19

Size: px

Start display at page:

Download "19"

원상 피
5 years ago
Views:

1 26 3 ( ) J Korean Oriental Med 2005;26(3): The Effect of Korean, Chinese and American Ginseng on Blood Pressure of Hypertensive Patients Cha-ro Lee, Sang-Ho Lee 1), Jun-Woo Rhee, Byong-Jo Na, Tae-Hun Kim, Woo-sang Jung, Sang-Kwan Moon, Ki-Ho Cho, Hyung-Sup Bae, Young-Suk Kim Department of Cardiovascular and Neurologic Disease(Stroke Center) College of Oriental Medicine, Kyunghee University, Seoul, Korea Department of Internal Medicine of Bupyeong Serim Oriental Hospital, Korea 1) Objectives : We conducted a randomized, double-blinded clinical trial to assess the anti-hypertensive effect of Ginseng and to know the difference of the effect according to it Øs growing districts and species by 24-hour ambulatory blood pressure measurement (ABPM). Methods : We allocated 96 hypertensive patients enrolled in this trial to Korean ginseng (KG), American ginseng (AG), Chinese ginseng (CG), and Korean red ginseng (KRG) groups by randomization. Each subject was administered 4.5mg/day of encapsulated ginseng for 4 weeks. We assessed anti-hypertensive effect, blood pressure variability using ABPM and toxicity by blood chemistry before and after treatment. We also evaluated changes of symptoms due to hypertension and adverse effect in all groups at the first visit, 2 weeks later and 4 weeks later. Results : Blood pressure after treatments showed significant decrease of systolic blood pressure (sbp) in the CG-group (p<0.05) and diastolic blood pressure (dbp) in the KRG-group (p<0.05). However, there were no significant changes of sbp (or dbp) after treatment in the other groups and no significant difference in changes of BP between before and after treatment among the 4 groups. Blood pressure variability in the CG-group showed significant decrease after treatment but not in the KRG-group. Symptoms such as headache or neck stiffness and heating sensation due to hypertension improved significantly in all groups, especially in the KRG-group. All patients had no adverse effect after treatment and there was no liver or kidney toxicity. Conclusions : CG and KRG seem to have anti-hypertensive effects, but there was no significantly different effect depending on growing district and species of Ginseng. Key Words: Blood pressure, ginseng, ambulatory blood pressure measurement, blood pressure variability, average real variability. : : : :. (Tel : , Fax : , withiscar@korea.com) 2000,,,,,,. 228

2 (687) 1),,, 2). 3) 4). short term anti-hypertensive effect 5),, 6).,, 4. 1) , JNC (Joint National Comitee On Prevention, Detection, Evaluation and Treatment of High Blood Pressure) 7) (prehypertension) 1 (Stage 1 hypertension),. 24 (,,, X, ), -HCG,. ( >1.5mg/dl, AST, ALT ) 2 3 (,, ) 2). 20% (2 3 ) 3) /80-99mmHg /90-99mmHg,,,., Panax Ginseng C.A. Meyer (American Ginseng) Panax quinquefolius., (Table 1). 1.0mm K-11-1(Japan) 229

3 (688) 26 3 ( ) 375mg., 4 1 4, 4., 2. 1),, (100 ), 8. 2) (TM-2421 made in A&D company, Japan) Oscillometric method, 10 10, :. 24 : Blood Pressure Variability(BPV), Average Real Variability(ARV). Visual Analogue Scale(VAS).,, 3., 2, 4. 3) :,,. : >240mmHg or <50mmHg, >140mmHg or <40mmHg, >100mHg or <20mmHg, >125 or <45 8), 3 data VAS, paired t-test, Wilcoxon signed rank test, one-way ANOVA test, Kruskall-Wallis test, Chi-square test. SPSS 12.0, p<0.05. ( ) , ,

