Effects of peppermint (Mentha x piperita L.) oil on cardiometabolic outcomes in patients with pre- and stage 1 hypertension: A placebo randomized controlled trial

Loading metrics Open Access Peer-reviewed Research Article Benjamin Sant, XuanYi Du, Gareth Shadwell, Stephanie Dillon, Bobbie Butters, Lindsay Bottoms Effects of peppermint (Mentha x piperita L.) oil on cardiometabolic outcomes in patients with pre- and stage 1 hypertension: A placebo randomized controlled trial Jonathan Sinclair, Benjamin Sant, XuanYi Du, Gareth Shadwell, Stephanie Dillon, Bobbie Butters, Lindsay Bottoms x Published: April 23, 2026 https://doi.org/10.1371/journal.pone.0344538 Figures AbstractHypertension represents the predominant risk factor for cardiovascular disease morbidity and mortality; with significant healthcare utilization and expenditure. Pharmaceutical management is habitually adopted; although its long-term effectiveness remains ambiguous, and accompanying adverse effects are disquieting. Peppermint, which is rich in menthol and flavonoids, may exert potential benefits relevant to hypertension. This trial aimed to explore the effects of twice-daily peppermint oil supplementation in individuals with pre- and stage 1 hypertension. A 20 day, parallel randomized, placebo-controlled trial was adopted (NCT05561543). 40 individuals with pre- and stage 1 hypertension were randomly assigned to receive 100 μL per day of either peppermint oil or peppermint-flavoured placebo. The primary trial outcome was the between-group difference in systolic blood pressure from baseline to 20 days. Secondary outcome measurements were the between-group differences in anthropometric, haematological, diastolic blood pressure/resting heart rate, psychological wellbeing, and sleep efficacy indices. Statistical analysis was conducted on an intention-to-treat basis using baseline-adjusted linear regression models comparing post intervention values between trial arms with the corresponding baseline value entered as a covariate; adjusted mean differences (b), 95% confidence intervals, and effect sizes (d) were calculated. In relation to the primary outcome, adjusted systolic blood pressure at 20 days was significantly lower (b = −8.48 mmHg, 95% CI = −14.24 to −2.73, d = −0.94) in the peppermint trial arm (baseline = 130.05 mmHg, 20 days = 121.97 mmHg) than in placebo (baseline = 130.93 mmHg, 20 days = 131.05 mmHg). Loss to follow-up (N = 1) and adverse events (N = 1) were low, both occurring in the peppermint arm, and compliance was very high in the peppermint (93.3%) trial arm. Given the substantial health and economic burden associated with hypertension worldwide, these findings suggest that twice-daily peppermint supplementation may represent a simple, low-cost, and well-tolerated strategy to support blood pressure reduction in this population. Trial registration ClinicalTrials.gov NCT05561543 Citation: Sinclair J, Sant B, Du X, Shadwell G, Dillon S, Butters B, et al. (2026) Effects of peppermint (Mentha x piperita L.) oil on cardiometabolic outcomes in patients with pre- and stage 1 hypertension: A placebo randomized controlled trial. PLoS One 21(4): e0344538. https://doi.org/10.1371/journal.pone.0344538Editor: S Ezhil Vendan, Central Food Technological Research Institute CSIR, INDIAReceived: August 18, 2025; Accepted: April 3, 2026; Published: April 23, 2026Copyright: © 2026 Sinclair et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Data Availability: Our data can be found at the attached link: https://doi.org/10.17030/uclan.data.00000632.Funding: This project was funded by the Dowager Countess Eleanor Peel Trust (MED1105).Competing interests: The authors declare no conflict of interest. IntroductionGlobally, hypertension is renowned as the leading risk factor for cardiovascular disease morbidity and mortality [1]. High blood pressure ranks first among modifiable risk factors attributable to cardiovascular disease aetiology, accounting for the largest proportion of coronary heart disease, heart failure, and stroke events [2]. It is associated with significant societal and economic consequences [3] and also mediates significant productivity loss from disability and premature death [4]. Thus, hypertension is one of the most consequential and remediable threats to the health of individuals and society. Pharmaceutical intervention is the predominant treatment approach for hypertensive disease, and angiotensin-converting enzyme inhibitors, beta-blockers, calcium antagonists, and diuretics are the most commonly adopted approaches [5].