South African Journal of Botany 173 (2024) 1�18 Contents lists available at ScienceDirect South African Journal of Botany journal homepage: www.elsevier.com/locate/sajb Southern African traditional herbal medicinal plants used to treat cardiovascular disease and related medical conditions: Traditional use and scientific evidence I.E. Cocka,b, A. Orchardc, L. Booic, S.F. van Vuurenc,* a Centre for Planetary Health and Food Security, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia b School of Environment and Science, Nathan Campus, Griffith University, 170 Kessels Rd, Nathan, Queensland 4111, Australia c Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Parktown, 2193, South Africa A R T I C L E I N F O Article History: Received 11 April 2024 Revised 18 June 2024 Accepted 3 August 2024 Available online xxx Edited by Prof. B.E. Van Wyk * Corresponding author. E-mail address: sandy.vanvuuren@wits.ac.za (S.F. van https://doi.org/10.1016/j.sajb.2024.08.002 0254-6299/© 2024 The Author(s). Published by Elsevier (http://creativecommons.org/licenses/by-nc-nd/4.0/) A B S T R A C T Multiple plant species are used in traditional southern African medicine to treat cardiovascular diseases. Tra- ditional southern African therapies used to treat cardiovascular diseases were identified and recorded follow- ing an extensive review of ethnobotanical books, reviews, and other scientific literature. This was followed by a critical analysis of the validation studies, while highlighting gaps for further investigation. A total of 235 plant species were identified and are itemised herein. Notably, only 45 of these plant species (»19%) have been tested in vivo or screened in vitro for any bio-activities relevant to the treatment of cardiovascular dis- eases. The remaining 190 species are yet to be tested in any cardiovascular disease biomarker assay. Addi- tionally, the plant species that have been evaluated for cardiovascular disease-relevant activities have generally only been tested in a single bio-assay model (most frequently ACE inhibition assays). This study highlights the need for further in vitro and in vivo assays in this neglected field of research. © 2024 The Author(s). Published by Elsevier B.V. on behalf of SAAB. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) Keywords: Cardiovascular Traditional use ACE inhibition Medicinal plants Hypertension Vuuren). B.V. on behalf of SAAB. This is an open access article under the CC BY-NC-ND license 1. Introduction Cardiovascular diseases (CVDs) are defined by the World Heart Federation as any disease of the heart or vascular system that carries the blood throughout the body (WHO, 2017). The CVDs encompass several conditions that include (but are not limited to) coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheu- matic heart disease, congenital heart disease, deep vein thrombosis and pulmonary embolism. In 2017, the World Health Organization (WHO) ranked CVDs as the leading cause of death globally, with more people dying annually from CVDs than from any other single disease or condition (WHO, 2017). Indeed, the World Health Organi- zation (WHO) estimated that 17.9 million people globally died from CVDs in 2016. This accounts for 31% of all recorded deaths that year. Whilst those statistics represent global trends, they are similar to the statistics from individual countries and regions. For example, CVDs are the second leading cause of death in South Africa after the Human immunodeficiency virus/ Acquired immunodeficiency (HIV/AIDS) syndrome (WHO, 2018). They were responsible for 17.3 % of the nation’s deaths in 2014. Similarly, in Eswatini (formerly named Swa- ziland), ischaemic heart disease and stroke are ranked as the country’s third and fifth causes of death respectively, further highlighting the impact of CVDs across the region (Msemburi et al., 2014; Statistics South Africa, 2014; WHO, 2018). The CVD-related deaths can be further divided into subcategories. The WHO lists the most common CVD-related conditions that cause death as ischaemic heart disease, cerebrovascular disease, hyperten- sive heart disease, inflammatory heart disease and rheumatic heart disease (WHO, 2011). Ischaemic heart disease is responsible for 46% and 38% of deaths due to CVDs in men and women respectively, whilst cerebrovascular diseases are responsible for 34% and 37% in men and women. Hypertensive heart disease is responsible for a fur- ther 6% and 7% in men and women respectively, whilst inflammatory heart disease is responsible for 2% in both sexes, and rheumatic heart disease is responsible for a further 1% in both men and women. A variety of other CVDs are responsible for the remaining 11% and 14% in men and women respectively. 1.1. Ischaemic heart disease The heart muscle (myocardium) requires oxygen and nutrients to efficiently contract and relax, and thereby to pump blood throughout the body (Boyette and Manna, 2020). The coronary arteries are responsible for facilitating adequate blood flow to the myocardium to deliver the required oxygen and nutrients (Boyette and Manna, http://crossmark.crossref.org/dialog/?doi=10.1016/j.sajb.2024.08.002&domain=pdf http://creativecommons.org/licenses/by-nc-nd/4.0/ mailto:sandy.vanvuuren@wits.ac.za https://doi.org/10.1016/j.sajb.2024.08.002 http://creativecommons.org/licenses/by-nc-nd/4.0/ https://doi.org/10.1016/j.sajb.2024.08.002 https://doi.org/10.1016/j.sajb.2024.08.002 http://www.ScienceDirect.com http://www.elsevier.com/locate/sajb I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 2020). Ischaemic heart disease occurs when blood flow through the coronary arteries is reduced, resulting in the inability of the coronary arteries to effectively supply adequate amounts of oxygen and nutrients, thereby affecting the myocardium’s functionality (Pappano and Wier, 2019). The most common cause of ischaemic heart disease is coronary heart disease, followed by less common conditions including coronary artery spasm and microcirculatory dysfunction (Bogaert and Symons, 2020). Coronary artery disease occurs when plaques (also known as atherosclerotic plaques), which consist of fats, cholesterol, calcium, etc. form on the inside surfaces of arterial walls. As this disease progresses, the plaques harden and increase in size, reducing the diameter of the arterial lumen, as well as arterial flexibility, and therefore the supply of blood to the myocardium (Mohrman and Heller, 2018). Progression of ischaemic heart disease may result in congestive heart failure, electrical instability with car- diac dysrhythmias, or myocardial infarction (commonly known as a heart attack) (Akhtar, 2017). Ischaemic heart disease may initially present as angina pectoris (the chest pain, discomfort, pressure, or heaviness that is experienced when the myocardium is deprived of oxygen), acute myocardial infarction (AMI, commonly known as a heart attack), or even sudden death. The discomfort from angina pec- toris may also radiate to the neck, jaw, left shoulder, left arm, the back, or down both arms, causing referred pain (Akhtar, 2017). Angina pectoris may often cause discomfort in the upper central region of the abdomen, which can resemble indigestion and chest constriction and may sometimes be mistaken for dyspnea, hampering timely treatment (Akhtar, 2017). The risk factors for the development of ischaemic heart disease include increasing age, hypercholesterol- emia, hypertension, cigarette smoking, diabetes mellitus, obesity, sedentary lifestyle, as well as genetic factors/family history (Akhtar, 2017). Additionally, ischaemic heart disease has a gender correlation and is significantly more common in males than in females (Akhtar, 2017). Hypertension has the largest impact and is the number one risk factor for mortality due to cardiovascular diseases (WHO, 2011; Kjeldsen, 2018). 1.2. Stroke (cerebrovascular accident) The brain is one of the most highly vascularised organs in the body, with an average blood supply of »15% of the cardiac output, as it requires a constant supply of oxygen to function correctly. Indeed, the brain consumes 20% of the total body’s resting oxygen consump- tion (Rink and Khanna, 2011). A stroke occurs when a part of the brain receives an inadequate supply of oxygen and nutrients due to diminished or interrupted blood flow (American Stroke Association, 2022). When blood flow to an area of the brain is completely blocked, brain tissue in that area will die within four to ten minutes, resulting in a myriad of functional inadequacies (Smith et al., 2018). Stroke is broadly classified as either ischaemic or haemorrhagic. Ischaemic stroke occurs due to a blockage in one of the cerebral blood vessels, whilst haemorrhagic stroke occurs due to a ruptured blood vessel, which causes bleeding within the brain (referred to as intracerebral haemorrhage) or in the area between the brain and tissue covering the brain (referred to as subarachnoid haemorrhage) (Ropper et al., 2019). Ischemic strokes are the major class, accounting for aproxi- mately 85% of strokes, whilst the remaining 15% of strokes are hae- morrhagic (Jameson et al., 2020). Both classes of stroke may be caused by numerous factors, including (but not limited to) athero- sclerotic thrombosis, transient ischemic attack, embolism, hyperten- sive hemorrhage, and ruptured or unruptured saccular aneurysm or arteriovenous malformation, with the most common cause being ath- erosclerosis of the large and medium-sized blood vessels in the neck and the base of the brain (Henderson, 2017; Ropper et al., 2019). Nau- sea and vomiting may also follow, along with lost or impaired con- sciousness that may last for a short period, or may progress to coma and death, depending on the severity (Douglas and Aminoff, 2022). 2 The risk factors for ischaemic stroke include hypertension, smoking, diabetes mellitus, obesity, physical inactivity, poor diet, alcohol con- sumption, psychosocial factors, depression and/or cardiac causes (e.g. atrial fibrillation, and the ratio of apolipoprotein B to apolipoprotein A1) (McGrath et al., 2017). Of these, hypertension is considered as the most important risk factor for stroke and is estimated to be responsible for approximately 500% of all ischaemic strokes (World Heart Federation, 2017). 1.3. Cardiovascular risk factors The development of cardiovascular disease can be attributed to several risk factors, which collectively account for »75 % of all cardio- vascular disease (WHO, 2002). These risk factors are divided into two groups: modifiable risk factors, and non-modifiable risk factors. The WHO (WHO, 2002) categorized high blood pressure (or hyperten- sion), abnormal blood lipids, diabetes mellitus, tobacco use, physical inactivity, obesity, and unhealthy diets as the major modifiable risk factors. Advancing age, gender, ethnicity or race, and heredity or fam- ily history make up the main non-modifiable risk factors. 