American Journal of Medicine and Medical Sciences 2014, 4(3): 87-91

DOI: 10.5923/j.ajmms.20140403.01

Effect of Liquid Extract of Pear Avocado Leaf (Persea

americana) on Plasma Levels of Aminotransferases,
Cholesterol and Total Bile Acids in Hypertensive Patients
Mathew Folaranmi Olaniyan

Achievers University, Owo, Ondo State, Nigeria

Abstract Raw liquid extract of Avocado pear leaf is of medicinal importance in the treatment of hypertension. In
Oke-Ogun area of Oyo state, this extract is being used as an alternative therapy in the treatment of hypertension in human
subjects. This work was designed to evaluate the Effect of Liquid Extract of Pear Avocado Leaf used in the Traditional
Treatment of Hypertension on the Plasma Levels of Aminotransferases, Total Bile Acids, Total and Low Density Lipoprotein
Cholesterol. Fifty (50) anicteric newly diagnosed hypertensive patients with an abnormal increase in plasma cholesterol and
blood pressure aged 45 and above that have not been treated with any hypertensive medication but have decided to be treated
traditionally using avocado pear leaf extract were recruited from the traditional homes in ATISBO, Saki-East and Saki-West
Local government areas of Oke-Ogun – the Northern part of Oyo state-Nigeria. Five (5) milliliter of venous blood was
obtained from each subjects after an overnight fasting before and after the administration of the liquid extract for the
extraction of plasma. Plasma Alanine amino-transferase(ALT), Aspartate amino-transferase (AST), Total Bile Acids(TBA),
Low Density Lipoprotein(LDL) and Total Cholesterol were analysed in the samples of the patients biochemically by
spectrophotometry including autoanalysis. The result obtained showed a significantly higher mean value of plasma Total
and Low Density Lipoprotein Cholesterol in the subjects before the administration of the liquid extract of avocado pear leaf
than the values obtained post-administration with p<0.01. However there was a significantly lower mean value of plasma
ALT and AST in the subjects before the administration of the liquid extract of avocado pear leaf than the values obtained
after the administration with p<0.01. There was a non-statistically higher plasma value of Total Bile Acids in the subjects
before the administration of the raw liquid extract of avocado pear leaf than the value obtained in the subjects after the
administration with p>0.01. The findings of this study revealed a significant alteration in the plasma level of ALT, AST, LDL
and Total Cholesterol in the subjects after the administration of the liquid extrac of avocado pear leaft. The evaluation of these
biochemical parameters in hypertensive patients undergoing traditional therapy using the extract is therefore recommended.
Keywords Aminotransferases, Hypertension, Liquid Extract, Pear Avocado Leaf, Total/LDL Cholesterol, Total Bile
Acids and Traditional Treatment

(P. pellucida) is also very effective in the treatment of

1. Introduction hypertension. This is also in line with earlier reports by
Ayitey-Smith [3] in Ghana, and Anslem [1] in Nigeria.
The medicinal effect of leaves of avocado pear (Persea
Phytochemical analysis of pear leaf revealed Tannins,
americana) for the treatment of hypertension has been
Saponins, Cardiacglycosides, Alkaloids and Inulin [5].
reported by [1] and [2] in Nigeria and [3] in Ghana. Leaves
Cholesterol is required to build and maintain membranes;
of avocado pear are cut into pieces, dried and made into tea,
it modulates membrane fluidity over the range of
for the management of hypertension. Odugbemi [4] has also
physiological temperatures. Animal fats are complex
documented the efficacy of the cotyledons of avocado pear
mixtures of triglycerides, with lesser amounts of
seed for the treatment of hypertension. The cotyledons are
phospholipids and cholesterol. As a consequence, all foods
cut into pieces, dried and grinded into powder. A dessert
containing animal fat contain cholesterol to varying extents
spoonful in 200ml hot water taken after meals gives relieve
[6]. Major dietary sources of cholesterol include cheese, egg
for the ailment [4]. According to Odugbemi [4] silver bush
yolks, beef, pork, poultry, fish, and shrimp. Human breast
* Corresponding author:
milk also contains significant quantities of cholesterol.
olaniyanmat@yahoo.com (Mathew Folaranmi Olaniyan) Cholesterol is susceptible to oxidation and easily forms
Published online at http://journal.sapub.org/ajmms oxygenated derivatives known as oxysterols, Cholesterol is
Copyright © 2014 Scientific & Academic Publishing. All Rights Reserved oxidized by the liver into a variety of Bile acids [7].
88 Mathew Folaranmi Olaniyan: Effect of Liquid Extract of Pear Avocado Leaf (Persea americana) on Plasma
Levels of Aminotransferases, Cholesterol and Total Bile Acids in Hypertensive Patients