4 (689) Table 1. Remaining Agricultural Chemicals from Chinese Ginseng, American Ginseng, Korean Ginseng and Korean Red Ginseng Used in this Study. Agricultural Permitted Limit Chemicals Name (ppm) KG AG CG KRG BHC 0.2 ND. ND ND. DDT 0.1 ND. ND. ND. ND. Aldrin/Diedrin 0.01 ND. ND. ND. ND. Endrin 0.01 ND. ND. ND. ND. Quintozene Endosulfan ND. ND Captan 2.0 ND. ND. ND. ND. Parathion 0.1 ND. ND. ND. ND. Diazinon 0.1 ND. ND. ND. ND. Metalaxyl Carbendazim Deltamethrin 0.02 ND. ND. ND. ND. Diethofencarb 0.5 ND. ND. ND. ND. Cypermethrin 0.1 ND. ND. ND. ND. Azoxystrobin 0.5 ND. ND. ND. ND. TolyFluanid 0.3 ND. ND. ND. ND. Tolclofosmethyl ND Difenoconazole 0.2 ND. ND. ND. ND. Procymidone ND. ND Limits are based upon standard of dry ginseng KG indicates Korean Ginseng; AG, American Ginseng; CG, Chinese Ginseng; KRG, Korean Red Ginseng; BHC, Benzene hexachloride; DDT, Dichloro-diphenyl-trichloroethane; ND. No detected. Table 2. Baseline Characteristics in Chinese Ginseng, American Ginseng, Korean Ginseng and Korean Red Ginseng Group. Korean American Chinese Korean Red Ginseng Ginseng Ginseng Ginseng Sig. (n=22) (n=25) (n=24) (n=25) Age (yr) NS.* Sex (M/F) 11/11 13/12 12/12 13/12 NS. sbp(mmhg) NS.* dbp(mmhg) NS.* Medical history HTN medication NS. Diabetes NS. Hyperlipidemia NS. * by One-way ANOVA test by Chisquare test Sig. indicates Significance; NS., non-significant; HTN, Hypertension; sbp, systolic blood pressure; dbp, diastolic blood pressure..,, lipid profile. (Table 2). 1) 231

5 (690) 26 3 ( ) Table 3. Changes of Blood Pressure from Baseline in Korean Ginseng, American Ginseng, Chinese Ginseng and Korean Red Ginseng Group. Korean American Chinese Korean Red Ginseng Ginseng Ginseng Ginseng Sig.* (n=22) (n=25) (n=24) (n=25) sbp, mmhg Baseline After 4 weeks Change NS. Sig. NS. NS..023 NS. dbp, mmhg Baseline After 4 weeks Change NS. Sig. NS. NS. NS..019 Values are mean standard deviation * by One-way ANOVA test by Paired T-test Sig. indicates Significance; NS., non-significant; sbp, Systolic blood pressure; dbp, Diastolic blood pressure. Table 4. Changes of Blood Pressure Variability in Korean Red Ginseng and Chinese Ginseng Group. sbp dbp Baseline After Mx. Sig.* Baseline After Mx. Sig.* KRG(n=25) BPV NS NS. ARV NS NS. CG(n=24) BPV NS ARV NS <.001 Values are mean standard deviation * by Paired T-test sbp indicates Systolic blood pressure; dbp, Diastolic blood pressure; Mx, Medication; Sig., Significance; NS., non-significant; KRG, Korean Red Ginseng; CG, Chinese Ginseng; BPV, Blood Pressure Variability; ARV, Average Real Variability. Table 5. Changes of Symptoms (Visual Analogue Sclae) Due to High Blood Pressure in All Subjects. Baseline After Mx. Sig. Headache or Heating (n=33) <0.001* Headache (n=23) <0.001* Heating (n=7) Values are mean standard deviation * by Paired T-test by Wilcoxon signed rank test Mx. indicates Medication; Sig., Significance.,,., 4 (Table 3). 2) 24 BPV 232

