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A Systematic Review and Meta-Analysis of the Haemodynamic Effects of Cannabidiol
Salahaden R Sultan1, Sophie A Millar1, Timothy J England1
1Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham Derby, UK.
Insights
Cannabidiol (CBD) does not affect blood pressure or heart rate in normal conditions but reduces them during stress. CBD also increases cerebral blood flow in stroke models, warranting further human studies.
Area of Science:
- Cardiovascular Pharmacology
- Neuropharmacology
Background:
- Cannabidiol (CBD) exhibits numerous cardiovascular effects in vitro, but its in vivo hemodynamic impact remains unclear.
- Clinical use of CBD (Epidiolex) is increasing, necessitating a clearer understanding of its physiological effects.
Purpose of the Study:
- To systematically review and meta-analyze existing studies on the in vivo hemodynamic effects of CBD.
- To determine if CBD administration is associated with changes in blood pressure, heart rate, and blood flow.
Main Methods:
- A systematic review and meta-analysis of 25 studies assessing CBD's hemodynamic effects.
- Data extraction and analysis of blood pressure (BP), heart rate (HR), and blood flow (BF) using random effects models.
- Inclusion of studies across multiple species and dosing conditions (acute and chronic).
Main Results:
- Acute and chronic CBD dosing showed no effect on BP or HR under control conditions.
- Acute CBD administration significantly reduced BP and HR increases during stress.
- CBD significantly increased cerebral blood flow (CBF) in mouse models of stroke.
Conclusions:
- CBD has no significant impact on basal BP or HR but demonstrates a beneficial effect in mitigating stress-induced hemodynamic changes.
- CBD administration increased CBF in preclinical stroke models, suggesting potential neuroprotective effects.
- Further research is essential to elucidate the full hemodynamic profile of CBD in human subjects under various physiological and pathological states.
Abstract:
Despite cannabidiol (CBD) having numerous cardiovascular effects in vitro, its haemodynamic effects in vivo are unclear. Nonetheless, the clinical use of CBD (Epidiolex) is becoming more widespread. The aim of this systematic review was to establish whether CBD is associated with changes in haemodynamics in vivo. Twenty-five studies that assessed the haemodynamic effects of CBD (from PubMed, Medline and EMBASE) were systematically reviewed and meta-analyzed. Data on blood pressure (BP), heart rate (HR), and blood flow (BF) were extracted and analyzed using random effects models. Twenty-two publications assessed BP and HR among 6 species (BP n = 344 and HR n = 395), and 5 publications assessed BF in 3 species (n = 56) after acute dosing of CBD. Chronic dosing was assessed in 4 publications in 3 species (total subjects BP, n = 6; HR, n = 27; BF, n = 3). Acute CBD dosing had no effect on BP or HR under control conditions. Similarly, chronic dosing with CBD had no effect on HR. In models of stress, acute CBD administration significantly reduced the increase in BP and HR induced by stress (BP, mean difference (MD) -3.54, 95% CI -5.19, -1.9, p < 0.0001; HR, MD -16.23, 95% CI -26.44, -6.02, p = 0.002). In mouse models of stroke, CBD significantly increased cerebral blood flow (CBF, standardized mean difference (SMD) 1.62, 95% CI 0.41, 2.83, p = 0.009). Heterogeneity among the studies was present, there was no publication bias except in HR of control and stressful conditions after acute CBD dosing, and median study quality was 5 out of 9 (ranging from 1 to 8). From the limited data available, we conclude that acute and chronic administration of CBD had no effect on BP or HR under control conditions, but reduces BP and HR in stressful conditions, and increases cerebral blood flow (CBF) in mouse models of stroke. Further studies are required to fully understand the potential haemodynamic effects of CBD in humans under normal and pathological conditions.
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