Cardiovascular diseases are the leading cause of death and disability worldwide. Although existing standard therapies can reduce the risk of acute events, a significant “residual risk” remains, highlighting the urgent need for multi-target intervention strategies. Tetrahydropalmatine (THP), the principal active alkaloid in Corydalis yanhusuo, features a unique tetracyclic scaffold and exhibits multitarget pharmacological characteristics. It plays significant roles in key pathological processes, including arrhythmia, platelet hyperaggregation and thrombosis, hypertension and endothelial dysfunction, and ventricular remodeling. Its mechanisms involve the coordinated regulation of multiple ion channels, enhancement of nitric oxide synthesis and endothelium-dependent relaxation, suppression of sympathetic nerve activity, and inhibition of fibrosis and hypertrophy. Furthermore, THP can activate protective signaling pathways such as the phosphatidylinositol 3-kinase/protein kinase B pathway, while inhibiting pathogenic pathways including the mitogen-activated protein kinase and nuclear factor-κB pathways, thereby exerting comprehensive effects such as anti-inflammatory, anti-apoptotic, antioxidant, and pro-angiogenic actions. However, THP still faces critical limitations, including low oral bioavailability, complex metabolic pathways, and insufficient clinical evidence. Therefore, this review systematically summarizes the pharmacological effects and molecular mechanisms of THP in cardiovascular diseases, aiming to elucidate its potential value as a multi-target and multi-pathway therapeutic agent, and to provide a theoretical foundation for further pharmacokinetic optimization, formulation improvement, and clinical investigation.

tetrahydropalmatine  /  cardiovascular diseases  /  anti-inflammatory  /  anti-apoptotic  /  antioxidant  /  arrhythmia  /  endothelial dysfunction  /  ventricular remodeling