The shining star among supplements is coenzyme Q10
John Bisognano, M.D., Ph.D and Kevin Woolf, M.D., a cardiology fellow at the Medical Center, conducted the most comprehensive review to date of the evidence behind a wide range of non-drug interventions for the treatment of high blood pressure. The review is featured in the September issue of the Journal of Clinical Hypertension.
Woolf said there is not enough data to recommend any of these alternative options on a routine basis, but on an individual basis he thinks they are useful. “Patients have different backgrounds and different approaches to living their lives,” said Woolf. “This is where the art of medicine comes in; getting to know patients and what they will and will not embrace can help physicians identify different therapies that suit their patients’ habits and that will hopefully make a difference for them.”
Woolf and Bisognano, who is a member of the editorial board of the Journal of Clinical Hypertension, emphasize that all patients with hypertension should adhere to the low-salt DASH diet, which is high in fiber, low in fats and incorporates lots of fruits and vegetables, and follow an exercise and weight loss regimen – lifestyle modifications recommended by the American Heart Association. Any alternative options should be considered for use in addition to these lifestyle changes.
The shining star among supplements is coenzyme Q10, an enzyme involved in energy production that also acts as an antioxidant. Patients with hypertension tend to have lower levels of the enzyme, and a meta-analysis – an overarching analysis of past studies – found that treatment with coenzyme Q10 supplements significantly reduced blood pressure.
Woolf noted that “Coenzyme Q10 has a pretty profound effect on blood pressure, but whenever research is based on a collection of other data you have to have some skepticism.” Woolf said he still thinks the compound is promising.
Woolf also found that potassium helps lower blood pressure, and there is evidence that increasing the amount of potassium we get through the foods we eat could carry some of the same mild benefits as taking supplements.
The potential herbal remedies Woolf identified include mistletoe extract, used in traditional Chinese medicine to treat hypertension. Mistletoe extract reduced blood pressure in animal studies, but Woolf cautions that it may be toxic at high doses. The extract from Hawthorn, a type of tree, is also used, but provides only a slight reduction in blood pressure. Conversely, Woolf uncovered a handful of herbal remedies – St. John’s wort, ephedra/ma huang, yohimbine and licorice – that may increase blood pressure.
Woolf and Bisognano stress that the Food and Drug Administration does not regulate dietary and herbal supplements the way they regulate traditional pharmaceuticals. They say health care providers and patients need to be aware that the safety of these products is not always rigorously established and that formulations can vary.