1.3.1. Hypertension Hypertensive is characterised by chronic elevation of blood pres- sure (systolic blood pressure greater than/equal to 140 mm Hg and/ or diastolic blood pressure greater than/equal to 90 mm Hg) (Alexan- der, 2019). Additionally, hypertension can be further categorized as: primary hypertension (also known as essential), whose cause(s) are not clearly defined; or identifiable, (secondary hypertension), which has clear and identifiable causes (Alexander, 2019). Primary hyper- tension is significantly more common than secondary hypertension. Indeed, the causes of hypertension generally can not be identified in 80�95 % of patients (Jameson et al., 2018). Despite the inability to identify the causes of primary hypertension, several notable factors may be associated with development. For example, lack of physical activity, a diet consisting of excessive salt, saturated fats, inadequate consumption of fruits and vegetables, excessive alcohol intake, and being overweight are common in people with primary hypertension (Benziger et al., 2017). Often patients with hypertension are unaware of their condition as they are asymptomatic during the early stages, and they usually remain that way until there is accumulation of sub- stantial organ damage. For this reason, hypertension is often referred to as “the silent killer” (Vongpatanasin, 2017). However, despite the serious nature of hypertension, it can be effectively controlled in most patients through pharmacological intervention, generally with minimal adverse effects (Katzung et al., 2018). Several classes of drugs are useful for treating hypertension, including diuretics, sym- pathoplegics, vasodilators, angiotensin antagonists and renin inhibi- tors (Katzung et al., 2018). If left uncontolled, hypertension can lead to the development of myocardial infarction, stroke, peripheral artery disease, retinopathy and renal failure (Graham, 2020). 1.3.2. Blood lipids Abnormal blood lipids (particularly high total cholesterol, LDL- cholesterol, and triglyceride levels) and low levels of HDL cholesterol increase the risk of coronary heart disease and ischaemic stroke (WHO, 2002). High levels of blood cholesterol can result in the devel- opment of atherosclerotic cardiovascular disease and lowering its level reduces the risk of cardiovascular disease (Blaha, 2020). The for- mation of plaques in response to high blood lipid levels is not fully understood. However, reducing blood lipid levels can reduce arterial plaque formation in artherosclerosis (Sharma and Shah, 2020). The cause of elevated lipid levels may be metabolic, renal, hepatic, hor- monal, due to medication, or due to lifestyle factors, including physi- cal inactivity, obesity and consumption of foods rich in saturated fats (Genest and Libby, 2018). Chemotherapeutic intervention with sta- tins, bile acid absorption inhibitors, cholesterol absorption inhibitors, I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 and fibrates are commonly used to decrease blood lipid levels (Papa- dakis et al., 2022). 1.3.3. Diabetes mellitus Individuals with diabetes mellitis are between two and four times more likely to develop CVD compared to non-diabetic patients. Car- diovascular disease is the leading cause of death in people with dia- betes mellitus (World Heart Federation, 2017). Uncontrolled diabetes can induce heart, blood vessel, eye, kidney, and nerve damage (Powers et al., 2018). However, type 2 diabetes mellitus is generally readily controlled, most frequently through lifestyle changes, although chemotherapeutic options are also available (Cock et al., 2021). 2. Current treatments for cardiovascular disease The three common risk factors each require pharmacological intervention to prevent the progression to cardiovascular disease resulting in coronary artery disease, heart failure, stroke, kidney damage, or dementia (Katzung et al., 2012). The medications used in hypertension are targeted toward reducing blood pressure either via volume loss by means of a diuretic, vasodilation, or by direct or indi- rect aldosterone inhibition (Katzung et al., 2012). Medications for dyslipidemia inhibit lipid synthesis or absorption, regulate gene expression, promote degradation of low-density lipoprotein recep- tors, or inhibit the catalytic enzyme that regulates the conversion of HMG CoA to mevalonate (Katzung et al., 2012; Lemus and Mendivil, 2015; Hajar, 2019). Diabetic medications may include insulin itself, or drugs aimed at increasing insulin secretion, or treatments aimed Fig. 1. Summary of cardiovascular disease risk factor treatment target sites and progressio 2020; Fisman and Tenenbaum, 2021). 3 at sensitizing the cells to insulin, decreasing insulin absorption, increasing excretion of glucose, inhibiting glucagon release, increas- ing incretin levels, or increasing feelings of satiety (Katzung et al., 2012; Vella, 2012; Wilcox, 2020; Fisman and Tenenbaum, 2021). Overall, each risk factor has multiple targets, (Fig. 1.) that can be con- sidered for treatment. 3. Medicinal plant use for cardiovascular diseases While the treatment of cardiovascular disease is complex and often requires a holistic treatment plan, natural products have been considered as alternate options. A study on ten medicinal plants was undertaken whereby the therapeutic effects on isoproterenol- induced heart failure in rats was monitored (Keihanian et al., 2021). Allium sativum L., Peganum harmala Hadidi, and Berberis vulgaris Vell, significantly enhance cardiac function (Keihanian et al., 2021). In another study the antihypertensive and vasodilator effects of etha- nolic extracts prepared from Calea glomerata Klatt, Croton schiedeanus Schlecht, Curatella americana L., Lippia alba (Mill) N.E.Br. and Lupinus amandus C.P.Sm were evaluated. A rat model was used and C. schiedeanus demonstrated antihy- pertensive and bradycardic effects (Guerrero et al., 2002). Some reviews have focused on specific areas of natural product research with cardiac therapy as the emphasis. The dysregulation of mitochondrial homeostasis and mitophagy and the protective role of medicinal plants on heart failure also received attention (Wang et al., 2022). Medicinal plants and their effects on cardiac ischemia-reperfusion injury has also been reported (Sedighi et al., 2019). However, little attention has been given to traditional use n (Katzung et al., 2012; Vella, 2012; Lemus and Mendivil, 2015; Hajar, 2019; Wilcox, I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 of medical plants for the treatment of heart disease. This review examines the traditional use of medicinal plants to treat cardiac diseases in southern Africa to provide insights into this relatively neglected area of research. 4. Materials and methods 4.1. Search strategy This study aimed to identify plant species used in southern African traditional medicine to treat cardiovascular diseases in humans. The information obtained was subsequently used to determine if the traditional uses of these plants is supported by scientific evidence. A thorough literature survey was undertaken using ethnobotanical books (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996; Felhaber and Mayeng, 1997; Adeniji et al., 2000; Van Wyk, 2008; Moffett, 2010), reviews and surveys. The ethnobotanical reviews and surveys were identified by searching the following electronic databases: ScienceDirect, Google Scholar, PubMed, and Scopus. The filters that were used (either alone or in combination) to identify the relevant literature were: “South African”, “southern African”, “medicinal plant”, “traditional medi- cine”, “high blood pressure” heart condition”, “heart ailment”, “weak heart”, “stroke”, and “myocardial infarction” “ethnobot- any”, “cardiovascular”, “cardiac disease”, “hypertension”, “heart disease”, “cardioprotective”, and “angiotensin-converting enzyme inhibitors”. Following identification of plant species, keywords were used to identify studies which included, “ACE”, “ARB”, “diuretic”, “calcium channel blocker", "beta-blocker", "vasodila- tor”, “anti-coagulant”, and “anti-thrombotic”. 4.2. Eligibility criteria Publications retrieved from the various electronic database searches were evaluated for eligibility based on their titles. The abstracts of all retrieved publications were read to confirm their suit- ability to this study. For studies that met the initial study criteria, full-text manuscripts were then obtained, and read to verify suitabil- ity. To be deemed eligible for this study, the following inclusion crite- ria was evaluated; � Only English language publications were used to avoid misinter- pretation. � Plants used in traditional medicine practices of any ethnic group in the southern African region were recorded. � Introduced plant species were included if they conformed to all other inclusion criteria. � The study was non-biased, without taxonomic preference, nor bias towards the traditional medicine practices of any single eth- nic group. � To be included herein, plant species must be recorded to be specif- ically used in the treatment of a cardiovascular ailment, rather than symptoms that are shared between multiple conditions (e.g., chest pain). Additionally, if a plant is used to treat other ailments (e.g., diabetes, inflammation) that are not cardiovascular diseases (despite being able to induce cardiovascular diseases) it was not included in this study. Publications were deemed ineligible and were not included herein if they met the following exclusion criteria; � Incomplete publications, where only the abstract and references were available. � Traditional medicines that did not indicate specific plant species, or studies where the species identity was in doubt. 4 4.3. Data collection Following a thorough review of ethnobotanical literature, the plant species, family, common name (and ethnic-specific names), the plant part used, and the method of traditional use (where available) were documented and recorded using Microsoft Excel software Ver- sion 365. 