Socio-demographic characteristics of the study participants
A total of 128 study participants were interviewed and blood pressure and lipid profile levels were measured. Among the participants, 50% were Moringa stenopetala herbal tea drinkers and the other 50% were non-drinkers.
The mean ± SD of ages among the study participants was 52.56 ± 10.20 and 55.56 ± 11.91 years for the Moringa stenopetala herbal tea drinkers and non-drinkers respectively. Sixty-four percent (64.1%) of Moringa stenopetala herbal tea drinkers and 56.3% of non-drinkers were found to be females. Among Moringa stenopetala herbal tea drinkers, 81.3% were married, 4.7% were divorced/separated, and 14.1% were widowed. Likewise, of nondrinkers, 82.8% were married, 7.8% were divorced/separated, and 9.4% were widowed. More than 57% of Moringa stenopetala herbal tea drinkers were urban dwellers. Of nondrinkers, 73.4% were urban dwellers. There was no statistically significant difference between Moringa stenopetala herbal tea drinkers and non-drinkers group regarding socio-demographic characteristics like age, gender, marital status, residence, educational status, occupation, monthly income, duration of hypertension, and type of medication (P > 0.05; Table 1). Our socio-demographic data, duration of hypertension, and types of medication reflected an ideal match between the study participants.
Table 1: Socio-demographic and clinical characteristics of the study participants attending Bale zone hospitals, South East Ethiopia, 2021 (n = 128)
Variables
|
M. stenopetala herbal tea drinkers (n=64)
|
Non-drinkers (n=64)
|
P-value
|
Age (years)
|
|
|
0.128
|
Mean ± SD
|
52.56 ± 10.20
|
55.56 ± 11.91
|
Range
|
35-73
|
28-80
|
Gender
|
|
|
0.367
|
Male
|
23 (35.9%)
|
28 (43.8%)
|
Female
|
41 (64.1%)
|
36 (56.2%)
|
Marital status
|
|
|
0.574
|
Married
|
52 (81.3%)
|
53 (82.8%)
|
Divorced/separated
|
3 (4.7%)
|
5 (7.8%)
|
Widowed
|
9 (14.1%)
|
6 (9.4%)
|
Residence
|
|
|
0.063
|
Rural
|
27 (42.2%)
|
17 (26.6%)
|
Urban
|
37 (57.8%)
|
47 (73.4%)
|
Educational level
|
|
|
0.630
|
Never attended
|
23 (35.9%)
|
20 (31.3%)
|
Can read and write
|
1 (1.6%)
|
3 (4.7%)
|
Primary (1-8)
|
15 (23.4%)
|
11 (17.2%)
|
Secondary (9-12)
|
11 (17.2%)
|
11 (17.2%)
|
College and above
|
14 (21.9%)
|
19 (29.7%)
|
Occupation
|
|
|
0.375
|
Government employee
|
10 (15.6%)
|
14 (21.9%)
|
Merchant
|
18 (28.1%)
|
12 (18.8%)
|
Farmer
|
20 (31.3%)
|
15 (23.4%)
|
Pensioner
|
|
6 (9.4%)
|
11 (17.2%)
|
Housewife
|
10 (15.6%)
|
12 (18.8%)
|
Monthly income (ETB)
|
|
|
0.172
|
<1,400
|
7 (10.9%)
|
7 (10.9%)
|
1,4013,500
|
40 (62.5%)
|
31 (48.4%)
|
3,5015,000
|
11 (17.2%)
|
11 (17.2%)
|
>5,000
|
6 (9.4%)
|
15 (23.4%)
|
Duration of hypertension
|
|
|
0.293
|
Mean ± SD
|
7.03 ± 4.61
|
8.08 ± 6.46
|
Range
|
1-20
|
1-30
|
Types of medication
|
|
|
0.929
|
Hydrochlorothiazide
|
43 (67.2%)
|
45 (70.3%)
|
Amlodipine
|
12 (18.8%)
|
11 (17.2%)
|
Enalapril
|
9 (14.1%)
|
8 (12.5%)
|
|
|
|
|
|
Key: SD, Standard Deviation; % = percentage; ETB, Ethiopian birr; Categorical variables are presented in frequency and percentage while continuous variables are presented as mean ± (SD) and range; Variables were statistically significant at P < 0.05; P-values were got from the chi-square test except for the age and duration of hypertension which is obtained from the independent sample t-test.
