Can Nattokinase replace conventional blood pressure (BP) medications, such as Angiotensin-Converting Enzyme (ACE) inhibitors, beta-blockers, or diuretics, in the management of hypertension?

Nattokinase Cannot Replace Conventional Blood Pressure Medications for Hypertension Management

Nattokinase should not replace conventional blood pressure medications such as ACE inhibitors, beta-blockers, or diuretics in the management of hypertension, as there is insufficient evidence supporting its efficacy and safety compared to established antihypertensive drugs. 1

Evidence-Based Antihypertensive Therapy

First-Line Medications for Hypertension

• The 2020 International Society of Hypertension guidelines recommend specific classes of medications as first-line therapy for hypertension, including:

  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) 1
  • Calcium channel blockers (CCBs) 1
  • Thiazide-type diuretics 1
  • Beta-blockers (in specific situations such as coronary artery disease or heart failure) 1

• These medications have demonstrated significant reductions in cardiovascular morbidity and mortality in numerous large-scale clinical trials 1

Treatment Strategy Based on Comorbidities

• For patients with coronary artery disease: RAS blockers, beta-blockers with or without CCBs 1
• For patients with previous stroke: RAS blockers, CCBs, and diuretics 1
• For patients with heart failure: RAS blockers, beta-blockers, and mineralocorticoid receptor antagonists 1
• For patients with chronic kidney disease: RAS inhibitors as first-line therapy 1

Limited Evidence for Nattokinase

• While nattokinase has shown some promising effects in small studies, the evidence is insufficient to recommend it as a replacement for conventional antihypertensive medications 2, 3

• A small randomized controlled trial (n=73) showed nattokinase supplementation resulted in modest blood pressure reductions of -5.55 mmHg systolic and -2.84 mmHg diastolic compared to placebo over 8 weeks 3

• This reduction is significantly less than what is typically achieved with conventional antihypertensive medications, which can reduce blood pressure by 10-15 mmHg or more 1

• The study on nattokinase was short-term (8 weeks) and small-scale, whereas conventional antihypertensive medications have been studied in large-scale trials with thousands of participants over many years 3, 1

Blood Pressure Targets and Mortality Benefits

• Current guidelines recommend lowering blood pressure to <130/80 mmHg for most patients with hypertension to reduce cardiovascular risk 1

• Conventional antihypertensive medications have demonstrated clear reductions in:

  • Stroke risk 1, 4
  • Cardiovascular events 1
  • All-cause mortality 1

• There is no evidence that nattokinase can achieve similar outcomes in terms of cardiovascular event reduction or mortality benefits 2, 3

Safety and Monitoring Considerations

• Conventional antihypertensive medications have well-established safety profiles with known adverse effects and monitoring parameters 1

• For patients on ACE inhibitors, ARBs, or diuretics, regular monitoring of serum creatinine, estimated glomerular filtration rate, and potassium levels is recommended 1

• The long-term safety profile of nattokinase is not well-established, particularly regarding potential interactions with other medications or effects on organ systems 2

Potential Role of Nattokinase

• While nattokinase should not replace conventional antihypertensive therapy, it might be considered as a complementary approach for individuals with:

  • Pre-hypertension (130-139/80-89 mmHg) who are not yet candidates for pharmacological therapy 3
  • Mild hypertension alongside lifestyle modifications, under medical supervision 2, 3

• Any use of nattokinase should be discussed with a healthcare provider, especially for patients already on antihypertensive medications or blood thinners 2

Conclusion

Based on current evidence and guidelines, nattokinase cannot replace conventional blood pressure medications for hypertension management. The established efficacy, safety profile, and mortality benefits of conventional antihypertensive medications make them the standard of care for hypertension treatment 1.