Written by the Nuvirox Research Team
Short answer: yes, with honest caveats. A handful of small human trials suggest nicotinamide riboside (NR) can modestly lower systolic blood pressure and arterial stiffness in midlife and older adults — but the trials are small, results are mixed across doses, and NAD+ precursors are not a treatment for hypertension.
Key Points
- A 2025 pilot RCT combining NR with exercise found the combination didn't clearly outperform exercise alone on daytime systolic blood pressure over 6 weeks.
- An earlier crossover trial found 6 weeks of NR meaningfully reduced systolic blood pressure and arterial stiffness in adults with age-related vascular impairment.
- Mechanistically, NAD+ supports the enzyme that helps blood vessels relax (eNOS) — but mechanism isn't the same as a proven clinical effect.
Why would NAD+ affect blood pressure at all?
Blood pressure control depends heavily on your arteries' ability to relax and stiffen appropriately — a process governed by the endothelium, the thin layer of cells lining every blood vessel. As NAD+ declines with age, so does the activity of sirtuin enzymes (particularly SIRT1) that keep endothelial nitric oxide synthase (eNOS) working properly. Less eNOS activity means less nitric oxide, and less nitric oxide means stiffer, less responsive arteries — a key driver of rising systolic blood pressure with age.
NAD+ precursors like nicotinamide riboside are proposed to interrupt that chain by restocking the NAD+ that SIRT1 and eNOS need to function. That's the theory. The question is whether raising NAD+ with a supplement actually moves the needle on blood pressure in real people.
What the human trials actually show
The strongest positive signal comes from Martens and colleagues (2018), who ran a 6-week, randomized, double-blind, placebo-controlled crossover trial of NR (1,000 mg/day) in healthy middle-aged and older adults who had impaired vascular function at baseline. NR supplementation was well tolerated and meaningfully raised NAD+ metabolites, and the researchers reported reductions in systolic blood pressure and aortic stiffness compared to placebo — enough to motivate a larger follow-up study.
Study snapshot: Martens et al., 2018 — NR and vascular function
| Design | Randomized, double-blind, placebo-controlled, crossover |
| Population | Healthy middle-aged/older adults with reduced endothelial function |
| Dose / duration | 1,000 mg/day NR, 6 weeks |
| Key finding | Reduced systolic BP and aortic stiffness vs. placebo |
The honest counterweight: a more recent 2025 pilot trial published in GeroScience tested whether adding NR (1,000 mg/day) to a supervised walking-exercise program improved blood pressure control better than exercise alone, in 54 sedentary older adults with elevated systolic BP. Over 6 weeks, the trial did not find that NR plus exercise clearly beat exercise plus placebo on the primary daytime systolic BP outcome — a genuinely mixed result that tempers the earlier finding [1,2].
A separate, larger phase IIa trial (NCT03821623) specifically designed to test 3 months of NR against placebo for lowering systolic blood pressure in adults with above-normal readings has been conducted to build on the earlier pilot data, reflecting that researchers themselves consider the question still open rather than settled.
What about NMN and blood pressure?
A separate NAD+ precursor, MIB-626 (a crystalline form of nicotinamide mononucleotide), was tested in overweight or obese middle-aged and older adults in a 28-day randomized trial. Alongside reductions in LDL and non-HDL cholesterol, the trial found MIB-626 significantly reduced diastolic blood pressure compared to placebo [3] — though this was a small, 30-person study focused primarily on metabolic and safety outcomes, not blood pressure as the main endpoint.
What NAD+ won't do
None of these trials suggest NAD+ precursors can replace blood pressure medication, and none were conducted in people with diagnosed hypertension on treatment. If your systolic blood pressure is consistently at or above 130/80 mmHg, that's a conversation for your doctor, not a supplement decision. The research so far is best read as: plausible mechanism, small positive signals in healthy or mildly elevated populations, and at least one trial that didn't replicate the effect when combined with exercise. That's not nothing, but it's not a treatment either.
