Hypertension and Coenzyme Q10

The supplement coenzyme Q10 (CoQ10) is often recommended as a complementary treatment for heart conditions such as congestive heart failure (CHF) and heart attack. It has also shown promise as a treatment for high blood pressure.

It is not yet clear how CoQ10 helps lower blood pressure. The supplement is used for other cardiovascular conditions because, among other things, it might assist the heart during times of stress on the heart muscle, perhaps by helping it use energy more efficiently.

Read more details about Coenzyme Q10.

An 8-week, double-blind, placebo-controlled study of 59 men already taking medication for high blood pressure found that 120 mg daily of CoQ 10 reduced blood pressure by about 9% as compared to placebo.⁷

In addition, a 12-week, double-blind, placebo-controlled study of 83 people with isolated systolic hypertension (a type of high blood pressure in which only the "top" number is high) found that use of CoQ 10 at a dose of 60 mg daily improved blood pressure measurements to a similar extent.⁵³

Also, in a 12-week, double-blind, placebo-controlled trial of 74 people with diabetes, use of CoQ 10 at a dose of 100 mg twice daily significantly reduced blood pressure as compared to placebo.⁶²

Antihypertensive effects were also seen in earlier smaller trials.^8-10

The typical recommended dosage of CoQ10 is 30 mg to 300 mg daily; higher daily intakes have been used in some studies. In the studies discusses here, patients were given daily doses of 60 mg, 120 mg, and 200 mg (in two doses).

CoQ10 is fat soluble and may be better absorbed when taken in an oil-based soft gel form rather than in a dry form such as tablets and capsules.¹¹ Dividing the total daily dosage up into two or more separate doses may produce higher blood levels.¹² A finely ground up (“nanoparticular”) form of the supplement appears to be much better absorbed than standard CoQ10 products.¹³

• Integrative MD
• Naturopathic doctor
• Clinical nutritionist or registered dietitian

Safety Issues

In general, CoQ 10 appears to be extremely safe. No significant side effects have been found, even in studies that lasted a year. ¹ However, people with severe heart disease should not take CoQ 10 (or any other supplement) except under a doctor's supervision.

As noted above, two studies suggest that CoQ 10 might reduce blood sugar levels in people with diabetes. ² While this could potentially be helpful for treatment of diabetes, it might present a risk as well; people with diabetes who are using CoQ 10 might inadvertently push their blood sugar levels dangerously low. However, another trial in people with diabetes found no effect on blood sugar control. ³ The bottom line: If you have diabetes, make sure to track your blood sugar closely if you start taking CoQ 10 (or, indeed, any herb or supplement).

CoQ 10 chemically resembles vitamin K . Since vitamin K counters the anticoagulant effects of warfarin (Coumadin), it has been suggested that CoQ 10 may have the same effect. ⁴ However, a small, double-blind study found no interaction between CoQ 10 and warfarin. ⁵ Nonetheless, in view of warfarin’s low margin of safety, prudence indicates physician supervision before combining CoQ 10 with warfarin.

CoQ 10 might also interact with reverse transcriptase inhibitors used for treatment of HIV (for example, lamivudine and zidovudine). These medications can cause damage to the mitochondria, the energy-producing subunits of cells, leading in turn to a variety of side effects, including lactic acidosis (a dangerous metabolic derangement), peripheral neuropathy (injury to nerves in the extremities), and lipodystrophy (cosmetically undesirable rearrangement of fat in the body). The supplement CoQ 10 has been tried for minimizing these side effects, but unexpected results occurred. In a double-blind, placebo-controlled study, use of CoQ10 improved general sense of well-being in people with HIV-infection using reverse transcriptase inhibitors; however, for reasons that are unclear, it actually worsened symptoms of peripheral neuropathy. ⁶ For this reason, people with HIV who have peripheral neuropathy symptoms should use CoQ 10 only with caution.

The maximum safe dosages of CoQ 10 for young children, pregnant or nursing women, or those with severe liver or kidney disease have not been determined.

Interactions You Should Know About

You may need more CoQ 10 if you are taking:

• Cholesterol-lowering drugs in the statin family
• Red yeast rice
• Beta-blockers (specifically propranolol metoprolol , and alprenolol )
• Antipsychotic drugs in the phenothiazine family
• Tricyclic antidepressants
• Methyldopa
• Hydrochlorothiazide
• Clonidine
• Hydralazine
• Oral diabetes drugs (especially glyburide, phenformin, and tolazamide)

You should not take CoQ 10 except on a physician's advice if you are taking:

• Coumadin (warfarin)

CoQ 10 might improve general sense of well-being, but worsen peripheral neuropathy symptoms if you are taking:

• Reverse-transcriptase inhibitors (for HIV infection)

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