Manual Therapy, Posturology & Rehabilitation Journal
Manual Therapy, Posturology & Rehabilitation Journal
Research Article

Effects of L-citrulline malate oral supplementation on post-exercise hypotension

Juliano Casonatto; Renata Cristina Góes; Kamila Grandolfi; João Vagner Cavalari


Background: L-citrulline malate supplementation promotes an increase in oxide nitric metabolites, which are considered important mediators of peripheral vasodilation. Thus, the supplementation with this substance might maximize the duration and magnitude of post-exercise hypotension. Objectives: To investigate the hypotensive effect of L-citrulline malate supplementation following a single session of aerobic exercise in normotensives. Methods: Forty adults, normotensives, sedentary, were randomly assigned to one of the four experimental groups (control-placebo, control-Lcitrulline, exercise-placebo and exercise-Lcitrulline). All participants ingested a sachet with placebo or L-citrulline with malate (6 grams), both dissolved in water and the ingestion was made 120 minutes before starting the experimental session. The subjects performed 40 minutes of walk/run at 60-70% of reserve heart rate. For the control session, they remained seated in rest during 40 minutes. The blood pressure was taken in rest and every 10 minutes until complete 60 minutes after the experimental session. The ambulatory blood pressure device take the readings every 20 minutes (awake time) and each 30 minutes (sleep time) over the course of 24 hours. Results: L-citrulline malate supplementation associated to aerobic exercise promoted significantly reductions on systolic blood pressure when compared with control-placebo at 20 min (net change[NC]: 9.7 mmHg [P=0.010]), 40 min (NC: 12.7 mmHg [P=0.010]), 50 min (NC: 12.1 mmHg [P=0.012]), 60 min (NC: 9.0 mmHg [P=0.050]) and overall mean (NC: 7.8 mmHg [P=0.018]) post exercise. Conclusion: Acute L-citrulline malate supplementation might potentiate the post-exercise hypotension effects in normotensive subjects.


Blood Pressure, Dietary Supplements, Ambulatory Blood Pressure Monitoring.


1. Breuillard C, Cynober L, Moinard C. Citrulline and nitrogen homeostasis: an overview. Amino acids. 2015;47(4):685-91.

2. Marini JC, Didelija IC, Castillo L, Lee B. Glutamine: precursor or nitrogen donor for citrulline synthesis? American journal of physiology Endocrinology and metabolism. 2010;299(1):69-79.

3. Marini JC. Interrelationships between glutamine and citrulline metabolism. Current opinion in clinical nutrition and metabolic care. 2016;19(1):62-6.

4. Marini JC, Didelija IC, Fiorotto ML. Extrarenal citrulline disposal in mice with impaired renal function. American journal of physiology Renal physiology. 2014;307(6):F660-5.

5. Marini JC, Didelija IC. Arginine depletion by arginine deiminase does not affect whole protein metabolism or muscle fractional protein synthesis rate in mice. PloS one. 2015;10(3):e0119801.

6. Cleroux J, Kouame N, Nadeau A, Coulombe D, Lacourciere Y. After reffects of exercise on regional and systemic hemodynamics in hypertension. Hypertension. 1992;19(2):183-91.

7. Sureda A, Cordova A, Ferrer MD, Perez G, Tur JA, Pons A. L-citrulline-malate influence over branched chain amino acid utilization during exercise. Eur J Appl Physiol. 2010;110(2):341-51.

8. Sureda A, Cordova A, Ferrer MD, Tauler P, Perez G, Tur JA, et al. Effects of L-citrulline oral supplementation on polymorphonuclear neutrophils oxidative burst and nitric oxide production after exercise. Free Radic Res. 2009;43(9):828-35.

9. Gordon CC, Chumlea WC, Roche AF. Stature, recumbent length, and weight. Lohman TG, Roche AF, Martorell R, editors. Champaign: Human Kinetics Books; 1988;3-8.