5. Results A thorough literature review identified 235 medicinal plants used traditionally in southern Africa to treat cardiovascular diseases (Table 1). The plants used in the treatment of cardiovascular diseases were from 69 families (Fig. 2). The greatest number of plant species were from the family Asteraceae (36 species), which is consistent with their usage to treat other medicinal conditions reported in other studies (Cock et al., 2019; Cock and Van Vuuren, 2020a, b; Van Wyk, 2020). Fabaceae was also well represented (30 species). Multiple spe- cies of Lamiaceae (16 species); Asphodelaceae, (eight species); Ana- cardiaceae, Apocynaceae, Aizoaceae (seven species each), Amaryllidaceae, Cucurbitaceae, Rutaceae (six species each); Celastra- ceae, Euphorbiaceae, Malvaceae (five species each); Apiaceae, (four species each) were also used to treat cardiovascular disease. All other families were represented by three or less species. While some plant species have been cited once or twice, others such as Cannabis sativa L., Commelina africana L., Elephantorrhiza ele- phantina (Burch.) Skeels, Eriocephalus punctulatus DC., Leonotis leonu- rus (L.) R.Br., Lessertia frutescens subsp. microphylla (Burch. ex DC.), Nidorella ivifolia (L.) J.C.Manning & Goldblatt, Olea europaea subsp. cuspidata (Wall. & G.Don) Cif., Pseudodictamnus africanus (L.) Salmaki & Siadati, and Ruta graveolens L., have been cited four or more times, denoting their importance in treating cardiovascular disease. For several cardiovascular conditions, the specific uses were ambiguous, whilst the uses of others were clearly listed. For example, the specific uses of plants listed for the treatment of hypertension, heart palpitations, angina, and stroke are indisputable. One hundred and sixty-three of the plant species used traditionally for the treat- ment of cardiovascular diseases were listed as treatments for hyper- tension or high blood pressure. Sixteen were used to treat oedema, twelve were used to treat or prevent stroke, seven were used to treat heart palpitations, four were used to promote diuresis, and four were used to treat low blood pressure (Fig.3). In contrast, “heart problems”, “heart complaints”and “heart conditions” were listed for some plant species. These descriptions could refer to multiple cardiovascular conditions. Sixty-one species were listed as being used to treat unspecified CVD. In this study, plants used traditionally to treat symptoms that could be attributed to conditions other than CVDs were excluded. For this reason, it is likely that the number of plant species identified herein may substantially underestimate the total number of southern African medicinal plants used for the treatment of cardiovascular diseases. Further ethnobotanical surveys of some ethnic groups may clarify this point and subsequently add to this inventory. Notably, in our study, we have only included plant species that are directly involved in treating CVDs (including hypertension and stroke), whilst plants used to treat conditions such as diabetes and inflammation are not recorded herein. The reader is referred to other detailed reviews by Cock et al. (2021) and Khumalo et al. (2022) for information of plants used to treat diabetes and inflamma- tion respectively. Roots/bulbs and rhizomes (29.4 %), and leaves (27.8 %) were the most frequently used southern African plant part to treat cardiovas- cular conditions (Fig. 4). Bark was also commonly used, accounting for 10.2 % of the total usage to treat CVDs. In contrast, whole plants (6.9 %) and fruit (2.3 %) were used substantially less frequently. For Table 1 Southern African plants used traditionally to treat cardiovascular and related diseases. Plant species Family Common name Plant part(s) used Traditional use Reference Acmella caulirhiza Delile Asteraceae Isishoshokazane, Isisinini (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Acokanthera oblongifolia Benth. & Hook.f. Apocynaceae Inhlungunyemba, Inhlungunyembe (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Acokanthera oppositifolia (Lam.) Codd Apocynaceae Inhlungunyembe (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Adenanthos linearisMeisn. Proteaceae Unspecified Not specified High blood pressure (Nortje and VanWyk, 2015) Adenia digitata (Harv.) Engl. Passifloraceae umphindamshaya; imfule; imfulwa; impinda (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Agapanthus africanus (L.) Hoff- manns. Amaryllidaceae African lily (English), bloelelie (Afrikaans), ubani-oluncane), uhlakahla (Zulu) Root Unspecified heart disease (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Agapanthus campanulatus F.M. Leight. Amaryllidaceae Bell agapanthus (English), bloulelie (Afri- kaans), ugebeleweni (Xhosa), ubani (Zulu) Tubular roots Unspecified heart disease (Mugomeri et al., 2016) Agathosma betulina (P.J. Bergium) Pillans Rutaceae Buchu (Xhosa) Leaves, stems High blood pressure (Olorunnisola et al., 2011) Agathosma capensis (L.) Dṻmmer Rutaceae Steenbokboegoe, boegoe, bre€eblaarboegoe, semelboegoe, lemoenboegoe (Afrikaans) Not specified High blood pressure (Hulley and VanWyk, 2019) Agave americana L. Asparagaceae Ikhamanga (Zulu) Leaf sap, whole plant High blood pressure (Maroyi, 2017) Ajuga ophrydis Burch. ex Benth. Lamiaceae Senyarrla (Southern Sotho) Not specified High blood pressure, oedema (Moffett, 2010) Albizia versicolor Welw ex. Oliv Fabaceae Muvhambangoma (Venda) Leaves, roots High blood pressure (Mudau et al., 2020) Albuca flaccida Jacq. Asparagaceae White onion (English), inqwebeba (Xhosa, Zulu) Bulbs High cholesterol and hypertension (Philander, 2011) Aloe arborescensMill. Asphodelaceae Krantz aloe (English), kransaalwyn (Afri- kaans), ikalene (Xhosa), inkalane, umhla- bana (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Aloe castanea Sch€onland Xanthorrhoeaceae Sekgopha sa setswiki, segafane (Sepedi) Leaves High blood pressure (Mogale et al., 2019) Aloe feroxMill. Asphodelaceae Cape aloe (English), bitteraalwyn, winke- laalwyn, (Afrikaans), ikhala (Xhosa), inhlaba (Zulu) Leaves, roots Hypertension (Moffett, 2010; De Beer and Van Wyk, 2011; Davids et al., 2016) Aloe maculata All. Asphodelaceae Soap aloe, zebra aloe (English) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Aloe striatula (Haw.) Klopper & Gideon F.Sm. Asphodelaceae Hardy aloe, striped stem aloe (English) Leaves High blood pressure (Moffett, 2010; Kose et al., 2015) Aloe vossii Reynolds Asphodelaceae Tshikhopha, tshikopa (Venda) Leaves High blood pressure (Mudau et al., 2020) Aloidendron barberae (Dyer) Klop- per & Gideon F.Sm. Asphodelaceae Eastern tree aloe (English), boomaalwyn (Afrikaans), ikhala, umgxwala (Xhosa), inkalane enkulu, inhlaba yesilungu (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Athanasia cuneifolia Lam. Asteraceae Ghwarrieson, kwarison (Afrikaans) Not specified heart conditions (Van Wyk and Gericke, 2000) Artemisia absinthium L. Asteraceae Wormwood (English), groenamara (Afri- kaans) Not specified High blood pressure (Nortje and VanWyk, 2015) Artemisia afra Jacq. Ex Willd. Asteraceae African wormwood (English), als, alsem, wildeals (Afrikaans), umhlonyane (Xhosa, Zulu), lengana (Sotho, Tswana) Leaves High blood pressure, heart problems (Thring andWeitz, 2006; Nortje and VanWyk, 2015; Davids et al., 2016) Aspalathus linearis (Burm.f.) R. Dahlgren Fabaceeae Rooibos (Afrikaans) Not specified High blood pressure (Nortje and VanWyk, 2015) Asparagus capensis L. Asperagaceae Wild asparagus (English), katdoring (Afri- kaans) Root High blood pressure (Philander, 2011) Athanasia cuneifolia Lam. Asteraceae Not specified Whole plant Weak heart (Philander, 2011) Berkheya montana J.M. Wood & M. S. Evans Asteraceae Mohatollo, ntsoa-ntsane-ea-loti (Sotho) Roots High blood pressure, oedema (Moffett, 2010) Berkheya setifera DC. Asteraceae Buffalo-tongue thistle (English), rasperdis- sel, rasperdisseldoring (Afrikaans), indlebe-lenkomo (Xhosa), ikhakhasi, ulimi-lwenkomo, ulimi-lwenyathi (Zulu), lelelemla-khomo, ntsoantsane (Sotho) Root Circulatory problems (Moffett, 2010) Bidens pilosa L. Asteraceae Blackjack (English); gewone knapsekerel (Afrikaans); ucadolo, uqadolo (Zulu) Leaves High blood pressure, oedema (Mhlongo and VanWyk, 2019; Mudau et al., 2020) Brachystegia boehmii Taub Fabaceae Mupfuti (Shona) Leaves Handful of chopped leaves added to 1 L of boiling water for 30 min, 1/2 cup taken 3 times/ day for heart problems (Shopo et al., 2022) Bridelia micrantha (Hochst.) Baill. Phyllanthaceae Munzere (Venda) Bark High blood pressure (Mudau et al., 2020) Bulbine latifolia (L.f.) Spreng. Asphodelaceae Red carrot (English), rooiwortel (Afrikaans) Root Hypertension (Philander, 2011) Bulbine narcissifolia Salm-Dyck Asphodelaceae Strap-leafed bulbine, snake flower (English), lintblaar bulbine, geelslangkop, wildekopieva (Afrikaans), khomo-ea- balisa, serelelile (Sotho) Roots Dilates blood vessels, promotes diuresis, improves blood circulation (Moffett, 2010; Mugomeri et al., 2016) Burkea africana Hook. Fabaceae Mufhulu (Venda) Leaves High blood pressure (Mudau et al., 2020) Cadaba aphylla (Thunb.) Wild Capparaceae Leafless worm bush (English), swartstorm- bos (Afrikaans), mfitshwana (Tswana), mudiatsiwana (Venda) Leaves, stem High blood pressure (Davids et al., 2016; Hulley and VanWyk, 2019) Cannabis sativa L. Cannabaceae Marijuana (English), dagga (Afrikaans), umya (Xhosa), insangu (Zulu), matek- wane (Sotho), mbanzhe (Venda) Leaves, stem Hypertension, unspecified heart ailments, Stroke, high blood pressure (Hutchings, 1996; Olorunnisola et al., 2011; Van Wyk and Gorelik, 2017; Hulley and VanWyk, 2019; Mudau et al., 2020) Capparis tomentosa Lam. Brassicaceae Muobadali (Venda) Roots High blood pressure (Mudau et al., 2020) Carpobrotus acinaciformis (L.) L. Bolus Aizoaceae Sour fig (English), ikhambilamabulawo, umgongozi (Zulu) Leaves, fruit Unspecified heart ailments (Watt and Breyer-Brandwijk, 1962) (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 5 Table 1 (Continued) Plant species Family Common name Plant part(s) used Traditional use Reference Carpobrotus edulis (L.) N.E.Br. Aizoaceae Sour fig (English), hotnotsvye, vyerank (Afrikaans) Not specified High blood pressure, oedema (Moffett, 2010) Catha edulis (Vahl) Endl. Celastraceae Abyssinian tea, bushman’s tea (English), boesmanstee (Afrikaans), umhlawazizi, umhlwazi (Zulu) Bark Heart stimulant (Hutchings, 1996) Catharanthus roseus (L.) G.Don Apocynaceae Madagasscan perriwinkle, Cape perriwin- kle, graveyard plant (English), imbali yamathuna, imbali yesibaya, isona, uba- nibezwe, umangashi (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Centaurea benedicta (L.) L. Asteraceae Holy thistle (English), karmedik (Afrikaans) Not specified High blood pressure (Hulley and VanWyk, 2019) Centella asiatica (L.) Urb Apiaceae Marsh pepperwort (English), waternael (Afrikaans), icudwane, umangobozane (Zulu), bolila-balinku (Sotho) Not specified Circulatory problems (Moffett, 2010) Chrysanthemoides monilifera L. Asteraceae Tick berry, bitou bush, boneseed (English), bietou, bosluisbessie (Afrikaans), igwa- baba, ikhambi lenyongo, imbozisa, yasol- wandle, isifulwane, ithenanja, ugudlulwandle, ugudlumfula, ulimi lwenkomo, unkuphunyane (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Chrysocoma ciliata L. Asteraceae Beesbos, swaelbossie (Afrikaans) Not specified Hypertension (Davids et al., 2016; Hulley and VanWyk, 2019) Cinnamomum camphora (L.) J. Presl Lauraceae Camphor (English), urosalina (Zulu) Bark Unspecified heart problems (Philander, 2011) Cissampelos capensis L.f. Menispermaceae Dawidjie (Afrikaans), umayisake (Xhosa) Root High blood pressure, unspecified heart problems (Van Wyk, 2008; Olorunnisola et al., 2011) Clausena anisata (Willd.) Hook.f. ex Benth. Rutaceae Horsewood (English), basternieshout, per- deboom, perdepis (boom/bos) (Afri- kaans); isifudu, isifuthu, umnukambhiba, umnukelambiba, umsanka (Zulu) Root, leaves, wood Unspecified heart ailments, strengthens the heart, heart tonic (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Cliffortia