Does niacin lower blood pressure?

Not in a way you could use. The closest pooled randomized evidence is on NMN, a supplement from the vitamin B3 family. Across 10 trials in 349 adults it lowered diastolic pressure by 2.15 mmHg (95% CI 0.61 to 3.68) and left systolic pressure unchanged. For niacin itself we found no meta-analysis on blood pressure, and a 2009 review found that most large niacin trials reported no significant change.

Myth. Niacin is not a blood pressure treatment. No trial we found was designed with blood pressure as its main niacin outcome. The small drops that turn up come from post hoc analyses at drug doses, and at those doses a sudden fall in blood pressure is listed as a side effect.

Fall in blood pressure against placebo, mmHg

Pooled differences with 95 percent confidence intervals from one 2026 meta-analysis of NMN, a niacin-related supplement and not niacin itself. Systolic pressure across all ages did not change significantly, so it has no bar. The age 60 result is a subgroup the authors call preliminary. Sources: cards ev-nibp-01 and ev-nibp-02 below.

What the trials found

Niacin itself

A 2009 review of the major niacin outcome and imaging trials found that, where both baseline and on-treatment values were reported, most blood pressure changes were not statistically significant. Part of the reason, the review says, is that these trials rarely tracked whether people were taking blood pressure drugs. The review was supported by Merck, which made an extended-release niacin product.

Two post hoc analyses reported in that review found small falls. In people with metabolic syndrome in the Coronary Drug Project, a trial in men after a heart attack, systolic pressure fell by 2.2 mmHg after one year on niacin and rose by 0.8 mmHg on placebo. Diastolic pressure fell by 2.9 mmHg, against a 0.9 mmHg fall on placebo. In a 24-week trial of 1,613 people with high cholesterol, extended-release niacin at 1 to 2 g a day lowered blood pressure against placebo, apparently more at the higher dose. The numbers for that trial sit in a figure, and we did not take them from it.

A small randomized trial gave 1,500 mg of niacin a day for 20 weeks to 15 statin-treated people with type 2 diabetes. Blood pressure and heart rate did not change. The trial had no placebo.

NMN, a related supplement

NMN is a precursor of NAD+ from the vitamin B3 family and is a different compound from the nicotinic acid used in the niacin trials. Its 2026 meta-analysis of 10 small trials found the diastolic fall shown above. Systolic pressure fell by 3.94 mmHg (95% CI 0.82 to 7.06) only in people aged 60 and older, a subgroup the authors treat as preliminary. A second 2026 meta-analysis of 15 NMN trials found no effect on systolic pressure.

Niacin from food

Unsettled. In 12,243 Chinese adults followed for about 6 years, the risk of new hypertension was lowest at a dietary niacin intake of 14.3 to under 16.7 mg a day, with a hazard ratio of 0.83 (95% CI 0.75 to 0.90) against under 12.4 mg. This is observational, it is about food and not supplements, and it cannot show cause.

Who should be careful

The NIH Office of Dietary Supplements says that 30 to 50 mg of nicotinic acid typically causes flushing, which can come with headache, rash, dizziness and a drop in blood pressure. At 1,000 to 3,000 mg a day, nicotinic acid can cause low blood pressure severe enough to raise the risk of falls, along with fatigue, impaired glucose tolerance, stomach upset and eye problems. These are drug doses, mostly used for blood fats.

Not for everyone. A 2017 meta-analysis of 47 studies with 11,741 people found that major adverse effects of nicotinic acid in healthy people occurred at doses below 1,000 mg a day. Across 18 trials with 69,515 patients, HDL-raising drugs, niacin and CETP inhibitors pooled, went with more serious adverse events (OR 1.24, 95% CI 1.18 to 1.31), with new diabetes in particular on niacin. One case report describes a man who took 11,000 mg on internet advice. His blood pressure fell to 58/40 mmHg and stayed there despite over 4.2 quarts (4 liters) of saline. If you take blood pressure medicine or have diabetes, high-dose niacin is a question for the person treating you.

For NMN we have no carded safety data. Its trials lasted at most 24 weeks, so how it behaves over years is unknown.

What expert bodies say

We found no AHA or ACC statement on niacin as a treatment for blood pressure. The US upper limit for supplemental niacin is 35 mg a day for adults. It covers both nicotinic acid and nicotinamide, is based on skin flushing, and does not apply to people taking niacin under medical supervision. The European upper limit for nicotinic acid is 10 mg a day.

How we searched

Searched: a local copy of PubMed on 7 October 2026, for niacin, nicotinic acid, vitamin B3 or nicotinamide with blood pressure or hypertension (111 results). Further queries covered flushing, hypotension and liver harm in meta-analyses and trials (59), and niacin with blood pressure across all study types. Europe PMC returned 15 results for niacin, blood pressure and meta-analysis, and only the two meta-analyses of NMN were relevant. We searched the NIH niacin fact sheet and ClinicalTrials.gov, which listed nothing, and ran two web searches. Every study used was checked against Retraction Watch, and none was retracted.

Included: two meta-analyses of NMN, one 2009 review of niacin trials read in full text, one small randomized trial and one cohort. Also one meta-analysis of niacin side effects and upper limits, one meta-analysis of HDL-raising drugs, one case report and three passages of the NIH fact sheet.

Excluded: a cross-sectional survey of B vitamins and diastolic pressure, weaker than the cohort. A nicotinamide riboside crossover trial whose abstract gives no blood pressure numbers. A study of endothelial function in HIV with no blood pressure outcome. The Linxian trial, which reported hypertension only for a different supplement group. Flush tests used in psychiatry, and a dialysis review about phosphate.

What we read: abstracts for most studies, the full text of the 2009 review, and the relevant sections of the NIH fact sheet.

What we could not get: the primary papers for the two post hoc analyses, the Coronary Drug Project subgroup and the 24-week extended-release trial. Their results reach this page only through the 2009 review.

What would change this answer

A randomized trial of niacin with blood pressure as its main outcome, recording blood pressure drugs. We found none.
A meta-analysis of nicotinic acid trials on blood pressure. We found none in PubMed or Europe PMC.
Trials of dietary niacin at food-level intakes, which would test what the Chinese cohort can only suggest.
Longer NMN trials, to see whether the small diastolic fall lasts and whether the age 60 subgroup holds up.

The rest of the nutrient, in one place. Niacin: the vitamin that became a heart drug and then failed the trials → What it does, how much you need, who runs short, and what too much does, with the evidence level shown on every line.

The full guide

Niacin: the vitamin that became a heart drug and then failed the trials

The same question for other foods (blood pressure)