10. Coleman A, Freeman P, Steel S, Shennan A. Validation of the Omron MX3 Plus oscillometric blood pressure monitoring device according to the European Society of Hypertension international protocol. Blood Press Monit. 2005;10(3):165-8.

11. Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45(1):142-61.

12. Casonatto J, Tinucci T, Dourado AC, Polito M. Cardiovascular and autonomic responses after exercise sessions with different intensities and durations. Clinics (Sao Paulo). 2011;66(3):453-8.

13. McKinley-Barnard S, Andre T, Morita M, Willoughby DS. Combined L-citrulline and glutathione supplementation increases the concentration of markers indicative of nitric oxide synthesis. J Int Soc Sports Nutr. 2015;12:27.

14. Glenn JM, Gray M, Jensen A, Stone MS, Vincenzo JL. Acute citrullinemalate supplementation improves maximal strength and anaerobic power in female, masters athletes tennis players. European journal of sport science. 2016;16(8):1095-103.

15. Suzuki T, Morita M, Kobayashi Y, Kamimura A. Oral L-citrulline supplementation enhances cycling time trial performance in healthy trained men: Double-blind randomized placebo-controlled 2-way crossover study. J Int Soc Sports Nutr. 2016;13:6.

16. Wong A, Alvarez-Alvarado S, Jaime SJ, Kinsey AW, Spicer MT, Madzima TA, et al. Combined whole-body vibration training and l-citrulline supplementation improves pressure wave reflection in obese postmenopausal women. Applied physiology, nutrition, and metabolism Physiologie appliquee, nutrition et metabolisme. 2016;41(3):292-7.

17. Cunniffe B, Papageorgiou M, O’Brien B, Davies NA, Grimble GK, Cardinale M. Acute Citrulline-Malate Supplementation and High-Intensity Cycling Performance. J Strength Cond Res. 2016;30(9):2638-47.

18. Bailey SJ, Blackwell JR, Lord T, Vanhatalo A, Winyard PG, Jones AM. l-Citrulline supplementation improves O2 uptake kinetics and highintensity exercise performance in humans. J Appl Physiol (1985). 2015;119(4):385-95.

19. Cutrufello PT, Gadomski SJ, Zavorsky GS. The effect of l-citrulline and watermelon juice supplementation on anaerobic and aerobic exercise performance. Journal of sports sciences. 2015;33(14):1459-66.

20. Wax B, Kavazis AN, Luckett W. Effects of Supplemental Citrulline-Malate Ingestion on Blood Lactate, Cardiovascular Dynamics, and Resistance Exercise Performance in Trained Males. Journal of dietary supplements. 2016;13(3):269-82.

21. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: A meta-analysis of randomized controlled trials. Hypertension. 2000;35(3):838-43.

22. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2(1):e004473.

23. Anunciação PG, Casonatto J, Polito M. Blood pressure responses and heart rate variability after resistance exercise with different intensities and same workload. Int Sport J. 2011;12(2):53-67.

24. Casonatto J, Goessler KF, Cornelissen VA, Cardoso JR, Polito MD. The blood pressure-lowering effect of a single bout of resistance exercise: A systematic review and meta-analysis of randomised controlled trials. European journal of preventive cardiology. 2016;23(16):1700-14.

25. Forjaz CL, Tinucci T, Ortega KC, Santaella DF, Mion D, Jr., Negrao CE. Factors affecting post-exercise hypotension in normotensive and hypertensive humans. Blood Press Monit. 2000;5(5-6):255-62.

26. Wallace JP, Bogle PG, King BA, Krasnoff JB, Jastremski CA. A comparison of 24-h average blood pressures and blood pressure load following exercise. Am J Hypertens. 1997;10(7 Pt 1):728-34.

27. Bermudes AM, Vassallo DV, Vasquez EC, Lima EG. Ambulatory blood pressure monitoring in normotensive individuals undergoing two single exercise sessions: resistive exercise training and aerobic exercise training. Arq Bras Cardiol. 2004;82(1):65-71.

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