Blood pressure is the force exerted against arterial walls as the heart pumps blood.  Primary (essential) hypertension - or high blood pressure (BP) is a serious medical condition, and this chronic overstretching of the arteries beyond a healthy limit can lead to tearing, scarring, weak spots & subsequent risk of rupture, blood clot formation, an increased workload on the heart and plaque build up. ^1,2

 Table 1 | Definition of Blood Pressure.²

Blood-Pressure Specific Mechanisms of Action of Coenzyme Q10

Ubiquinol is the reduced form of coenzyme Q10 (CoQ10); it is also the active and most common form of CoQ10 in the body^3,4 and directly affects the endothelium by causing vasodilation. This mechanism of actions is linked to its ability to improve nitric oxide bioavailability, especially in patients with hypertension.^5,6

In addition, ubiquinol improves mitochondrial energy metabolism (and therefore myocardial bioenergetics),^7,8 while its potent antioxidant and anti-inflammatory properties help to decrease total peripheral resistance, reduce the effects of free radicals (such as superoxide dismutase) on the vascular endothelium, and decrease the production of pro-inflammatory cytokines and inflammatory markers (i.e. CRP, IL-6 and TNF-α.).⁹

Evidence Supporting the Use Coenzyme Q10 in Hypertension

• A 2018 systematic review & meta-analysis of 17 randomised controlled trials (RCTs) including 684 participants assessed the effects of CoQ10 supplementation on BP among patients with metabolic disease. Of these, eight RCTs involved diabetic disease. Results showed that daily CoQ10 supplementation with predominantly 100 to 200 mg taken for 4 to 24 weeks significantly decreased SBP. While CoQ10 supplementation also decreased diastolic BP, this was not found to be statistically significant.¹⁵ However, conflicting results may include differences in hypertension at baseline, adjustments made to conventional antihypertensive medications and the presence of various concomitant factors.¹⁶
• A Cochrane review of 3 double-blind, randomised, placebo-controlled, parallel or crossover trials evaluated the BP lowering efficacy of CoQ10 for a duration of at least 3 weeks in patients with primary hypertension. It concluded that oral treatment with ≥100 mg CoQ10 in subjects with an SBP >140 mm Hg or a DBP >90 mm Hg resulted in a mean decrease in SBP of 11 mm Hg and in DBP of 7 mm Hg (respectively), after 4 weeks of treatment.¹⁷
• In another meta-analysis of 12 placebo controlled RCTs in 362 hypertensive patients, CoQ10 was shown to lower SBP by up to 17 mm Hg and DBP by up to 10 mm Hg.¹⁸
• Moreover, according to a 2012 meta-analysis of five RCTs involving 194 patients, daily supplementation with 150 to 300 mg CoQ10 was associated with significant improvement in endothelial function in patients with and without established cardiovascular disease.¹⁹

Clinical Application

The discussed research findings highlight the need for clinicians to consider the considerable array of and CoQ10 have to offer when supporting their hypertensive patients, especially when used concomitantly with conventional treatment.

Based on research findings, practitioners should consider the following treatment approaches:

• Supplement CoQ10 at around a dose of around 150 to 300 mg per day for at least 3 weeks.
• CoQ10, ideally in its reduced form as ubiquinol as it has a statistically higher absorption rate and therefore superior bioavailability.^10-12 This is particularly important for certain groups with decreased levels such as the elderly population¹³, as well as those taking cholesterol-lowering medication (statins) which deplete available CoQ10 levels in the body.¹⁴
• Identify patients reporting symptoms of CoQ10 deficiency, common side effects experienced with statin medications include mild muscle complaints, muscle weakness and cramping. Research has shown that supplementing with up to 300mg/day of ubiquinol improves plasma CoQ10 concentrations in patients taking statins^20-21

 