Anthropometric characteristics of the study participants
The current study showed that the mean value of weight had a significant difference between the Moringa stenopetala herbal tea drinkers and non-drinkers which is higher among the non-drinkers with a mean difference of -9.33kg (p = 0.000). The mean±SD height (cm) of study participants was 161.91 ± 5.53 and 163.69 ± 7.54 in Moringa stenopetala herbal tea drinkers and non-drinkers, respectively, and was not significantly different (P = 0.130). The mean±SD body mass index (BMI) of the Moringa stenopetala herbal tea drinkers (21.87 ± 3.33Kg/m2) was significantly lower (P = 0.000) by 12.03% than the non-drinkers (control) group (24.86 ± 4.10Kg/m2). The mean±SD waist circumference (WC) of the Moringa stenopetala herbal tea drinkers and non-drinkers were 81.86 ± 7.48cm and 88.59 ± 10.81cm respectively. There was also a statistically significant difference between Moringa stenopetala herbal tea drinkers and the non-drinkers group regarding WC with a p-value of 0.000 (Table 2).
Table 2: Anthropometric measurements of study participants attending Bale zone hospitals, South East Ethiopia, 2021
Variables
|
Mean ± SD
|
Mean difference
|
|
P-value
|
Moringa stenopetala herbal tea drinker (n=64)
|
Non-drinkers (n=64)
|
%
|
Weight (Kg)
|
57.37 ± 9.17
|
66.70 ± 11.91
|
-9.33
|
-13.99
|
0.000*
|
Height (m)
|
161.91 ± 5.53
|
163.69 ± 7.54
|
-1.78
|
-1.09
|
0.130
|
BMI (Kg/m2)
|
21.87 ± 3.33
|
24.86 ± 4.10
|
-2.99
|
-12.03
|
0.000*
|
WC (cm)
|
81.86 ± 7.48
|
88.59 ± 10.81
|
-6.73
|
-7.60
|
0.000*
|
Key: BMI, body mass index; WC, waist circumference; % = percentage of change; (-) = Decreased from controls; (+) = Increased from controls; * = statistically significant, P-values were obtained by independent samples t-test.
Moringa stenopetala herbal tea consumption-related conditions
Of the participants, 50% were non-drinkers, while 28.1%, 14.8%, and 7.1% reported monthly, weekly, and daily Moringa stenopetala herbal tea intakes, respectively. The majority (79.7%) of the Moringa stenopetala herbal tea drinkers were beginning to drink Moringa stenopetala herbal tea due to the perception that Moringa stenopetala is entirely safe and effective in managing high blood pressure. Positive previous experience (12.5%) and dissatisfaction with conventional medicine (7.8%) were also among the other reasons given by the participants. All Moringa stenopetala herbal tea drinkers sweeten their Moringa stenopetala tea with sugar.
Lipid profile of Moringa stenopetala herbal tea drinkers and non-drinkers
The lipid profiles that were assessed in this study included low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglyceride (TG), and total cholesterol (TC). The serum concentration of LDL-c in Moringa stenopetala herbal tea drinkers was significantly lower (P <0.001) by 28.50% than in the non-drinkers group. There was an 8.51% increment of serum HDL-c level in Moringa stenopetala herbal tea drinkers compared to non-drinkers, but the difference was not statistically significant (P = 0.077). The serum TG level in Moringa stenopetala herbal tea drinkers was decreased by 20.89% from controls (P = 0.001). The serum concentration of TC of Moringa stenopetala herbal tea drinkers and non-drinkers had a Mean ± SD value of 149.88 ± 28.93 mg/dL and 188.78 ± 47.43 mg/dL respectively (P <0.001) (Tables 3).
