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hypertension (15,16). However, magnesium sup- plementation should be avoided in individuals with renal insufficiency. Calcium: This supplement, better known for building strong and healthy bones, may also play a role in hypertension.  It has been noted that some hyperten- sive people have lower calci- um levels in the blood and higher excretion of calcium in the urine (21). In a review of over 20 stud- ies, individuals given 1 to 2 grams of calcium per day had lower blood pressure as a result (22).  Unfortunately, some may also experience a rise.  Therefore, the best advice is to maintain a healthy diet that includes cal- cium from dairy products or supplementation. If taken as a dietary supple- ment, 500 mg of elemental calcium is most appropriate. Of note, calcium carbonate contains 400 mg/gram of ele- mental calcium and should be taken with meals. Calcium citrate contains 211 mg/gram of elemental calci- um and does not need to be taken with meals.  This may be preferable for people tak- ing medications best known as H2 blockers (23). Examples include raniditine (Zantac), famodi- tine (Pepcid), cimeditine (Tagemet), or proton pump inhibitors that suppress stomach acid such as omeprazole (Prilosec, Losec), rabeprazole (Aciphex), lansoprazole (Prevacid) and pantoprazole (Protonix, Pantoloc). Coenzyme Q-10: This sup- plement may play a role in hypertension by decreasing the body's chemical response to the condition, specifically a rise in diastolic blood pressure, which is recorded when the heart is relaxed (11,24). While several studies have identified a potential benefit for coenzyme Q-10 in the treatment of high blood pressure, the largest study - of 109 patients - found that patients taking coenzyme Q-10 had a substantially reduced need for medica- tions that lower blood pres- sure:   • 51% of patients taking coenzyme Q-10 were able to discontinue between one and three medications, con- tributing to a substantial cost savings.   • Patients also exhibited a marked improvement in their quality of life, with fewer symptoms - potential- ly related to an improvement in cardiac performance - or perhaps due to fewer side effects from medication.   • Traditional drug therapy for high blood pressure may be supplemented with coen- zyme Q-10 in an effort to limit the number and dosage of medications required, but it should never be utilized on its own for this purpose, nor substituted for proven thera- pies.   • No specific dose has been identified; however, 200 to 300 mg in two or three divid- ed doses is most likely appropriate. Garlic:  This supplement is recommended by many holistic practitioners for the reduction of blood pressure and the promotion of cardio- vascular health.  In an analy- sis of eight published and unpublished trials, garlic sup- plementation for at least 4 weeks led to a modest reduction in blood pressure (25): • The suggested dosage is 4 mg of the allicin potential, a common measure of the potency of garlic-containing supplements. • Depending on its percent- age of allicin, this may require 200 to 300 mg of garlic 3 times per day.   • It should not be expected that garlic will effectively treat high blood pressure alone; however, it may lower the dosage or number

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