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.

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.

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.

Studies lacked control groups and showed variability in dosing regimens and blood pressure monitoring.

LDOM appears to be a safe treatment for alopecia with no significant impact on blood pressure.