Low-dose oral minoxidil does not significantly affect blood pressure: A systematic review and meta-analysis

Introduction: Minoxidil, traditionally used as an antihypertensive, is now widely used for treating various forms of alopecia due to its vasodilatory effects. While topical minoxidil has been the standard treatment, low-dose oral minoxidil (LDOM) is emerging as an effective alternative. This study investigates LDOM's potential hypotensive effects. Methods: Studies were selected based on criteria such as the use of LDOM (≤5 mg/day) and reporting on blood pressure changes. Mean differences (MDs) were calculated for mean arterial pressure (MAP), systolic blood pressure, diastolic blood pressure, and heart rate. Results: LDOM did not significantly alter systolic blood pressure (MD: −0.13, 95% CI: −2.67-2.41) or diastolic blood pressure (MD: −1.25, 95% CI: −3.21-0.71). Though MAP was not significantly altered, there was a strong tendency toward decreased MAP (MD: −1.92, 95% CI: −4.00-0.17). There was a significant increase in heart rate (MD: 2.67, 95% CI: 0.34-5.01). Hypotensive symptoms were reported in 119 patients (5.0%), but no hypotensive episodes were observed. Hypertrichosis was the most frequent side effect, leading to 34.6% of discontinuations. Limitations: Studies lacked control groups and showed variability in dosing regimens and blood pressure monitoring. Conclusion: LDOM appears to be a safe treatment for alopecia with no significant impact on blood pressure.