International Journal of Clinical Case Reports 2024, Vol.14, No.5, 262-275 http://medscipublisher.com/index.php/ijccr 270 administration. The study also found that Eucommia ulmoides modulated the gut microbiota, enriching the Parabacteroides strain, which is associated with anti-hypertensive effects (Yan et al., 2022). These findings suggest that Eucommia ulmoides not only lowers blood pressure but also exerts beneficial effects on gut health and inflammation. 7.2 Comparative effectiveness with other treatments Comparative studies have been conducted to evaluate the effectiveness of Eucommia ulmoides against other antihypertensive treatments. One such study compared the effects of lignan extracts from Eucommia ulmoides bark with captopril, an angiotensin-converting enzyme (ACE) inhibitor, and epalrestat, an aldose reductase inhibitor, in SHRs. The results showed that both captopril and lignan extracts significantly lowered blood pressure and improved cardiac remodeling, similar to epalrestat (Li et al., 2013). This indicates that Eucommia ulmoides lignans are as effective as conventional antihypertensive drugs in managing hypertension and preventing cardiac complications. Another study focused on the combination of Eucommia ulmoides and Tribulus terrestris (ET) in elderly SHRs. The ET treatment not only decreased blood pressure but also improved colonic tissue morphology and altered the intestinal microbiota composition. The study identified Eubacterium as a target microbe for ET, which was negatively correlated with certain metabolites associated with hypertension (Figure 3) (Qi et al., 2020). This combination therapy highlights the potential of Eucommia ulmoides in enhancing the efficacy of other herbal treatments for hypertension. 7.3 Long-term outcomes in patients using Eucommia ulmoides Long-term studies on the use of Eucommia ulmoides in hypertensive models have shown promising results. For instance, a study on SHRs treated with Eucommia ulmoides lignans for 16 weeks demonstrated significant reductions in blood pressure and improvements in vascular remodeling. The study found that lignans from Eucommia ulmoides inhibited aldose reductase activity, which plays a crucial role in hypertensive vascular remodeling (Gu et al., 2011). These findings suggest that long-term use of Eucommia ulmoides can effectively manage hypertension and prevent vascular complications. Another long-term study investigated the effects of Eucommia ulmoides leaf extract (ELE) on vascular function in SHRs. The ELE was administered for seven weeks, and the results showed significant improvements in endothelium-dependent relaxation, increased plasma nitric oxide (NO) levels, and reduced media thickness in the aorta. These outcomes indicate that long-term ELE administration can enhance vascular function and prevent hypertrophy, contributing to better management of hypertension (Zhang et al., 2021). In conclusion, Eucommia ulmoides has demonstrated significant antihypertensive effects in various animal models, with potential mechanisms involving modulation of gut microbiota, inhibition of aldose reductase activity, and enhancement of vascular function. Comparative studies have shown that Eucommia ulmoides is as effective as conventional antihypertensive drugs, and long-term use can lead to sustained improvements in blood pressure and vascular health. These findings support the potential of Eucommia ulmoides as a valuable treatment option for hypertension. 8 Potential Synergistic Effects with Other Hypotensive Agents 8.1 Combination therapies involving Eucommia ulmoides Eucommia ulmoides (EU) has been traditionally used in combination with other herbs to enhance its therapeutic effects. One notable combination is with Tribulus terrestris (TT), which has been utilized in clinical practice for thousands of years to treat hypertension. The combination of Eucommia ulmoides and Tribulus terrestris (ET) has shown promising results in reducing blood pressure in spontaneously hypertensive rats (SHRs). The ET combination not only decreased blood pressure but also improved colonic tissue morphology and altered the structure and composition of the gut microbiota, which is believed to play a role in its antihypertensive effects (Qi et al., 2020). Another study explored the Eucommia ulmoides–Dipsaci Radix (EU-DR) herbal pair, which is
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