Mild arterial hypertension
Stage 1 hypertension: office systolic BP 140–159 mmHg or diastolic 90–99 mmHg confirmed by repeated measurement and home or ambulatory monitoring. ESC/ESH 2024 and SEH-LELHA frame the first line as lifestyle change (salt below 5 g/day, Mediterranean diet, physical activity, weight loss, smoking and alcohol cessation) and allow 3–6 months of non-pharmacological correction in low-cardiovascular-risk patients without target organ damage.
Also known as: Stage 1 hypertension, Borderline blood pressure, High-normal blood pressure
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- CAged garlic extract (AGE, Kyolic)Not recommended · Supplement of Allium sativum extract aged for 20 months and standardised to S-allylcysteine (SAC); sold under the Kyolic brand; not registered as a medicine by AEMPSAged garlic extract is one of the most studied herbal supplements in mild hypertension. The Ried 2013 meta-analysis (n ≈ 970) and the 2020 update reported reductions of about 7 mmHg systolic and 5 mmHg diastolic BP in hypertensive patients on SAC 600–1500 mg/day for 8–12 weeks. The effect is non-significant in normotensive subjects. ESC/ESH 2024, SEH-LELHA 2022 and SEC do not include garlic in hypertension treatment algorithms. EFSA 2009 rejected all garlic health claims linked to cardiovascular disease – the evidence base did not meet the regulatory threshold. Replacing ACE inhibitors, ARBs or calcium channel blockers with aged garlic is not justified. If antihypertensive medication has been prescribed, do not stop it in favour of an iHerb supplement.
- CBeetroot juice / dietary nitrate (Beta vulgaris)Not recommended · Food product rich in inorganic nitrate; sold as a sports supplement and a «biohack» BP-lowering aid; not registered as a medicine by AEMPSBeetroot juice and powder are sold as a «natural way to lower blood pressure». The Siervo 2013 meta-analysis (n = 254, 16 trials) reported a reduction of about 4.4 mmHg systolic and 1.1 mmHg diastolic BP with 300–500 mg/day dietary nitrate. The Bahadoran 2017 update confirmed the modest effect and identified a nitrate-independent component. The effect is not significant in normotensive subjects. ESC/ESH 2024 and SEH-LELHA 2022 do not include beetroot in hypertension treatment algorithms. Substituting ACE inhibitors, ARBs, thiazides or calcium channel blockers with beetroot juice is not justified. If BP remains above 140/90 mmHg, discuss standard pharmacotherapy with a general practitioner or cardiologist.
- DHawthorn (Crataegus monogyna / laevigata)Not recommended · Medicinal plant; EMA HMPC well-established use for mild nervous tension and traditional use in mild chronic heart failure; standardised WS 1442 extract (Crataegutt)Hawthorn is popular in Spain and Russia as a «mild remedy for blood pressure». The small Walker 2006 trial in patients with type 2 diabetes and hypertension reported a minor diastolic BP reduction of about 3 mmHg with 1000 mg/day extract over 16 weeks – clinically marginal. No systematic review confirms an antihypertensive effect. ESC/ESH 2024 and SEH-LELHA 2022 guidelines do not include hawthorn in initial or maintenance hypertension therapy. Substituting hawthorn for ACE inhibitors, ARBs, thiazide diuretics or calcium channel blockers is not justified. If BP remains uncontrolled, discuss standard pharmacotherapy with a general practitioner or cardiologist.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit