# Synergistic Effects of Compound Dendrobium Candidum and Antihypertensive Medications on Refractory Hypertension in Spontaneously Hypertensive Rats

## TL;DR

This study shows that combining a herbal compound with blood pressure medications can effectively treat hard-to-control hypertension in rats.

## Contribution

The study introduces a novel synergistic treatment for refractory hypertension using a herbal compound and conventional drugs.

## Key findings

- CDC combined with antihypertensive drugs achieved 100% blood pressure target success in refractory hypertensive rats.
- CDC reduced the compensatory increase in AT1R and AT2R levels caused by antihypertensive drugs.
- CDC treatment lowered mRNA and protein expression of AT1R and AT2R in glomerular endothelial cells.

## Abstract

Compound dendrobium candidum (CDC) is formulated from Dendrobium candidum and fragrant peony. Preliminary studies have demonstrated that the combination of CDC with conventional antihypertensive medications exhibits significant synergistic effects in lowering blood pressure. The objective of this study was to evaluate the synergistic effect of combining CDC with antihypertensive medications on refractory hypertension in spontaneously hypertensive rats (SHRs) and to elucidate the underlying mechanisms involved.

SHRs were treated with either CDC alone or CDC combined with two or three antihypertensive agents including irbesartan, amlodipine, or terazosin, for a duration of 6 weeks. The alterations in blood pressure, angiotensin II (Ang II), insulin, blood sugar, angiotensin II type I receptor (AT1R), angiotensin II type II receptor (AT2R), insulin receptor, insulin α receptor, and insulin β receptor levels were assessed. Glomerular endothelial cells from refractory SHR were then taken for overexpression and knockdown of AT2R gene and co‐cultured with CDC serum to measure the expression levels of Ang II receptor gene and protein.

In comparison to the findings observed in the irbesartan + amlodipine + terazosin (IAT) group, the addition of CDC significantly enhanced antihypertensive efficacy. The rate of achieving blood pressure targets (< 150 mmHg) in SHRs with refractory hypertension increased from 0% to 100%. Treatment with CDC significantly reduced the compensatory increase in AT1R and AT2R levels caused by IAT treatment and showed a significant antihypertensive and synergistic effect. Primary glomerular endothelial cells extracted from SHRs and Wistar rats and treated with 0.5% CDC‐containing serum showed significantly reduced AT2R levels in the AT2R‐overexpression condition. The combination of CDC and antihypertensive drugs was effective in reducing the messenger RNA (mRNA) and protein expression levels of AT1R and AT2R in glomerular endothelial cells.

CDC in combination with antihypertensive drugs showed a synergistic effect in controlling refractory hypertension. The mechanism of action may be related to the attenuation of excessive expression of AT2R. This study offers a novel approach for the treatment of clinically resistant hypertension.