Blood pressure is one of the most important markers of cardiovascular health. That diet and certain nutrients can influence blood pressure regulation is well studied — the DASH diet and a moderate salt intake are well-known examples. Omega-3 fatty acids (EPA and DHA) have also been a focus of blood pressure research for decades. The European Food Safety Authority (EFSA) has approved a health claim for EPA and DHA relating to the maintenance of a normal blood pressure — but only from a considerably higher daily intake than for the cardiac function claim. This article sets out the approved claim, its conditions and the associated evidence factually. Important to note up front: this is about the maintenance of a normal blood pressure — not about the treatment of high blood pressure (arterial hypertension), which always belongs in a doctor's hands.
The claim on normal blood pressure is tied to a daily intake of 3 g EPA+DHA. How well supplied you are to begin with is measured by the Omega-3 Index.
Test & prices →The EFSA health claim: normal blood pressure
The European Food Safety Authority (EFSA) has approved a health claim for EPA and DHA that reads, verbatim: “EPA and DHA contribute to the maintenance of normal blood pressure.” Unlike the cardiac function claim (250 mg/day), this claim may only be used at a daily intake of 3 g (3,000 mg) EPA+DHA. This is a considerable amount that is barely achievable through a normal diet. The claim refers explicitly to a normal blood pressure — it says nothing about the treatment or lowering of pathologically elevated blood pressure (hypertension).
EFSA health claim: blood pressure
Approved wording: “EPA and DHA contribute to the maintenance of normal blood pressure.”
Condition: The claim may only be used at a daily intake of 3 g EPA+DHA. A food or dietary supplement may carry the claim only if it provides this amount per daily portion.
Warning: Consumers must be informed that the total intake of EPA and DHA from all sources should not exceed 5 g per day. (EU Regulation No. 432/2012)
The high requirement of 3 g/day reflects the fact that associations between EPA+DHA and blood pressure appear in studies primarily at higher intakes. The EFSA claim is deliberately limited to the maintenance of a normal blood pressure.
The key study: Miller et al. — meta-analysis of 70 RCTs
The most comprehensive and widely cited analysis on omega-3 and blood pressure comes from Miller, Van Elswyk and Alexander (2014), published in the American Journal of Hypertension. The authors analysed 70 randomised controlled trials (RCTs) — one of the largest summaries on this topic at the time.
Study design and methodology
To be included in the meta-analysis, studies had to meet the following criteria: a randomised, controlled design; supplementation with marine omega-3 fatty acids (EPA and/or DHA); blood pressure as a measured endpoint; a minimum intervention duration. The data from these 70 RCTs were pooled into an overall result and analysed by various subgroups.
Results: systolic and diastolic
In the total population of all 70 RCTs, omega-3 supplementation showed:
- Systolic blood pressure: −1.52 mmHg (statistically significant)
- Diastolic blood pressure: −0.99 mmHg (statistically significant)
These figures sound small — and on average they are. However, the subgroup analyses are decisive.
Subgroup analysis: higher baseline values
In the subgroup with elevated baseline blood pressure values, the authors reported numerically larger differences between the omega-3 and control groups in their analysis:
- Systolic: −4.51 mmHg (figure from the meta-analysis)
- Diastolic: −3.05 mmHg (figure from the meta-analysis)
These values are the results of a meta-analysis and are not an assurance of an individual effect. They do not prove a blood pressure-lowering effect in a medicinal sense and are not evidence that omega-3 is suitable for the treatment of high blood pressure. Whether and to what extent an individual person's values change cannot be inferred from them. Persistently elevated blood pressure must be medically assessed and treated.
Omega-3 and blood pressure: analysis of 70 randomised trials
The meta-analysis of 70 RCTs reported, in the total population, a calculated difference in systolic blood pressure of −1.52 mmHg (95% CI −2.10 to −0.94) and diastolic of −0.99 mmHg (95% CI −1.54 to −0.44). In the subgroup with elevated baseline values: systolic −4.51 mmHg, diastolic −3.05 mmHg. Higher intakes and higher baseline values were associated with larger differences. These are analytical results, not a therapeutic proof of efficacy.
Mechanisms: how can omega-3 influence blood pressure?
Several physiological mechanisms are discussed for the blood pressure-relevant effects of EPA and DHA:
Endothelial function and nitric oxide
EPA and DHA can increase the release of nitric oxide (NO) from endothelial cells. NO acts as a vasodilator — it relaxes the smooth muscle of blood vessel walls and thereby influences peripheral vascular resistance. Good endothelial function is regarded as an important factor for normal vascular function. These mechanisms are the subject of scientific discussion and do not constitute proof of efficacy for the treatment of any disease.
