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CBD for Hypertension: How does cannabidiol affect blood pressure?

CBD hypertension

On the occasion of World Heart Day, we bring you this post about CBD and Hypertension.

With its potential benefits in the spotlight, in recent years CBD has conquered a space of its own within wellness products. In relation to its use, one of the doubts that may arise when buying CBD online is its impact on blood pressure and hypertension.

How does CBD affect blood pressure? Can you lower the pressure? Does it interact with hypertension medications? If you are interested in the subject, we tell you about the current scientific research on CBD and hypertension, resolving all these doubts.

Note: We remind you that this is an informative article that is not intended to prevent, diagnose or treat any disease. Its content can complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Consult with your physician before using CBD.

Introduction to CBD and hypertension

The CBD or cannabidiol is a natural compound found in the cannabis plant. Unlike tetrahydrocannabinol (THC), the cannabinoid responsible for the effects of marijuana, CBD is not psychoactive. This compound is being widely investigated for its potential health benefits, including control of hypertension.

What is hypertension?

Hypertension occurs when the force exerted by the blood against the walls of the arteries is too high over time. It is an important and frequent health problem: in Spain, up to 75% of people over 60 years of age have elevated blood pressure (1).

Although technically it is not a disease, but a cardiovascular risk factor, hypertension (together with other cardiovascular risk factors such as age, obesity, smoking, diabetes…) can progressively damage the inside of the arteries, reducing their diameter and hindering normal blood flow. In the long term, this can trigger heart problems and strokes.

The causes of hypertension are genetic and environmental: some people are born with a greater predisposition to develop this problem. Diets rich in salt, obesity, stress and lack of physical activity are modifiable factors that also influence its development.

Diagnosis is made with regular blood pressure measurements. Many hypertension problems can be controlled with lifestyle changes and, in some cases, medication.

The endocannabinoid system and hypertension

The endocannabinoid system and the circulatory system are interconnected and have a mutual influence on several aspects. An example of this is the presence of endocannabinoid receptors in different parts of the cardiovascular system.

CB1 receptors are found in:

  • Endothelial cells that line the inside of blood vessels (veins, arteries and capillaries).
  • Smooth muscle cells that regulate vasodilatation and vascular constriction.
  • Muscle cells of the heart, where they contribute to regulate cardiac function (frequency, force of contraction…).

CB2 receptors are found on cells of the immune system, interacting with the inflammatory response and immune function in cardiovascular disorders. Some of these cells, such as leukocytes, interact directly with the circulatory system. Activation of CB2 receptors affects inflammatory response and immune function in the context of cardiovascular disease and other disorders.

In addition, the endocannabinoid system interacts with orphan receptors, ion channels and nuclear receptors, contributing to a wide range of physiological and pathological functions in the cardiovascular system. Its complexity and ubiquity make the endocannabinoid system a key player in various physiological and pathological states (13).

When THC marijuana is administered in isolation, that is, without taking into account other factors or conditions, the effect observed is orthostatic hypotension and reflex tachycardia. Simply put, if you smoke joints you get dizzy because it lowers your blood pressure. A sudden drop in blood pressure occurs as a result of dilation of the blood vessels, blood pressure drops suddenly when you change position, and your heart tries to compensate by speeding up the heartbeat to increase the pressure.

Frequently asked questions about CBD and hypertension

Can I use CBD if I am hypertensive?

Considering the available data on the pharmacology of cannabinoids and their action on the cardiovascular system as a whole, as well as the available studies, there are no data suggesting that the use of CBD in hypertensive patients increases cardiovascular risk or worsens hypertension. The package insert of the CBD-rich cannabis oil-based drug, recently approved in Europe for the treatment of some epileptic syndromes, makes no mention or warning of hypertension or any other cardiovascular pathology in its contraindications. In any case, hypertension includes a very wide range of manifestations, from mild symptoms that can be controlled with diet to very severe ones. We recommend that you consult your doctor before using CBD.

Can CBD lower blood pressure?

CBD can lower blood pressure through the endocannabinoid system. In basic research studies, this effect seems to be related to the direct interaction with CB1 receptors (2), its anti-inflammatory effect (3) and its action on the nervous system (5,6). The hypotensive effect has also been demonstrated in healthy humans and in patients with hypertension (11,12). However, it still needs to be confirmed in large-scale clinical trials (thousands of patients) before it can be considered as another antihypertensive drug.

Can CBD interact with hypertension medications?

