Alternative strategies for reducing blood pressure.

"Only about one-third of patients achieve optimal [blood pressure] control using drug therapy," says Richard Nahas, MD, CCFP, in a clinical review for Canadian Family Physician. Clearly, prescription medicine alone is not enough to reduce hypertension in most people. As a result, conventional medicine also recommends lifestyle changes such as reducing sodium intake, increasing exercise, moderating alcohol consumption, losing weight, and following a low-fat diet that includes whole grains, four to six servings of vegetables, and four to six daily servings of fruits. (See Dietary Approaches to Stop Hypertension [DASH] at www.dashdiet.org.) Nahas, the medical director of Seekers Centre for Integrative Medicine (Ottawa, Ontario), says that many people are also using complementary and alternative (CAM) strategies to reduce their blood pressure. His review of human clinical trials and prospective studies targets six CAM interventions for reducing hypertension: chocolate, coenzyme Q10 (CoQ10), melatonin, vitamin D, mind-body approaches, and acupuncture.

Most of the CAM interventions in Nahas's review have produced modest systolic reductions of 2 to 5 mm Hg in small studies. In some cases, such as acupuncture, trials have produced mixed results. Mind-body interventions are an exception. A meta-analysis of nine Transcendental Meditation studies reported a 4.7 mm Hg reduction in systolic pressure (95% CI 7.4 to 1.9 mm Hg) and 3.2 mm Hg (95% CI 5.4 to 1.3 mm Hg) in diastolic pressure. Qigong can also reduce blood pressure, according to two systematic reviews, involving a total of 2,126 people with hypertension.

Unlike most of the CAM strategies in this review, CoQ10 has produced a significant decrease in systolic blood pressure in many studies, allowing some patients to discontinue blood pressure medication. CoQ10 functions as a carrier in the mitochondrial electron transport chain. People with high blood pressure tend to have low CoQ10 blood levels. Nahas cites a meta-analysis of 12 clinical trials involving 352 people (J Hum Hypertens 2007;21[4]:297-306). Participants took 60 to 120 mg of CoQ10 per day for six to 12 weeks. In three randomized, double-blind controlled trials (n=120), systolic pressure decreased by 16.6 mm Hg and diastolic pressure decreased by 8.2 mm Hg (P<.001). In eight uncontrolled studies, systolic blood pressure decreased by 13.5 mm Hg, and diastolic fell by 10.3 mm Hg (P<.001). One crossover CoQ1O study resulted in a systolic pressure decrease of 11 mg Hg and a diastolic decrease of 8 mm Hg. Whether this reduction in blood pressure produces a decrease in heart attacks or death is unknown; a large, prospective, multicenter trial is needed. Supplemental CoQ10 at doses of 50 to 150 mg per day produced a low incidence of side effects in a 1994 Italian trial of 2,664 people with congestive heart failure.

Baggio E, Gandini R, Plancher AC, Passeri M, Carmosino G. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. CoQ10 Drug Surveillance Investigators [abstract]. Mol Aspects Med. 1994;15(Suppl):s287-s294. Available at www.ncbi.nlm.nih.gov. Accessed March 26, 2009.

Nahas R. Complementary and alternative medicine approaches to blood pressure reduction: An evidence-based review. Can Fam Physician. November 2008;54(11): 1529-1533. Available at www.cfp.ca. Accessed February 25, 2009.

Rosenfeldt FL, Haas SJ, Krum H, et al. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials [abstract]. J Hum Hypertens. April 2007;21 (4):297-306. Available at www.ncbi.nlm.nih.gov. Accessed March 26, 2009.

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briefed by Jule Klotter

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