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Guidelines further recommend follow-up after at least 6 weeks to check the effectiveness of treatment and potential change of BP medication regime by adding other BP medication classes, increasing dosage, or changing BP medication type, depending also on tolerability and potential side effects.15 Approximately 40% of hypertensive patients can achieve the target BP of 4 g of fresh garlic or 3 mg allicin) should be avoided in patients taking antithrombotic medications including warfarin, due to the antiplatelet properties of garlic.65 However, a trial using higher concentrations of aged garlic extract (10 mL/day, containing 14.7 mg S -allylcysteine) for patients on warfarin therapy found no increase in the incidence of hemorrhage compared with placebo.64 Mechanisms for blood pressure-lowering effect of garlic Several mechanisms of action for the BP-lowering properties of organosulfur compounds in garlic have been postulated, including mediation of intracellular nitric oxide (NO) and hydrogen sulfide (H 2 S) production as well as blockage of angiotensin-II production, which in turn promotes vasodilation and thus reduces the BP.6671 The strongest evidence of and insights into the mechanisms of the BP-lowering effect of garlic supplementation involve endothelium-dependent vasodilation, and thus, this review will focus on the current knowledge of the physiological and biochemical processes within blood vessels
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