Does Lemongrass Benefit Coronary Microvasculature?
No, there is no evidence that lemongrass benefits the coronary microvasculature in patients with hypertension and possible angina. The provided clinical guidelines and research evidence contain no data supporting the use of lemongrass for coronary microvascular dysfunction or any cardiovascular condition.
Evidence-Based Management of Coronary Microvascular Dysfunction
For a patient with hypertension and possible microvascular angina already taking nebivolol, amlodipine, and ranolazine, the current regimen is already guideline-concordant:
Current Medication Rationale
Nebivolol (beta-blocker) + amlodipine (dihydropyridine CCB) represents the recommended first-line combination for chronic coronary syndromes, as this pairing is specifically endorsed by guidelines 1
Ranolazine is appropriately added as second-line therapy for microvascular angina when symptoms persist despite beta-blocker and CCB therapy, with a Class IIa, Level B recommendation from the European Society of Cardiology 2, 1
Ranolazine works through inhibition of the late sodium current, reducing intracellular calcium overload during ischemia without affecting heart rate or blood pressure—making it particularly suited for microvascular dysfunction 3, 4
Evidence for Ranolazine in Microvascular Angina
Ranolazine has been shown to improve coronary flow reserve (CFR) in patients with microvascular angina, with five studies demonstrating that patients with low baseline CFR values had significant improvement after ranolazine treatment 5
In a case report, ranolazine induced complete relief of angina and relevant improvement in transthoracic Doppler-derived CFR after 6 months of therapy in a patient with isolated coronary microvascular dysfunction 4
Ranolazine reduces mechanical compression of coronary microcirculation and may improve coronary self-regulation 2
Important Limitations and Monitoring
Ranolazine does not improve cardiovascular outcomes (mortality or myocardial infarction)—it is purely symptomatic therapy, as demonstrated in the MERLIN-TIMI 36 trial 1, 6
QTc prolongation occurs in a dose-dependent manner; obtain baseline ECG before starting ranolazine 1
Contraindicated in hepatic impairment or liver cirrhosis due to increased plasma levels and arrhythmia risk 2, 3, 7
Drug interactions: Ranolazine increases digoxin concentrations by 40-60% through P-glycoprotein inhibition and should be used cautiously with strong CYP3A inhibitors 3, 8
Alternative Add-On Options if Symptoms Persist
Long-acting nitrates (isosorbide mononitrate) are an equally valid Class IIa recommendation for add-on therapy if ranolazine fails to control symptoms 1, 7
Trimetazidine (Class IIb recommendation) may be considered if hypotension develops, as it has no hemodynamic effects 1
Bottom Line on Lemongrass
There is zero clinical evidence supporting lemongrass for coronary microvascular dysfunction. Stick with evidence-based pharmacotherapy: beta-blockers, calcium channel blockers, and ranolazine as outlined above 2, 1.