REVIEW OF RELATED LITERATURE Cymbopogon citratus (Lemon grass), is cultivated throughout the Philippines where it is locally known as tanglad.

It is also grown in South and Central America, Africa, Australia, and in other tropical and subtropical areas of Asia. The plant is an aromatic perennial tall grass with rhizomes and densely tufted fibrous root. It has short underground stems with ringed segments, coarse, scabrous, flate, long-acuminate, and smooth green slightly leathery leaves in dense clusters of up to 1 meter long and about 1-1.5 cm wide. Panicles are thirty to eighty centimeters long, with noding branches and branchlets. Spikelets are linear-lanceolate and pointed, about six millimeters long (Oloyede, 2009). The usefulness of the said plant is based on its presenting chemical constituents. The leaves and roots of fresh lemon grass contain approximately 0.4% volatile oil which includes citral (40%), citral (32%), nerol (4.18%), geranicol (3.04%), citronellal (2.10%), terpinolene (1.23%) and geranyl acetate (0.83%) etc and all are important raw material used in the pharmaceutical, perfumery and cosmetics industries, especially for the synthesis of Vitamin A and ionones. C. Nonvolatile components include total carbohydrates (17 g), saturated fat (0.1 gm), total omega-3 fatty acids (20.8 mg), total omega-6 fatty acids (92.4 mg) and protein (1gm). Among the vitamins present are vitamin A (4.0 IU), vitamin B6 (0.1 mg), vitamin C (1.7 mg), riboflavin (0.1 mg), niacin (0.7 mg) and folate (50.2 mcg). Aside from vitamins, they are also rich in iron (5.5 mg), manganese (3.5 mg), copper (0.2 mg), selenium (0.5 mcg), potassium (484 mg) , calcium (43.6 mg), phosphorous (67.7 mg), and magnesium (40. 2 mg). Flavonoids luteolin and 6-C-glucoside have also been isolated (Ravinder, 2010). A research study was conducted by Elson et. al. on antihypercholesterolemic and antihypertensive action of geraniol and citral. Results indicate that the twenty-two hypercholesterolemic subjects (3159 mg cholesterol/dl) who were asked to take a daily capsule containing 140 mg of lemon grass oil and completed the 90-day study showed a paired difference in serum cholesterol levels of significance (p <0.06, 2-tailed t-test) proving that lemon grass has significant antihypercholesterolemic and antihypertensive effects. Harrison et. al. in 2008 stated that LDL levels promote atherogenesis developmental process of atheromatous plaques characterized by remodelling or arteries

involving the concomitant accumulation of fatty substances. A wealth of epidemiologic data support a relationship between hypertension and atherosclerotic risk, clinical trial evidence has established that pharmacologic treatment of hypertension, can reduce the risk of stroke, heart failure and CHD events. This is also supported by Durante et. al. in 1991 conducted a large clinical research trial entitled A Parallel Group DoubleBlind Study of Once Daily Quinapril Versus Enalapril in the Treatment of Mild-ToModerate Hypertension showed that the further risk reduction in cardiovascular endpoints were achieved by lowering low density lipoprotein. Moreover as reported by Torres R, et al, presence of geraniol in lemon grass believed to work as a tonic for improving the strength and functions of the nervous system. It acts as a diuretic and helps promote urination and relieves retained water. In the book entitled Medicinal Plants of the Philippines by Quisumbing in 1978, states that the roots yield a decoction used as a diuretic. This is supported by the study made by Carbajal et. al. in 1989 where a pharmacological screening for cardiotonic, hypotensive, or bronchodilator activities was performed on their traditional medical use by the Cuban population. One of which is lemon grass (Cymbopogon citriatus) leaves employed by the Cuban population as antihypertensive and antiinflammatory. But the diuretic property of the lemon grass is yet to be determined. The decoction showed diuretic and anti-inflammatory effect when given orally. This diuretic effect of lemon grass was also claimed by Montala in 2006. Hypertension is a state of abnormally elevated arterial pressure and is one of the most important health problems today. It is one of the top ten leading causes of morbidity and can be diagnosed using the criteria JNC VII. Diagnosis can be made when the average of two or more diastolic blood pressure measurements on at least two subsequent visits is 90 mmHg or higher and systolic blood pressure is consistently greater than 140 mmHg. Shown below is the classification of hypertension by JNC VII based on the average of two or more readings (Harrison, et.al., 2008). Table 1 Seventh Joint National Committee Classification of Hypertension: Based on at Least Two Separate Measurements Hypertension Category Systolic (mm Hg) Diastolic (mm Hg)

Normal Prehypertension Hypertension Stage 1 (mild) Hypertension Stage 2 (moderate-severe)

