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Commentary to the letter to the editor


Magnesium Research. Volume 24, Numéro 1, March 2011, Letter to the editor

DOI : 10.1684/mrh.2011.0274


Auteur(s) : Mario Barbagallo, Ligia J. Dominguez, Geriatric Unit, Dept. of Internal Medicine and Emergent Pathologies, University of Palermo, Italy.

ARTICLE

mrh.2011.0274

Auteur(s) : Mario Barbagallo mabar@unipa.it, Ligia J Dominguez

Geriatric Unit, Dept. of Internal Medicine and Emergent Pathologies, University of Palermo, Italy

Correspondence: M. Barbagallo

Dear Editor,

We thank Dr Kisters for his comments; we agree with the potentiality of magnesium supplementation in the management of hypertension. However, although our data show the effectiveness of magnesium supplementation to improve endothelial vascular function [1], we would be more careful to extrapolate from our data a specific effect of magnesium supplementation on blood pressure. This is for several reasons. First of all, our study was conducted in patients in whom, beside hypertension, there were at least other two conditions that may contribute to alter endothelial function (old age and type 2 diabetes mellitus); in addition, in our study the modest effect of magnesium on blood pressure was not significant, while the reported effect of magnesium on endothelial function was strong, and independent of blood pressure, age, and glucose levels, as confirmed by a multivariate analysis.

Altogether, although the therapeutic role of magnesium in type 2 diabetes and hypertension was first reported over 85 years ago for malignant hypertension [2], its effects on borderline hypertension still remain unclear. There are several data supporting a role for an altered magnesium metabolism in hypertension [3], but a consistent, reproducible effect of oral magnesium supplementation on blood pressure (except in pre-eclampsia) is still to be confirmed in hypertension.

Magnesium supplementation has been shown to decrease blood pressure in many [4, 5] but not in all clinical studies [6]. Together with the absence of focused large clinical trials, there are numerous other reasons for these discrepancies, but we believe that one of the most important may be the failure to appreciate the heterogeneity of the underlying mechanisms contributing to arterial hypertension (i.e. magnesium may be very effective in decreasing blood pressure in some hypertensive patients but not in others with different characteristics; hence, with subjects in whom opposite effects are lumped together, the final result will be the false modest or negative results shown so far in some clinical trials). As we previously suggested, in future clinical trials, not only does the magnesium deficient status need to be assessed on the basis of specific and reliable tools (intracellular or ionized magnesium), but future trials design should also be able to distinguish subjects on the basis of underlying pathophysiologic differences such as (among others), plasma renin activity, salt sensitivity, interactive intra/extra cellular alterations of other ions (calcium, sodium, potassium). We believe that these studies are still clearly needed before we can fully consider magnesium as a non-pharmacologic tool for treating hypertension.

References

1 M Barbagallo, LJ Dominguez, A Galioto, A Pineo, M. Belvedere Oral magnesium supplementation improves vascular function in elderly diabetic patients Magnes Res 2010; 23: 131-137.

2 K Blackfan, B. Hamilton Uremia in acute glomerular nephritis: the cause and treatment in children Med Surg J 1925; 193: 617-628.

3 M Barbagallo, L.J. Dominguez Magnesium metabolism in hypertension and type 2 diabetes mellitus Am J Therapeutics 2007; 14: 375-385.

4 Y Kawano, H Matsuoka, S Takishita, T. Omae Effects of magnesium supplementation in hypertensive patients: assessment by office, home, and ambulatory blood pressures Hypertension 1998; 32: 260-265.

5 T Dyckner, P.O. Wester Effect of magnesium on blood pressure Br Med J 1983; 286: 1847-1849.

6 FP Cappuccio, ND Markandu, GW Beynon, AC Shore, B Sampson, G.A. MacGregor Lack of effect of oral magnesium on high blood pressure: a double blind study Br Med J 1985; 291: 235-238.


 

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