Medium-term effects of dietary nitrate supplementation on systolic and diastolic blood pressure in adults

Ashor, Ammar W.; Lara, José; Siervo, Mario

doi:10.1097/hjh.0000000000001305

Cited by 80 publications

(69 citation statements)

References 37 publications

(103 reference statements)

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“…A few meta‐analyses of randomized trials with either nitrate salts or a vegetable‐source of nitrate, most often beetroot juice, indicate a more pronounced effect of nitrate on systolic compared to diastolic pressure . Dietary nitrate induces both acute (often peaking after 2‐3 hours) and chronic effects.…”

Section: Human Studies On Blood Pressure and Dietary Nitratementioning

confidence: 99%

“…Dietary nitrate induces both acute (often peaking after 2‐3 hours) and chronic effects. In a meta‐analysis on dietary nitrate supplementation (5.2‐10.0 mmol/day) and blood pressure, focusing on studies with intervention ranging between 1 and 6 weeks, the overall mean change in systolic and diastolic pressure was −4.1 mm Hg and −2.0 mm Hg, respectively . In the analysis, the effect size for systolic and diastolic pressure was not significantly associated with baseline blood pressure values and higher doses of nitrate were not associated with greater vascular benefits.…”

Section: Human Studies On Blood Pressure and Dietary Nitratementioning

confidence: 99%

“…One of the most studied and reproducible effects of dietary nitrate in humans is the reduction in blood pressure, both in normotensive and hypertensive subjects. Meta‐analyses indicate a more pronounced effect on systolic compared to diastolic blood pressure . With respect to the pluripotency of NO and its participation in widely different physiological processes such as vasoregulation, nerve transmission, metabolism, inflammation and renal function, it is most likely that several concomitant mechanisms determine the blood pressure‐lowering effect of inorganic nitrate.…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

2018

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Nitric oxide (NO) importantly contributes to cardiovascular homeostasis by regulating blood flow and maintaining endothelial integrity. Conversely, reduced NO bioavailability is a central feature during natural ageing and in many cardiovascular disorders, including hypertension. The inorganic anions nitrate and nitrite are endogenously formed after oxidation of NO synthase (NOS)-derived NO and are also present in our daily diet. Knowledge accumulated over the past two decades has demonstrated that these anions can be recycled back to NO and other bioactive nitrogen oxides via serial reductions that involve oral commensal bacteria and various enzymatic systems. Intake of inorganic nitrate, which is predominantly found in green leafy vegetables and beets, has a variety of favourable cardiovascular effects. As hypertension is a major risk factor of morbidity and mortality worldwide, much attention has been paid to the blood pressure reducing effect of inorganic nitrate. Here, we describe how dietary nitrate, via stimulation of the nitrate-nitrite-NO pathway, affects various organ systems and discuss underlying mechanisms that may contribute to the observed blood pressure-lowering effect.

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Section: Human Studies On Blood Pressure and Dietary Nitratementioning

confidence: 99%

Section: Human Studies On Blood Pressure and Dietary Nitratementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

2018

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“…Inorganic (dietary) nitrate, abundant in green leafy vegetables and beetroot reduces BP in healthy and hypertensive volunteers via the nitrate–nitrite–NO pathway, but not in patients with T2DM, or with their inclusion in a meta‐analysis of 24 h ambulatory BP monitoring . PWV reductions with inorganic nitrate have also been noted in healthy and hypertensive volunteers, but over too short a period for vessel remodelling; these were likely BP‐dependent reductions .…”

Section: Introductionmentioning

confidence: 99%

A randomised, factorial trial to reduce arterial stiffness independently of blood pressure: Proof of concept? The VaSera trial testing dietary nitrate and spironolactone

