Nonprescription Coenzyme Q10 Shown to Lower Blood Pressure

Over-the-counter supplements may also relieve statin-related leg pain.

Many patients with hypertension require three or more medications to bring their blood pressure into an acceptable range. That’s why the news that taking nonprescription Co-Q10 may reduce the need for antihypertension medication is so encouraging.

"There is good information showing that Co-Q10 can have a positive effect in the treatment of hypertension," says Thomas Morledge, MD of Cleveland Clinic’s Center for Integrative Medicine.

Dr. Morledge and two colleagues in the Department of Pharmacy authored a paper on the effects of Co-Q10 in hypertension and statin-related muscle pain (myalgia) in the July issue of the Cleveland Clinic Journal of Medicine. Although the clinical trial data for hypertension was strong, the findings of trials on Co-Q10 in patients taking statins was less convincing.

"The results of these trials varied widely. The fact is that we don’t know if low Co-Q10 levels are the cause of myalgia," says Dr. Morledge.

Co-Q10 is an enzyme found in all human cells, where it acts as a powerful antioxidant, a membrane stabilizer and a key player in creating energy. When medications or diseases cause Co-Q10 levels to drop, adding back Co-Q10 may reverse or prevent side effects in some patients.

Co-Q10 for hypertension
Just how Co-Q10 supplements reduce blood pressure is unknown. The enzyme may relax peripheral arteries by preserving nitric oxide, or boost vasodilation by increasing the production of prostacyclin, thereby enhancing the sensitivity of cells in the lining of arteries to prostacyclin, or both.

Studies showed Co-Q10 often increased the effectiveness of prescription antihypertension medications. In one trial, Co-Q10 supplements enabled half the participants to discontinue taking one or more of their hypertension medications. In other trials, Co-Q10 enabled the dosage of hypertension medication to be significantly decreased.

Co-Q10 supplements were not always effective, however. In a trial of patients with systolic hypertension, 45 percent had no response to Co-Q10, while 55 percent experienced a statistically significant drop in blood pressure.

Co-Q10 for myalgia
Statins interfere with the production of mevalonate, a protein involved in the creation of both Co-Q10 and cholesterol. As a result, taking statins will cause Co-Q10 levels to drop along with cholesterol levels. Lack of Co-Q10 causes muscle cells to malfunction at the most basic level. Whether or not this increases the risk of myalgia is unknown.

"We do not understand the implications of low tissue levels of Co-Q10. Although low levels may be responsible for myalgia in some patients, more subtle and undefined problems may be occurring.

In one double-blind, randomized trial, patients were given 100 mg of Co-Q10 or 400 mg of vitamin E daily with their statin. The extent of muscle pain and its impact on daily activities were measured before and after the study. After 30 days of supplementation, 16 of the 18 patients taking Co-Q10, but only 3 of the 14 patients taking vitamin E, reported less discomfort. Co-Q10 also significantly improved patients’ ability to perform daily activities, whereas vitamin E did not.

Co-Q10 was not beneficial in all clinical trials. In a study of 44 patients who had previously suffered from statin-induced myalgia, 200 mg of Co-Q10 daily failed to raise the number who could tolerate 40 mg doses of simvastatin. Nor did it improve myalgia pain.

Considerations
Co-Q10 supplements are generally well-tolerated, but patients taking certain medications should be alert to potential interactions with prescription medications.

Co-Q10 may increase risk of bleeding in patients taking clopidogrel (Plavix) or aspirin, prevent warfarin (Coumadin) from working or increase sensitivity to insulin. Because Co-Q10 it boosts the antihypertensive effect of other hypertension drugs, blood pressure may drop too low.

Drug interactions aside, Co-Q10 is considered safe. Therefore, it might be worth your while to ask your doctor whether you should try Co-Q10.

"Co-Q10 appears to be a reasonable alternative to prescription-based therapies for hypertension. It can be used by patients under the guidance of their medical practitioner for blood pressure management," says Dr. Morledge.

"There is not enough data to determine the value of Co-Q10 in statin-induced myalgia, but considering the value of statins in preventing heart attack, stroke and cancer, if Co-Q10 enables you to take these cholesterol-lowering drugs, you might want to work with your doctor to see if Co-Q10 is effective," he says.

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