stage 1 essential
hypertension.

METHODOLOGY

This study used a single-blind, placebo controlled study with a 24 week duration. This was
conducted in different primary health care centers in Karachi, Pakistan in cooperation with registered
medical practitioners. The study was performed involving patients of either sex, who are newly
diagnosed with stage 1 essential hypertension(systolic blood pressure between 140 to 159 mmHg and
diastolic blood pressure between 90 to 99 mmHg), and aged between 20-70 years. The patients were
forbidden to take any other drug throughout the study period. These patients were enrolled and divided
into 7 groups named as A,B,C,D,E,F, and G. Each group consisted of 30 patients. In group A,B,C,D, and
E, patients received garlic tablet at the dose of 300mg, 600mg, 900mg, 1200mg, and 1500mg in divided
dose per day for 24 weeks. Group F patients received Atenolol 100mg once daily for 24 weeks. Group G
patients were given placebo for the same duration.

At each visit, patients’ blood pressure readings were taken in a sitting position after providing 10
minutes rest. The study used a mercury sphygmomanometer with a cuff size of 14 x 54 cms. The study
utilized a Statistical Analysis by using one-way analysis of variance (ANOVA), followed by Tukey post-
hoc test. A statistical p value of less than 0.05 was considered significant.

RESULTS

The result in the study showed significant drop off in both Systolic Blood Pressure and Diastolic
Blood Pressure in both dose dependent and duration dependent manner when compared with placebo.
Significant fall in SBP was observed with garlic at all doses when compared with placebo at week 0,
week 12 and week 24. When compared statistically, on week 12 and 24 significant difference (P<0.005)
was seen between garlic at all doses and placebo treated groups. When different doses of garlic are
compared, significant difference was seen between different doses with greater and comparable
reduction in systolic blood pressure observed at higher doses of 900 mg, 1200/mg and 1500/mg. Highly
significant reduction in DBP was seen at higher doses of garlic as compared to lower doses, when
compared from week 0 to week 24. Garlic preparation used in our study was found to produce
significant and analogous reduction in both systolic and diastolic blood pressure when compared with
atenolol at week 12 and 24
 DISCUSSION

The study monitored the antihypertensive effects of garlic by determining its ability to produce a
decrease in systolic and diastolic blood pressure. This study also determined the time taken for the
reduction of blood pressure in comparison with placebo and one of the standard hypertensive agent,
‘Atenolol’ in patient with stage 1 essential hypertension. The reduction in systolic and diastolic was
found to be significantly higher when compared with placebo and analogous when compared with
Atenolol. While, greater reduction in blood pressure was observed to be associated with higher doses of
garlic and with increased duration of the therapy.

The antihypertensive effect of garlic was studied to be associated to its hydrogen sulphide
production and allicin content which is reported to have angiotensin II inhibiting and vasodilating
effects. The Hydrogen Sulfide dependent BP-reducing effect is thought to be primarily mediated through
sulfhydration of ATP-sensitive potassium (KATP) channels, which in turn leads to voltage- sensitive
channel opening and relaxation of vascular smooth muscle cells. Experiments with CSE knock-out
rodents have found reduced levels of hydrogen sulfide and hypertension. Also, spontaneously
hypertensive rats have reduced expression of cystathionine-γ-lyase in aortic tissues and lowered plasma
levels of hydrogen sulfide. In a series of elegant experiments, Benavides et al, showed that garlic-
derived polysulfides can produce hydrogen sulfide under physiologically relevant O2 conditions in rat
aortic tissue. They provided evidence for a mechanism involving reduced thiols. While it is unknown
which garlic bioactives can release hydrogen sulfide nonenzymatically, it has been hypothesized that
the major bioactive S-allylcysteine found in aged garlic extract may also act as a substrate for the
enzyme cystathionine-γ-lyase to produce hydrogen sulfide

REFERENCE

• Ashraf ,R., Khan, R.A., Ashraf,I., & Qureshi, A.A.(2013). Effects of Allium sativum (garlic) on
systolic and diastolic blood pressure in patients with essential hypertension. Pak J Pharm Sci, 26(5):
859–863.
• Benavides, G.A., Squadrito ,G.L., Mills ,R.W., et al. (2007). Hydrogen sulfide mediates the
vasoactivity of garlic. Proc Natl Acad Sci, 104(46):17977–17982.
• Zhang ,Y., Tang ,Z.H., Ren, Z., et al. (2013). Hydrogen sulfide, the next potent preventive and
therapeutic agent in aging and age-associated diseases. Mol Cell Biol, 33(6):1104–1113.