6 (691) Table 6. Changes of Symptoms(Visual Analogue Scale) Due to High Blood Pressure in Korean Red Ginseng Group Only. Baseline After Mx. Sig.* Headache or Heating (n=12) Headache (n=7) Heating (n=4) NS. Values are mean standard deviation * by Wilcoxon signed rank test Mx. indicates Medication; Sig., Significance; NS., non-significant. Table 7. Changes of Aspartate aminotransferase(ast), Alanine aminotransferase(alt), Blood urea nitrogen(bun), Creatine(Cr) in All subjects Baseline After Mx. Sig.* AST(U/L) ALT(U/L) N.S. BUN(mg/dl) N.S. Cr(mg/dl) N.S. Values are mean standard deviation by Paired t-test Mx. indicates Medication; Sig., Significance; AST, aspartate aminotransferase; ALT, alanine aminotransferase; BUN, Blood urea nitrogen; Cr, Creatine.. BPV ARV. BPV (Table 4). 3),, VAS (Table 5). (Table 6), AST,. ALT, BUN, Cr (Table 7) ), , 10).,, % % 10,11). 12) 1999 (36.0%) angiotensin-converting enzyme (ACE) inhibitor(18.1%)., amlodipine 22%, ACE inhibitor 3-25% 13). ACE inhibitor 14), 15). 233

7 (692) 26 3 ( ) 16). 17), 18), 19), 20). Kim 21) NO, oxygen free radical injury, Jeon 22) Gillis 25) NO. Han 23) 12 NO level, Sung 24) NO.,., ), 4)., 27) 3.0g/,. 28) 3-4g/, 4.5g/, 4). 4.5g/.,,, 4. Panax ginseng (Asian ginseng), Panax quinquefolius (American ginseng), Panax japonicus (Japanese ginseng) 3. Panax ginseng, Panax quinquefolius (American ginseng),, 29)., asian ginseng, american ginseng.,,,,., Pringle 30) BPV stroke cardiovascular event, end-organ damage BPV 31) , 1, 7 32)., BPV ARV 33). BPV ARV. 4.,., Han 4). 234

8 (693) 24 BPV. BPV ARV., BPV...,,,, 34,35).,,,, (Health Related Quality of Life, HRQoL) 36).,.,, 37)...,,. 38,39 )., 4) g/. 3g, 15g ,,, 35)., ,, 4. 1.,, BPV(SD ARV),. 3. VAS,. 4., 235

9 (694) 26 3 ( ).,,, ;2: Coon JT, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions. Drug Saf. 2002;25(5): Jeon BH, Kim CS, Park KS, Lee JW, Park JB, Kim KJ, Kim SH, Chang SJ, Nam KY. Effect of Korea red ginseng on the blood pressure in conscious hypertensive rats. Gen Pharmacol. 2000(35); Han KH, Choe SC, Kim HS, Sohn DW, Nam KY, Oh BH, Lee MM, Park YB, Choi YS, Seo JD, Lee YW. Effect of Red Ginseng on Blood Pressure in Patients with Essential Hypertension and White Coat Hypertension. Am J Chin Med. 1998;26(2): Stavro PM, Woo M, Heim TF, Leiter LA, Vuksan V. North American Ginseng Exerts a Neutral Effect on Blood Pressure in Individuals With Hypertension. Hypertension. 2005;46: Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19): Radauceanu A, Virion JM, Boivin JM, Zannad F. Time-effect profile of antihypertensive agents assessed with trough/peak ratio, smoothness index and dose omission: an ambulatory blood pressure monitoring study with trandolapril vs. quinapril. Fundam Clin Pharmacol. 2002;16: Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, Horan MJ, Labarthe D. Prevalence of hypertension in the US adult population : Results from the Third National Health and Nutrition Examination Survey, Hypertension. 1995;25: Tomlinson B, Woo J, Thomas GN, Chau YM, Critchley JA. Randomized, Controlled, Parallel- Group Comparison of Ambulatory and Clinic Blood Pressure Response to Amlodipine or Enaalapril During and After Treatment in Adult Chinese Patients with Hypertension. Clinical Therapeutics. 2004;26(8): Jamerson K, DeQuattro V. The impact of ethnicity on response to antihypertensive therapy. Am J Med. 1996;101(suppl):S22-S Woo KS, Norris RM, Nicholls G. Racial difference in incidence of cough with angiotensinconverting enzyme inhibitors(a tale of two cities). Am J Cardiol. 1995;75: Handler J. Quality of life and antihypertensive drug therapy. J Clin Hypertens (Greenwich) May;7(5): Townsend RR, McFadden CB, Ford V, Cadee JA. A Randomized, Double-Blind, Placebo- Controlled Trial of Casein Protein Hydrolysate 236