Some older sources suggested a possible interaction between CBD and some compounds of some of the families of drugs used in the treatment of hypertension (specifically beta-blockers, calcium antagonists and angiotensin-converting enzyme inhibitors). However, in the technical data sheet of the CBD-rich cannabis oil-based drug, there is no mention of any of these drugs in the section on pharmacological interactions. Neither the FDA (United States) nor the EMEA (Europe) data sheet contains any indication that the combination of CBD with antihypertensive drugs is dangerous. Pharmacovigilance systems are a mechanism that especially monitors drugs that have been on the market for a short time, seeking to detect infrequent problems or those that have not manifested themselves in previous clinical trials. In this regard, there are also no reports of pathological conditions that could be attributed to the combination of antihypertensives with CBD. Thus, overall, the available data indicate that CBD does not interact with drugs approved for the treatment of hypertension. In any case, if you are taking antihypertensive drugs, we advise you to consult your doctor before using CBD.

Additional benefits of CBD for cardiovascular health

According to all animal research studies, the effect of the endocannabinoid system on the cardiovascular system is moderate under normal conditions.

In the absence of disease, the modulation exerted by the endocannabinoid system has small consequences and does not result in constant changes in the circulatory system.

However, this interaction is much more important under disease conditions. In this situation, the endocannabinoid system is regulated very differently. In vitro, in vivo and some human clinical/epidemiological studies suggest that during the development of cardiovascular disease pathology, the endocannabinoid system is modified. Thus, modulation of the endocannabinoid system (through natural or synthetic cannabinoids) has been suggested as a therapeutic pathway for various disorders of the cardiovascular system. In relation to CBD, the most significant data are:

  • Myocardial infarction: In experimental studies, CBD has shown potential to reduce cardiac damage by improving heart function and increasing blood flow (7).
  • Arrhythmia: administration of CBD to animals undergoing experimental infarction has also been associated with a lower incidence and severity of associated cardiac arrhythmias (8).
  • Heart failure: Heart failure is a disease in which the heart is not able to perform its function at a normal level, producing different affectations to the rest of the organism. In in vitro models, CBD has been shown to be a promising potential treatment due to its anti-inflammatory and antioxidant properties (9).

Scientific studies on CBD for hypertension control

The vasodilatory effects of CBD and its influence on lowering blood pressure have been demonstrated in animal and healthy human studies. But the key to the matter is to know the effect of CBD in hypertensive people (we pointed out at the beginning that cannabinoids act differently in states of health and disease) and whether, in the long term, it can contribute to lowering blood pressure in a sustained manner over time.

The importance of this avenue of research is high. CBD is a safe drug, with few adverse effects. It works by different mechanisms than other drugs used to control blood pressure. In principle, it would be a good candidate for use in combination with other drugs to achieve greater efficacy.

The results of the first research on CBD in hypertensive patients are now available and invite optimism.

A study published just this summer investigated how CBD affects people with untreated hypertension (10). Sixteen volunteers with hypertension participated, receiving cannabidiol (150 mg orally every 8 hours or placebo) for 24 hours. Different aspects were measured, such as blood pressure throughout the day and arterial stiffness. Results showed that cannabidiol reduced artery stiffness and blood pressure measurements, especially during sleep .

A larger trial has studied the effect of CBD over a longer period of time. 70 patients with mild to moderate hypertension who were untreated or on standard therapy were randomized to receive 5 weeks of oral CBD or placebo. Some of the patients were untreated, but most were using drugs, which they continued to take during the study period. The results showed that CBD reduced mean blood pressure measured every 24 hours, as well as systolic (“high”) and diastolic (“low”) blood pressure. The effect was most noticeable 2 weeks after starting treatment (11). The results were supported by a different statistical analysis in a subgroup of these patients, which was published separately (12). In conclusion, chronic administration of CBD reduced blood pressure in patients with untreated and treated hypertension. The absence of serious adverse events suggests the safety and tolerability of CBD.

Current research yields promising results on the impact of CBD on hypertension. Although still in development, CBD could be a safe and effective option in combination with other treatments.

These results do not mean that CBD lowers blood pressure. Remember that, as mentioned above, CBD affects people without pathology and people with hypertension differently.

CBD doses used in the study of hypertension.

The doses used in these clinical trials ranged from 225-300 mg/day during the first 2 weeks and 300-450 mg during the remainder of the study. The maximum effect occurred in the 300 mg range, with no further increase in dose implying a greater effect.

The researchers used a special patented CBD formulation (DaHydraTECH-CBD), which uses a particular system to dehydrate CBD and achieve higher concentrations in the body.

Considerations before using CBD

The post aims to clarify doubts about CBD and its relationship with hypertension. Although research in this field is still under development, the results so far are promising. However, it is essential to remember that CBD should not be considered as a replacement for conventional medical treatment, and that there is currently insufficient data to consider it as a treatment option.

Note: We remind you that this is an informative article that is not intended to prevent, diagnose or treat any disease or symptom. Its content can complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Consult your physician for more information and personalized advice on the treatment of hypertension before using CBD.