Table 3: Mean serum level and mean percent differences of LDL-c, HDL-c, Triglyceride, and Total cholesterol of study participants attending Bale zone hospitals, South East Ethiopia, 2021
Variables
|
Mean ± SD
|
|
|
P-value
|
Moringa stenopetala herbal tea drinker (n=64)
|
Non-drinkers (n=64)
|
Mean difference
|
%
|
LDL-c
|
83.08 ± 28.87
|
116.19 ± 40.83
|
-33.11
|
-28.50
|
<0.001*
|
HDL-c
|
42.06 ± 11.80
|
38.48 ± 10.93
|
+3.58
|
+8.51
|
0.077
|
Triglyceride
|
129.60 ± 42.43
|
163.83 ± 72.20
|
-34.23
|
-20.89
|
0.001*
|
Total cholesterol
|
149.88 ± 28.93
|
188.78 ± 47.43
|
-38.90
|
-20.61
|
<0.001*
|
Key: SD, standard deviation; LDL-c, low-density lipoprotein cholesterol; HDL-c, high-density lipoprotein cholesterol; % = percentage of change; (-) = Decreased from controls; (+) = Increased from controls; values (Mean ± SD) are represented as (mg/dL); * = statistically significant; P-values were obtained by student’s independent t-test
Lipid ratios for Moringa stenopetala herbal tea drinkers and non-drinkers
Recent data have shown that Castelli’s risk index I and II (estimated as TC/HDL-c and LDL-c/HDL-c ratios) are more accurate predictors of cardiovascular risk than individual lipid parameters such as serum TC, TG, HDL-c, and LDL-c. Castelli’s risk index-I is produced from the ratio of two important lipid parameters, TC and HDLc, whereas Castelli's risk index II, is calculated as the ratio of LDL-c and HDL-c [33]. There was a statistically significant difference (p <0.001) between the mean ratio of LDL-c to HDL-c for Moringa stenopetala herbal tea drinkers (2.23 ± 1.28) and non-drinkers (3.28 ± 1.69). Similarly, the mean ratio of TC to HDL-c was significantly lowered (p <0.001) for Moringa stenopetala herbal tea drinkers than non-drinkers (3.87 ± 1.49 vs 5.27 ± 2.13) (Figure 1).
The serum concentration of LDL-c, HDL-c, triglyceride, and total cholesterol varied according to grades of Moringa stenopetala herbal tea consumption. Considering individual lipid parameters, one-way ANOVA with Tukey post hoc test results indicated that there were statically significant differences (P <0.05) in mean serum LDL-c and TC level between subgroups of “daily drinkers” and “non-drinkers”. There was also a significant difference between “daily drinkers” and “monthly drinkers” in mean serum LDL-c and TC. The mean serum LDL-c and TC level of weekly drinkers was also significantly lower than monthly drinkers and non-drinkers. On the contrary, Castell’s risk index I & II showed significant differences (P <0.001) between the subgroups of Moringa stenopetala tea drinkers (i.e between subgroups of daily drinkers and non-drinkers; weekly drinkers, and non-drinkers) (Table 4).
Table 4: Lipid profiles of different groups of Moringa stenopetala herbal tea drinkers attending Bale zone hospitals, South East Ethiopia, 2021.
Variables
|
Mean (95% Confidence interval)
|
P-value
|
Non-drinkers
|
Monthly drinkers
|
Weekly drinkers
|
Daily drinkers
|
LDL-c
|
116.19 (105.99-126.39)
|
101.61 (93.34-109.88)
|
63.04 (58.16-67.92)ab
|
51.22 (44.38-58.07)ab
|
<0.001*
|
HDL-c
|
38.48 (35.75-41.20)
|
40.60 (36.35-44.86)
|
42.32 (38.66-45.97)
|
47.33 (35.57-59.09)
|
0.131
|
TG
|
163.83 (145.80-181.87)
|
134.39 (122.78-146.00)
|
125.11 (98.05-152.17)
|
119.90 (88.49-151.31)
|
0.113
|
TC
|
188.78 (176.94-200.63)
|
167.48 (158.97-175.99)a
|
129.07 (122.47-135.67)ab
|
123.39 (112.91-133.87)ab
|
<0.001*
|
CRI-I
|
5.27 (4.74-5.81)
|
4.52 (3.97-5.07)
|
3.13 (2.85-3.40)a
|
2.82 (2.16-3.48)a
|
<0.001*
|
CRI-II
|
3.29 (2.86-3.71)
|
2.84 (2.37-3.31)
|
1.54 (1.36-1.73)ab
|
1.24 (0.76-1.72)ab
|
<0.001*
|
Key: Data are presented as mean (95% Confidence Interval); Obtained from ANOVA test for the between-group comparisons; * = statistically significant; a = significantly different when compared to non-drinkers (Tukey post hoc); b = significantly different when compared to monthly drinkers (Tukey post hoc); CRI, castell’s risk index
Blood pressure of Moringa stenopetala herbal tea drinkers and non-drinkers
The mean systolic blood pressure (SBP) of Moringa stenopetala herbal tea drinkers and non-drinkers in the study was 128.72 ± 13.71 mmHg and 139.68 ± 15.61 mmHg respectively. The mean SBP was significantly lower (P <0.001) among the Moringa stenopetala herbal tea drinkers than non-drinkers. On the other hand, the mean diastolic blood pressure (DBP) of Moringa stenopetala herbal tea drinkers and non-drinkers were 83.77 ± 9.26 and 88.63 ± 8.49 mmHg respectively. The mean DBP was also significantly lower (P = 0.002) among the Moringa stenopetala herbal tea drinkers than non-drinkers. The mean arterial blood pressure (MAP) of study participants was 98.76 ± 10.19 mmHg and 105.64 ± 9.90 mmHg in Moringa stenopetala herbal tea drinkers and non-drinkers, respectively, and was significantly different (P <0.001; Table 5).
