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Can nicotinamide supplements lower blood pressure?

Could something as simple as supplementing with nicotinamide be an effective way of reducing blood pressure? Rod Tucker looks at a recent analysis which examined this question in more detail

Ross Ferguson, 04 Jun 2026clock4 Min

In Evidence Review

Hypertension, defined as a systolic blood pressure (SBP) at or above 140mmHg or a diastolic blood pressure (DBP) at or above 90mmHg, is estimated to affect around 30% of adults in the UK. What’s more, according to the World Health Organization, an estimated 600 million adults globally are unaware that they have the condition.

Left untreated, hypertension can lead to several serious sequelae, including kidney disease, myocardial infarction, stroke and heart failure.

When hypertension is detected during screening, ambulatory monitoring can be performed to confirm the diagnosis. Several lifestyle modifications, including reducing salt intake, increasing physical activity, stopping smoking, and reducing or stopping alcohol intake, all play an important adjunctive role in managing hypertension. But are there any dietary modifications that might be more impactful?

Antihypertensive effect?

It has recently been proposed that dysfunction of the endothelium, the single-cell layer lining the walls of blood vessels, is implicated in the development of diseases such as atherosclerosis, hypertension and diabetes.1

Animal studies have shown that a higher intake of nicotinamide mononucleotide (NMN; vitamin B3) acts as a precursor to, and boosts, levels of nicotinamide adenine dinucleotide (NAD+), which is an essential cofactor involved in biological processes that help ameliorate endothelial dysfunction.2

Consequently, it is possible that supplementing with NMN could ultimately prevent hypertension. This is particularly relevant given that NAD+ levels reduce with ageing3 and that the prevalence of hypertension increases with advancing age.

Despite this, studies to date have been inconsistent, so the clinical efficacy of NMN in lowering blood pressure remains uncertain. However, a recent meta-analysis provides a clearer picture of NMN’s benefits.

Latest findings

For the systematic review and meta-analysis,
10 relevant trials were identified with a total of 349 participants.4 The daily NMN dosage ranged from 250mg to 1,500 mg, and interventions lasted 4-12 weeks.

The results showed that, compared to placebo, supplementing with NMN was associated with a small but significant mean reduction in diastolic blood pressure of 2.15mmHg. There was also a non-significant reduction of 1.58mmHg in systolic blood pressure.

Furthermore, when looking more closely at subgroups (e.g. those aged 60 and over), there was a significant reduction in both systolic (3.94mmHg) and diastolic (2.14mmHg) blood pressure.

Implications for practice

So supplementing with NMN appears to reduce blood pressure for patients with hypertension, especially among those aged 60 years and older.

The absolute reduction in diastolic blood pressure (DBP) might seem small but it has been suggested that on a population level and when combined with medical treatment, such reductions could result in a 17% drop in the prevalence of hypertension, a 6% reduction in the risk of coronary heart disease and a 15% decrease in the risk of stroke.5

Furthermore, this decrease in DBP is comparable to that achieved with other lifestyle modifications, such as diet and increased physical activity. For instance, the Dietary Approach to Stop Hypertension (DASH) has been advocated as an effective strategy for lowering blood pressure. Indeed, a meta-analysis of 65 trials examining the DASH diet found that the intervention significantly reduced DBP by 2.6mmHg.6

Similarly, an analysis of 54 randomised trials of aerobic exercise observed a significant reduction in DBP of 2.58mmHg.7

Limitations

It is worth noting some limitations of this meta-analysis. Firstly, at least two of the trials were at a high risk of bias. Secondly, the trials included a small number of patients and used different NMN doses. Thirdly, the trials enrolled patients with existing hypertension, so it is impossible to know whether taking NMN would exert a protective role against developing high blood pressure in the first place.

It is clear that NMN has some effect on blood pressure. However, in the absence of more definitive trials examining the optimal dose and longer-term safety, it is currently impossible to determine whether or not pharmacists should recommend supplementing with the vitamin.

 

  References

  1. Xu S et al.  Endothelial Dysfunction in Atherosclerotic Cardiovascular Diseases and Beyond: From Mechanism to Pharmacotherapies. Pharmacol Rev. 2021 Jul;73(3):924-967. doi: 10.1124/pharmrev.120.000096. 

  1. Mateuszuk Ł et al. Reversal of endothelial dysfunction by nicotinamide mononucleotide via extracellular conversion to nicotinamide riboside. Biochem Pharmacol. 2020 Aug; 178:114019. doi: 10.1016/j.bcp.2020.114019. 

  1. Massudi H et al. Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS One. 2012;7(7):e42357. doi: 10.1371/journal.pone.0042357. 

  1. Zhang, M et al. Effects of Nicotinamide Mononucleotide Supplementation on Blood Pressure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients 2026, 18, 890. https://doi.org/10.3390/nu18060890 

  1. Cook NR et al.  Implications of small reductions in diastolic blood pressure for primary prevention. Arch Intern Med. 1995 Apr 10;155(7):701-9. 

  1. Siervo M et al. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr. 2015 Jan 14;113(1):1-15. doi: 10.1017/S0007114514003341. 

  1. Whelton SP et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002 Apr 2;136(7):493-503. doi: 10.7326/0003-4819-136-7-200204020-00006.  

 



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