Referencias
  1. Menéndez E, Delgado E, Fernández-Vega F et al. Prevalence, diagnosis, treatment and control of arterial hypertension in Spain. Diabet.es study results. Vol. 69, No. 6, pp. 572-578, June 2016. DOI: 10.1016/j.recesp.2015.11.036
  2. Stanley CP, Wheal AJ, Randall MD, O’Sullivan SE. Cannabinoids alter endothelial function in the Zucker rat model of type 2 diabetes. Eur J Pharmacol. 2013 Nov 15;720(1-3):376-82. doi: 10.1016/j.ejphar.2013.10.002. Epub 2013 Oct 8. PMID: 24120371.
  3. Atalay S, Jarocka-Karpowicz I, Skrzydlewska E. Antioxidative and Anti-Inflammatory Properties of Cannabidiol. Antioxidants (Basel). 2019 Dec 25;9(1):21. doi: 10.3390/antiox9010021. PMID: 31881765; PMCID: PMC7023045.
  4. Alfulaij N, Meiners F, Michalek J, Small-Howard AL, Turner HC, Stokes AJ. Cannabinoids, the Heart of the Matter. J Am Heart Assoc. 2018 Jul 13;7(14):e009099. doi: 10.1161/JAHA.118.009099. PMID: 30006489; PMCID: PMC6064852.
  5. Kendall DA, Yudowski GA. Cannabinoid Receptors in the Central Nervous System: Their Signaling and Roles in Disease. Front Cell Neurosci. 2017 Jan 4;10:294. doi: 10.3389/fncel.2016.00294. PMID: 28101004; PMCID: PMC5209363.
  6. Silvestro S, Schepici G, Bramanti P, Mazzon E. Molecular Targets of Cannabidiol in Experimental Models of Neurological Disease. Molecules. 2020 Nov 7;25(21):5186. doi: 10.3390/molecules25215186. PMID: 33171772; PMCID: PMC7664437.
  7. Feng Y, Chen F, Yin T, Xia Q, Liu Y, Huang G, Zhang J, Oyen R, Ni Y. Pharmacologic Effects of Cannabidiol on Acute Reperfused Myocardial Infarction in Rabbits: Evaluated With 3.0T Cardiac Magnetic Resonance Imaging and Histopathology. J Cardiovasc Pharmacol. 2015 Oct;66(4):354-63. doi: 10.1097/FJC.0000000000000287. PMID: 26065843.
  8. Walsh SK, Hepburn CY, Kane KA, Wainwright CL. Acute administration of cannabidiol in vivo suppresses ischaemia-induced cardiac arrhythmias and reduces infarct size when given at reperfusion. Br J Pharmacol. 2010 Jul;160(5):1234-42. doi: 10.1111/j.1476-5381.2010.00755.x. PMID: 20590615; PMCID: PMC2936031.
  9. Lozano O, García-Rivas G, Ramos M, et al. Cannabidiol Therapy For Chronic Heart Failure Prevents Cardiac Pathological Remodelling In A Non-Ischemic Cardiomyopathy Murine Model. J Am Coll Cardiol. 2023 Mar, 81 (8_Supplement) 438. https://doi.org/10.1016/S0735-1097(23)00882-3
  10. Dragun T, Brown CV, Tulppo MP, Obad A, Dujić Ž. The Influence of Oral Cannabidiol on 24-h Ambulatory Blood Pressure and Arterial Stiffness in Untreated Hypertension: A Double-Blind, Placebo-Controlled, Cross-Over Pilot Study. Adv Ther. 2023 Aug;40(8):3495-3511. doi: 10.1007/s12325-023-02560-8. Epub 2023 Jun 8. PMID: 37291376.
  11. Dujic G, Kumric M, Vrdoljak J, Dujic Z, Bozic J. Chronic Effects of Oral Cannabidiol Delivery on 24-h Ambulatory Blood Pressure in Patients with Hypertension (HYPER-H21-4): A Randomized, Placebo-Controlled, and Crossover Study. Cannabis Cannabinoid Res. 2023 Apr 21. doi: 10.1089/can.2022.0320. Epub ahead of print. PMID: 37093160.
  12. Kumric M, Dujic G, Vrdoljak J, Svagusa K, Kurir TT, Supe-Domic D, Dujic Z, Bozic J. CBD supplementation reduces arterial blood pressure via modulation of the sympatho-chromaffin system: A substudy from the HYPER-H21-4 trial. Biomed Pharmacother. 2023 Apr;160:114387. doi: 10.1016/j.biopha.2023.114387. Epub 2023 Feb 11. PMID: 36780785.
  13. Dziemitko S, Harasim-Symbor E, Chabowski A. How do phytocannabinoids affect cardiovascular health? An update on the most common cardiovascular diseases. Ther Adv Chronic Dis. 2023 Jan 6;14:20406223221143239. doi: 10.1177/20406223221143239. PMID: 36636553; PMCID: PMC9830002.

Dr. Fernando Caudevilla
Family Physician | Expert in Drug Addictions. He works in different assistance, research and training projects related to drugs, including therapeutic cannabis.

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