Abnormally low levels of cholesterol are termed b. Preparation of the raw Liquid extract of pear
hypocholesterolemia. Research into the causes of this state is avocado
relatively limited, but some studies suggested a link with The leaves of the pear avocado fruit are plucked and
depression, cancer, and cerebral hemorrhage. In general, the washed in water. The water is drained and the leaves are
low cholesterol levels seem to be a consequence, rather than crushed or squished for the extraction of the liquid content
a cause, of an underlying illness, contrary to elevated into a container. A plastic cup with a capacity of 60ml was
cholesterol level which is associated with heart disease [8]. dedicated by the healers for the measurement of the extract to
Bile acids are synthesized in the liver as a breakdown be administered into the patients. The liquid extract is freshly
product of cholesterol and secreted into the gall bladder. prepared on daily bases prior to administration. The raw
They are released into the small intestine where they liquid content of the leaf is extracted without the addition of
solubilize dietary lipids such as cholesterol, aiding their water and also administered undiluted.
absorption. Bile acids are reabsorbed from the portal blood
c. Reagents
by hepatocyte extraction and re-excreted into bile, passing
through the enterohepatic circulation several times before They include: Randox test kit of Randox for TBA
final excretion. The measurement of bile acids in serum is a estimation and Roche Cobas C111 compatible reagent kit
sensitive indicator of liver function [7]. was used for the estimation ALT, AST, Total and LDL
Low-density lipoprotein (LDL) is one of the five major Cholesterol.
groups of lipoproteins, which, in order of molecular size, Study area
largest to smallest, are chylomicrons, very low-density The study was carried out in ATISBO, Saki-East and
lipoprotein (VLDL), intermediate-density lipoprotein (IDL), Saki-West Local government areas of Oke-Ogun – the
LDL, and high-density lipoprotein (HDL). Lipoprotein Northern part of Oyo state-Nigeria. The three local
molecules enable the transportation of lipids (fats), such as governments constitute the former Ifedapo Local
cholesterol, phospholipids, and triglycerides, in the government area of Oyo state. The three local governments
extracellular fluid including the bloodstream. Studies have share border with Kwara state-Nigeria, Ogun state-Nigeria
shown that higher levels of type-B LDL particles (as and the Republic of Benin.
opposed to type-A LDL particles) are associated with health
Study design
problems, including cardiovascular disease [9].
Although the nickname is overly simplistic and thus Experimental research design.
misleading, LDL molecules are often informally called bad Study population
cholesterol because they can transport their content of many a. Fifty (50) newly diagnosed hypertensive patients with
fat molecules into artery walls, attract macrophages, and thus an abnormal increase in plasma cholesterol and blood
drive atherosclerosis. In contrast, HDL molecules are pressure aged 45 and above that have not been treated with
frequently referred to as good cholesterol or healthy any hypertensive medication but have decided to be treated
cholesterol, because they can remove fat molecules from traditionally using pear leaf extract were recruited from the
macrophages in the wall of arteries [10]. traditional homes in ATISBO, Saki-East and Saki-West
Alanine transaminase (ALT (SGPT) is solely found in the Local government areas of Oke-Ogun – the Northern part of
liver. It is a biomarker of liver injury in a patient with some Oyo state-Nigeria. None of the subject was jaundiced as at
degree of intact liver function. Its plasma level is raised in the time of sample collection.
liver damage [11].
Sample size
This work was therefore, designed to evaluate the effect of
liquid extract of pear leaf used in the traditional treatment of Fifty (50) out of the sixty eight (68) hypertensive patients
hypertension on the plasma levels of aminotransferases, (Female:n=25; Male: n=25) that visited the traditional
cholesterol and total bile acids healers between September, 2013 and February, 2014 for
treatment that volunteered themselves for this study were
recruited based on the inclusion and the exclusion criteria.
2. Materials and Methods Case selection procedure/s
Materials: Inclusion criteria
a. Blood Sample Anicteric newly diagnosed hypertensive patients with
abnormal increase in plasma cholesterol and blood pressure
Five (5) milliliter of blood were collected from each of the aged 45 and above that have not been treated with any
patients before the administration of the pear leaf liquid hypertensive medication were recruited.
extract for the baseline plasma Alanine transaminase,
Aspartate transaminase, Total Bile Acids, LDL and Total Exclusion criteria
Cholesterol. Another blood sample was collected from each 1. Hypertensive patients that have been treated or being
of the patients after an appreciable decrease in blood treated with antihypertensive drugs were not recruited for
pressure. the study.
 American Journal of Medicine and Medical Sciences 2014, 4(3): 87-91 89