Table 5: Blood pressure measurements of Moringa stenopetala herbal tea drinkers and non-drinkers attending Bale zone hospitals, South East Ethiopia, 2021
Variables
|
Mean ± SD
|
Mean difference
|
|
P-value
|
Moringa stenopetala herbal tea drinker (n=64)
|
Non-drinkers (n=64)
|
%
|
SBP (mmHg)
|
128.72 ± 13.71
|
139.68 ± 15.61
|
-10.96
|
-7.85
|
<0.001*
|
DBP (mmHg)
|
83.77 ± 9.26
|
88.63 ± 8.49
|
-4.86
|
-5.48
|
0.002*
|
MAP (mmHg)
|
98.76 ± 10.19
|
105.64 ± 9.90
|
-6.88
|
-6.51
|
<0.001*
|
Key: SBP, systolic blood pressure; DBP, diastolic blood pressure; MAP, mean arterial blood pressure; % = percentage of change; (-) = Decreased from controls; (+) = Increased from controls; * = statistically significant; P-values were obtained by student’s independent t-test
Systolic blood pressure of non-drinkers, monthly-drinkers, weekly-drinkers, and daily drinkers in the study had a mean (95% confidence interval) of 139.68 (135.78-143.58) mmHg, 131.93 (127.33-136.54) mmHg, 126.76 (120.20-133.32) mmHg, and 120.0 (111.90-128.10) mmHg respectively. Regarding DBP, the mean (95% confidence interval) was found 88.63 (86.50-90.75) mmHg, 86.61 (83.85-89.38) mmHg, 82.24 (77.37-87.11) mmHg, and 75.67 (70.94-80.39) mmHg for non-drinkers, monthly-drinkers, weekly-drinkers, and daily-drinkers respectively. One-way ANOVA with Tukey post hoc test results indicated that; daily and weekly Moringa stenopetala herbal tea drinkers appeared to have significantly lower SBP, DBP, and MAP compared with non-drinkers groups (P <0.001; Table 6).
Table 6: Blood pressure measurements of different Moringa stenopetala herbal tea consuming groups at Bale zone hospitals, South East Ethiopia, 2021
Parameters (unit)
|
Means (95% Confidence Interval)
|
P-value
|
Non-drinker
|
Monthly drinker
|
Weekly drinker
|
Daily drinker
|
SBP (mmHg)
|
139.68 (135.78-143.58)
|
131.93 (127.33-136.54)
|
126.76 (120.20-133.32)a
|
120.0 (111.90-128.10)a
|
<0.001*
|
DBP (mmHg)
|
88.63 (86.50-90.75)
|
86.61 (83.85-89.38)
|
82.24 (77.37-87.11)a
|
75.67 (70.94-80.39)ab
|
<0.001*
|
MAP (mmHg)
|
105.64 (103.17-108.12)
|
101.72 (98.52-104.92)
|
97.08 (91.93-102.23)a
|
90.44 (85.22-95.67)ab
|
<0.001*
|
Key: Data are presented as mean (95% Confidence Interval); Obtained from ANOVA test for the between-group comparisons; * = statistically significant; a = significantly different when compared to non-drinkers (Tukey post hoc); b = significantly different when compared to monthly drinkers (Tukey post hoc);
Association between Moringa stenopetala herbal tea consumption categories and lipid profiles, lipid ratios, and blood pressure measurements
The observed and the adjusted means of LDL-c, HDL-c, TG, TC, CRI-I, CRI-II, SBP, DBP, and MAP in the four groups are shown in Table 8. In the fully adjusted generalized linear model (M2), the mean LDL-c, TC, CRI-I, and CRI-II increased towards the higher Moringa stenopetala herbal tea consumption categories. In contrast, no differences were observed amongst the four groups in HDL-c and TG. Moreover, in the fully adjusted generalized linear model (M2), the mean SBP, DBP, and MAP decreased toward the higher Moringa stenopetala herbal tea consumption categories (Table 7).
