Cited by 114Nitric Oxide and Endothelin EffectsCardiovascular Health and Disease PreventionSodium Intake and Health

The DOI matches its Crossref record; 110 of the 110 references it cites were found in a registry or an index; none of the 53 sources its claims cite is checked for support yet.

The effects of dietary nitrate on blood pressure and endothelial function: a review of human intervention studies

Open access
Hobbs, Ditte A., George, Trevor W., Lovegrove, Julie A.·2013·Nutrition Research Reviews

Abstract

Evidence has accumulated in recent years that suggests that nitrate from the diet, particularly vegetables, is capable of producing bioactive NO in the vasculature, following bioconversion to nitrite by oral bacteria. The aim of the present review was to consider the current body of evidence for potential beneficial effects of dietary nitrate on blood pressure and endothelial function, with emphasis on evidence from acute and chronic human intervention studies. The studies to date suggest that dietary nitrate acutely lowers blood pressure in healthy humans. An inverse relationship was seen between dose of nitrate consumed and corresponding systolic blood pressure reduction, with doses of nitrate as low as 3 mmol of nitrate reducing systolic blood pressure by 3 mmHg. Moreover, the current studies provide some promising evidence on the beneficial effects of dietary nitrate on endothelial function. In vitro studies suggest a number of potential mechanisms by which dietary nitrate and its sequential reduction to NO may reduce blood pressure and improve endothelial function, such as: acting as a substrate for endothelial NO synthase; increasing vasodilation; inhibiting mitochondrial reactive oxygen species production and platelet aggregation. In conclusion, the evidence for beneficial effects of dietary nitrate on blood pressure and endothelial function is promising. Further long-term randomised controlled human intervention studies assessing the potential effects of dietary nitrate on blood pressure and endothelial function are needed, particularly in individuals with hypertension and at risk of CVD.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review concludes that dietary nitrate acutely lowers blood pressure in healthy humans, with promising but limited evidence for improved endothelial function. It calls for further long-term randomised controlled trials, especially in hypertension and CVD-risk populations.

Key findings

  • Acute dietary nitrate lowered blood pressure in healthy humans; an inverse relationship was observed between nitrate dose and systolic blood pressure reduction, with doses as low as 3 mmol nitrate reducing systolic blood pressure by 3 mmHg.
  • In the dose-response analysis, systolic blood pressure reduction was significant (R² 0.45; P=0.033), while diastolic blood pressure reduction did not reach significance (R² 0.233; P=0.27).
  • Individual studies reported larger effects: beetroot juice (500 ml; 23 mmol nitrate) reduced systolic and diastolic blood pressure by 10 and 8 mmHg, respectively; in drug-naive grade 1 hypertensives, 3.5 mmol nitrate reduced systolic blood pressure by 12 mmHg.
  • Endothelial function evidence was promising but mixed: beetroot juice protected against ischaemia-reperfusion injury and preserved flow-mediated dilatation, whereas 8 mmol potassium nitrate did not alter flow-mediated dilatation but reduced pulse wave velocity by 0.3 m/s and systolic blood pressure by 4 mmHg.

Methods

  • Narrative review of human intervention studies examining dietary nitrate effects on blood pressure and endothelial function, with emphasis on acute and chronic studies; animal and in vitro evidence was used to explore mechanisms.
  • Data were extracted from randomised placebo-controlled trials summarised in Tables 2 and 3, including beetroot juice and inorganic nitrate salts, with varied doses, controls, populations, and vascular measures.
  • A dose-response analysis was presented for acute effects of dietary nitrate from beetroot juice and inorganic salts on peak systolic and diastolic blood pressure changes in healthy normotensive subjects.

Limitations

  • The paper states that further long-term randomised controlled human intervention studies are needed, particularly in individuals with hypertension and at risk of CVD.
  • The paper states that there are limited human intervention studies on endothelial function and that replication is needed using a wider range of in vivo measures.
  • Evident from the text: this is a narrative review without a described systematic search or meta-analysis, and the included studies are heterogeneous in dose, vehicle, population, duration, and outcome measures, with several small samples.

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Integrity signals

Registry

Crossref · 10.1017/s0954422413000188

Cites

110 of 110 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

40 Not checked yet · 11 Own interpretation · 4 No basis given · 1 Own result

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Show all 37 claims

  • It may state two separate claims as one. 16
  • Probably not a substantial claim. 5
19 of 19
  • The paper relies on this without support.

    The studies included in the review are of sufficient methodological quality and comparability to allow synthesis of their findings.

    “When evaluating the studies investigating the acute effects of dietary nitrate from beetroot juice or inorganic supplements on BP a significant inverse relationship between dose of nitrate and reduction in SBP (R 2 2 0•45; P¼0•033; Fig. 2(a)) was observed”
  • The paper relies on this without support.

    The mechanisms observed in in vitro and animal studies are relevant to humans.

    “In vitro studies suggest a number of potential mechanisms by which dietary nitrate and its sequential reduction to NO may reduce blood pressure and improve endothelial function, such as: acting as a substrate for endothelial NO synthase; increasing vasodilation; inhibiting mitochondrial reactive oxygen species production and platelet aggregation.”
  • The paper relies on this without support.

    The inverse relationship between nitrate dose and SBP reduction reflects a causal effect of nitrate.

    “When evaluating the studies investigating the acute effects of dietary nitrate from beetroot juice or inorganic supplements on BP a significant inverse relationship between dose of nitrate and reduction in SBP (R 2 2 0•45; P¼0•033; Fig. 2(a)) was observed”
  • The paper relies on this without support.

    The human intervention studies included in the review provide valid estimates of the effect of dietary nitrate on blood pressure and endothelial function.

    “There is a modest but convincing body of evidence from acute and chronic human intervention studies that show BP-lowering effects of dietary nitrate, with limited but promising evidence for potential beneficial effects on endothelial function.”
4 of 4

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Citations

Cites

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Research works printed but not linked: 1

  1. 2006, Hypertension: Management of Hypertension in Adults in Primary Care. NICE Clinical Guideline 34

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Metadata

Authors
Hobbs, D. A., George, T. W., & Lovegrove, J. A.
Affiliations
  • University of Reading (GB)
  • Northumbria University (GB)
Corresponding author
Lovegrove, Julie A.
Venue
Nutrition Research Reviews
Published
2013-10-18
Volume
26
Issue
2
Pages
210-222
ISSN
  • 0954-4224 (ISSN-L)
  • 1475-2700
OpenAlex
W2168363136
Cited by
114
References
110
Citations by year
2026: 12 · 2025: 8 · 2024: 6 · 2023: 4 · 2022: 6 · 2021: 8 · 2020: 8 · 2019: 13 · 2018: 15 · 2017: 10 · 2016: 8 · 2015: 12 · 2014: 3
FWCI
0.84
Type
journal article
Language
en
Open access
Locations
  • Nutrition Research Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion)
  • Northumbria Research Link (Northumbria University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Keywords
dietary nitrate, blood pressure, endothelial function, nitric oxide, oral bacteria, hypertension, cardiovascular disease, endothelial nitric oxide synthase, vasodilation, platelet aggregation, reactive oxygen species
MeSH terms
Blood Pressure, Diet, Endothelium, Vascular, Humans, Hypertension, Mitochondria, Nitrates, Nitric Oxide, Platelet Aggregation, Vasodilation, Reactive Oxygen Species, Nitric Oxide Synthase

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