How do methylated multivitamins (methylated multi-vitamins) affect blood pressure (hypertension)?

Effect of Methylated Multivitamins on Blood Pressure

Methylated multivitamins generally have no significant effect on blood pressure in healthy individuals, though specific components like Coenzyme Q10 may provide modest blood pressure reduction benefits in people with hypertension or cardiometabolic disorders.

Overview of Methylated Multivitamins and Blood Pressure

Methylated multivitamins are supplements containing vitamins in their methylated forms (such as methylfolate instead of folic acid), which are thought to be more bioavailable for certain individuals. When examining their impact on blood pressure:

General Effects on Blood Pressure

• Standard multivitamin supplementation shows minimal impact on blood pressure in healthy individuals 1, 2
• A meta-analysis of 12 randomized controlled trials found that multivitamin and multimineral supplementation had only a small lowering effect on systolic blood pressure (-1.31 mmHg) and diastolic blood pressure (-0.71 mmHg) 1
• In healthy older adults, a randomized controlled trial found no significant effect of multivitamin supplementation on central blood pressure measurements 2

Specific Components and Their Effects

Coenzyme Q10 (CoQ10)

• CoQ10 supplementation showed a significant reduction in systolic blood pressure (-4.77 mmHg) in patients with cardiometabolic disorders 3
• The blood pressure-lowering effect was more pronounced in:
  • Patients with diabetes (-5.80 mmHg)
  • Those with dyslipidemia (-6.71 mmHg)
  • Those with baseline systolic BP ≥130 mmHg (-5.44 mmHg) 3
• Longer treatment duration (≥12 weeks) showed better results (-5.48 mmHg) 3

B Vitamins

• B vitamins, including those in methylated forms, have shown mixed results:
  • Supplemental riboflavin has been shown to lower systolic BP by up to 13 mmHg in adults with the MTHFR C677T polymorphism 4
  • However, a study of B vitamin supplementation (folate, B12, B6) in older adults with elevated homocysteine found no effect on blood pressure despite successfully lowering homocysteine levels 5

Other Minerals in Multivitamins

• Calcium and magnesium achieved modest reductions in both systolic and diastolic blood pressure (-1.37/-1.63 mmHg and -2.79/-1.56 mmHg, respectively) in normotensive populations 6
• Potassium yielded small but significant reductions in systolic BP (-2.10 mmHg) 6

Clinical Recommendations

When to Consider Methylated Multivitamins

• Not recommended as a primary intervention for hypertension management
• Major clinical guidelines, including those from the American Heart Association, American College of Cardiology, and European Society of Cardiology, do not recommend multivitamin supplementation for blood pressure control 3
• The National Institution for Health and Care Excellence (UK) explicitly states that calcium, magnesium, or potassium supplements should not be offered as a method for reducing BP 7

Dietary Approaches Instead of Supplements

• The DASH diet (Dietary Approaches to Stop Hypertension) is recommended as a first-line dietary intervention for blood pressure management 7
• Focus on food sources rather than supplements to increase mineral intake 7
• Sodium restriction (reducing intake by 4.7-5.8g of sodium chloride per day) can reduce blood pressure by 4-6 mmHg 3

Special Populations

• Patients with cardiometabolic disorders: May benefit from CoQ10 supplementation, with more significant BP reductions observed in this population (-6.29 mmHg systolic and -2.32 mmHg diastolic) 3, 1
• Hypertensive individuals: The effect of multivitamin supplementation on systolic BP was more pronounced in hypertensive subjects (-7.98 mmHg) compared to normotensive subjects (-1.25 mmHg) 1
• Individuals with MTHFR genetic variants: May benefit from methylated B vitamins, particularly riboflavin 4

Potential Interactions and Cautions

• Be aware that certain medications can affect micronutrient status and vice versa 3
• Metformin can affect vitamin B12 status, which may be relevant when considering methylated multivitamins 3
• Antihypertensive medications, particularly diuretics, can affect potassium, calcium, and magnesium levels 3
• Avoid methylated multivitamins with high potassium content in patients taking potassium-sparing diuretics or those with kidney disease 3

Conclusion

While methylated multivitamins are not recommended as a primary intervention for blood pressure management, certain components may provide modest benefits in specific populations. The focus should remain on established lifestyle modifications such as the DASH diet, sodium restriction, weight reduction, regular physical activity, and moderation of alcohol intake, along with appropriate pharmacological therapy when indicated.