strobilifera L. Rosaceae Bog rice bush, cone rice-bush (English), kammiebos, kammie-rysbos, vleibos (Afrikaans), umnwele, unwele (Xhosa) Not specified High blood pressure (Hulley and VanWyk, 2019) Combretum molle R.Br. ex G. Don Combretaceae Velvet bushwillow (English), basterrooibos, hardekool, rooibos, (Afrikaans), umdubu wehlathi, umbondwe; umbondwe-omh- lope; umbondo (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Combretum zeyheri Sond. Combretaceae Mufhatelathundu (Venda) Roots High blood pressure (Mudau et al., 2020) Commelina africana L. Commelinaceae Common yellow commelina (English), gee- leendagsblom (Afrikaans), idangabane (Zulu), khotsoana (Sotho), Roots Strengthens heart (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996; Mof- fett, 2010; Moteetee and Van Wyk, 2011) Commelina benghalensis L. Commelinaceae Tropical spiderwort (English), blouselblom- metjie (Afrikaans), uhlotshane (Xhosa), idangabane (Zulu), khotsoana (Sotho), damba (Venda) Whole plant High blood pressure (Hutchings, 1996) Convolvulus capensis Burm. f. Convolvulaceae Bitterpatat (Afrikaans) Bulb High blood pressure (Davids et al., 2016) Crassula muscosa L. Crassulaceae Lizard’s tail, watch chain, zipper plant (English), Akkedisbos (Afrikaans) Leaves, stems, flow- ers, roots High blood pressure (Davids et al., 2016) Crotalaria natalitiaMeisn. Fabaceae Not specified Root Unspecified heart conditions (Watt and Breyer-Brandwijk, 1962) Croton gratissimus Burch. Euphorbiaceae Masunungule (Venda) Leaves High blood pressure (Mudau et al., 2020) Croton sylvaticus Hochst. Euphorbiaceae Amahlabakufeni, indumbahlozi, ugibele- weni, umgeleweni, umhlalajuba, umh- loshazane, uminya, ummbila, umzilanyoni (Zulu) Not specified High blood pressure, stroke (Mhlongo and VanWyk, 2019) Cussonia paniculata Eckl. & Zeyh. Araliaceae Mountain cabbage tree (English), bergkie- persol (Afrikaans) Bark Unspecified heart conditions (Mugomeri et al., 2016) Cynanchum insipidum E. Mey Apocynaceae Morogo wa lebje, leshwe, lefotosane (Pedi) Roots High blood pressure, heart attack (Mogale et al., 2019) Datura stramonium L. Solanaceae Jimsonweed, devil’s trumpet, thornapple (English), malpitte (Afrikaans), ijoqi, iloyi (Zulu) Not specified Stroke (Mogale et al., 2019) Dianthus micropetalus Ser. Caryophyllaceae Grashoutjie, grashout (Afrikaans) Root Angina (Van Wyk, 2008) Dicerothamnus rhinocerotis (L.f.) Koek Asteraceae Renosterbos (Afrikaans) Leaves, stem High blood pressure (Davids et al., 2016) Dicoma anomala Sond. Asteraceae Fever bush (English), maagbitterwortel, kal- werbossie, koorbossie, gryshout (Afri- kaans), isihlabamakhondlwane, umuna (Zulu) Roots, leaves High blood pressure (Moffett, 2010; Kose et al., 2015; Mugomeri et al., 2016) Dicoma capensis Less. Asteraceae Wilde karmedik, koorsbossie (Afrikaans) Leaves, twigs, roots High blood pressure (Van Wyk, 2008; De Beer and Van Wyk, 2011) Dietes iridioides (L.) Sweet ex Klatt Iridaceae Painted lady, wild Iris (English), wilde-iris, klein wittulp (Afrikaans), ndaw’ihlathi, indawo yehlathi, isigqiki-sikatokoloshe, isishupe somfula (Zulu) Rhizomes Hypertension (Hutchings, 1996) Dioscorea hemicrypta Burkill Dioscoreaceae Olifantsvoet, skilpadtoon (Afrikaans) Not specified Unspecified heart conditions (Hulley and VanWyk, 2019) Diosma oppositifolia L. Rutaceae Skaapbos (Afrikaans) Leaves, stems, flowers High blood pressure (Davids et al., 2016) Dipcadi brevifolium (Thunb.) Fourc. Asparagaceae Brownbells, curly-curly, wild hyacinth (English), slangui (Afrikaans), ikhakhakha elimpofu (Zulu) Bulb Heart pains (Hutchings, 1996) Dittrichia graveolens (L.) Greuter Asteraceae Kakiebos (Afrikaans) Not specified High blood pressure (Nortje and VanWyk, 2015) (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 6 Table 1 (Continued) Plant species Family Common name Plant part(s) used Traditional use Reference Dombeya rotundifolia (Hochst.) Planch. Malvaceae Wild pear (English), dikbas (Afrikaans), unhliziyonkulu (Zulu), mohlabaphala (Sotho), mulanga (Venda) Inner bark, leaves Weakness of the heart, palpita- tions, heart problems (Hutchings, 1996; Reid et al., 2001) Dodonaea viscosa subsp. angustifo- lia (L.f.) J.G.West Sapindaceae Ysterhouttoppe (Afrikaans) Leaves Heart conditions (Olorunnisola et al., 2011) Drimia elata Jacq. ex Willd. Asparagaceae Red onion (English), jeukoi, roijukei (Afri- kaans), intelezi, mascaban, brandui, indongana-zibomvana, isiklenama (Zulu) Bulb Brings back sensation after a stroke, high blood pressure (Hutchings, 1996; Philander, 2011) Drimia sanguinea (Schinz) Jessop Asparagaceae Tshiganama (Venda) Bulb High blood pressure (Mudau et al., 2020) Durio graveolens Becc. Malvaceae Durian (English) Not specified High blood pressure (Nortje and VanWyk, 2015) Ekebergia capensis Sparrm. Meliaceae Cape ash (English), essenhout (Afrikaans), isimanaye (Xhosa), umnyanmathi (Zulu), nyamaru, mmidibidi (Sotho), nyamaru (Tswana), mutovuma (Venda) Bark, root Unspecified heart conditions (Hutchings, 1996; Oyedeji-Amusa et al., 2021) Elachyptera parvifolia (Oliv.) N. Hall�e Celastraceae Malambamapikwa (Venda) Roots High blood pressure (Mudau et al., 2020) Elaeodendron transvaalense (Burtt Davy) R.H. Archer Celastraceae Transvaal saffron wood (English), Transvaal saffraan (Afrikaans), ingwavuma (Zulu), monamane (Sotho), mukuvhazwivhi (Venda) Bark High blood pressure (Hutchings, 1996; Mudau et al., 2020) Elephantorrhiza elephantina (Burch.) Skeels Fabaceae Eland’s bean, elephant’s foot (English), bas- wortel, elandsboontjie (Afrikaans), intol- wane, igwejobmvu (Xhosa), intolwana enkulu, intolwane, ugweje, umdabu (Zulu) Rhizome or root Hypertension and rheumatic heart conditions, chest complaints (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996; Moteetee and VanWyk, 2011; Olorunnisola et al., 2011; Kose et al., 2015; Mudau et al., 2020) Eriobotrya japonica (Thunb.) Lindl. Rosaceae Ulokhwathi (Zulu) Not specified High blood pressure, heart "sickness" (Watt and Breyer-Brandwijk, 1962; Mhlongo and VanWyk, 2019) Eriocephalus africanus L. Asteraceae Infection bush (English), kapokbos (Afri- kaans) Leaves High blood pressure and oedema (Philander, 2011) Eriocephalus punctulatus DC. Asteraceae Cape chamomile (English), kapokbos (Afri- kaans) Whole plant, leaves High blood pressure; Heart problems (Thring andWeitz, 2006; Moffett, 2010; Moteetee and VanWyk, 2011; Philander, 2011) Erythrina caffra Thunb. Fabaceae Umsinsi (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Erythrina lysistemon Hutch. Fabaceae Common coral tree (English), gewone kor- aalboom (Afrikaans), umnsinsi, umsinsi (Zulu), muvale (Sotho) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Eucalyptus camaldulensis Dehnh. Myrtaceae Murray red gum (English), ugamthrini omhlophe (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Euclea crispa subsp. linearis Zeyh. Ex Hiern Ebenaceae Mukwatikwati (Venda) Roots High blood pressure (Mudau et al., 2020) Euclea undulata Thunb. Ebenaceae Ghwarrie (Afrikaans) Leaves, bark Unspecified heart problems (Watt and Breyer-Brandwijk, 1962; Philander, 2011) Euphorbia clavarioides Boiss. Euphorbiaceae Lion’s spoor (English), grootvingerpol, melkpol, slangpol, vingerpol (Afrikaans), isantilele, isihlekehleke (Zulu), sehlehle, sehloko, thethebale (Sotho) Whole plant High blood pressure and oedema (Moffett, 2010; Kose et al., 2015) Euphorbia inaequilatera Sood. Euphorbiaceae Not specified Leaf Unspecified heart problems (Watt and Breyer-Brandwijk, 1962) Euphorbia milii Des Moul. Euphorbiaceae Le blommo, malese (Pedi) Whole plant Angina (Mogale et al., 2019) Euryops abrotanifolius (L.) DC. Asteraceae Harpuisbos (Afrikaans) Stem, leaves High blood pressure (Davids et al., 2016) Garuleum woodii Schinz Asteraceae Mahloko-a-baroa (Sotho) Leaves, roots, stems Hypertension (Mugomeri et al., 2016) Geranium incanum (Burm. F) Geranaiceae Tlako (Xhosa) Leaves, stem Heart conditions (Olorunnisola et al., 2011) Gladiolus dalenii Van Geel Iridaceae African gladiolus, Natal lily (English), pape- gaai gladiolus, wildeswaardlelie (Afri- kaans), isidwi esibomvu, udwendweni, uhlakahle (Zulu), khahla-e-kholo (Sotho) Corms High blood pressure and oedema (Moffett, 2010) Gunnera perpensa L. Gunneraceae River pumpkin (English), ubhoqo, ughobo (Xhosa, Zulu), iPhuzi, lomlambo (Xhosa) Root bulb, leaves Hypertension and high cholesterol (Olorunnisola et al., 2011; Mugo- meri et al., 2016) Gymnosporia buxifolia (L.) Szyszy». Celastraceae Not specified Thorns Unspecified heart problems (Watt and Breyer-Brandwijk, 1962) Harpagophytum procumbens DC. ex Meisn. Pedaliaceae Devil’s claw (English), duiwelsklou (Afri- kaans), lekgagamare (Tswana), x’aata- taba, tloutaxaba (San) Tuber High blood pressure, stroke and heart disease (Felhaber and Mayeng, 1997; Mncwangi et al., 2012) Helichrysum crispum (L.) D.Don Asteraceae Kooigoed (Afrikaans) Dried leaf infusions drunk as tea Unspecified heart conditions (Thring andWeitz, 2006) Helichrysum cymosum (L.) D. Don Asteraceae Umathithibala (Xhosa), timie (Afrikaans) Leaves Unspecified heart problems (Philander, 2011) Helichrysum odoratissimum (L.) Sweet Asteraceae Everlanstings (English), kooigoed (Afri- kaans), imphepho (IsiXhosa), imphepho (Zulu) Leaves, whole plant, root Unspecified heart problems, high blood pressure, stroke, chest pain complaints. and hypertension (Van Wyk, 2008; Olorunnisola et al., 2011; Philander, 2011) Helichrysum pandurifolium Schrank Asteraceae Not specified Not specified Unspecified heart problems (Watt and Breyer-Brandwijk, 1962) Helichrysum patulum D.Don Asteraceae Honey everlasting (English), kooigoed (Afri- kaans), impepho (Xhosa), phefo (Seso- tho) Not specified Heart problems (Watt and Breyer-Brandwijk, 1962) Hypoxis colchicifolia Baker Hypoxidaceae Broad-leaved Hypoxis, yellow star (English), gudu, ilabatheka, ilabetheka, ingcobo, inkomfe (Zulu) Corms Strengthens heart, diuretic (Hutchings, 1996) Hypoxis filifolia Eckl Hypoxidaceae Ikhubalo (Xhosa) Bulb High blood pressure (Olorunnisola et al., 2011) Hypoxis hemerocallidea Fisch., C.A. Mey. & Av�e-Lall. Hypoxidaceae Inonqwe (Xhosa), inkomfe (Zulu), Corm, root High blood pressure, stroke, and heart weakness (Olorunnisola et al., 2011; Mhlongo and VanWyk, 2019) (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 7 Table 1 (Continued) Plant species Family Common name Plant part(s) used Traditional use Reference Hypoxis obtusa Burch. ex Ker Gawl Hypoxidaceae Mmona wa maledu, titikwane, sesogadi (Sepedi) Roots High blood pressure (Mogale et al., 2019) Kedrostis capensis (Sond.) A. Meeuse Cucurbitaceae Not specified Tubular roots, leaves Hypertension (Mugomeri et al., 2016) Kedrostis nana (Lam.) Cogn. Cucurbitaceae Bitter patat (Afrikaans) Tuber Hypertension (Philander, 2011) Kirkia wilmsii Engl. Kirkiaceae Mogaba, legaba, modumela (Pedi) Roots High blood pressure (Mogale et al., 2019) Lagenaria sphaerica (Sond.) E. Naudin Cucurbitaceae Inthsungu, iselwa lentaba (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Lannea schweinfurthii (Engl.) Engl. Anacardiaceae Muadaba, mulivhadza (Venda) Roots High blood pressure (Mudau et al., 2020) Lavandula angustifoliaMill. Lamiaceae Lavander (English) Leaves Hypertension (Philander, 2011) Ledebouria apertiflora (Baker) Jessop Asparagaceae Sekanama, sefulanyana, sekunkuru (Sepedi) Leaves Angina (Mogale et al., 2019) Leonotis leonurus (L.) R.Br. Lamiaceae Wild dagga (English), wildedagga, duiwel- stabak (Afrikaans), mvovo, umfincafin- cane (Xhosa), uyshwala-bezinyoni (Zulu) Leaves, bulbs Hypertension; heart problems; high blood pressure and chest complaints (Thring andWeitz, 2006; Olorun- nisola et al., 2011; Philander, 2011; Davids et al., 2016) Leonotis ocymifolia (Burm.f.) Iwarsson Lamiaceae Minaret flower (English), rooidagga (Afri- kaans), umcwili (Zulu), mununzu (Venda) Not specified High blood pressure (Van Wyk, 2008) Lessertia depressa Harv. Fabaceae Musa-pelo (Sotho) Not specified Heart palpitations (Moffett, 2010; Moteetee and Van Wyk, 2011) Lessertia frutescens subsp.micro- phylla (Burch. ex DC.) J.C. Man- ning & Boatwr. Fabaceae Cancer bush (English), wildekeur, kalkoen- bel, kankerbos (Afrikaans), umnwele (Xhosa), insiswa, unwele (Xhosa, Zulu), musa-pelo, motlepelo (Sotho) Whole plant, leaves High blood pressure, oedema, heart failure (Watt and Breyer-Brandwijk, 1962; Van Wyk and Gericke, 2000; Van Wyk, 2008; Moffett, 2010; Olorunnisola et al., 2011; Philander, 2011; Davids et al., 2016) Lessertia montana (E.Phillips & R. A. Dyer) Goldblatt & J.C. Manning Fabaceae Mountain cancer bush, balloon pea (English), kankerbos, blaasbossie, blaas- ertjie, eendjies, gansiekeurtjie, klappers, hoenderbelletjie (Afrikaans), umnwele (Xhosa, Zulu) Leaves High blood pressure, oedema (Moffett, 2010) Lessertia perennans (Jacq.) DC. Fabaceae Blaasertjie (Afrikaans), musa-pelo-o- moholo-oa-liliba (Sotho) Not specified High blood pressure, oedema (Moffett, 2010; Moteetee and Van Wyk, 2011) Leucosidea sericea Eckl. & Zeyh. Rosaceae Oldwood (English), ouhout (Afrikaans), isid- wadwa, umyityi (Xhosa), umtshitshi (Zulu) Leaves, stem (bark) High blood pressure (Moffett, 2010; Kose et al., 2015) Lichtensteina lacera Cham. & Schltdl. Apiaceae Iqwili (Xhosa) Leaves, bulbs Heart conditions (Olorunnisola et al., 2011; Davids et al., 2016) Lotononis decumbens (B.-E. van Wyk) B.-E. van Wyk & Boatwr. Fabaceae Nomele (Sotho) Not specified High blood pressure, oedema (Moteetee and VanWyk, 2011) Mangifera indica L. Anacardiaceae Mango (English) Stem bark Heart conditions (Mongalo and Makhafola, 2018) Medicago sativa L Fabaceae Luserene (Pedi), Lesere (Sotho) Whole plant Heart conditions (Mogale et al., 2019) Melia azedarach L. Meliaceae Museranga (Venda) Leaves High blood pressure (Mudau et al., 2020) Melolobium alpinum Eckl. & Zeyh. Fabaceae Motsoehla, ’musa-pelo-o-moholo-oa-thaba (Sotho) Leaves High blood pressure, oedema (Moffett, 2010; Moteetee and Van Wyk, 2011) Mentha aquatica L. Lamiaceae Aromatic thyme, wild mint, water mint (English), kruisememt, kruistement, waterment (Afrikaans), ityaleba (Xhosa), umaliwane, umayime, umnukani, ama- bunu, imbozisa (Zulu), koena-e-nye- nyane, koena-ya-libida (Sotho) Leaves Hypertension (Moffett, 2010; Moteetee and Van Wyk, 2011) Mentha longifolia (L.) L. Lamiaceae Ballerja (Afrikaans) Stem, leaves High blood Pressure (Davids et al., 2016) Mesembryanthemum tortuosum (L.) N.E. Br. Aizoaceae Kougoed (Afrikaans) Leaves and roots High blood pressure (Davids et al., 2016) Millettia stuhlmannii Taub Asteraceae Muangaila (Venda) Roots High blood pressure (Mudau et al., 2020) Momordica balsamina L. Cucurbitaceae Balsam pear (English), laloentjie (Afrikaans), intshungu (Zulu), mohodu (Sotho) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Momordica boivinii Baill. Cucurbitaceae Nyapiringuhule (Venda) Roots High blood pressure (Mudau et al., 2020) Momordica foetida Schumach. Cucurbitaceae Gifappel, gifappeltjie (Afrikaans), intshungu (Zulu) Leaves, stems High blood pressure (Hutchings, 1996) Moraea spathulata (L.f.) Klatt Iridaceae Umaphipha (Xhosa, Zulu) Bark Strengthens the heart (Philander, 2011) Moringa oleifera Lam. Moringaceae Muringa (Venda) Leaves High blood pressure (Mudau et al., 2020) Myrovernix glandulosus (Less.) Koek. Asteraceae Not specified Not specified Unspecified heart problems (Watt and Breyer-Brandwijk, 1962) Myrsine melanophloeus (L.) R.Br. ex Sweet Primulaceae Cape beech (English), boekenhout, beukeh- out (Afrikaans), isiqwane sehlati (Xhosa), isicalabi, umaphipha, ikhubalwane, isiqa- laba sehlati (Zulu) Bark Strengthens the heart (Hutchings, 1996) Mystroxylon aethiopicum (Thunb.) Loes. Celastraceae Mukwatikwati (Venda) Bark, root High blood pressure (Mudau et al., 2020) Nidorella ivifolia (L.) J.C.Manning & Goldblatt DC. Asteraceae Oven bush, albany gall-sick bush (English), bakbesembossie, galsiektebossie, koue- bos, bakbos (Afrikaans), uhlabo, uman- zimnyama (Zulu) Leaf infusion Strengthens heart, low blood pressure (Thring andWeitz, 2006; Van Wyk, 2008; Van Wyk et al., 2008; Van Wyk and Gorelik, 2017; Hulley and VanWyk, 2019) Notobubon galbanum (L.) Magee Apiaceae Berg celery, blister bush (English), bergsel- dery (Afrkaans) Leaves Hypertension (Philander, 2011) (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 8 Table 1 (Continued) Plant species Family Common name Plant part(s) used Traditional use Reference Ocimum basilicum L. Lamiaceae Basil (English), timie (Afrikaans) Leaves, stem Heart conditions (Olorunnisola et al., 2011) Oldenlandia affinis (Roem. & Schult.) DC. Rubiaceae Umampeshane (Zulu) Root Unspecified heart problems (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Olea europea subsp. africana. Mill. P.S. Green Oleaceae Umquma (Xhosa) Roots, leaves Heart conditions (Olorunnisola et al., 2011) Olea europaea subsp. cuspidata (Wall. & G. Don) Cif. Oleaceae Wild olive (English), olienhout (Afrikaans), umnquma (Zulu, Xhosa), mohlware (Sotho), mutlhwari (Venda) Leaves, roots, stem bark High blood pressure, stroke, and palpitations (VanWyk, 2008;Moffett, 2010; Phi- lander, 2011; Kose et al., 2015; Nortje and VanWyk, 2015) Opuntia ficus-indica (L.) Mill. Cactaceae Mudoro (Venda) Bark High blood pressure (Mudau et al., 2020) Osteospermum imbricatum Subsp. nervatum (DC) T. Nor Asteraceae Inkhupuhlana (Xhosa) Bulb and leaves Heart conditions (Olorunnisola et al., 2011) Osteospermum monilifera L. Asteraceae Igwababa, ikhambi lenyongo, imbozisa, yasolwandle, isifulwane, ithenanja, ugudlumfula, ulimi iwenkomo, unkuphunyane (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Osyris lanceolata Hochst. & Steud. Santalaceae Mupeta (Venda) Roots High blood pressure (Mudau et al., 2020) Ozoroa reticulata (Baker f.) R.Fern. & A. Anacardiaceae Munungumaswi (Venda) Roots High blood pressure (Mudau et al., 2020) Paederia bojeriana (A.Rich. Ex DC.) Drake Rubiaceae Sulesule (Venda) Leaves High blood pressure (Mudau et al., 2020) Parinari curatellifolia Planch. ex Benth. Chrysobalanaceae Muchakata, muhute (Shona), muvhula (Venda) Bark or fruits Unspecified heart problems, high blood pressure (Mudau et al., 2020; Shopo et al., 2022) Pelargonium odoratissimum (L.) L’Her. Geraniaceae Not specified Leaves Cardiac stimulant (Van Wyk, 2008) Pentanisia prunelloides (Klotzsch) Walp. Rubiaceae Wild verbena (English), sooibrandbossie (Afrikaans), icimamlilo (Zulu), setima- mollo (Sotho) Root Palpitations, high blood pressure (Hutchings, 1996; Felhaber and Mayeng, 1997; Kose et al., 2015) Persea americanaMill. Lauraceae Avocado, alligator pear (English) Not specified Hypertension (Adeniji et al., 2000) Petroselinum crispum (Mill.) Fuss Apiaceae Parsley (English) Leaves, seeds Can raise blood pressure (Asowata-Ayodele et al., 2016) Phyllogeiton discolor (Klotzsch) Herzog Rhamnaceae Munie (Venda) Leaves High blood pressure (Mudau et al., 2020) Phylsalis peruviana L. Scophulariaeae Gquzu (Xhosa) Leaves, bulb Chest complaints (Olorunnisola et al., 2011) Piper capense L.f. Piperaceae Wild pepper (English), wildepeper (Afri- kaans), ihlolane, uluphokwane (Zulu) Fruit Unspecified heart problems (Watt and Breyer-Brandwijk, 1962) Pittosporum viridiflorum Sims Pittosporaceae Umkhwenkhwe (Zulu) Bark Hypertension (Philander, 2011) Polygonum aviculare L. Polygonaceae Litjiesgras (Afrikaans) Roots Angina (Van Wyk, 2008) Protorhus longifolia (Bernh.) Engl. Anacardiaceae Red beech, purple currant, (English), harpuis- boom, rooibeukeblaar, rooibeukehout, rooi- boekenhout, rooimelkhout (Afrikaans), ikhubalo, isifuce, umhluthi (Xhosa), isifice, isifico-sehlathi, isifuze, umhlangothi, umh- luthi (Zulu), mutu-musolde (Venda) Not specified Strengthens the heart (Hutchings, 1996) Pseudodictamnus africanus (L.) Sal- maki & Siadati Lamiaceae Cat mint (English), kattekruie (Afrikaans) Leaves Improves blood circulation, low- ers blood pressure, (Watt and Breyer-Brandwijk, 1962; De Beer and VanWyk, 2011; Phi- lander, 2011; Davids et al., 2016; Hulley and VanWyk, 2019) Ptaeroxylon obliquum (Thub.) Radlk. Rutaceae Sneeze wood (English), umthathe (Zulu) Bark, leaves Unspecified heart problems (Watt and Breyer-Brandwijk, 1962; Philander, 2011) Pterocarpus angolensis DC Fabaceae Mutondo (Venda) Leaves High blood pressure (Mudau et al., 2020) Pterocarpus rotundifolius (Sond.) Druce Fabaceae Muhataha (Venda) Roots High blood pressure (Mudau et al., 2020) Pyrenacantha kaurabassana Baill. Icacinaceae Galange (Venda) Roots High blood pressure (Mudau et al., 2020) Rauvolfia caffra Sond Apocynaceace Munadzi (Venda) Leaves High blood pressure (Mudau et al., 2020) Rhoicissus digitata (L.f.) Gilg. & M. Brandt Vitaceae Uchithibhunga (Xhosa), mutumbulambud- zana (Venda) Bulb, roots High blood pressure (Olorunnisola et al., 2011; Mudau et al., 2020) Rhynchosia africanum Ser. var. africanum . Phillips & R.A. Dyer Fabaceae Moqopolla-thula, ’musa-pelo (Sesotho) Whole plant Heart trouble (Moteetee and VanWyk, 2011) Rhynchosia burchellianum Ser. subsp. Burchellianum . Phillips & R.A. Dyer Fabaceae Moqopolla-thula, moroko, ‘musa-pelo (Sesotho) Roots Heart problems (Moteetee and VanWyk, 2011) Rhynchosia sutherlandia montana E. Phillips & R.A. Dyer Fabaceae ’Musa-pelo-o-moholo-oa-noka (Sesotho) Leaves Dropsy of heart (Moteetee and VanWyk, 2011) Rhynchosia tephrosia capensis (Jacq.) Pers. Fabaceae ‘Musa-pelo-oa-noka (Sesotho) Root Heart palpitations (Moteetee and VanWyk, 2011) Roepera morgsana (L.) Beier & Thulin Zygophyllaceae Not specified Seed Stroke (Watt and Breyer-Brandwijk, 1962) Rumex lanceolatus Thunb. Polygonaceae Common dock (English), gladdetongblaar (Afrikaans), idolonyana (Xhosa), idolo lenkonyane (Zulu), khamane (Sotho) Whole plant Unspecified heart problems (Moffett, 2010) Ruschia putterillii (L. Bolus) L.Bolus Aizoaceae Leqhwaba, sebabetsane, sebabetsi, seba- betswane (Sotho) Not specified High blood pressure, oedema (Moffett, 2010) Ruschia spinosa (L.) Dehn Aizoaceae Steekkaroo (Afrikaans) Leaves Angina (Van Wyk, 2008) Ruta graveolens L. Rutaceae Rue (English), wynruit (Afrikaans), gwabeni, ivendrit (Xhosa) Leaves High blood pressure, heart