Mills

Govoni

Faconti

et al. 2020

Brit J Clinical Pharma

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Aims:To test if spironolactone or dietary nitrate from beetroot juice could reduce arterial stiffness as aortic pulse wave velocity (PWVart), a potential treatment target, independently of blood pressure. Methods:Daily spironolactone (≤50 mg) vs doxazosin (control ≤16 mg) and 70 mL beetroot juice (Beet-It ≤11 mmol nitrate) vs nitrate-depleted juice (placebo; 0 mmol nitrate) were tested in people at risk or with type-2 diabetes using a double-blind, 6-month factorial trial. Vascular indices (baseline, 12, 24 weeks) were cardiac-ankle vascular index (CAVI), a nominally pressure-independent stiffness measure (primary outcome), PWVart secondary, central systolic pressure and augmentation. Analysis was intention-to-treat, adjusted for systolic pressure differences between trial arms.Results: Spironolactone did not reduce stiffness, with evidence for reduced CAVI on doxazosin rather than spironolactone (mean difference [95% confidence interval]; 0.25 [−0.3, 0.5] units, P = .080), firmer for PWVart (0.37 [0.01, 0.7] m/s, P = .045). There was no difference in systolic pressure reduction between spironolactone and doxazosin (0.7 [−4.8, 3.3] mmHg, P = .7). Circulating nitrate and nitrite increased on active vs placebo juice, with central systolic pressure lowered −2.6 [−4.5, − 0.8] mmHg, P = .007 more on the active juice, but did not reduce CAVI, PWVart or peripheral pressure. Change in nitrate and nitrite concentrations were 1.5-fold [1.1-2.2] and 2.2-fold [1.3, 3.6] higher on spironolactone than on doxazosin respectively; both P < .05.Conclusion: Contrary to our hypothesis, in at-risk/type 2 diabetes patients, spironolactone did not reduce arterial stiffness, rather PWVart was lower on doxazosin.Dietary nitrate elevated plasma nitrite, selectively lowering central systolic pressure, observed previously for nitrite.PI statement: The authors confirm that the Principal Investigator for this paper is Professor J.K. Cruickshank and that he had direct clinical responsibility for patients.Clinical trial registration: ISRCTN registry: ISRCTN25003627

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“…14 Another example is leafy green vegetables, such as spinach and lettuce, which are a rich source of the nitrogen-containing compound, nitrate. Nitrate has been shown in clinical trials to lower blood pressure, 16,17 a major risk factor for cardiovascular disease. If specific components have a greater protective role in atherosclerosis, then particular types of vegetables rich in these components may confer a greater cardioprotective effect, as we have previously demonstrated.…”

mentioning

confidence: 99%

Cruciferous and Total Vegetable Intakes Are Inversely Associated With Subclinical Atherosclerosis in Older Adult Women

Blekkenhorst

Bondonno

Lewis

et al. 2018

JAHA

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BackgroundDietary patterns rich in fruits and vegetables are considered to reduce atherosclerotic disease presentation and are reported to be inversely associated with subclinical measures of atherosclerosis, such as carotid artery intima‐media thickness (IMT) and plaque. However, the effect of vegetable intake alone, and relationships to specific types of vegetables containing different phytochemical profiles, is important. The aim of this study was to investigate the associations of total vegetable intake and specific vegetables grouped according to phytochemical constituents with common carotid artery IMT (CCA‐IMT) and carotid plaque severity in a cohort of older adult women (aged ≥70 years).Methods and ResultsTotal vegetable intake was calculated at baseline (1998) using a validated food frequency questionnaire. Vegetable types included cruciferous, allium, yellow/orange/red, leafy green, and legumes. In 2001, CCA‐IMT (n=954) and carotid focal plaque (n=968) were assessed using high‐resolution B‐mode carotid ultrasonography. Mean (SD) total vegetable intake was 199.9 (78.0) g/d. Women consuming ≥3 servings of vegetables each day had ≈4.6% to 5.0% lower mean CCA‐IMT (P=0.014) and maximum CCA‐IMT (P=0.004) compared with participants consuming <2 servings of vegetables. For each 10 g/d higher in cruciferous vegetable intake, there was an associated 0.006 mm (0.8%) lower mean CCA‐IMT (P<0.01) and 0.007 mm (0.8%) lower maximum CCA‐IMT (P<0.01). Other vegetable types were not associated with CCA‐IMT (P>0.05). No associations were observed between vegetables and plaque severity (P>0.05).ConclusionsIncreasing vegetables in the diet with a focus on consuming cruciferous vegetables may have benefits for the prevention of subclinical atherosclerosis in older adult women.Clinical Trial Registration URL: http://www.anzctr.org.au. Unique identifier: ACTRN12615000750583.

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Medium-term effects of dietary nitrate supplementation on systolic and diastolic blood pressure in adults

Cited by 80 publications

References 37 publications

Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

Mechanisms underlying blood pressure reduction by dietary inorganic nitrate

A randomised, factorial trial to reduce arterial stiffness independently of blood pressure: Proof of concept? The VaSera trial testing dietary nitrate and spironolactone

Cruciferous and Total Vegetable Intakes Are Inversely Associated With Subclinical Atherosclerosis in Older Adult Women

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