One Week of Daily Dosing With Beetroot Juice Improves Submaximal Endurance and Blood Pressure in Older Patients With Heart Failure and Preserved Ejection Fraction
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Objectives This study sought to determine whether a relatively low single dose or a week-long dosage of dietary inorganic nitrate could improve exercise tolerance in patients with heart failure with preserved ejection fraction (HFpEF).Background Exercise intolerance is the primary manifestation of HFpEF and is largely due to noncardiac factors that reduce oxygen delivery to active skeletal muscles. A recent study showed improved exercise capacity in patients with HFpEF after a single, acute dose of beetroot juice (BRJ) (12.9 mmol inorganic nitrate) while another recent study showed neutral and negative effects of an organic nitrate.Methods Twenty HFpEF patients (69 ± 7 years of age ) were enrolled in an initial cross-over design comparing a single, acute dose of BRJ (6.1 mmol nitrate) to a nitrate-depleted placebo BRJ. A second phase, 1 week of daily doses, used an all-treated design in which patients consumed BRJ for an average of 7 days. The primary outcome of the study was submaximal aerobic endurance, measured as cycling time to exhaustion at 75% of measured maximal power output.Results No adverse events were associated with the intervention. Submaximal aerobic endurance improved 24% after 1 week of daily BRJ dosing (p = 0.02) but was not affected by the single, acute dose of the BRJ compared to placebo. Consumption of BRJ significantly reduced resting systolic blood pressure and increased plasma nitrate and nitrite in both of the dosing schemes.Conclusions One week of daily dosing with BRJ (6.1 mmol inorganic nitrate) significantly improves submaximal aerobic endurance and blood pressure in elderly HFpEF patients.
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Dietary nitrate has been shown to improve exercise tolerance in heart failure patients (~65-69-year-olds) with preserved ejection fraction.
“in heart failure patients (∼65-69-year-olds) with preserved ejection fraction (39,171)”
From Dietary Nitrate and Physical Performance (2018) · cites this paper as [39]
In another study, there was a 24% improvement in submaximal aerobic endurance with 1 week of daily beetroot juice consumption (6.1 mmol nitrate).
“and in another study, a 24% improvement in submaximal aerobic endurance with 1 week of daily beetroot juice consumption (6.1 mmol nitrate)[151].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [151]
Clinically, nitrate supplementation improves exercise performance in patients with heart failure and HFpEF.
“improved exercise performance in patients with heart failure and HFpEF[135,137,151].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [151]
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- Authors
- Eggebeen, J., Kim-Shapiro, D. B., Haykowsky, M., Morgan, T. M., Basu, S., Brubaker, P., Rejeski, J., & Kitzman, D. W.
- Affiliations
- Wake Forest University Health Sciences (US)
- The University of Texas at Arlington (US)
- Wake Forest University (US)
- Corresponding author
- Kitzman, Dalane W.
- Venue
- JACC: Heart Failure
- Publisher
- Elsevier BV
- Published
- 2016-06
- Volume
- 4
- Issue
- 6
- Pages
- 428-437
- ISSN
- 2213-1779 (ISSN-L)
- PMC
- PMC4892939
- OpenAlex
- W2257034273
- Cited by
- 190
- References
- 48
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 11 · 2023: 16 · 2022: 16 · 2021: 17 · 2020: 19 · 2019: 23 · 2018: 21 · 2017: 36 · 2016: 14
- FWCI
- 64.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR001420)
- National Institute on Aging (R01AG018915, R01AG045551, P30AG021332)
- National Heart, Lung, and Blood Institute (R29HL058091, R37HL058091, R01HL058091)
- National Center for Research Resources (M01RR007122)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- beetroot juice, heart failure with preserved ejection fraction, inorganic nitrate, exercise endurance, blood pressure, older adults, exercise intolerance
- MeSH terms
- Fruit and Vegetable Juices, Aged, Blood Pressure, Double-Blind Method, Female, Heart Failure, Humans, Male, Middle Aged, Nitrates, Oxygen Consumption, Physical Endurance, Stroke Volume, Exercise Tolerance, Cross-Over Studies, Beta vulgaris
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