Dosing and timeline from the trials
Where an effect was observed, it used 1,000 mg/day of NR, taken consistently for 6 weeks before blood pressure changes were measured. None of the trials found meaningful safety concerns at this dose. If you're exploring NAD+ precursors for general cardiovascular and cellular energy support, that timeline — several weeks of consistent daily use before evaluating any change — matches what researchers themselves used before assessing outcomes.
Frequently asked questions
Can NAD+ supplements replace my blood pressure medication?
No. No trial has tested NAD+ precursors as a replacement for antihypertensive medication, and none were conducted in people with diagnosed hypertension. Don't change or stop a prescribed medication without talking to your doctor.
Which NAD+ precursor has the best blood pressure evidence?
Nicotinamide riboside (NR) has the most direct human data, though results are mixed across trials. NMN (as MIB-626) has one small trial showing a diastolic BP reduction as a secondary finding.
How long before I'd see any effect?
The trials that found an effect measured it after 6 weeks of consistent daily use. There's no evidence for a faster timeline.
Is it safe to take NAD+ precursors with blood pressure medication?
The trials didn't specifically study drug interactions with antihypertensives. If you take blood pressure medication, check with your doctor or pharmacist before adding any new supplement.
Blood pressure rarely moves in isolation from the rest of cardiovascular health — if you’re looking at NAD+ research for heart-related reasons more broadly, our review of NAD+ and heart health covers the wider cardiovascular evidence, and our companion piece on NAD+ and cholesterol looks at the closely related lipid research from many of these same research groups.
Does resveratrol add anything to the blood pressure effect?
The NICE trial and related PAD research tested NR with and without resveratrol and found resveratrol didn't add meaningful benefit over NR alone for walking distance outcomes; blood-pressure-specific combination data is limited, so this isn't yet a settled question for BP specifically.
From Nuvirox
Why we formulated NAD+ Restore
If what you're dealing with sounds like it belongs in a doctor's office rather than a supplement aisle, please start there — a clinician can rule out the specific causes discussed above. For general cellular energy support, each serving of NAD+ Restore provides 500 mg of nicotinamide riboside chloride (NR), one of the two most-researched NAD+ precursors, within the dose range used in published human trials, alongside 150 mg trans-resveratrol and 50 mg quercetin (polyphenols studied alongside NAD+ pathways for cellular health support) and 10 mg of galactomannans from fenugreek to support absorption.
We back it with a 60-day money-back guarantee — long enough to actually evaluate it the way the research says you should.
Learn more about NAD+ Restore →The bottom line
The honest reading: NAD+ precursors have a real, biologically plausible link to blood vessel function, and one well-designed trial found a meaningful systolic blood pressure drop. But a more recent trial testing the same precursor alongside exercise didn't clearly replicate that benefit, and none of this research was done in people being treated for hypertension. If blood pressure is a genuine medical concern for you, this is mechanism-level supporting evidence at best — not a substitute for monitoring and treatment.
References
- Lin Y, Zeidan RS, Lapierre-Nguyen S, et al. Nicotinamide riboside combined with exercise to treat hypertension in middle-aged and older adults: a pilot randomized clinical trial. GeroScience. 2025;47(6):6895-6908. doi:10.1007/s11357-025-01815-2. PMID: 40770531.
- Freeberg KA, et al. Nicotinamide Riboside Supplementation for Treating Elevated Systolic Blood Pressure and Arterial Stiffness in Midlife and Older Adults. Front Cardiovasc Med. 2022;9:881703. PMCID: PMC9127073.
- Martens CR, Denman BA, Mazzo MR, et al. Chronic nicotinamide riboside supplementation is well-tolerated and elevates NAD+ in healthy middle-aged and older adults. Nat Commun. 2018;9:1286. doi:10.1038/s41467-018-03421-7.
- Pencina KM, Valderrabano R, Wipper B, et al. Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study. J Clin Endocrinol Metab. 2023;108(8):1968-1980. doi:10.1210/clinem/dgad027.
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This article is for informational purposes only and is not a substitute for professional medical advice.