2. Anicteric newly diagnosed hypertensive patients post-administration with p<0.01. However there was a
with normal plasma cholesterol aged 45 and above that significantly lower mean value of plasma ALT and AST in
have not been treated with any hypertensive medication the subjects before the administration of the liquid extract of
were not included in the study. avocado pear leaf than the values obtained
3. Icteric newly diagnosed hypertensive patients with post-administration with p<0.01.(Table 1 and 2). There was
abnormal increase in plasma cholesterol and blood a non-statistically higher plasma value of Total Bile Acids in
pressure aged 45 and above that have not been treated with the subjects before the administration of the raw liquid
any hypertensive medication were not included for the extract of avocado pear leaf than the value obtained in the
study. subjects post-administration with p>0.01(Table 1 and 2).
Methods: Table 1. Result of the Mean and the Standard deviation of the plasma
values of ALT, TBA, AST, Total and LDL Cholesterol in the subjects before
a. Based on the information obtained from the fifteen and after treatment with the Liquid extract of pear avocado leaf
traditional homes visited in the three local governments
Mean Values with SD
about 60ml of the raw undiluted liquid extract of the pear
Measurements Before treatment After treatment
leaves is administered to the patients on daily bases until
ALT
there is an appreciable decrease in the blood pressure to an U/L
20±1.0 48±2.1
acceptable range. TBA µmol/L 8.0±1.5 5.0±1.8
b. Estimation of plasma Aspartate transaminase, AST
14.0±2.4 42±1.2
Alanine Transaminase, Total cholesterol and LDL U/L
Cholesterol were carried out using Cobas C111 Total Cholesterol
281±10.0 180±2.1
auto-chemistry analyzer using the reagent kit of Roche. mg/dl
LDLCholesterol
c. Estimation of Total Bile Acids was carried out on the 160±5.0 96±2.2
mg/dl
plasma samples of the subjects using Randox reagent kit.
The manufacturer’s instruction was strictly followed. Table 2. Results of the students’ ‘t’ test, probability(‘p’) and the level of
Principle: Two reactions are combined in this kinetic significance of the differences in plasma values of ALT, TBA, AST and
Cholesterol in the subjects before and after treatment
enzyme cycling method. In the first reaction bile acids are
oxidised by 3-α hydroxysteroid dehydrogenase with the ‘t’ value ‘p’ value Comment
subsequent reduction of Thio-NAD to Thio-NADH. In the
ALT 13.8 0.005 P<0.01S
second reaction the oxidised bile acids are reduced by the
same enzyme with the subsequent oxidation of NADH to TBA 1.06 0.4 p>0.01NS
NAD. The rate of formation of Thio-NADH is determined by AST 12.5 0.006 P<0.01S
measuring the specific absorbance change at 405nm. Total Cholesterol 10.95 0.008 P<0.01S
(Abreviations: NADH, NAD, Thio-NADH, Thio-NAD) LDL Cholesterol 11.8 0.007 P<0.01S
d. Ethical Consideration S-Significant, NS- Not significant, ‘t’=student ‘t’ test, ‘p’ = probality value
The proposal was reviewed and approved by the Research
and Ethical Committee of Baptist Medical Centre, Saki-Oyo
state- Nigeria before the commencement of the work. This is
4. Discussion
to protect the interest of patients to ensure that the patients Hypertensive patients with abnormal increase in plasma
and the community are not harmed in any form by the total and LDL cholesterol levels were studied in this work
procedure because of the contribution of the lipid to the cause of heart
e. Statistical Analysis disease. This could be supported by the report of CDC [12]
the values of the biochemical parameters obtained in the that high blood pressure and cholesterol are the two main
patients before and after treatment with the raw liquid extract reasons that could be associated with the deadly but
were subjected to statistical analysis to determine the mean preventable heart disease or stroke. Nearly 2 out of 3 adults
values, standard deviation and students’ ‘t’ test, for t value, p with high cholesterol and about half of adults with high
value and level of significant at 0.01(99%) using online blood pressure do not have their condition yet under control.
Student T-Test Calculator for 2 Independent Means on line Clearly, other steps are needed to gain control of these health
at. http://www.socscistatistics.com/tests/studentttest risks [12].
High cholesterol accelerates the progression of
atherosclerosis, which is thought to contribute significantly
3. Result to hypertension [12]. Atherosclerosis of renal artery leading
to renovascular diseases (arterial stenosis) which ended up
The results obtained considering tables 1 and 2 showed a with less blood flow to the kidney and subsequent triggering
significantly higher mean value of plasma Total and LDL of renin-angiotensin-aldosterone system that involves a
Cholesterol in the subjects before the administration of the variety of hormones to increase blood pressure.
liquid extract of avocado pear leaf than the values obtained The increase in blood pressure necessary to return kidney
90 Mathew Folaranmi Olaniyan: Effect of Liquid Extract of Pear Avocado Leaf (Persea americana) on Plasma
Levels of Aminotransferases, Cholesterol and Total Bile Acids in Hypertensive Patients