<120 120-139 14-159 160

<80 80-89 90-99 100

A lot of factors may influence the disease that may lead to its reduction towards normal or further elevation. The considered risk factors include age, race, sex, smoking, alcohol intake, serum cholesterol, glucose intolerance, weight, family history and physical activity). The The Seventh Report of the Joint National committee reported that prevalence of hypertension increases with advancing age to the point where more than 50% of people 6069 years of age and approximately 75% of those 70 years of age and older are affected. The age related rise in SBP is primarily responsible for an increase in both incidence and prevalence of hypertension with increasing age. However, the younger the patient when hypertension first noted, the greater the life expectancy if the hypertension is left untreated. In the United States urban blacks have about twice the prevalence of hypertension as whites and more than four times the hypertension-induced morbidity rate. At all ages and in both white and nonwhite populations, females with hypertension fare better than males up to the age of 65, and the prevalence of hypertension in premenopausal females is substantially less than that in age-matched males or postmenopausal women. Yet, compared with their normotensive counterparts, females with hypertension run the same relative risk of a morbid cardiovascular event as do males ( Harrison, et. al, 2008). Cigarette smoking transiently increases blood pressure, likely because the effect of nicotine on the automic ganglia, and a risk factor for the development of sustained hypertension. In addition, the atherogenic effect of smoking may contribute to the development of renovascular hypertension. Cigarette usage is associated with many other health hazards, and all patients should be discouraged from smoking. The chronic intake of alcoholic beverages correlates with high blood pressure. The reason for this link remains incompletely understood experimental evidence shows that blood pressure (especially systolic) may rise acutely following alcohol consumption. In people with hypertension, who are obese or have type 2 diabetes there is impaired

insulin independent transport of glucose into many tissues termed insulin resistance. As a result serum glucose levels rise, stimulating the pancreas to release additional insulin. Elevated insulin levels may contribute to hypertension via increased sympathetic activation or by stimulation of vascular smooth cell hypertrophy, which increases vascular resistance. Obesity itself has been directly associated with hypertension. The current epidemic of obesity has led to a dramatic increase in the number of people with metabolic syndrome. This condition represents a clustering of atherogenic risk factors, including hypertension, hypertriglyceridemia, low serum HDL, a tendency toward glucose intolerance and truncal obesity (Lily, 2007). About 90-95% of hypertension is idiopathic (no known cause) which appears to be primary (essential hypertension), while the remaining 5-10% is mostly secondary. Essential hypertension may be caused by generalized or functional abnormalities while secondary hypertension may be either benign or malignant. The most dangerous of which is malignant or accelerated hypertension that leads to death within a year or two in about 5% of hypertensive persons that show a rapidly rising blood pressure when left untreated (Cotran, et.al , 1996). The choice of treatment of hypertension is such that a satisfactory program to control arterial pressure with minimal side effects can be developed for most patients. A reasonable guideline would be that all patients with a diastolic arterial pressure that persistently exceeds 90mmHg, unless contraindications exist should be treated and that all patients with a systolic arterial pressure over 180mmHg should be treated if they are over age 65. Nondrug therapeutic intervention is probably indicated in all patients with sustained hypertension and probably in most with labile hypertension. The general measures employed include (1) relief of stress, (2) dietary management, (3) regular aerobic exercise, (4) weight reduction (if needed), and (5) control of other risk factors contributing to the development of arteriosclerosis through restriction in the intake of cholesterol and saturated fats and other dietary management aimed to control risk factors such as sodium restriction. Probably the most signicant additional step that could be taken in this area would be to convince the smoker to give up cigarettes. In general, there are seven classes of drugs: diuretics, ACE inhibitors, angiotensin receptor antagonists, calcium channel antagonists; antiadrenergic agents, vasodilators,

and mineralocorticoid receptor antagonists. The aim of drug therapy is to use these agents above or in combination, to return arterial pressure to normal levels with minimal side effects. Ideally a therapeutic program should be chosen which specifically corrects to underlying defect, resulting in the elevated blood pressure, taking into consideration efficacy, saety, imapct on quality life, compliance, ease of administration and cost (Harrison, et. al., 2008). Patel et. al. in 2011 stated that diuretics are the oldest and most studied antihypertensive agents. It increases the kidneys' excretion of salt and water, decreasing the volume of fluid in the bloodstream and the pressure in the arteries. With continued diuretic therapy, blood volume is restored, and vasodilator mechanisms sustain the antihypertensive action. Traditionally thiazide diuretics have formed the cornerstone of most therapeutic programs designed to lower arterial pressure, and they are usually effective within 3 to 4 days. Furthermore, they have been shown to reduce mortality and morbidity in long-term trials. Lemon grass has no potential toxic properties. Leite et. al. in 1986 conducted a study on the effect of lemon grass as eventual, toxic, hypnotic, and anxiolytic effects on humans. A herbal tea (called an abafado in Brazil) prepared from the dried leaves of lemongrass was administered to healthy volunteers. Following a single dose or 2 weeks of daily oral administration, the abafado produced no changes in serum glucose, urea, creatinine, cholesterol, triglycerides, lipids, total bilirubin, indirect bilirubin, GOT, GPT, alkaline phosphatase, total protein, albumin, LDH and CPK. Urine analysis (proteins, glucose, ketones, bilirubins, occult blood and urobilinogen) as well as EEG and EKG showed no abnormalities. There were slight elevations of direct bilirubin and of amylase in some of the volunteers, but without any clinical manifestation. These results taken together indicate that lemon grass as used in Brazilian folk medicine is not toxic for humans.