Moringa oleifera for blood pressure regulation and endothelial dysfunction - Mechanisms and therapeutic potential in cardiovascular disease: A review.

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide. Atherosclerosis, the primary pathological mechanism underlying CVDs, culminates in endothelial dysfunction (ED). Reversible ED, characterized by impaired vascular relaxation and increased inflammation, represents a critical therapeutic target. Moringa oleifera (M. oleifera), often referred to as the "miracle tree," is garnering significant interest due to its broad spectrum of medicinal properties, including antihypertensive and endothelial-protective activities. Rich in bioactive compounds such as flavonoids, polyphenols, and vitamins, this plant exhibits diverse pharmacological activities.This review aims to explore the role of M. oleifera in hypertension management and the improvement of endothelial function. Clinical evidence primarily supports the blood pressure-lowering effects of M. oleifera. Preclinical studies, however, suggest additional mechanisms, including enhanced nitric oxide (NO) bioavailability, angiotensin-converting enzyme (ACE) inhibition, potent antioxidant activity, diuretic effects, and direct endothelial protective actions. Furthermore, preclinical findings elucidate that its vasodilatory and diuretic effects may involve NO-mediated pathways, hydrogen sulfide (H₂S) signaling, and endothelium-derived hyperpolarizing factor (EDHF)-dependent mechanisms, thereby highlighting its potential therapeutic value in vascular health. Its antioxidant capacity may also confer protection against the oxidative and nitrosative stress commonly associated with hypertension- and diabetes-induced endothelial dysfunction. While promising, the majority of current evidence is derived from animal models and small-scale clinical studies. Therefore, further well-designed, large-scale human studies are imperative to definitively establish the efficacy and safety of M. oleifera as a natural therapeutic agent for cardiovascular health. This review underscores the critical need for additional research to fully clarify the therapeutic potential of M. oleifera in the prevention and management of CVDs.