10 (695) (C12 Peptide) in Human Essential Hypertension. Am J Hypertens. 2004;17(11 Pt 1): Sharifi AM, Darabi R, Akbarloo N. Study of antihypertensive mechanism of Tribulus terrestris in 2K1C hypertensive rats: role of tissue ACE activity. Life Sci. 2003;73(23): Chang FC, Huang YT, Hong CY, Lin JG, Chen KJ. Haemodynamic effects of chronic tetramethylpyrazine administration on portal hypertensive rats. Eur J Gastroenterol Hepatol. 1999;11(9): Kim H, Chen X, Gillis CN. Ginsenosides protect pulmonary vascular endothelium against free radical-induced injury. Biochem Biophys Res Commun. 1992;189(2): Jeon BH, Kim CS, Kim HS, Park JB, Nam KY, Chang SJ. Effect of Korean red ginseng on blood pressure and nitric oxide production. Acta Pharmacol Sin. 2000;21(12): Gillis CN. Panax ginseng pharmacology: a nitric oxide link?. Biochem Pharmacol. 1997;54(1): Han K, Shin IC, Choi KJ, Yun YP, Hong JT, Oh KW. Korea red ginseng water extract increases nitric oxide concentrations in exhaled breath. Nitric Oxide ;12(3): Sung J, Han KH, Zo JH, Park HJ, Kim CH, Oh BH. Effects of red ginseng upon vascular endothelial function in patients with essential hypertension. Am J Chin Med. 2000;28(2): Fagard RH, Staessen JA, Thijs L, Bulpitt CJ, Clement D, de Leeuw PW, Jaaskivi M, Mancia G, O'Brien E, Palatini P, Tuomilehto J, Webster J. Relationship between ambulatory blood pressure and follow-up clinic blood pressure in elderly patients with systolic hypertension. J Hypertens. 2004;22(1): ,,,,,,,,,, ;18(2): , (24);2: Yuan CS, Dey L. Multiple effects of American ginseng in clinical medicine. Am J Chin Med. 2001;29(3-4): Pringle E, Phillips C, Thijs L, Davidson C, Staessen JA, de Leeuw PW, Jaaskivi M, Nachev C, Parati G, O'Brien ET, Tuomilehto J, Webster J, Bulpitt CJ, Fagard RH. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens. 2003;21(12): Su DF, Miao CY. Reduction of blood pressure variability: a new strategy for the treatment of hypertension. Trends Pharmacol Sci. 2005;[Epub ahead of print]. Available from:url: nce/journal/ Lede RL, Voto LS, Orti J, Margulies M. Agreement between different frequencies of measurements in ambulatory blood pressure monitoring. J Obstet Gynaecol. 1997;17(4): Mena L, Pintos S, Queipo NV, Aizpurua JA, Maestre G, Sulbaran T. A reliable index for the prognostic significance of blood pressure variability. J Hypertens. 2005;23(3): Coon JT, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions. 237

11 (696) 26 3 ( ) Drug Saf. 2002;25(5): DD Kitts and C Hu. Efficacy and safety of ginseng. Public Health Nutr. 2000;3(4A): Ellis JM, Reddy P. Effects of Panax ginseng on quality of life. Ann Pharmacother. 2002;36(3): Cui J, Garle M, Eneroth P, Bjorkhem I. What do commercial ginseng preparations contain? Lancet. 1994;344(8915): ,,,,,,, ;18(2): ,,,,,,, :17(3);

012임수진

012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar