The Role of Riboflavin in Resistant Hypertension: A Novel Approach to Treating and Managing High Blood Pressure

Hypertension affects one billion people worldwide and is a leading risk factor for heart attack and stroke responsible for around 9 million annual deaths.¹ Despite a wide range of medications available, ~15% of hypertensive patients globally fail to control the condition despite the use of multiple anti-hypertensives.^2,3,4,5 Such resistant hypertension increases the risk for subsequent complications and death, and the economic and societal burden is high.⁶ Hypertension control is an important public health concern given the high prevalence of hypertension and the risk associated with untreated, inadequately treated and uncontrolled hypertension.⁷

The role of genetics in resistant hypertension is well established. In recent years, genome-wide association studies have identified a region near the gene encoding the folate-metabolizing enzyme MTHFR among eight loci associated with blood pressure. Individuals carrying this genotype are often hypertensive patients who fail to achieve blood pressure control with available antihypertensive treatment. With an estimated global prevalence of 10%, this 677TT homozygous subgroup represents a large proportion of patients who could potentially be targeted with gene-specific therapeutic approaches as a first line therapy.⁸

Emerging evidence indicates that riboflavin has a genotype-specific effect on blood pressure in (MTHFR) 677C→T patients. The therapeutic effect of oral riboflavin administration has been found to be independent of the concurrent use of antihypertensive therapies: In 3 randomized control trials in hypertensive patients with the 677 TT genotype daily consumption of 1.6 mg riboflavin resulted in the blood pressure decline 6 to 13 mm Hg.^9,10,11

Despite the availability of affordable therapies, treatment with commonly used antihypertensive medicines may not work in specific patients (e.g. (MTHFR) 677C→T genotype). Thus, the inclusion of riboflavin in clinical practice may have significant implications in achieving safe and cost-effective blood pressure treatment targets in patients with genetic predispositions.