Antihypertensive drugs (general)

Active substances and pharmaceuticals concernedSpecially affected active substances and pharmaceuticalsMechanism of interactionConsequences and possible symptoms of the interactionRecommended SupplementationSpecial instructions for use

Active substances and pharmaceuticals concerned

Name of active substance	Trade name	Affected micronutrients
Beta-blockers	Beloc®, Tenormin®	Magnesium Vitamin D L-Arginine Coenzyme Q10 Calcium Pycnogenol
ACE inhibitors	Enac®, Hypren®
AT1-blocker	Atacand®, Blopress®
Calcium antagonists	Verapabene®, Isoptop®
Thiazide	Fludex®

Specially affected active substances and pharmaceuticals

Name of active substance	Trade name	Affected micronutrients
Calcium antagonists	Isoptin®, Nifedibene®	Calcium

Mechanism of interaction

Mechanism of interaction
Magnesium	Magnesium is a natural calcium antagonist that dilates blood vessels and lowers blood pressure. There is an improvement in cardiac bioenergetics and the bioavailability of NO is increased.
Vitamin D	Vitamin D limits the activity of the renin-angiotensin system. This leads to support for antihypertensive treatment.
L-arginine	The bioavailability of NO increases with the administration of L-arginine as its precursor. Vasodilation occurs. Muscle cell proliferation, plaque formation, platelet aggregation and monocyte adhesion decreases.
Coenzyme Q10	Antihypertensives such as metoprolol interfere with coenzyme-Q10-dependent mitochondrial energy metabolism. This results in an impairment of cardiac bioenergetics.
Calcium	A mainly parenteral calcium therapy with simultaneous use of calcium antagonists leads to a loss of effect.
Pycnogenol	Pycnogenol increases the bioavailability of NO and the associated activity of endothelial NO synthase due to its antioxidant and anti-inflammatory properties.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction		Possible symptoms
Coenzyme Q10	Decrease in coenzyme Q10 levels	Fatigue, Weakness Muscle weakness and pain Disorders of cardiac bioenergetics, endothelial dysfunctions Increased risk of Alzheimer's disease, tumors, Parkinson's disease Increased laboratory parameters for nitrosative stress
Calcium	Decrease in blood pressure-lowering effect	Increase in blood pressure

Positive consequences of the interaction		Possible symptoms
Magnesium	Synergy with antihypertensives	Blood pressure reduction is supported Additional losses resulting from combinations with diuretics are compensated Positive influence on heart rhythm, sleep disorders, irritability and nervousness
Vitamin D	Synergy with antihypertensives	Blood pressure reduction is supported
L-arginine	Synergy with antihypertensives	Blood pressure reduction is supported
Pycnogenol	Hypotensive effect is increased	Thromboxane A2 and endothelin-1 levels are lowered Microcirculation is improved Endothelium and coronary protection The need for antihypertensives is reduced

Recommended Supplementation

Medical substance	Recommended supplementation	Dosage
Antihypertensive drugs	Magnesium	400 mg/d p.o.
	Vitamin D	3000 I.U./d p.o.
	L-arginine	2-3 x 2 g/d p.o.
	Coenzyme Q10	100 mg/d p.o.
	Pycnogenol	100-300 mg/d p.o.

Special instructions for use

Instructions for use
L-arginine	L-arginine can react with superoxide radicals and thus trigger nitrosative stress. Therefore, a combination with omega-3 fatty acids, coenzyme Q10, folic acid and vitamin B₁₂ is recommended.
Coenzyme Q10	WARNING: Local use of Timolol can also cause systemic side effects. Coenzyme Q10 supplementation should be considered.
Calcium	Urgent medical attention required when used in conjunction.

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