Nicotinamide riboside combined with exercise to treat hypertension in middle-aged and older adults: a pilot randomized clinical trial

Aerobic exercise lowers blood pressure (BP) with varying effects in hypertensive adults, potentially due to age-related nicotinamide adenine dinucleotide (NAD) metabolism dysregulation. This pilot randomized clinical trial (RCT) tested the efficacy of combining aerobic exercise with the NAD booster nicotinamide riboside (NR) to enhance BP control. In this double-blinded RCT, 54 sedentary adults (≥ 55 years) with mean daytime systolic BP (SBP) ≥ 130 mmHg were randomized to 6 weeks of 1000 mg/day of NR combined with 3 days/week of supervised 30-min walking exercise (NR + Ex), Placebo combined with the same exercise regimen (PL + Ex), or NR alone (NR). The primary outcome was daytime SBP. Other outcomes included pulse wave velocity (PWV), NAD catabolites, and nighttime BP. The primary comparison was between NR + Ex and PL + Ex. Of 54 participants (mean age 67 years, 61% female), 49 (NR + Ex: n = 15, PL + Ex: n = 16, NR: n = 18) completed all study visits (93% adherence to exercise and 90% to supplementation). NR + Ex (mean change = 5.19 ± 13.2 mmHg) did not reduce SBP more than PL + Ex (- 2.71 ± 10.5 mmHg). NR + Ex (- 0.31 ± 0.77 m/s) showed a trend toward a greater reduction in PWV. Levels of NAD catabolites were higher in NR groups. In a post hoc analysis, NR + Ex showed a trend toward greater nighttime BP reductions (systolic: - 9.6 ± 9.22; diastolic: - 4.51 ± 7.12 mmHg) in participants without antihypertensive medications. NR + Ex was not superior to PL + Ex in reducing BP in hypertensive middle-aged and older. However, trends toward greater nighttime BP reduction in NR + Ex in participants without antihypertensive medication warrant further investigation in a Phase IIb RCT.