Mitochondria produce reactive oxygen species that may contribute to vascular dysfunction. Alpha-lipoic acid and acetyl-L-carnitine reduce oxidative stress and improve mitochondrial function. In a double blind, crossover study, we examined the effects of combined alpha-lipoic acid /acetyl-L-carnitine treatment and placebo (eight weeks per treatment) on vasodilator function and blood pressure in 36 subjects with coronary artery disease. Active treatment increased brachial artery diameter by 2.3% (P=0.008), consistent with reduced arterial tone. Active treatment tended to decrease systolic blood pressure for the whole group (P=0.07) and had a significantly effect in the subgroup with blood pressure above the median (151±20 to 142±18 mmHg, P=0.03) and in the subgroup with the metabolic syndrome (139±21 to 130±18 mmHg, P=0.03). Thus, mitochondrial dysfunction may contribute to the regulation of blood pressure and vascular tone. Further studies are needed to confirm these findings and determine the clinical utility of alpha-lipoic acid/acetyl-L-carnitine as antihypertensive therapy.