Hypertension is one of the most common chronic conditions in the world today, affecting up to 45% of adults, and 60% of persons over 60 years of age. Hypertension is primarily managed using conventional western medication, and the majority of the patients who have hypertension seek TCM treatment for other conditions. Hypertension is not mentioned in historical TCM literature, however, there are many references to the common presentations of hypertension, such as headache and dizziness, and in some cases where hypertension has progressed and caused systemic complications, there is mention of edema, angina, heart palpitations, and stroke. According to the published National herbal medicine assembly (全国中草药汇编), Astragalus membranaceous is able to strengthen contractions of the heart muscle in individuals with heart failure which then increase blood flow from the heart and raises blood pressure; it is also able to dilate blood vessels, improve peripheral circulation, which reduces the blood pressure in hypertensive individuals.

Various research has revealed Astragaloside IV (黄芪皂苷Ⅳ /黄芪甲苷) to be the main active ingredient in improving cardiac function and possibly increasing blood pressure. The mechanism of action is yet to be fully understood, but research has shown Astragaloside IV is able to inhibit the activity of myocardial sodium-potassium-ATPase, improve myocardial energy metabolism, as well as promote recovery in Ca2+-pump function of the sarcoplasmic reticulum (SR)12. The Anti-hypertensive effects of Astragalus membranaceous is more widely researched, with animal studies indicating that it is able to inhibit ACE activities in a dose-dependent manner via an ACE inhibitory phytopeptide, and so reduce systolic blood pressure. As such there is legitimate basis to be concerned about blood pressure fluctuations in hypertensive patients taking Astragalus membranaceous, would the effects of Astragalus membranaceous nullify the effect of existing hypotensive medication? or would it further increase the hypotensive effect of existing medication?

We examined a few clinical trials involving various conditions where Astragalus membranaceous was used in the treatment of patients who have hypertension. The trials were conducted in China where Chinese Medicine is used alongside Western Medication as part of standard healthcare and among papers that published a record of observed adverse events, there was no mention of patients’ blood pressure going beyond the normal range. In all cases, Astragalus membranaceous was used as part of a formula with multiple herbs to treat the target condition (in some cases, the papers specifically looked at hypertension) and never used alone as a single herb. Based on existing research, we are unable to confirm how the interaction of other herbs with Astragalus membranaceous impacts blood pressure. Available evidence does suggest that the usage of Astragalus membranaceous as part of a herbal formula doesn’t negatively affect patients’ hypertension, however, this is while keeping to the recommended dosage recommended in most Chinese Medicine Directories.

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