Review Article

Effect of Pycnogenol Supplementation on Blood Pressure: A Systematic Review and Meta-analysis


Background: Pycnogenol exhibits many biological activities, including control of blood pressure (BP). However, the reported results are inconsistent because of varied characteristics of participants and quality of studies. Thus, a meta-analysis was conducted to examine the effect of Pycnogenol supplementation on BP.

Methods: This literature search of PubMed, the Web of Science and the Cochrane library was performed in May 2016 to identify eligible studies. Reference lists of the retrieved articles were also reviewed. Either a fixed-effects or, in the presence of heterogeneity, a random-effects model was used to calculate the effect of combined treatment.

Results: We identified nine trials involving 549 participants who received Pycnogenol supplementation ranging from 150 mg/d to 200 mg/d. Compared with the control, the pooled estimate of change in systolic and diastolic BPs were -3.22 mmHg (95% CI: -6.20, -0.24) and -3.11 mmHg (95% CI: -4.60, -1.62), respectively. Subgroup analyses showed higher BP reduction among hypertensive participants or those who received intervention for more than 12 wk. However, this significant reduction was not observed in well-designed trials.

Conclusion: This meta-analysis with nine trials provides better evidence that Pycnogenol exerts beneficial effects on BP.


Rohdewald P (2002). A review of the French maritime pine bark extract (Pycnogenol), a herbal medication with a diverse clinical pharmacology. Int J Clin Pharmacol Ther, 40(4): 158-168.

Masquelier J, Michaud J, Laparra J, Dumon MC (1979). Flavonoides and pycnogen-ols. Int J Vitam Nutr Res, 49(3):307-11.

Gulati OP (2015). Pycnogenol® in metabolic syndrome and related disorders. Phytother Res, 29(7): 949-968.

Blazso G, Gaspar R, Ga´bor M et al (1996). ACE inhibition and hypertensive effect of procyanidins containing extract from the bark of Pinus pinaster sol. Pharm Pharmacol Lett, 6: 8–11.

Rezzani R, Porteri E, De Ciuceis C et al (2010). Effects of melatonin and Pycno-genol on small artery structure and func-tion in spontaneously hypertensive rats. Hypertension, 55(6): 1373-80.

Hosseini S, Jeongmin L, Sepulveda RT et al (2001). A randomized, double-blind, pla-cebocontrolled, prospective, 16-week crossover study to determine the role of Pycnogenol® in modifying blood pres-sure in mildly hypertensive patients. Nutr Res, 21(9): 1251-1260.

Liu X, Wei J, Tan F et al (2004). Pycnogenol, French maritime pine bark extract, im-proves endothelial function of hyperten-sive patients. Life Sci, 74(7): 855-862.

Drieling RL, Gardner CD, Ma J et al (2010). No beneficial effects of pine bark extract on cardiovascular disease risk factors. Arch Intern Med, 170(17): 1541-7.

Moher D, Liberati A, Tetzlaff J et al (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med, 151(4): 264-269.

Jadad AR, Moore RA, Carroll D et al (1996). Assessing the quality of reports of ran-domized clinical trials: Is blinding neces-sary? Control Clin Trials, 17(1): 1-12.

Follmann D, Elliott P, Suh I, Cutler J (1992). Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol, 45(7):769-73.

Higgins JP, Thompson SG, Deeks JJ, Alt-man DG (2003). Measuring inconsistency in meta-analyses. BMJ, 327(7414): 557-560.

DerSimonian R, Laird NP (1986). Meta-analysis in clinical trials. Control Clin Trials, 7(3): 177-188.

Egger M, Davey Smith G, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315(7109): 629-634.

Hu S, Belcaro G, Cornelli U et al (2015). Ef-fects of Pycnogenol® on endothelial dys-function in borderline hypertensive, hy-perlipidemic, and hyperglycemic individu-als: the borderline study. Int Angiol, 34(1): 43-52.

Belcaro G, Cornelli U, Luzzi R et al (2013). Pycnogenol® supplementation improves health risk factors in subjects with meta-bolic syndrome. Phytother Res, 27(10): 1572-8.

Enseleit F, Sudano I, Périat D et al (2012). Effects of Pycnogenol on endothelial function in patients with stable coronary artery disease: a double-blind, random-ized, placebo-controlled, cross-over study. Eur Heart J, 33(13): 1589-1597.

Cesarone MR, Belcaro G, Stuard S et al (2010). Kidney flow and function in hy-pertension: protective effects of pycno-genol in hypertensive participants-a con-trolled study. J Cardiovasc Pharmacol Ther, 15(1): 41-46.

Stuard S, Belcaro G, Cesarone MR et al (2010). Kidney function in metabolic syndrome may be improved with Pycno-genol®. Panminerva Med, 52(2 Suppl 1): 27-32.

Nishioka K, Hidaka T, Nakamura S et al (2007). Pycnogenol, French maritime pine bark extract, augments endothelium-dependent vasodilation in humans. Hy-pertens Res, 30(9): 775-780.

Cesarone MR, Belcaro G, Rohdewald P et al (2006). Improvement of diabetic micro-angiopathy with pycnogenol: A prospec-tive, controlled study. Angiology, 57(4): 431-436.

Zibadi S, Rohdewald PJ, Park D, Watson RR (2008). Reduction of cardiovascular risk factors in subjects with type 2 diabe-tes by Pycnogenol supplementation. Nutr Res, 28(5): 315-320.

Cesarone MR, Di Renzo A, Errichi S et al (2008). Improvement in circulation and in cardiovascular risk factors with a proprie-tary isotonic bioflavonoid formula OPC-3. Angiology, 59(4): 408-414.

Fitzpatrick DF, Bing B, Rohdewald P (1998). Endothelium-dependent vascular effects of Pycnogenol. J Cardiovasc Pharmacol, 32(4): 509-515.

Devaraj S, Vega-López S, Kaul N et al (2002). Supplementation with a pine bark extract rich in polyphenols increases plasma antioxidant capacity and alters the plasma lipoprotein profile. Lipids, 37(10): 931-934.

Hage FG (2014). C-reactive protein and hy-pertension. J Hum Hypertens, 28(7): 410-5.

Belcaro G, Cesarone MR, Errichi S et al (2008). Variations in C-reactive protein, plasma free radicals and fibrinogen values in 23 treated with Pycnogenol. Redox Rep, 13(6): 271-276.

Freis ED (1985). Angiotensin converting enzyme inhibition in clinical practice. Choice of initial treatment. J Cardiovasc Pharmacol, 7 Suppl 1:S112-6.

Weber HA, Hodges AE, Guthrie JR et al (2007). Comparison of proanthocya-nidins in commercial antioxidants: grape seed and pine bark extracts. J Agric Food Chem, 55(1): 148-156.

IssueVol 47 No 6 (2018) QRcode
SectionReview Article(s)
Pycnogenol Blood pressure Randomized controlled trial Meta-analysis

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
ZHANG Z, TONG X, WEI Y-L, ZHAO L, XU J-Y, QIN L-Q. Effect of Pycnogenol Supplementation on Blood Pressure: A Systematic Review and Meta-analysis. Iran J Public Health. 2018;47(6):779-787.