References

• World Health Organization. Hypertension. 2019. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
• Linus Pauling Institute. Oregon State University. What is Blood Pressure. 2019. Available from: https://lpi.oregonstate.edu/mic/health-disease/high-blood-pressure
• Hosoe K et al. Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers. Regul Toxicol Pharmacol. 2007 Feb;47(1):19-28.
• Bloomer RJ et al. Impact of oral ubiquinol on blood oxidative stress and exercise performance. Oxid Med Cell Longev. 2012;2012:465020.
• Martelli A, Testai L, Colletti A, Cicero AFG. Coenzyme Q10: Clinical Applications in Cardiovascular Diseases. Antioxidants (Basel). 2020 Apr 22;9(4):341.
• Kawashima C, Matsuzawa Y, Konishi M, Akiyama E, Suzuki H, Sato R, et al. Ubiquinol Improves Endothelial Function in Patients with Heart Failure with Reduced Ejection Fraction: A Single-Center, Randomized Double-Blind Placebo-Controlled Crossover Pilot Study. Am J Cardiovasc Drugs. 2020 Aug;20(4):363-372.
• Yang YK, Wang LP, Chen L, Yao XP, Yang KQ, Gao LG, Zhou XL. Coenzyme Q10 treatment of cardiovascular disorders of ageing including heart failure, hypertension and endothelial dysfunction. Clin Chim Acta. 2015 Oct 23;450:83-9.
• Littarru GP, Tiano L, Belardinelli R, Watts GF. Coenzyme Q(10) , endothelial function, and cardiovascular disease. Biofactors. 2011 Sep-Oct;37(5):366-73.
• Ghaffari S, Roshanravan N. The role of nutraceuticals in prevention and treatment of hypertension: An updated review of the literature. Food Res Int. 2020 Feb;128:108749.
• Evans M et al. A randomized, double-blind trial on the bioavailability of two CoQ10 formulations. Journal of Functional Foods, 2009, 1(1):65-73.
• Hosoe K, Kitano M, Kishida H, Kubo H, Fujii K, Kitahara M. Study on safety and bioavailability of ubiquinol (Kaneka QH) after single and 4-week multiple oral administration to healthy volunteers. Regul Toxicol Pharmacol. 2007 Feb;47(1):19-28.
• Miles MV et al. Bioequivalence of coenzyme Q10 from over-the-counter supplements. Nutrition Research 22 (2002) 919–929.
• Pravst I, Rodríguez Aguilera JC, Cortes Rodriguez AB, Jazbar J, Locatelli I, Hristov H, Žmitek K. Comparative Bioavailability of Different Coenzyme Q10 Formulations in Healthy Elderly Individuals. Nutrients. 2020 Mar 16;12(3):784.
• Braun L. Cohen M. Herbs & Natural Supplements - An evidence-based guide. 4th ed. Volume 2. Sydney: Churchill Livingstone; 2015.
• Tabrizi R, Akbari M, Sharifi N, Lankarani KB, Moosazadeh M, Kolahdooz F, et al. The Effects of Coenzyme Q10 Supplementation on Blood Pressures Among Patients with Metabolic Diseases: A Systematic Review and Meta-analysis of Randomized Controlled Trials. High Blood Press Cardiovasc Prev. 2018 Mar;25(1):41-50.
• Natural Medicines. Coenzyme Q10. Professional Monographs. Therapeutic Research Centre. 2020. Available from: https://naturalmedicines.therapeuticresearch.com/
• Ho MJ, Bellusci A, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD007435.
• Rosenfeldt FL, Haas SJ, Krum H, Hadj A, Ng K, Leong JY, Watts GF. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. J Hum Hypertens. 2007 Apr;21(4):297-306.
• Gao L, Mao Q, Cao J, Wang Y, Zhou X, Fan L. Effects of coenzyme Q10 on vascular endothelial function in humans: a meta-analysis of randomized controlled trials. Atherosclerosis. 2012 Apr;221(2):311-6.
• Marcoff L, Thompson PD. The role of coenzyme Q10 in statin-associated myopathy: a systematic review. J Am Coll Cardiol. 2007;49(23):2231-7.
• Mazirka P, Jones E, Strachan P, McNurlan M, Lawson W, Caso G. effect of Coenzyme Q10 Supplementtion in patients with Statin-related Myalgia. The FASEB Journal. 2015;29(1):LB334.