Clinical antihypertensive efficacy and safety of <i>Moringa oleifera</i> Lam. (Moringaceae) leaf: a systematic review

In low- and medium-income countries (LMICs) where access to medicines is challenging, hypertension prevalence is increasing, justifying the need to integrate traditional herbal medicines like Moringa oleifera into mainstream clinical practice. This review examines clinical studies in literature, starting from 2011, on the efficacy and safety of Moringa oleifera in hypertension treatment. Outcomes including effects on blood pressure, other cardiovascular risks, blood biochemistry, and adverse drug events were extracted from the articles. The quality of evidence was assessed with the risk of bias in non-randomised studies of interventions (ROBINS-1) tool. A total of 295 articles were identified, of which 16 were included for review. All but one were non-randomised studies. Regarding clinical efficacy, three articles, (n=131) showed that in normotensive patients, Moringa treatment has an acute BP-lowering effect butrepeated doses failed to demonstrate a BP-lowering effect (3 articles, n=82). In hypertensive populations (3 articles, n=112) Moringa supplementation had BP-lowering effects. In terms of clinical safety (2 articles, n=66) there are non-significant changes in blood biochemistry including alanine aminotransferase, creatinine and blood urea nitrogen in normotensive patients. Regarding treatment tolerability, there was no incidence of adverse events (2 articles, n=209) while others reported minor gastrointestinal upset and changes in appetite and sleep patterns (2 articles, n=103). Limited literature using non-randomised trial designs shows that Moringa oleifera leaf supplementation lowers blood pressure in persons with hypertension. Moringa oleifera leaf appears safe in normotensive patients.