blood flow to normal is often much greater than normal there is a decrease in the plasma cholesterol level following
blood pressure; consequently these patients develop the administration of the extract which could also affect the
hypertension. Which doubles coronary heart disease (CHD) metabolism of bile acids [9].
risk. Treating hypertension only reduces CHD risk ≈25%
while Treating hypercholesterolemia in hypertensive
patients reduces residual CHD risk >35% [12]. 5. Conclusions
The results obtained showed a lowering effect of the The findings of this study revealed a significant alteration
extract on plasma Total and LDL Cholesterol in the in the plasma level of ALT, AST, LDL and Total Cholesterol
hypertensive subjects. This could be associated with the in the subjects after the administration of the liquid extract. A
relevance of the extract in the treatment of hypertension due significant increase in plasma ALT and AST in the subject
to arteriosclerosis caused by abnormal increase in Total and after the administration of the liquid extract indicates that the
LDL cholesterol. This biochemical decrease in the plasma extract seems to have a toxic effect on the liver that could
level of Total and LDL cholesterol in the hypertensive cause liver damage. Consequently, evaluation of these
patients after the administration of the pear leaf extract could biochemical parameters in hypertensive patients undergoing
be due to the effect of the phytochemical constituents of the traditional therapy using the extract is therefore
leaf which include: Tannins, Saponins, Cardiac glycosides, recommended.
Alkaloids and [5]. These chemical substances are also found
in Buccholzia coriacea seeds reported by Omolekan and
Olaiya [13] responsible for the reduction in plasma LDL –
cholesterol in hypercholesterolemic rats treated with the
alcoholic extract of the seed and that the extract is potent in
REFERENCES
reducing the formation of plaques in the coronary arteries [1] Anslem, A. Nature Power. Christian Approach to Herbal
and also the generation of atherosclerosis. Medicine. Don Bosco Training Centre, School of PTP,
The health benefits of saponin include cholesterol Printing and Finishing, Akure. 2006: 206p.
lowering and anticancer properties [16]. Alkaloids have been [2] Okoli, R. I., Aigbe, O., Ohaju – Obodo, J. O, and Mensah, J.
found to possess analgesic, antimalarial, antibacterial, K. Medicinal herbs usedfor managing some common
antihypertensive [17] properties. Pigments like tannins and ailments among Esan people of Edo state, Nigeria. Pakistan
flavonoids may have been responsible for this cholesterol Journal of Nutrition 2007: 6(5): 490 – 496,.
lowering action. Phytochemicals like tannins, saponins and [3] Ayitey – Smith, E. Prospect and Scope of Plant Medicine in
flavonoids are constituents of plant extracts such as avocado Health Care. Ghana University Press, Accra. 1989: 29pp,.
pear that have lipid lowering. These phytochemicals also
[4] Odugbemi, T. T. Outline and Pictures of Medicinal Plants
prevent the oxidation of LDL, preventing it from being from Nigeria. University of Lagos Press, Lagos, Nigeria,
atherogenic [18, 19]. 2006 : 283pp.
When too much LDL (bad) cholesterol circulates in the
blood, it can slowly build up in the inner walls of the arteries [5] Mensah J.K., Okoli R I., Turay A. A. and Ogie-Odia E.A.
Phytochemical Analysis of Medicinal Plants Used for the
that feed the heart and brain. Together with other substances, Management of Hypertension by Esan people of Edo State,
it can form atherosclerosis characterized by a thick, hard Nigeria. Ethnobotanical Leaflets2009: 13: 1273-87.
deposit that can narrow the arteries and make them less
[6] Sadava D, Hillis DM, Heller HC, Berenbaum MR. Life: The
flexible, and if a clot forms and blocks a narrowed artery,
Science of Biology 9th Edition. San Francisco: Freeman.
heart attack or stroke can result. The formation of plaque 2011: pp. 105–114. ISBN 1-4292-4646-4.
could be affected by the phytochemical constituents of the
extract thereby preventing atherosclerosis and consequently [7] John S, Sorokin AV, Thompson PD. "Phytosterols and
vascular disease". Curr.Opin.Lipidol. 2007: 18 (1): 35–40..
preventing hypertension [2].
doi:10.1097/MOL.0b013e328011e9e3.PMID 17218830.
In this study a significant increase in plasma ALT and
AST in the subject after the administration of the liquid [8] Ohvo-Rekilä H, Ramstedt B, Leppimäki P, Slotte JP.
extract indicates that it seems to have a toxic effect on the "Cholesterol interactions with phospholipids in membranes".
Prog. Lipid Res. 2007: 41 (1): 66–97. 2002.
liver that could cause liver damage which is slightly doi:10.1016/S0163-7827(01)00020-0. PMID 11694269.
comparable with the report of Friday et al., [14] that reported
a non-statistical increase in plasma ALT, AST in albino rat [9] Dashty M, Motazacker MM, Levels J, de Vries M, Mahmoudi
after the administration aqueous extract of the seed of M, Peppelenbosch MP, Rezaee F. "Proteome of human
plasma very low-density lipoprotein and low-density
Avocado and African pear seeds. lipoprotein exhibits a link with coagulation and lipid
There was a non-statistically higher plasma value of Total metabolism.". ThrombHaemost. 2014: 23 (111): 518–530..
Bile Acids in the subjects before the administration of the doi:10.1160/TH13-02-0178. PMID 24500811
raw liquid extract of avocado pear leaf compared with the
[10] Dashti M, Kulik W, Hoek F, Veerman EC, Peppelenbosch
values obtained in the subjects after the administration of the MP, Rezaee F. "A phospholipidomic analysis of all defined
extract. This could be attributed to the metabolic relationship human plasma lipoproteins.". Sci Rep. 2011: 1 (139)..
between the Cholesterol and Total Bile Acids. In this study doi:10.1038/srep00139. PMID 22355656.
 American Journal of Medicine and Medical Sciences 2014, 4(3): 87-91 91

