
concentrations may be risk factors for hypertension.
But these studies are contradictory, and negative
results have been reported in many other studies.
Some interventional studies have evaluated the effect
of magnesium supplements on hypertensive individ-
uals. Preliminary evidence suggests that, in hyper-
tensive individuals treated with thiazide diuretics,
magnesium supplementation can lower blood pres-
sure. This is physiologically plausible, as thiazides
inhibit magnesium reabsorption in the kidney and
may lead to magnesium deficiency. However, a similar
effect has been demonstrated with potassium supple-
mentation, with no additional benefit from combined
magnesium and potassium supplementation. Further,
magnesium supplementation of hypertensive individ-
uals with normal serum magnesium levels has not
been of any benefit. Clearly, the current literature is
confusing, and further work to determine potential
interactions among hypertension, diuretic use, and
magnesium supplementation is urgently needed.
Cardiovascular Disease
0034 There is increasing evidence that populations residing
in areas supplied with hard water (which has higher
mineral content, including magnesium) have a lower
risk of cardiovascular disease than people who live in
similar regions supplied with soft water. Early studies,
however, suggested that higher levels of serum mag-
nesium can be detected in serum immediately after
myocardial infarcts. More recent studies have sug-
gested that this is a result of magnesium released
from dying heart cells, rather than an indication that
an existing high serum magnesium concentration
is a risk factor for myocardial infarct per se. Some
intervention studies have shown that intravenous
magnesium may be a useful adjuvant therapy in
acute myocardial infarcts.
Diabetes Mellitus
0035 Diabetics have increased urinary magnesium losses.
Such losses are especially high in individuals with
poorly controlled diabetes, those with high amounts
of glucosuria, and those with diabetic complications.
It is unclear whether the correlation between low
serum magnesium concentrations and diabetic
complications is a cause and effect relationship, or
whether both are independent effects of poor glyce-
mic control. However, magnesium supplementation
has been reported to improve insulin sensitivity and
glycemic control in adults with noninsulin-dependent
diabetes mellitus. In 1992, the American Diabetic
Association (www.diabetes.org) convened a consen-
sus panel to evaluate the possibility of a relationship
between magnesium deficiency and diabetes mellitus.
The panel members felt that there was evidence to
suggest that magnesium deficiency might be related to
some of the underlying causes of diabetes, such as
insulin resistance and carbohydrate intolerance.
However, they recognized the difficulty of diagnosing
magnesium deficiency, and did not recommend
universal magnesium supplementation for diabetics.
Osteoporosis
0036Thirty percent of total body magnesium is in bone.
Magnesium is important for normal bone growth and
mineralization. Some studies have suggested that
magnesium supplementation can increase bone min-
eral content in subjects on relatively low magnesium
intakes, but such benefits were not seen in women on
higher magnesium intakes. Two studies have shown
that magnesium supplementation may have beneficial
effects on bone mineral content in women with
established osteoporosis.
Magnesium as a Pharmacological Agent
0037Magnesium is unusual in that it has physiological
effects as a nutrient, and in much higher doses, has a
pharmacological effect as well.
0038One of the important biological functions of mag-
nesium is to alter the excitability of nerves and
muscles, either directly or through an interaction
with calcium. Large doses of intravenous magnesium
have been used to treat medical conditions involving
excessive excitability of nervous tissues. The classic
example is the use of intravenous magnesium to treat
pregnancy-induced hypertension. This condition,
also called preeclampsia, is characterized by protei-
nuria, edema, and hypertension. Untreated, pre-
eclampsia leads to central nervous system
excitability, convulsions and, ultimately, death. It is
the most common cause of maternal morbidity in
western countries. Intravenous magnesium has been
widely used for many years to treat this condition; it
has been shown to decrease the risk of seizures and
improve maternal and fetal outcome.
0039Magnesium is also used to delay the progression of
preterm labor, again by relaxing excitable cells, in this
case, uterine muscle cells. It is also used as a treatment
for primary pulmonary hypertension of the newborn
(or persisting fetal circulation). This latter condition
is caused by abnormal contraction of the blood
vessels entering the lung, and leads to profound hyp-
oxia and, ultimately, death. Magnesium acts to relax
these pulmonary blood vessels and improve oxygen-
ation. Unfortunately, it may also relax other blood
vessels and lead to hypotension, counteracting its
beneficial effect on pulmonary vessels.
0040There are conflicting data on the benefit of
intravenous magnesium following acute myocardial
MAGNESIUM 3645