Sources

ev-nibp-01 · Meta-analysis or systematic review · systematic review and common-effects meta-analysis of RCTs · n = 349
Compared with the placebo, NMN supplementation was associated with a statistically significant but modest reduction in resting DBP (WMD, -2.15 mmHg; 95% CI: -3.68 to -0.61).
Who: adults in RCTs of nicotinamide mononucleotide (NMN)
Effect: diastolic BP WMD -2.15 mmHg (95% CI -3.68 to -0.61); systolic BP not significant
Certainty: NMN is an NAD+ precursor from the vitamin B3 family, not nicotinic acid; small short RCTs.
Nutrients, 2026 · checked 2026-10-07 · we read the abstract
ev-nibp-02 · Meta-analysis or systematic review · subgroup analysis within a meta-analysis of RCTs · n = —
Notably, subgroup analyses revealed that NMN supplementation resulted in a significant reduction in SBP specifically among participants aged 60 years and older (WMD: -3.94 mmHg; 95% CI: -7.06 to -0.82).
Who: participants aged 60 years and older in NMN RCTs
Effect: systolic BP WMD -3.94 mmHg (95% CI -7.06 to -0.82) in age 60+
Certainty: Subgroup; the authors call the result preliminary.
Nutrients, 2026 · checked 2026-10-07 · we read the abstract
ev-nibp-03 · Meta-analysis or systematic review · systematic review and random-effects meta-analysis of RCTs with GRADE · n = 15 trials
No significant effects were observed on body weight, BMI, fasting glucose, HbA1c, lipid profiles, or systolic blood pressure.
Who: adults in parallel RCTs of oral NMN or NMN-related preparations, 14 days to 24 weeks
Effect: no significant change in systolic BP, body weight, BMI, fasting glucose, HbA1c or lipids
Certainty: Short studies; long-term safety of NMN is unknown.
Nutrients, 2026 · checked 2026-10-07 · we read the abstract
ev-nibp-04 · Randomized controlled trial(s) · narrative review of randomized niacin trials · n = —
Among studies of chronic niacin administration that reported both baseline and on-treatment mean values for SBP and DBP (or changes in BP), most described BP changes from baseline to end-point (or between niacin-treated and control groups) that were not statistically significant (Table 3) (6,8,13,18,39).
Who: major niacin outcome, angiographic and ultrasonographic trials reporting baseline and end-point blood pressure
Effect: most chronic trials: BP change from baseline or versus control not statistically significant
Certainty: No formal meta-analysis of nicotinic acid on BP; the review is supported by Merck (maker of ERN/LRPT).
Bays HE, Rader DJ. Does nicotinic acid (niacin) lower blood pressure? International Journal of Clinical Practice, 2009 · checked 2026-10-07 · we read the fulltext
ev-nibp-05 · Randomized controlled trial(s) · post hoc subgroup analysis of a randomized placebo-controlled trial, reported in a review · n = —
Compared with baseline, SBP declined by a mean of 2.2 mmHg (vs. +0.8 mmHg with placebo; p < 0.0001), and DBP declined by 2.9 mmHg (vs. −0.9 mmHg with placebo; p < 0.0001) (12).
Who: Coronary Drug Project participants with metabolic syndrome, men after myocardial infarction
Effect: year 1: SBP -2.2 vs +0.8 mmHg placebo; DBP -2.9 vs -0.9 mmHg (both p<0.0001)
Certainty: Post hoc, subgroup; the primary paper is outside the corpus. Nicotinic acid doses in CDP are 3 g/day (medicinal).
Bays HE, Rader DJ. Does nicotinic acid (niacin) lower blood pressure? International Journal of Clinical Practice, 2009 · checked 2026-10-07 · we read the fulltext
ev-nibp-06 · Randomized controlled trial(s) · post hoc analysis of a randomized placebo-controlled trial, reported in a review · n = 1613
In a post hoc analysis of this study, reductions in BP were significant in patients receiving either extended-release niacin or extended-release niacin/laropiprant compared with placebo at both 4 and 24 weeks, and this effect seemed to be dose dependent (Figure 1) (3).
Who: patients with dyslipidemia randomized to extended-release niacin 1 g, then 2 g, with or without laropiprant, or placebo
Effect: significant BP reductions versus placebo at 4 and 24 weeks, apparently dose dependent; laropiprant did not attenuate it
Certainty: Numbers are in the review figure, not in the text; medicinal doses; post hoc.
Bays HE, Rader DJ. Does nicotinic acid (niacin) lower blood pressure? International Journal of Clinical Practice, 2009 · checked 2026-10-07 · we read the fulltext
ev-nibp-07 · Randomized controlled trial(s) · parallel-group RCT, niacin vs no additional treatment · n = 15
Niacin increased maximal post-ischaemic forearm blood flow (mean ± SEM 6.4±2.4 vs. -2.3±1.2 ml/100 ml/min, p = 0.001) and small artery compliance (1.3±0.8 vs. -2.3±1.1 ml/mmHg, p = 0.01) compared with no additional treatment, but did not alter large artery compliance, blood pressure nor heart rate.
Who: statin-treated type 2 diabetic patients with endothelial dysfunction
