Does Creatine Supplementation Raise Blood Pressure?
No, creatine supplementation does not raise blood pressure and may actually improve vascular health in older adults. The available evidence consistently demonstrates that creatine is safe with regard to cardiovascular parameters, including blood pressure.
Evidence from Clinical Trials
Blood Pressure Effects
The most robust evidence shows creatine supplementation does not adversely affect blood pressure:
Acute supplementation (20 g/day for 5-7 days) does not increase blood pressure in healthy men and women, with no changes observed in systolic, diastolic, or mean blood pressure 1, 2.
In older men (ages 55-80), 7-day creatine supplementation (20 g/day) showed a non-significant trend toward reducing systolic blood pressure (144.0 to 136.1 mmHg, p=0.08), particularly on the right side 3.
Vascular Health Benefits
Recent evidence suggests potential cardiovascular benefits:
Creatine improved the cardio-ankle vascular index (a measure of arterial stiffness) in older adults, decreasing from 8.7 to 8.2 (p=0.03), indicating reduced arterial stiffness and atherosclerosis risk 3.
Upstroke time showed a favorable trend toward reduction (178.9 to 158.4 ms, p=0.07), suggesting improved vascular function 3.
Safety Profile
Renal Function Monitoring
A critical caveat: creatine supplementation increases serum creatinine levels, which can be misinterpreted as renal impairment 2:
The elevation in serum creatinine is due to increased creatine metabolism, not kidney dysfunction 2.
This is particularly important when monitoring patients on medications that affect renal function (ACE inhibitors, ARBs, diuretics), as these require regular creatinine monitoring 4.
Estimated creatinine clearance remains unchanged despite elevated serum creatinine 1.
Other Safety Parameters
Long-term and short-term creatine supplementation appears safe regarding:
No adverse effects on cardiac function: stroke volume, contractility index, and ejection fraction remain unchanged 3.
No elevation in creatine kinase (CK) activity, distinguishing it from muscle damage 1, 2.
The only consistent side effect is increased fat-free mass and total body mass 1.
Clinical Context
While the evidence provided focuses primarily on diabetes and hypertension management 4, these guidelines emphasize monitoring serum creatinine when using various medications. Clinicians should be aware that creatine supplementation will elevate serum creatinine without indicating renal dysfunction, which is relevant when interpreting laboratory values in patients taking antihypertensive medications that require creatinine monitoring.
Practical Recommendations
Creatine supplementation does not contraindicate use in individuals with hypertension or those on blood pressure medications 1, 3, 2.
When monitoring patients on ACE inhibitors, ARBs, or diuretics who are also taking creatine, interpret elevated serum creatinine in context and consider calculating estimated GFR rather than relying on creatinine alone 1, 2.
Older adults may experience vascular benefits from creatine supplementation, potentially serving as an adjuvant in cardiovascular disease management 3.
Standard dosing protocols (20 g/day for 5-7 days loading phase) have been studied and found safe regarding blood pressure effects 1, 3, 2.