The Effect of Chinese Herbal Medicine Combined With Western Medicine on Vascular Endothelial Function in Patients With Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Systematic review and meta-analysis of randomized controlled trials in adults with essential hypertension, primarily Chinese participants. The included studies compared combined Chinese herbal medicine plus conventional antihypertensive drugs versus conventional Western therapy alone across multiple active intervention arms.

Active intervention arms received Chinese herbal medicine added to conventional Western antihypertensive therapy, compared with Western medicine alone. Regimens varied widely across trials and included decoctions, pills, capsules, granules, and soft capsules with treatment durations ranging from 4 weeks to 6 months; examples included Bushen Qinggan decoction, Yindanxinnaotong soft capsule, Tianma Gouteng decoction, and Danshen Dripping pills.

Overall, adding Chinese herbal medicine to Western antihypertensive therapy was associated with better blood pressure control and improved vascular endothelial function than Western medicine alone. Across outcomes, the combination was linked to higher nitric oxide, lower endothelin-1, and better flow-mediated dilation, with additional improvements reported in several trials for SBP, DBP, 24 h-SBP, 24 h-DBP, VEGF, Ang II, vWF, hs-CRP, and TGFb-1. Adverse events were generally mild and completion rates were high. However, the certainty of evidence was very low to low, so the findings remain uncertain.

The evidence base was limited by risk of bias, substantial heterogeneity, and very low to low certainty of evidence. Interventions were highly variable in formula, dose, and duration, and the trials were mostly conducted in China, which limits generalizability. Some study-level reporting was incomplete, and adverse event reporting was not uniform.