Nitrate-Rich Beetroot Juice Reduces Blood Pressure in Tanzanian Adults with Elevated Blood Pressure: A Double-Blind Randomized Controlled Feasibility Trial
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BACKGROUND: In Sub-Saharan Africa, current strategies are struggling to control the burgeoning hypertension epidemic. Dietary interventions such as inorganic nitrate or folic acid supplementation could represent promising strategies for reducing blood pressure (BP) in this setting. OBJECTIVES: This feasibility study explores the effects of dietary inorganic nitrate supplementation, alone or in combination with folic acid, on BP in Tanzanian adults with elevated BP in Tanzania. METHODS: A placebo-controlled, double-blind, randomized controlled feasibility trial was conducted. Forty-seven middle-aged and older participants (age: 50-70 y, BMI: 26.3-29.1 kg/m2) were randomly assigned to 3 conditions for a period of 60 d: 1) high-nitrate beetroot juice (∼400 mg nitrate) and folic acid (∼5 mg folic acid) (N + F), 2) high-nitrate beetroot juice and placebo (N + P), or 3) nitrate-depleted beetroot juice and placebo (P + P). Clinic and 24-h ambulatory BP and measurements of compliance in plasma (nitrate and folate concentrations) and saliva (nitrate and nitrite) were obtained at baseline, 30 d, and 60 d. RESULTS: Baseline resting systolic and diastolic BP (mean ± SD) was 151.0 ± 19.4 mm Hg and 91.8 ± 11.7 mm Hg, respectively. Compliance to the interventions was high (>90%) in all groups which was confirmed by the significant increase in nitrate and folic acid concentrations in plasma and saliva samples in the treatment arms. After 60 d, 24-h systolic BP dropped by -10.8 ± 9.8 mm Hg (P < 0.001), -6.1 ± 13.2 mm Hg (P = 0.03), and -0.3 ± 9.7 mm Hg (P = 0.83) in the N + P, N + F, and P + P groups, respectively. There was a significant decrease in 24-h diastolic BP in the N + P group (-5.4 ± 5.0 mm Hg, P = 0.004), whereas changes were not significant in the N + F (-1.8 ± 8.1 mm Hg, P = 0.32) and P + P (1.6 ± 8.3 mm Hg, P = 0.43) groups. CONCLUSIONS: Dietary inorganic nitrate represents a potential nutritional strategy to lessen the hypertension epidemic in Sub-Saharan Africa. These findings support the rationale for future long-term investigations exploring the efficacy of dietary nitrate for lowering BP and attenuating cardiovascular disease risk in this setting.This trial was registered at isrctn.com as ISRCTN67978523.
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Interventions involving beetroot reduce blood pressure in various populations, including pregnant women with hypertension, adults with elevated blood pressure and older individuals.
“Interventions involving beetroot have been shown to reduce blood pressure in various populations, including pregnant women with hypertension, adults with elevated blood pressure and older individuals [19,20,21].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [20]
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- Authors
- Siervo, M., Shannon, O., Kandhari, N., Prabhakar, M., Fostier, W., Köchl, C., Rogathi, J., Temu, G., Stephan, B. C., Gray, W. K., Haule, I., Paddick, S.-M., Mmbaga, B. T., & Walker, R.
- Affiliations
- University of Nottingham (GB)
- Newcastle University (GB)
- Kilimanjaro Christian Medical Centre (TZ)
- Northumbria Healthcare NHS Foundation Trust (GB)
- Government of Tanzania (TZ)
- Corresponding author
- Siervo, Mario
- ORCID
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 150
- Issue
- 9
- Pages
- 2460-2468
- ISSN
- 0022-3166 (ISSN-L)
- PMC
- PMC7467850
- OpenAlex
- W3046478922
- Cited by
- 57
- References
- 29
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 9 · 2023: 8 · 2022: 13 · 2021: 8 · 2020: 3
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- Medical Research Council (BH171899)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- beetroot juice, dietary nitrate, folic acid supplementation, hypertension, blood pressure reduction, 24-hour ambulatory blood pressure, dietary intervention, older adults, Tanzania, sub-Saharan Africa, folic acid, nitrite, medication adherence, feasibility trial, dietary sodium reduction, dietary fiber
- MeSH terms
- Fruit and Vegetable Juices, Aged, Antihypertensive Agents, Blood Pressure, Double-Blind Method, Female, Humans, Hypertension, Male, Middle Aged, Plant Roots, Beta vulgaris
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