Effect: no change in blood pressure or heart rate; small artery compliance improved; triglycerides -47%
Certainty: Very small, no placebo.
Diab Vasc Dis Res, 2010 · checked 2026-10-07 · we read the abstract
ev-nibp-08 · Observational data · prospective cohort · n = 12243
When dietary niacin was assessed in quartiles, the lowest risk of new-onset hypertension was found in participants in quartile 3 (14.3 to <16.7 mg/d; adjusted hazard ratio, 0.83; 95% CI, 0.75-0.90) compared with those in quartile 1 (<12.4 mg/d).
Who: Chinese adults in the China Health and Nutrition Survey, mean intake 14.8 mg/day
Effect: Q3 (14.3 to <16.7 mg/d) vs Q1 (<12.4 mg/d) adjusted HR 0.83 (95% CI 0.75 to 0.90)
Certainty: Observational data on food, not supplements; residual confounding.
JAMA Netw Open, 2021 · checked 2026-10-07 · we read the abstract
ev-nibp-09 · Position of an expert body · government fact sheet · n = —
However, the flushing can be accompanied by more serious signs and symptoms, such as headache, rash, dizziness, and/or a decrease in blood pressure.
Who: users of nicotinic acid supplements
Effect: flushing from 30-50 mg; may be accompanied by headache, rash, dizziness and/or a decrease in blood pressure
Certainty: An acute drop in BP is an adverse effect, not a treatment.
Niacin, Fact Sheet for Health Professionals, NIH Office of Dietary Supplements · checked 2026-10-07 · we read the section
ev-nibp-10 · Position of an expert body · government fact sheet · n = —
These adverse effects can include hypotension severe enough to increase the risk of falls; fatigue; impaired glucose tolerance and insulin resistance; gastrointestinal effects, such as nausea, heartburn, and abdominal pain; and ocular effects, such as blurred or impaired vision and macular edema (a buildup of fluid at the center of the retina).
Who: people taking pharmacologic doses of nicotinic acid
Effect: hypotension with fall risk, fatigue, impaired glucose tolerance, GI and ocular effects; hepatotoxicity with long use
Certainty: Medicinal doses, mostly in the treatment of dyslipidemia.
Niacin, Fact Sheet for Health Professionals, NIH Office of Dietary Supplements · checked 2026-10-07 · we read the section
ev-nibp-11 · Position of an expert body · government fact sheet reporting FNB ULs · n = —
These ULs are based on the levels associated with skin flushing.
Who: healthy infants, children and adults
Effect: UL applies to supplemental niacin only, both forms; adult UL 35 mg/day
Certainty: EU: UL of nicotinic acid 10 mg (see ev-nibp-12).
Niacin, Fact Sheet for Health Professionals, NIH Office of Dietary Supplements · checked 2026-10-07 · we read the section
ev-nibp-12 · Meta-analysis or systematic review · systematic review and benchmark-dose meta-analysis · n = 11741
In healthy individuals treated with nicotinic acid alone, major adverse effects occurred at doses below 1000 mg/d.
Who: individuals receiving nicotinic acid or nicotinamide supplementation
Effect: healthy individuals on nicotinic acid alone: major adverse effects below 1,000 mg/day; UL 35 mg/day US, 10 mg/day Europe
Certainty: Mixes RCTs and other designs; the authors consider the ULs conservative.
Nutr Rev, 2017 · checked 2026-10-07 · we read the abstract
ev-nibp-13 · Meta-analysis or systematic review · meta-analysis of randomized trials · n = 69515
Niacin but not CETP-I reduced myocardial infarction and coronary revascularization, but higher rate of SAE occurred with HDL-modifiers (OR [95%CI] = 1.24 [1.18-1.31], p < 0.00001, phet = 0.02), in particular new onset of diabetes with niacin and worsening of hypertension with CETP-inhibitors.
Who: patients in randomized trials of niacin or CETP inhibitors
Effect: serious adverse events OR 1.24 (95% CI 1.18 to 1.31); cardiovascular death OR 0.96 (0.87 to 1.05)
Certainty: Pools niacin and CETP inhibitors; hypertension worsened on CETP-I, not on niacin.
Nutr Metab Cardiovasc Dis, 2015 · checked 2026-10-07 · we read the abstract
ev-nibp-14 · Laboratory or animal data · case report · n = 1
Hypotension with a blood pressure of 58/40 developed over the next few hours and persisted despite intravenous infusion of over 4 liters of normal saline.
Who: 56-year-old man with schizophrenia after a massive oral niacin overdose
Effect: blood pressure fell to 58/40 mmHg and persisted despite over 4.2 quarts (4 L) saline
Certainty: A single case; the dose is hundreds of times above the UL.
Clin Toxicol (Phila), 2006 · checked 2026-10-07 · we read the abstract

How this page was made. Evidence was extracted from primary sources into cards, every number was re-checked against the source, and the text was written from those cards. Bioma Learn has no human medical reviewer at this time, and we say so rather than invent one. Methodology. This is information, not medical advice.