disease and cardiac asthma. (Watt and Breyer-Brandwijk, 1962; VanWyk, 2008; Olorunnisola et al., 2011; Philander, 2011; Van Wyk and Gorelik, 2017) (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 9 Table 1 (Continued) Plant species Family Common name Plant part(s) used Traditional use Reference Salvia africana L. Lamiaceae Blousali, bloublomsalie (Afrikaans) Leaves High blood pressure (Davids et al., 2016) Salvia disermas L. Lamiaceae Teesalie, grootblousalie, terpentynbos, muishondbos (Afrikaans) Not specified Unspecified heart problems and high blood pressure (Van Wyk and Gorelik, 2017) Salvia repens Burch. ex Benth. Lamiaceae Creeping sage (English), kruipsalie (Afri- kaans), usikiki (Xhosa) Not specified High blood pressure (Moffett, 2010) Salvia rosmarius Spenn. Lamiaceae Rosemary (English) Leaves Low blood pressure and unspeci- fied heart problems (Philander, 2011) Scabiosa columbaria L. Caprifoliaceae Small scabious, dwarf pincushion flower (English) Roots, leaves High blood pressure (Kose et al., 2015) Schkuhria pinnata (Lam.) Kuntze ex Thell. Asteraceae Yellow tumbleweed (English), rolkakiebos- sie (Afrikaans), tetapiso(Sotho) Whole plant High blood pressure and oedema (Mahwasane et al., 2013) Sclerocarya birrea (A.Rich.) Hochst. Anacardiaceae Marula (English), maroela (Afrikaans), umganu (Zulu), morula (Sotho), mufula (Venda) Bark Strengthen the heart (Hutchings, 1996; Corrigan et al., 2011) Scolopia mundii (Nees) Warb. Salicaceae Red pear (English), bergsaffraan, bergsaf- fraanhout, klipdoring, rooipeer (Afri- kaans), udwendwelwegcuba (Zulu) Not specified Unspecified heart problems (Hutchings, 1996) Searsia burchellii (Sond. Ex Engl.) Moffett Anacardiaceae Taaibos (Afrikaans) Leaves, stem and roots High Blood Pressure (Davids et al., 2016) Searsia lancea (L.f.) F.A.Barkley Anacardiaceae Makkaree, kareeboom (Afrikaans), t�silabele (Sesotho) Leaves, fruit High blood pressure (Moteetee and VanWyk, 2011; Kose et al., 2015) Selaginella cinerascens A.A. Eaton Selaginellaceae Resurrection plant (English) matlapa, mafika (Sotho) Not specified High blood pressure (Nortje and VanWyk, 2015) Senecio asperulus DC. Asteraceae Makhona-tsohle, moferefere (Sotho) Whole plant Improves blood circulation (Moffett, 2010; Kose et al., 2015) Senecio bupleuroides DC. Asteraceae Idwarane (Xhosa), indabula-luvalo, insan- gansanga yentaba, isiqandamatshana, unsonkonsoko (Zulu), lehlongoana, ler- eko (Sotho) Not specified Unspecified heart problems (Hutchings, 1996) Senecio cinerascens Aiton Asteraceae Handjiebos, vieroulap (Afrikaans) Not specified High blood pressure (Nortje and VanWyk, 2015) Senecio inornatus DC. Asteraceae Tall marsh senecio (English), groot vlei- senecio (Afrikaans), inkanga, uhlabo (Zulu), lehlongoana-le-leholo (Sotho) Root Palpitations (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Senna didymobotrya (Fresen). H.S Irwin & Barneby Fabaceae Mutsheketsheke (Venda) Aerial parts High blood pressure (Mudau et al., 2020) Senna italicaMill. Fabaceae Muḓuwaḓuwane (Venda) Leaf, root High blood pressure (Mudau et al., 2020) Senna obtusifolia (L.) H.S. Irwin & Barneby Fabaceae Muyekeyeke (Venda) Root High blood pressure (Mudau et al., 2020) Senna occidentalis (L.) Link Fabaceae Mutsheketsheke (Venda) Root High blood pressure (Mudau et al., 2020) Seriphium cinereum L. Asteraceae Not specified Not specified Unspecified heart problems (Watt and Breyer-Brandwijk, 1962) Sida cordifolia L. Malvaceae Flannel weed (English), hartblaartaaiman, koekbossie (Afrikaans) Whole plant High blood pressure (Mongalo and Makhafola, 2018) Solanum aculeastrum Dunal Solanaceae Bitter apple (English), bitterappel (Afri- kaans), umthuma, itunga (Xhosa), intuma (Zulu), thola (Tswana), murulwa (Venda) Not specified High blood pressure and stroke (Mhlongo and VanWyk, 2019) Solanum americanumMill. Solanaceae Seshoa-bohloko (Sotho) Roots, leaves, berries Unspecified heart problems, angina (Watt and Breyer-Brandwijk, 1962; Moteetee and VanWyk, 2011) Solanum incanum L. Solanaceae Intuma, intuma encane, umagangeni (Zulu) Not specified Cardiovascular (stroke) (Mhlongo and VanWyk, 2019) Solanum schefferi F.Muell. Solanaceae Intuma, intuma encane, umagangeni (Zulu) Not specified High blood pressure and stroke (Mhlongo and VanWyk, 2019) Solanum tomentosum L. Solanaceae Slangappel, slangappelbos (Afrikaans) Roots and stem Angina (Mugomeri et al., 2016) Spermacoce natalensis Hochst. Rubiaceae Insulansula, isindiyandiya, umabophe (Zulu) Bark Unspecified heart problems (Hutchings, 1996) Stangeria eriopus (Kunze) Baill. Zamiaceae Natal grass cycad (English), (Afrikaans), umncuma (Xhosa), imfingo (Zulu) Tuber High blood pressure (Hutchings, 1996) Strelitzia nicolai Regel & K. K€orn Strelitziaceae Isigude, inkalvasi, inkamanga (Zulu) Not specified High blood pressure, heart problems (Mhlongo and VanWyk, 2019) Strychnos madagascariensis Poir. Loganiaceae Black monkey range, spineless monkey orange, wild orange (English), botter- klapper, swartklapper (Afrikaans), muk- wakwa (Venda) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Strychnos potatorum L.f. Loganiaceae Mukongovhoti (Venda) Leaves, roots High blood pressure (Mudau et al., 2020) Strychnos spinosa Lam. Loganiaceae Amahlala, igulukungqa, igulukuza, ingola (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Tabernaemontana elegans Stapf Apocynaceae Muhatu (Venda) Roots High blood pressure (Mudau et al., 2020) Teedia lucida (Aiton) Rudolphi Scrophulariaceae Klipkersie, predikant-op-die-preekstoel, stinkbos (Afrikaans), hlwenya (Zulu) Not specified High blood pressure (Moffett, 2010) Tephrosia capensis (Jacq.) Pers. Fabaceae Not specified Roots Strengthens heart, heart palpitations (Watt and Breyer-Brandwijk, 1962; Moffett, 2010; Kose et al., 2015) Tephrosia semiglabra Sond. Fabaceae Not specified Roots, leaves Unspecified heart problems and tachycardia (Mugomeri et al., 2016) Thespesia garckeana F. Hoffm. Malvaceae Tree hibiscus, slime apple, snot apple (English), slymappel, snotappel (Afri- kaans), mutogwe (Venda) Roots High blood pressure (Mongalo and Makhafola, 2018) Thymus serpyllum L. Lamiaceae German thyme, common thyme (English) Not specified Unspecified heart problems (Watt and Breyer-Brandwijk, 1962) Trifolium africanum Ser. Fabaceae Erasmus clover, wild clover (English), wild- eklawer (Afrikaans), mmusapelo, Roots High blood pressure, heart related ailments, diuretic (Watt and Breyer-Brandwijk, 1962; Moffett, 2010) (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 10 Table 1 (Continued) Plant species Family Common name Plant part(s) used Traditional use Reference moroko, musapelo, mokopshwe, mootsa- pelo, moqoiqoi, moqophi (Sotho) Trifolium burchellianum Ser. Fabaceae Erasmus clover, wild clover (English), wild- eklawer (Afrikaans), mmusapelo, moroko, musapelo, mokopshwe, mootsa- pelo, moqoiqoi, moqophi (Sotho) Roots High blood pressure, heart related ailments, diuretic (Moffett, 2010) Tropaeolum majus L. Tropaeolaceae Bopa (Venda) Leaves High blood pressure (Mudau et al., 2020) Tulbaghia acutiloba Harv. Amaryllidaceae Sefotha-fotha (Sesotho) Not specified High blood pressure (Moffett, 2010; Moteetee and Van Wyk, 2011) Tulbaghia alliacea L.f. Amaryllidaceae Wild garlic, woodland garlic (English), wild- eknoflok (Afrikaans), ishaladilezinyoka, umwelela (Zulu), molela (Southern Sotho) Bulb Infusion (milk) used to treat high blood pressure (Van Wyk, 2008) Tulbaghia capensis L. Amaryllidaceae Wild garlic (English), wilde knoffel (Afri- kaans) Bulb Hypertension (Philander, 2011) Tulbaghia violacea Harv. Amaryllidaceae Wild garlic (English), wilde knoffel (Afri- kaans), isihaqa (Zulu) Bulb, leaves, roots High blood pressure (Davids et al., 2016; Mhlongo and VanWyk, 2019) Turraea floribunda Hochst. Meliaceae Honeysuckle (English), kanferfoelieboom (Afrikaans), umadlozane (Zulu), umdlo- zana (Swazi) Root Weak heart, high blood pressure, oedema (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Urtica urens L. Urticaceae Annual nettle, burning nettle, sting nettle bush, dwarf stinging nettle (English), brandnekel (Afrikaans) Leaves Unspecified heart problems (Moffett, 2010; Moteetee and Van Wyk, 2011) Vachellia eburnea (L. f.) P.J.H. Hurter & Mabb. Fabaceae Isinqawe esimphlope, umkhamba, uselephe (Zulu) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Vachellia sieberiana (DC.) Kyal. & Boatwr. Fabaceae Paperbark thorn (English), papierbasdoring (Afrikaans), umkhamba (Zulu), mphoka (Sotho), umnganduzi (Swazi), mokha (Tswana) Not specified High blood pressure (Mhlongo and VanWyk, 2019) Vigna vexillata (L.) A.Rich. Asteraceae Mukundulela (Venda) Leaves High blood pressure (Mudau et al., 2020) Viscum capense L.f. Santalaceae Cape mistletoe (English), lidjiestee, voelent (Afrikaans) Not specified Strengthens the heart (Van Wyk, 2008) Vitis vinifera L. Vitaceae Grape vine (English) Roots High blood pressure, used for weak heart (Van Wyk et al., 2008; Mongalo and Makhafola, 2018) Volkameria glabra (E. Mey.) Mabb. & Y.W. Yuan Lamiaceae Mukwatikwati (Venda) Leaf, root High blood pressure (Mudau et al., 2020) Warburgia salutaris (G. Bertol.) Chiov. Canellaceae Pepper-bark tree (English), peperbasboom (Afrikaans), isibhaha (Zulu), mulanga, manaka (Venda) Bark, leaves Angina, high blood pressure (Felhaber and Mayeng, 1997; Mudau et al., 2020) Withania somnifera (L.) Dunal. Solanaceae Indian ginseng, poison gooseberry, winter cherry (English), bitterappelliefie, koorshout (Afrikaans), ubuvuma (Xhosa), ubuvimbha (Zulu) Tubular roots, leaves Strengthens blood circulation (Mugomeri et al., 2016) Ximenia americana L. Olacaeae Tshitanzwatanzwa (Venda) Roots High blood pressure (Mudau et al., 2020) Xylopia odoratissima Welw. Ex Oliv Annonaceae Muvhulavhusiku (Venda) Roots High blood pressure (Mudau et al., 2020) Xysmalobium undulatum (L.) W.T. Aiton Apocynaceae Milk bush (English), ishongwe, ishinga (Zulu) Root Unspecified heart problems (Watt and Breyer-Brandwijk, 1962; Hutchings, 1996) Introduced and/or widely used alien species are indicated in bold text. I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 approximately 29.6 % of species, the plant part used was not defini- tively documented. Notably, most of the ethnobotanical studies iden- tified in the literature review documented Zulu traditional plant usage as a substantially greater number of Zulu ethnobotanical stud- ies have been published. Future studies into the traditional medicine systems (when they are ultimately available) may provide additional detail about the plant part used, as well as the method of preparation of the medicines and their methods of use. Of the 235 species documented in Table 1, only 43 species have been screened for bio-activies related to CVDs (Table 2). Notably, the screening of foreign/introduced species has generally been substantially more extensively reported than for native southern African species. Indeed, of the 40 introduced species listed in Table 1, 13 (33 %) have been screened for one or more CVD-related effects. In