A total of 109 patients with symptomatic essential hypertension presenting to a private cardiology practice were observed after the addition of CoQ(10) (average dose, 225 mg/day by mouth) to their existing antihypertensive drug regimen. In 80 per cent of patients, the diagnosis of essential hypertension was established for a year or more prior to starting CoQ(10) (average 9.2 years). Only one patient was dropped from analysis due to noncompliance. The dosage of CoQ(10) was not fixed and was adjusted according to clinical response and blood CoQ(10) levels. Our aim was to attain blood levels greater than 2.0 mu g/ml (average 3.02 mu g/ml on CoQ(10)). Patients were followed closely with frequent clinic visits to record blood pressure and clinical status and make necessary adjustments in drug therapy. Echocardiograms were obtained at baseline in 88% of patients and both at baseline and during treatment in 39% of patients. A definite and gradual improvement in functional status was observed with the concomitant need to gradually decrease antihypertensive drug therapy within the first one to six months. Thereafter, clinical status and cardiovascular drug requirements stabilized with a significantly improved systolic and diastolic blood pressure. Overall New York Heart Association (NYHA) functional class improved from a mean of 2.40 to 1.36 (P < 0.001) and 51% of patients came completely off of between one and three antihypertensive drugs at an average of 4.4 months after starting CoQ(10). Only 3% of patients required the addition of one antihypertensive drug. In the 39.4% of patients with echocardiograms both before and during treatment, we observed a highly significant improvement in left ventricular wall thickness and diastolic function. We observed no side effects or drug interactions from CoQ(10). The time course to improvement in functional class, brood pressure control and myocardial function is in keeping with an improvement in myocardial bioenergetics by CoQ(10) and not a pharmacological effect. The reduction in blood pressure seems likely to be secondary to a decrease in the neurohumoral response to an early impairment in myocardial function which is primarily diastolic in nature. The gratifying improvement in patients' quality of life was enhanced by a marked reduction in their need for antihypertensive drugs along with the substantial medical and financial burden that these drugs entail.
