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Tetrahydrobiopterin: a novel antihypertensive therapy

Journal of Human Hypertension volume 22, pages 401–407 (2008)Cite this article

Abstract

Tetrahydrobiopterin (BH4) is a cofactor for the nitric oxide (NO) synthase enzymes, such that its insufficiency results in uncoupling of the enzyme, leading to release of superoxide rather than NO in disease states, including hypertension. We hypothesized that oral BH4 will reduce arterial blood pressure (BP) and improve endothelial function in hypertensive subjects. Oral BH4 was given to subjects with poorly controlled hypertension (BP >135/85 mm Hg) and weekly measurements of BP and endothelial function made. In Study 1, 5 or 10 mg kg−1 day−1 of BH4 (n=8) was administered orally for 8 weeks, and in Study 2, 200 and 400 mg of BH4 (n=16) was given in divided doses for 4 weeks. Study 1: significant reductions in systolic (P=0.005) and mean BP (P=0.01) were observed with both doses of BH4. Systolic BP was 15±15 mm Hg (P=0.04) lower after 5 weeks and persisted for the 8-week study period. Study 2: subjects given 400 mg BH4 had decreased systolic (P=0.03) and mean BP (P=0.04), with a peak decline of 16±19 mm Hg (P=0.04) at 3 weeks. BP returned to baseline 4 weeks after discontinuation. Significant improvement in endothelial function was observed in Study 1 subjects and those receiving 400 mg BH4. There was no significant change in subjects given the 200 mg dose. This pilot investigation indicates that oral BH4 at a daily dose of 400 mg or higher has a significant and sustained antihypertensive effect in subjects with poorly controlled hypertension, an effect that is associated with improved endothelial NO bioavailability.

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Acknowledgements

Markus Porkert was supported by an American Heart Association training Grant Award Number: 0425402B. Other funding came from a research grant from the Emory University General Clinical Research Center (Grant no. MO1-RR00039).

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Authors and Affiliations

  1. Division of Cardiology, Emory University, Atlanta, GA, USA

    M Porkert, S Sher, U Reddy, F Cheema, C Niessner, W R Taylor, D Harrison & A A Quyyumi

  2. Christiana Care Center for Outcomes Research, Newark, DE, USA

    P Kolm

  3. General Clinical Research Center, Emory University, Atlanta, GA, USA

    D P Jones

  4. Centers for Disease Control, Atlanta, GA, USA

    C Hooper

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  1. M Porkert
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Correspondence to A A Quyyumi.

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Porkert, M., Sher, S., Reddy, U. et al. Tetrahydrobiopterin: a novel antihypertensive therapy. J Hum Hypertens 22, 401–407 (2008). https://doi.org/10.1038/sj.jhh.1002329

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