Hypertension induced by liquorice tea

Allcock, Emily; Cowdery, James R.

doi:10.1136/bcr-2015-209926

Cited by 14 publications

(11 citation statements)

References 8 publications

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“…[ 11 ] Several administrations have issued advice on the dose of glycyrrhizin to increase the awareness of health hazards associated with excessive intake. [ 12 ] For example, the European Scientific Committee on Food advises a safe average daily intake of glycyrrhizin should not be >10 mg daily, and believes that regular intake of 100 mg of glycyrrhizin daily have potential health hazards. The Food Standards Agency in the UK requires a warning stating potential harms on any beverage with >50 mg/L of glycyrrhizin.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive crisis with 2 target organ impairment induced by glycyrrhizin

Li¹,

Fan

Wang³

2018

Medicine

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Rationale:Glycyrrhizin is the main active component of licorice. Licorice and glycyrrhizin induced hypertension has been widely reported, yet licorice and glycyrrhizin induced hypertensive crisis has been rarely known.Patient concerns:The case of this report was a 47-year-old woman, who took 225 mg of glycyrrhizin daily for 3 years due to primary biliary cholangitis. She was found to have a dramatically elevated blood pressure of about 230/110 mmHg without a history of hypertension and was referred to the emergency department.Diagnoses:Hypokalemia, hypertensive retinopathy, and nephropathy were found during the following work-up. Since no other risk factors of hypertension were identified, she was suspected to have glycyrrhizin induced pseudo-hyperaldosteronism.Interventions:Glycyrrhizin was discontinued. Intravenous sodium nitroprusside was used during the first few days. Nifedipine and irbesartan were taken after discharge, and the dosage was reduced gradually under supervision.Outcomes:She stopped all the anti-hypertensive drugs 6 months since glycyrrhizin was stopped. Her blood pressure was about 110/60 mmHg after repetitive measurement. Her serum potassium and urine albumin/creatinine ratio were also normalized.Lessons:Licorice and glycyrrhizin induced hypertension due to pseudo-hyperaldosteronism has been widely reported, yet only 3 cases reported that excessive consumption of licorice could lead to hypertensive emergencies. This is the first case that glycyrrhizin induced hypertensive crisis with target organ impairment. By presenting this case, we remind clinicians of glycyrrhizin induced hypertension, a condition which could lead to medical emergencies.

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Section: Discussionmentioning

confidence: 99%

Hypertensive crisis with 2 target organ impairment induced by glycyrrhizin

Li¹,

Fan

Wang³

2018

Medicine

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“…Licorice induces its effect on blood pressure primarily by the inhibition of renal 11-β-hydrogenase type II enzyme by 3 β-monoglucuronyl-18 β-glycyrrhetinic acid and 18 β-glycyrrhetinic acid. Water and sodium retention in the kidney increases blood volume and elevates blood pressure [ 70 ].…”

Section: Resultsmentioning

confidence: 99%

Bioactive Compounds and Their Effect on Blood Pressure—A Review

et al. 2020

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Elevated blood pressure affects a great part of the elderly population and is the leading risk factor for cardiovascular disease. New approaches have been taken in the fight against this growing problem, in the form of diets (Mediterranean, Dietary Approaches to Stop Hypertension (DASH) and intermittent fasting). Recent research has shown the promising results regarding diets and their effect on the prevention and improvement of elevated blood pressure. This review attempts to take this a step further, reviewing 26 studies in the search for dietary elements that may be causing this improvement. Although good evidence was found in favor of lycopene, Docosahexaenoic acid (DHA), fiber and anthocyanin, further evidence is needed before any conclusions can be made. In contrast, the evidence shows that licorice increases blood pressure.

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“…Less commonly, licorice has been shown to cause de novo hypertension in previously unaffected individuals. 2 • Given Canada's multicultural population, physicians should consider screening for licorice root intake in patients with difficult-to-control hypertension.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive emergency induced by licorice tea

Falet

Elkrief

Green

2019

CMAJ

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A n 84-year-old man presented to the emergency department with a hypertensive emergency. He reported a 1-week history of persistently elevated measurements, taken at home, of systolic blood pressure (between 180 and 210 mm Hg), along with symptoms of headache, photophobia, chest pain and fatigue. On presentation to the emergency department, his blood pressure was 196/66 mm Hg. He had signs of volume overload on physical examination, including pulmonary crackles on auscultation and pitting edema of the lower extremities up to the knees. Chest radiography was consistent with mild pulmonary edema.The patient's initial laboratory results in the emergency department showed a low potassium level of 2.5 (reference range 3.5-5.0) mmol/L, an elevated bicarbonate level of 31 (reference range 23-29) mmol/L and an increased troponin level of 0.14 (upper limit of normal 0.04) µg/L, with no signs of myocardial ischemia on the electrocardiogram.The patient had long-standing hypertension. A blood pressure measurement taken 4 months earlier showed adequate control (125/60 mm Hg). He also had a history of coronary artery disease, type 2 diabetes and dyslipidemia. His medications included irbesartan, hydrochlorothiazide, acetylsalicylic acid, metformin, empagliflozin, insulin, ezetimibe and atorvastatin. He took furosemide on alternating days for mild venous insufficiency causing pitting edema of the feet.On admission, the patient was started on a combination of amlodipine, metoprolol and hydralazine. Irbesartan was initially held to avoid altering tests of endocrine biochemistry and later resumed. Hydrochlorothiazide was held until the end of his hospital stay to avoid aggravating the hypokalemia. The patient's presenting symptoms resolved over the next 24 hours, except for orthopnea and paroxysmal nocturnal dyspnea, which improved after several days of diuresis with intravenous furosemide.On further questioning, the patient volunteered that he had been ingesting 1 to 2 glasses of homemade licorice root extract called "erk sous" daily for the 2 weeks leading up to his presentation. Although he knew of the potential association between licorice consumption and high blood pressure, he did not think of it when he noticed his blood pressure starting to rise.Screening for pheochromocytoma and Cushing syndrome was negative. Plasma renin activity (0.01 ng/L/s; reference range 0.45-2.06 ng/L/s) and serum aldosterone (71 pmol/L; reference range 111-860 pmol/L) were both suppressed, confirming a state of pseudohyperaldosteronism. We diagnosed licorice-induced pseudohyperaldosteronism.With complete abstinence from licorice extract while he was in hospital, the patient's blood pressure gradually improved and was 140/80 mm Hg on discharge from the hospital 13 days after presentation. He was sent home on amlodipine, metoprolol, irbesartan, hydrochlorothiazide and a taper of furosemide, along with the remainder of his usual medications.The patient was seen in clinic 3 weeks later; his blood pressure was 110/57 mm Hg and he felt well. He had not ...

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Hypertension induced by liquorice tea

Cited by 14 publications

References 8 publications

Hypertensive crisis with 2 target organ impairment induced by glycyrrhizin

Hypertensive crisis with 2 target organ impairment induced by glycyrrhizin

Bioactive Compounds and Their Effect on Blood Pressure—A Review

Hypertensive emergency induced by licorice tea

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