contrast, of the 194 native southern Afri- can plant species listed herein, only 31 species (16 %) had been tested for CVD-related bio-activities. This greater exploration of the introduced species may be related to these species being used in multiple medicinal systems globally. They may therefore have been tested due to their usage in the other traditional sys- tems. Thus, many of the plants listed herein are yet to be tested 11 for any CVD-related bio-activities and substantially more research is required. With regard to the screening of the southern African plants used traditionally to treat CVDs, the predominant bio-activity screened was angiotensin-converting enzyme (ACE) inhibitory activity. The ACE is involved in increased blood pressure in hypertension. Inhibition of ACE reduces blood pressure, and it is a target for the development of drugs targeting hypertension (Benowitz, 2017). In general, plant preparations are regarded as drug targets for the development of anti-hypertensive therapies if they inhibit ACE activity by greater than 50 % (Duncan et al., 1999; Ramesar et al., 2008). Of the 21 plant species that were screened specifically for ACE- inhibitory activity, only ten species/plant extracts had an ACE-inhibi- tory effects greater than 50% and were therefore considered to be targets for anti-hypertensive drug development. Leaf extracts pro- duced noteworthy ACE-inhibitory activity more frequently than other plant parts. No clear correlation was observed regarding the best solvent, with similar numbers of aqueous and ethanolic extracts inhibiting ACE activity by >50%. The effects of the extracts in rat hyperlipedemia models were also relatively well studied. Ten of the Fig. 2. The frequency that plant families were cited as being used in southern African traditional medicine to treat cardiovascular disease. Numbers above individual bars indicate the number of species in that family listed to treat CVDs. Bars labelled as either 2 or 1 species families refers to the number of families represented by the indicated number of spe- cies. I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 plant preparations were reported to significantly decrease hyperlipe- demia. Surprisingly, relatively few studies have examined the direct effects of the plant extracts on hypertension in vivo. Indeed, only ten studies (Table 2) examined the effects of the extracts on hyperten- sion, and nearly all those studies used rats as the test model. In vitro studies that screen the effects of the extracts against specific in vitro targets are important to understand the therapeutic mechanisms in treating CVDs. However, these models do not account for the bio- availability of the therapeutic components (including gastrointestinal absorption rates, metabolism and inactivation, cell entry etc.). In vivo studies are required to verify that the extracts/isolated components Fig. 3. The cardiovascular disease types treated with the southern African plants expressed as a percentage of the total uses. Several plant species were used to treat more than one type of CVD. Those species are included in all the administration catego- ries in which they are listed. 12 also work in complex multicellular systems. Substantially more research is required to verify that these plant preparations have ther- apeutic effects against CVDs in vivo, and thereby to validate their use for those purposes. Furthermore, only a single clinical trial in humans was found, with A. ferox treatment inducing substantial decreases in hyperlipidemia and hypertension in obese human patients. 6. Discussion Notably, of the 235 documented plant species recorded herein as being used traditionally to treat CVDs, only 43 species have been screened for any CVD-related properties (Table 2). Perhaps more sur- prisingly, only 10 studies (one clinical trial and nine studies using rat models) directly verified the anti-hypertensive activity of the extracts in vivo. A further 10 studies reported the ability of some extracts to reduce blood lipid levels in both normal and induced-hyperlipidemia Fig. 4. The relative proportion that individual plant parts were used to treat cardiovas- cular disease, expressed as a percentage of the overall usage. For several plant species, more than one part was used therapeutically to treat CVDs. Those species are included in all of the plant part categories in which they are listed. Table 2 Scientific evaluations of southern African medicinal plants for cardio-preventative and/or therapeutic properties. Plant species Plant part tested Type of extract Outcome of study References Agapanthus africanus (L.) Hoffmanns. Leaves Aqueous extract Inhibited ACE activity by 63% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 44% Roots Aqueous extract Inhibited ACE activity by 37% Ethanol extract Inhibited ACE activity by 19% Agave americana L. Leaves Aqueous extract Inhibited ACE activity by 72% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 82% Aloe feroxMill. Multiple dietary supple- ments containing pow- dered A. ferox leaf Powdered leaf All supplements reduced hyperlipidemia and reduced blood pressure in a clini- cal study of obese patients. (Gherbon et al., 2021) Artemisia afra Jacq. Leaves Methanol extracts Highest% ACE inhibition activity noted at approximately 60% at a concentration of 250mg/ml. (Reddy et al., 2023) Aspalathus linearis (Burm.f.) R.Dahlgren Leaves Aqueous extract Protects against nicotine-induced vascu- lar injury in Wistar rats. (Smit-van Schalkwyk et al., 2020) Leaves Aqueous extract Reported to have a significant reduction after 30 min (P < 0.01) and after 60 min (P < 0.05) of ACE in 17 healthy volunteers, however, no nitric oxide (NO) donation was observed. (Persson, 2012) Leaves Fermented tea The lipid profiles showed that tea con- sumption decreased serum LDL-cho- lesterol (4.6 § 1.3 mmol/L vs. 3.9 § 0.7 mmol/L) and triacylglycerols (1.7 § 0.8 mmol/L vs. 1.2 § 0.7 mmol/ L), Consumption of fermented, tradi- tional rooibos significantly improved the lipid profile as well as redox status which are both relevant to heart disease (Marnewick et al., 2011) Bidens pilosa L. Leaves Methanol extract Reduces hypertension and systolic blood pressure in hypertensive rats. Also reduces hyperlipidemia. (Dimo et al., 2003) Leaves Aqueous extract Decreased systolic blood pressure by 34% at 20 mg/kg in induced hypertensive rats. (Dimo et al., 2003) a Boophone disticha (L.f.) Bulbs Aqueous ethanolic extract Significantly reduced blood pressure response in mice as compared to diaz- epam treatments (Pote et al., 2013) Cannabis sativa L. Seeds Aqueous extract Whole seeds incorporated into rat feed exhibited significantly post- ischemic recovery and enhanced rates of cardiac tension development and relaxation in Sprague-Dawley rat hearts. (Al-Khalifa et al., 2007) Leaves Not specified Decreased levels of LDH in experimental mice compared to untreated mice. (Ahmed et al., 2016) Leaves Aqueous extract Inhibited ACE activity by 3% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 18% Catha edulis (Vahl) Forssk. Endl. Leaves Aqueous extract Inhibited ACE activity by 48% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 82% Catharanthus roseus (L.) G. Don Leaves Leaf juice Reduces hyperlipidemia in rats. (Azam et al., 2022) Centella asiatica (L.) Urb Not specified Aqueous extract Inhibited ACE activity by 38% (Ramesar et al., 2008) Ethanol extract Inhibited ACE activity by 11% Clausena anisata (Willd.) Hook.f. Leaves Aqueous extract Inhibited ACE activity by 54% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 1% Methanol Highest% ACE inhibition activity noted at approximately 60% at a concentration of 250mg/ml. (Reddy et al., 2023) Combretum molle R.Br. ex G. Don Leaf Aqueous extract and an iso- lated compound (1a- hydroxycycloartenoid saponin) Both the extract and the isolated saponin reduced contractions of the portal veins in guinea pig andWistar rats. They also relaxed pre-contracted aortic rings and produced significant reduc- tions in arterial blood pressure and heart ratess in hypertensive rats. (Ojewole et al., 2006) Dicoma anomala Sond. Roots Aqueous extract Treatment with extract (500 mg/kg) ameliorated oedema and myocardial necrosis in myocardial damage induced Wistar rats. (Balogun and Ashafa, 2016) Dietes iridioides (L.) Sweet ex Klatt Leaves Aqueous extract Inhibited ACE activity by 80% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 7% Roots Aqueous extract Inhibited ACE activity by 13% Ethanol extract Inhibited ACE activity by 13% Leaves Aqueous extract Inhibited ACE activity by 10% (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 13 Table 2 (Continued) Plant species Plant part tested Type of extract Outcome of study References Dombeya rotundifolia (Hochst.) Planch. (Duncan et al., 1999; Reddy et al., 2023) Ethanol extract Inhibited ACE activity by 83% Methanol Highest% ACE inhibition activity noted at approximately 90% at a concentration of 250mg/ml. Bark Aqueous extract Inhibited ACE activity by 5% Ethanol extract Inhibited ACE activity by 24% Drimia elata Jacq. ex Willd. Leaves Aqueous extract Inhibited ACE activity by 16% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 16% Bulbs Aqueous extract Inhibited ACE activity by 2% Ethanol extract Did not inhibit ACE activity. Ekebergia capensis Sparrm. Leaves Aqueous extract Inhibited ACE activity by 26% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 37% Eriobotrya japonica (Thunb.) Lindl. Leaves Isolated polysaccharide Improves myocardial ischemic injury via antioxidant and anti-inflammatory activities. (Huang et al., 2022) Leaves Aqueous infusion Decreased cardiac heterotrophy in H9c2 cardioblasts, and in induced-hyperten- sive rats. (Chiang et al., 2018) a Galenia africana L. var. africana Stems and leaves Dichloromethane extrct Reduced the peak tail human ether-a-go- go-related gene current by 50.4 § 5.5 % (n = 3) at a concentration of 100 mg/ mL, and therefore would mitigate car- diac arrhythmia. (Du et al., 2015) Harpagophytum procumbens DC. ex Meisn. Roots Aqueous extract Inhibited blood coagulation and haemol- ysis by 11.5% in vitro.May therefore prevent stroke. (Cordier et al., 2012) Hypoxis colchicifolia Baker Leaves Aqueous extract Inhibited ACE activity by 30% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 37% Roots Aqueous extract Inhibited ACE activity by 4% Ethanol extract Inhibited ACE activity by 15% Hypoxis hemerocallidea Fisch., C.A. Mey. & Av�e- Lall. Corms Aqueous extract The extract (25�400 mg/kg) reduced inotropic and chronotropic effects in induced-hypertensive guinea pig iso- lated hearts. The extract also signifi- cantly reduced myogenic contractions of portal veins isolated from induced hypertensive rats. (Ojewole et al., 2006) Lavandula angustifolia Mill. Leaves Essential oil Lavendar oil (200 mg/kg) reduced myo- cardial injury via reductions in tropo- nin I and TNF-a in experimental rats. (Sadeghzadeh et al., 2017) Leaves Essential oil Injected