Reduced synthesis of vasoconstrictive eicosanoids
Omega-3 fatty acids compete in cell membranes with arachidonic acid (omega-6) for the same enzymes (cyclooxygenase, lipoxygenase). When EPA and DHA are present, fewer vasoconstrictive prostaglandins (e.g. thromboxane A2) and more vasodilatory eicosanoids are formed. This shifts the balance towards lower vascular tension.
Reduction in heart rate
Some studies show that EPA and DHA can slightly lower heart rate. A lower heart rate means a lower cardiac output with the same stroke volume — a further blood pressure-relevant mechanism.
Inflammation modulation
Chronic inflammatory processes in the vascular wall contribute to the development of hypertension. EPA and DHA consistently reduce the inflammatory markers CRP, IL-6 and TNF-alpha in meta-analyses. They can thereby indirectly dampen vascular inflammatory processes that raise blood pressure.
What daily intake is relevant for the blood pressure claim?
The EFSA health claim for the maintenance of a normal blood pressure starts at 3 g/day EPA+DHA. This is the highest intake condition among all EFSA omega-3 claims. The following overview places intake amounts in relation to the claim and the evidence — it is not a dosage recommendation for the treatment of high blood pressure:
| Daily intake EPA+DHA | Relation to the EFSA blood pressure claim | Interpretation of the evidence |
|---|---|---|
| < 1,000 mg | Claim condition not met | In studies, mostly no relevant blood pressure differences reported |
| 1,000–2,000 mg | Claim condition not met | At most small differences reported |
| 2,000–3,000 mg | Blood pressure claim not yet met (triglyceride claim from 2 g) | Inconsistent evidence |
| 3,000 mg (EFSA condition) | Condition for the blood pressure claim met | EFSA: contribution to the maintenance of a normal blood pressure |
| > 3,000 mg (max. 5 g/day) | Above the claim condition; observe the 5 g/day warning | Only after consulting a doctor |
Important: omega-3 fatty acids are a food or dietary supplement and do not replace blood pressure-lowering medications. The total intake of EPA+DHA from all sources should not exceed 5 g per day. Anyone already taking blood pressure-lowering medication should always discuss a higher EPA+DHA intake with their doctor beforehand.
Omega-3 in context: what else acts on blood pressure?
For orientation: how large are the blood pressure differences reported for omega-3 in studies compared to other lifestyle measures?
Comparison with other interventions
In clinical reviews, the following blood pressure differences (systolic, mean values) observed in meta-analyses are reported for various lifestyle measures — as a rough orientation, not a therapeutic assurance:
- Salt reduction (to < 5 g/day): approx. −4 to −5 mmHg
- DASH diet: approx. −6 mmHg
- Regular aerobic exercise (5x/week): approx. −5 mmHg
- Weight loss (−5 kg): approx. −4 mmHg
- EPA+DHA (3 g/day, subgroup with elevated baseline values): approx. −4.5 mmHg (figure from the meta-analysis)
- Alcohol reduction: approx. −3 mmHg
These figures come from different meta-analyses and cannot be added together directly. They are not evidence that EPA+DHA can replace medical blood pressure treatment or represent an equivalent alternative to it.
Study overview: further evidence
In addition to the meta-analysis by Miller et al., there are a number of further relevant studies:
Studies in metabolic risk groups
Omega-3 and blood pressure have also been investigated in groups with an increased metabolic risk (such as type 2 diabetes). The results of such individual studies are inconsistent and do not allow a generally valid statement. More robust interpretations tend to come from summarising meta-analyses than from individual studies.
Mozaffarian & Wu — comprehensive review
In a widely noted review article in the Journal of the American College of Cardiology (JACC 2011), Mozaffarian and Wu summarise the literature on omega-3 and cardiovascular markers. They describe that associations with blood pressure are reported primarily at higher intakes and in people with elevated baseline values. Such reviews describe the state of the evidence and are not proof of a medicinal effect.
Dose-response observations
Several meta-analyses report consistently that the observed association between EPA+DHA and blood pressure depends on the intake amount. This explains why the EFSA set the condition of 3 g/day for the blood pressure claim — at lower intakes, the reported differences are smaller and less consistent.
A combined approach: omega-3 and cardiovascular health
Blood pressure and blood lipids are often linked in cardiovascular health. For EPA and DHA there are two separate EFSA claims: for the maintenance of a normal blood pressure (at 3 g/day) and for the maintenance of normal blood triglyceride levels (at 2 g/day). At a daily intake of 3 g EPA+DHA, the conditions of both claims are met. In both cases it is about maintaining normal values, not treating elevated values.
