A Closer Look at Magnesium Supplementation in Normomagnesemic Patients: Does Formulation Make a Difference?

Authors : Özge Çetinarslan

Pages : 379-387

Doi:10.53446/actamednicomedia.1774901

View : 28 | Download : 21

Publication Date : 2025-10-22

Article Type : Research Paper

Abstract :Objectives: Magnesium (Mg) influences vascular tone, cardiac conduction, and autonomic balance. Its use as an oral supplement has increased rapidly in recent years. However, comparative data on oral formulations are limited, particularly in individuals with normal serum Mg levels. This study aimed to compare the haemodynamic, electrophysiologic, and autonomic effects of Mg oxide with an organic combination (malate + bisglycinate + citrate) in normomagnesemic adults. Methods: We conducted a single‑centre, ambispective cohort of 181 adults assigned to Mg‑oxide (n=62), combination (n=61), or control (no supplement; n=58). All participants had paired evaluations after ≥1 month including ECG, 24‑hour Holter, and ambulatory blood pressure monitoring (ABPM). Outcomes were 24‑hour BP and HR, ECG intervals, arrhythmic burden, and time‑ and frequency‑domain HRV. Adjusted analyses used inverse‑probability weighting. Key exclusions were recent medication changes, cardiac implantable devices, chronic kidney disease, new cardiovascular disease, active infection, and shifts in physical activity. Results: Serum Mg increased in both supplementation arms; serum creatinine fell modestly, with no between‑group differences in change. Compared with combination and control, Mg‑oxide achieved greater reductions in 24‑hour systolic BP (mean Δ −4.2 mmHg; p=0.003) and 24‑hour diastolic BP (Δ −3.5 mmHg; p=0.003), plus a decrease in nighttime diastolic BP (Δ −4.4 mmHg; p=0.014). HR also declined with Mg‑oxide overnight (Δ −2.9 bpm; p=0.049) and over 24 hours (Δ −2.9 bpm; p=0.007), whereas changes with the combination or control were negligible. Time‑domain HRV improved with Mg‑oxide (RMSSD +22.2 ms, p=0.000; pNN50 +2.9%, p=0.006; NN50 +4.1×10³, p=0.032), with between‑group differences favouring Mg‑oxide for RMSSD, pNN50, and NN50 (all p<0.005). In the combination group, frequency‑domain indices indicated a sympathovagal shift-LF decreased, HF increased, and LF/HF fell (p≤0.015)-yet these changes were not mirrored by consistent gains in time‑domain measures or HR. On ECG, PR interval shortened in both supplementation groups (each −3.9 ms; p≈0.01), while QRS narrowed slightly (−1.9 ms; p=0.024) and QTc shortened (−7.4 ms; p=0.049) only with the combination. Arrhythmic burden (atrial/ventricular premature contractions, bigeminy, couplets) did not change meaningfully in any group. Self‑reported sleep satisfaction increased substantially in both supplementation arms (to 78.3% with Mg‑oxide and 83.3% with the combination), whereas controls were unchanged. Findings were robust to multivariable adjustment and inverse‑probability weighting. Conclusions In normomagnesemic adults, both magnesium oxide and an organic combination (malate + bisglycinate + citrate) were associated with modest and formulation‑specific physiological changes. Magnesium oxide showed small but consistent improvements in 24‑hour blood pressure and mean heart rate alongside gains in time‑domain vagal HRV indices (e.g., RMSSD, pNN50), whereas the combination produced a selective frequency‑domain shift (↓LF/HF with ↑HF) and a small QTc shortening, without parallel changes in ambulatory BP or mean HR. Arrhythmic burden did not meaningfully change in any group, and self‑reported sleep satisfaction improved in both supplementation arms. Given the modest effect sizes and similar short‑term safety signals, cost and access considerations can justify magnesium oxide as a cost‑effective default; however, formulation choice should ultimately be individualized to patient goals and context.
Keywords : kalp hızı değişkenliği (HRV), magnezyum oksit, magnezyum takviyesi, organik magnezyum (şelatlı formlar), otonom modülasyon, uyku memnuniyeti

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