Effects of Pomegranate Extract Supplementation (Punica granatum L.) on Clinical Manifestations of Pulmonary Arterial Hypertension in Children with Acyanotic Congenital Heart Disease

Background: Pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) mechanism includes vasoconstriction and vascular remodeling. In Indonesia, sildenafil as a vasodilator is the only standard treatment for PAH. Research on pomegranate extract showed its potential as an anti-inflammatory and anti-proliferative agent that could work synergically with sildenafil in reducing pulmonary arterial pressure (PAP) Objective: To investigate the effect of pomegranate supplementation in the clinical manifestation of PAH in children with acyanotic CHD. Methods: This study was a randomized controlled clinical trial that compared the clinical manifestation of PAH in children with acyanotic CHD who received standard therapy for PAH and pomegranate extract supplementation with the placebo group. Observations were carried out over three months, and pre-and post-test evaluations were conducted to assess changes in PAP, functional classification of PAH, body weight, systolic blood pressure, heart rate, respiratory rate, and oxygen saturation in both groups. Statistical analysis was undertaken using the Wilcoxon, Mann-Whitney, and Spearman correlation tests. Results: There was no significant difference in PAP reduction between the pomegranate and placebo groups (p = .44) and no significant difference in the functional classification of PAH in the placebo and pomegranate groups (p = .55). There was a considerable reduction in the respiratory rate in the pomegranate group (p = .017). Respiratory rate was positively correlated with the functional classification of PAH (p = .011). Conclusion: There was a significant reduction in the respiratory rate in the pomegranate group that correlated with the functional classification of PAH.