[11] McClatchey, Kenneth D. Clinical laboratory medicine. PhD; Tamara E. Wolfman, MD. Blood Pressure and
Lippincott Williams & Wilkins2002:pp. 288–.ISBN Cholesterol Control in Hypertensive Hypercholesterolemic
978-0-683-30751-1. Patients. National Health and Nutrition Examination Surveys
1988–2010.
[12] Centers for Disease Control and Prevention (CDC) High
Blood Pressure and Cholesterol Out of Control February 2011. [16] Kim, S.W, S.K. Park, S.I. Kang, H.C. Kang, H.J. Oh, C.Y.
http://www.cdc.gov/Vitalsigns/CardiovascularDisease/ Bae and D.H. Bae, Hypocholesterolemic property of Yucca
schidigera and Quillaja saponaria extracts in human body.
[13] T. O. Omolekan1 and C. O. O. Olaiya. Anti – Atherogenic 2003:Arch Pharm. Res., 26: 1042-1046
Activity of Ethanol Extract of Buccholziacoriacea Seeds on
Hypercholesterolemic Rats. International Journal of [17] Dangi, S.Y., C.I. Jolly and S. Narayanan, Antihypertensive
Biochemistry Research & Review2013: 3(3): 190-199, activity of the total alkaloids from the leaves of Moringa
SCIENCEDOMAIN international www.sciencedomain.org oleifera. Pharm. Biol., 2002:40(2): 144-148.
[14] Friday O.U, Amadike C.U, and Kingsley C.N. Effect of [18] Adeneye AA, Adeneke TI, Adeneye AK.Hypoglycemic and
aqueous extract of Pear seeds on some biochemical hypolipidemic effects of the aqueous leaves extracts of
parameters in albino rats. A comparative study of Persea Clerodendrum capitatum in wistar rats. J. Ethanopharmacol.,
Americana (Avocado pear) and Dacryodesedulis (African 2008: 116(1): 7-10
pear). Journal of Reasearch in Biochemistry. 2013: 2(1): 110
-115, [19] Ram A, Laura P, Gupta R, Kumar P, Sharma VN.
Hypocholesterolaemic effects of Terminalia arguna tree bark.
[15] Brent M. Egan, MD; Jiexiang Li, PhD; SuparnaQanungo, J. Ethanopharmacol., 1997 :55(3): 165-169.