Read more about lowering triglycerides in the article Lowering triglycerides with omega-3. For an overview of all cardiovascular aspects, see the article Omega-3 and heart health.
Who should be particularly careful with a higher omega-3 intake?
People taking anticoagulants
Omega-3 fatty acids can influence platelet function at high doses. When taking anticoagulants (warfarin, direct oral anticoagulants such as apixaban or rivaroxaban), there may theoretically be an enhancement of the bleeding-time-prolonging effect. Always inform your treating doctor before high-dose omega-3 supplementation.
People on antihypertensive therapy
If blood pressure-lowering medications (ACE inhibitors, beta-blockers, calcium channel blockers, etc.) are already being taken and a higher omega-3 intake is additionally planned, this should be discussed with a doctor beforehand and blood pressure should be monitored medically. Independent changes to existing medication are not advised.
Self-treatment of high blood pressure is not an option
High blood pressure is a medical condition that must be diagnosed and treated. Omega-3 fatty acids are a food or dietary supplement and not a medicine — they do not replace blood pressure measurement, medical diagnosis or medically prescribed medications. Please speak with your doctor before taking high-dose omega-3 supplements, especially if you have existing high blood pressure or ongoing medication.
Practical implementation: how to reach 3 g EPA+DHA per day
3 g EPA+DHA per day is an amount that is difficult to reach through a normal diet. A portion of salmon (150 g) typically provides around 1.5–2.5 g EPA+DHA — varying considerably by origin and season. For a reliable supply at this intake, a high-quality dietary supplement is practically unavoidable.
What to look for when choosing a product
- Check the actual EPA+DHA content per portion (not just the total fish oil content, which often contains only 30% EPA+DHA)
- Concentrated preparations (60–80% EPA+DHA) allow a higher intake in fewer capsules
- The triglyceride form (TG form) shows better bioavailability than the ethyl ester form in studies
- Check the TOTOX value (a measure of oxidation) — a value < 10 is aimed for in quality products
- A fresh, neutral smell as a quality indicator
Frequently asked questions
What does the EFSA say about omega-3 and blood pressure?
According to the EFSA, EPA and DHA contribute to the maintenance of normal blood pressure. This health claim applies only at a daily intake of 3 g EPA+DHA. In addition, the following warning applies: the total intake of EPA and DHA from all sources should not exceed 5 g per day. The claim refers to normal blood pressure, not to the treatment of high blood pressure.
When do studies show a change in blood pressure?
In clinical studies, measurable changes in blood pressure were mostly observed after 4–12 weeks of regular intake. Short-term intake over a few days is not sufficient. The omega-3 index (a blood biomarker) stabilises at a new level after approximately 8–12 weeks.
Is 1 g of omega-3 per day enough for the blood pressure claim?
No. The EFSA health claim for the maintenance of normal blood pressure applies only from a daily intake of 3 g EPA+DHA. For the normal cardiac function claim, 250 mg EPA+DHA per day is sufficient — but this does not relate to blood pressure.
What does the evidence show in people with normal blood pressure?
In the meta-analysis by Miller et al. (2014), the observed blood pressure changes in the normotensive subgroup were small. For general cardiovascular prevention, the DGE and AHA recommend regular fish consumption or an intake in the range of 250–500 mg EPA+DHA per day.
Can omega-3 replace blood pressure medications?
No. Omega-3 fatty acids are a food or dietary supplement and not a medicine. They do not replace a medical diagnosis or medically prescribed blood pressure-lowering medications. Elevated blood pressure requires medical treatment; any changes to medication must always be discussed with a doctor.
Related articles
Blood pressure is only one of several cardiovascular markers for which there are EFSA claims and a body of evidence around EPA and DHA:
- Omega-3 and heart health — EFSA health claim, REDUCE-IT trial and meta-analyses with 127,477 participants
- Lowering triglycerides with omega-3 — AHA Science Advisory and EFSA health claim from 2,000 mg/day
Your next step
How well supplied are you?
Questionnaires estimate, a blood test measures. Start with the free self-check and then decide whether a measurement is worth it for you.
Medical disclaimer
This article is for general information and does not replace medical advice. The health statements relate to the EFSA-approved health claim “EPA and DHA contribute to the maintenance of normal blood pressure” (at a daily intake of 3 g EPA+DHA; the total intake from all sources should not exceed 5 g/day) as well as to published studies. High blood pressure (arterial hypertension) is a condition requiring treatment that must be medically diagnosed and treated. Omega-3 fatty acids are not a substitute for blood pressure-lowering medications. Existing medications must not be changed or discontinued on your own initiative — please discuss any change with your doctor.