essential oil had significant car- dio-protective effects in Wistar rats. (Ziaee et al., 2015; Souri et al., 2019) Leonotis leonurus (L.) R.Br. Leaves Aqueous extract Relieved hypertension in induced-hyper- tensive rats. (Nkadimeng et al., 2018) Momordica balsamina L. Not specified Aqueous extract Inhibited ACE activity by 49% (Ramesar et al., 2008) Ethanol extract Inhibited ACE activity by 9% Olea europaea L Leaf Ethanol extract Showed a possible ability to antogonise calcium in the aorta of rabbits. (Rauwald et al., 1994) Persea americanaMill. Fruit pulp Fruit pulp Improves cardiac recovery (heart rate, and rate variability) after running. (Sousa et al., 2020) Leaves Aqueous extract Reduces hyperlipidemia in rats. (Brai et al., 2007) Leaves Aqueous extract Significantly reduced blood pressure in hypertensive Sprague-Dawley rats. (Sokpe et al., 2020) Petroselinum crispum (Mill.) Fuss Aerial parts Aqueous extract Decreased systolic, diastolic and mean arterial pressure in hypertensive rats. Functions via vasodilation. (Ajebli and Eddouks, 2019) Leaves Aqueous extract Significantly reduces hyperlipidemia in streptozotocin treated rats. (Soliman et al., 2015) Protorhus longifolia Engl. Leaves Aqueous extract Inhibited ACE activity by 64% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 77% Ruta graveolens L. Leaves Methanolic extract Increased atrioventricular conduction and functional refractory times in iso- lated rat hearts, indicating potential to treat tachyarrhythmia. (Khori et al., 2008) Root Dichloromethane Showed a possible ability to antagonise calcium in the aorta of rabbits. (Rauwald et al., 1994) Salvia Rosmarinus Spenn. Leaves Methanol extracts Reduced vasoconstrictor peptide (angio- tensin II and endothelin-1) levels, increased vasodilators angiotension 1�7 and bradikinin in ischemic Wistar rat hearts. Also restored intraventricu- lar pressure and cardiac mechanical work. (Cuevas-Dur�an et al., 2017) Leaves Ground leaves were mixed with rat chow Attenuates cardiac remodelling after induced myocardial infarction in rats. (Murino Rafacho et al., 2017) (continued) I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 14 Table 2 (Continued) Plant species Plant part tested Type of extract Outcome of study References Leaves Aqueous infusion Reduces hyperlipidemia in streptozoto- cin-induced rats. (Alnahdi, 2012) Schkuhria pinnata (Lam.) Kuntze Whole plant Aqueous extract Reduces hyperlipidemia via inhibition of lipase activity in Wistar rats. (Kiage-Mokua et al., 2020) Sclerocarya birrea Hochst. Leaves Aqueous extract Did not inhibit ACE activity (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 68% Methanol Highest% ACE inhibition activity noted at approximately 80% at a concentration of 250mg/ml. (Reddy et al., 2023) Solanum aculeastrum Dunal Bark Aqueous and methanol extracts Inhibited blood coagulation and haemol- ysis by up to 100% in vitro.May there- fore prevent stroke. (Cordier et al., 2012) Stangeria eriopus (Kunze) Baill. Leaves Aqueous extract Inhibited ACE activity by 55% (Duncan et al., 1999) Ethanol extract Inhibited ACE activity by 7% Thymus serpyllum L. Aerial parts Aqueous extract Protects against induced myocardial ischemia at 15 mg/kg in Sprague-Daw- ley rats. Decreased the levels of the cardiac enzymes CK-MB, LDH, AST. (Alotaibi et al., 2022) Leaves Aqueous infusion Injection of extract into Wistar rats induced substantial reductions in sys- tolic and diastolic blood pressure. (Mihailovic-Stanojevic et al., 2013) Tulbaghia acutiloba Harv. Roots, leaves and flowers Hydro-methanol extracts Inhibits ACE enzyme activity. (Isaiah et al., 2019) Tulbaghia violacea Harv. Leaves Aqueous extract Inhibited ACE activity by 72% (Duncan et al., 1999; Oje- wole et al., 2006; Balogun and Ashafa, 2016) Ethanol extract Inhibited ACE activity by 61% Roots Aqueous extract Inhibited ACE activity by 49% Ethanol extract Inhibited ACE activity by 27% Not specified Aqueous extract Inhibited ACE activity by 68% (Ramesar et al., 2008) Ethanol extract Inhibited ACE activity by 71% Not specified Not specified Showed a reduction in systolic blood pressure of 10.8 % in the rat model. (Mackraj et al., 2008) Turraea floribunda Hochst. Leaves Aqueous extract Inhibited ACE activity by 45% (Duncan et al., 1999) Ethanol extract Did not inhibit ACE activity. Urtica urens L. Aerial parts Hydro-alcohol extract Blocked lipase activity and therefore decreases hyperlipidemia. Has a car- dio-protective effect as hyperlipidemia can induce cardiac disease. (Jaradat et al., 2017) Warburgia salutaris (G. Bertol.) Chiov. Leaves Methanol Highest% ACE inhibition activity noted at approximately 35% at a concentration of 250mg/ml. (Reddy et al., 2023) Withania somnifera (L.) Dunal. An Ayugverdic medicine Aqueous suspension Protects against doxirubicin-induced car- diac toxicity. (Hamza et al., 2008) Roots Aqueous extract Prevents hyperlipidemia and therefore cardic disease in rats. (Anwer et al., 2017) Roots Aqueous extract Inhibited cardiac injury after ischemia and reperfusion in Wistar rats. (Mohanty et al., 2004) Introduced and/or widely used alien species are indicated in bold text. a indicates tested species for which no record of traditional use to treat cardiovascular diseases was found. ACE = angiotensin converting enzyme; DCM = dichloromethane. I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 rat models. Additionally, a single study also reported anti-hyperlipi- demic effects of A. ferox leaves in obese human patients. Substantially more studies are required to test all the traditionally used plant spe- cies against these effects in vivo. Most of the studies into the effects of southern African plants used in vitro assays to screen the extracts for specific effects rele- vant to CVDs. Many of these studies examined the extracts for ACE inhibitory activity. Notably, 10 species/plant extracts inhib- ited ACE activity by >50 % and were therefore deemed to be good drug targets. Specifically, methanolic and aqueous A. americana leaf, aqueous A. africanus leaf, ethanolic C. edulis leaf, aqueous C. anisata leaf, aqueous D. iridoides leaf, aqueous D. rotundifolia leaf, aqueous and ethanolic P. longifiolia leaf, ethanolic S. birrea leaf, aqueous S. eriopus leaf, as well as aqueous and ethanolic T. viola- ceae leaf extracts each inhibited >50% ACE activity and warrant further investigation as anti-hypertensive therapies. However, potent in vitro ACE inhibitory activity does not guarantee that the plant preparation would have good anti-hypertensive activity in vivo and substantially more work is required before these plants are used clinically. Similarly, poor ACE inhibitory activity does not necessarily mean that the plant species is ineffective at low- ering blood pressure, as the extract compounds may function via 15 different mechanisms. These plant species should also be tested against other anti-hypertensive targets, such angiotensin receptor blockers (ARBs), b-blockers, calcium channel blockers (CCBs) and vasodilators. Additionally, further studies are required to test the other species for ACE inhibitory activity (Wagner et al., 1991). Except for the effect of the extracts on hyperlipidemia, other CVD biomarker assays, including oedema and hypertension have been rel- atively neglected. Eleven studies have confirmed the ability of south- ern African plant extracts to significantly reduce blood lipid levels. Hyperlipidemia can result in fatty deposits in the arteries and subse- quent blockages. Therefore, the ability of the plant extracts to decrease blood lipid levels is interesting and indicates that those extracts may be useful in decreasing the incidence of some CVDs (e.g. strokes). Further studies are required to evaluate the specific blood lipids affected by these extracts. For example, decreases in low den- sity lipoprotein (LDLs) levels would be beneficial. However, if high density lipoproteins (HDLs) also decrease, this may result in increased risks of artherosclerosis as HDLs (which contain low levels of cholesterol) essentially absorb free cholesterol, thereby decreasing its levels in the bloodstream. Notably, the studies documented in Table 2 that screen the southern African plants for anti- I.E. Cock, A. Orchard, L. Booi et al. South African Journal of Botany 173 (2024) 1�18 hyperlipidemia effects generally did not discriminate between clas- ses of lipid. Further studies are required to determine the types of lip- ids and lipoproteins affected by these extracts. It is widely (although often erroneously) believed that plant- based medicines are safe for therapeutic use. However, many plants have substantial toxicity and caution may be required with the prep- aration and dosage of traditional medicines (Khumalo et al., 2023). This is especially true for long term therapeutic usage, as is required for anti-hypertensive and anti-hyperlipidemia medicines. Notably, few of the screening studies listed in Table 2 examined the toxicology profiles of the extracts in parallel with the bio-activity studies. For many of these plant species, the toxicity of the extracts has been eval- uated in other studies examining different bio-activities. Toxicity should be evaluated in the same study that the therapeutic effects are examined to allow for determination of safety/therapeutic indices. 7. Conclusion This study documented plant species that are used in southern African traditional medicine to treat CVDs, and highlighted previous studies that have verified their effects, or screened them for bio- activities relevant to treating CVDs. A review of the ethnobotanical records and surveys identified 235 plant species that are traditionally used in southern Africa to manage CVDs. Despite this, validation studies to confirm the therapeutic properties of preparations of these plants against CVDs have been largely neglected. Indeed, approxi- mately 19% of the plant species used in southern African traditional medicine to treat CVD have been screened for any properties relevant to CVD therapy. Furthermore, for those plants that have been exam- ined scientifically, few have been tested against more than one target (most commonly ACE inhibitory activity). Additionally, relatively few in vivo studies were reported and only a single clinical study in humans was undertaken. Much more research is needed to verify the effectiveness of the southern African plant-based traditional medi- cines, as well, and to determine the therapeutic mechanisms. Addi- tionally, the toxicity and therapeutic index of the listed plant species needs to be reported before these plants can be considered clinically. Declaration of competing interest The authors declare that they have no conflicts of interest. CRediT authorship contribution statement I.E. Cock: Writing � review & editing, Writing � original draft, Supervision, Formal analysis, Data curation, Conceptualization. A. Orchard: Writing � review & editing, Supervision. L. 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