Table 7: Associations between Moringa stenopetala herbal tea consumption categories and lipid profiles and blood pressure measurements among hypertensive patients attending Bale zone hospitals, South East Ethiopia, 2021.
Variables
|
Model
|
Mean (95% Wald Confidence interval)
|
P-value
|
Non-drinkers
|
Monthly drinkers
|
Weekly drinkers
|
Daily drinkers
|
LDL-c
|
M1
|
116.19 (108.43-123.95)
|
101.61 (91.27-111.96)
|
63.04 (48.80-77.28)
|
51.22 (30.53-71.91)
|
<0.001*
|
M2
|
116.15 (108.11-124.18)
|
101.65 (91.25-112.04)
|
63.11 (48.73-77.48)
|
51.28 (29.56-72.99)
|
<0.001*
|
HDL-c
|
M1
|
38.48 (35.74-41.21)
|
40.60 (36.95-44.25)
|
42.32 (37.29-47.34)
|
47.33 (40.04-54.63)
|
0.115
|
M2
|
38.58 (35.71-41.45)
|
40.41 (36.69-44.12)
|
42.12 (36.99-47.25)
|
47.80 (40.05-55.55)
|
0.171
|
TG
|
M1
|
163.83 (149.47-178.19)
|
134.39 (115.24-153.54)
|
125.11 (98.75-151.47)
|
119.90 (81.61-158.20)
|
0.009*
|
M2
|
157.37 (143.51-171.24)
|
139.71 (121.77-157.66)
|
131.33 (106.54-156.13)
|
131.40 (93.93-168.87)
|
0.220
|
TC
|
M1
|
188.78 (179.89-197.68)
|
167.48 (155.62-179.34)
|
129.07 (112.74-145.39)
|
123.39 (99.67-147.11)
|
<0.001*
|
M2
|
187.84 (178.68-196.99)
|
168.21 (156.36-180.06)
|
129.98 (113.60-146.36)
|
125.29 (100.54-150.04)
|
<0.001*
|
CRI-I
|
M1
|
5.27 (4.85-5.70)
|
4.52 (3.95-5.09)
|
3.13 (2.34-3.91)
|
2.82 (1.68-3.96)
|
<0.001*
|
M2
|
5.19 (4.76-5.63)
|
4.60 (4.03-5.17)
|
3.19 (2.41-3.98)
|
2.93 (1.75-4.11)
|
<0.001*
|
CRI-II
|
M1
|
3.29 (2.94-3.63)
|
2.84 (2.38-3.30)
|
1.54 (0.91-2.18)
|
1.24 (0.32-2.16)
|
<0.001*
|
M2
|
3.25 (2.89-3.60)
|
2.88 (2.42-3.34)
|
1.57 (0.93-2.20)
|
1.29 (0.33-2.25)
|
<0.001*
|
SBP
|
M1
|
139.68 (136.18-143.18)
|
131.93 (127.27-136.59)
|
126.76 (120.35-133.18)
|
120.00 (110.68-129.32)
|
<0.001*
|
M2
|
138.84 (135.34-142.34)
|
132.84 (128.31-137.37)
|
126.10 (119.84-132.36)
|
123.75 (114.28-133.21)
|
0.001*
|
DBP
|
M1
|
88.63 (86.57-90.68)
|
86.61 (83.87-89.35)
|
82.24 (78.46-86.01)
|
75.67 (70.18-81.15)
|
<0.001*
|
M2
|
88.31 (86.20-90.42)
|
86.74 (84.01-89.47)
|
82.30 (78.53-86.07)
|
77.26 (71.55-82.96)
|
0.001*
|
MAP
|
M1
|
105.64 (103.30-107.99)
|
101.72 (98.59-104.84)
|
97.08 (92.78-101.38)
|
90.44 (84.19-96.70)
|
<0.001*
|
M2
|
105.15 (102.77-107.54)
|
102.11 (99.02-105.19)
|
96.90 (92.63-101.17)
|
92.75 (86.31-99.20)
|
<0.001*
|
Key: Data are presented as mean (95% Wald Confidence Interval); Obtained from generalized linear models; * = statistically significant; CRI, castell’s risk index; Model 1 (M1), unadjusted; Model 2 (M2), adjusted for age, gender, weight, BMI, WC, duration of hypertension, and types of medication.