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Acute Blood Pressure Lowering, Vasoprotective, and Antiplatelet Properties of Dietary Nitrate via Bioconversion to Nitrite
Open accessAbstract
Diets rich in fruits and vegetables reduce blood pressure (BP) and the risk of adverse cardiovascular events. However, the mechanisms of this effect have not been elucidated. Certain vegetables possess a high nitrate content, and we hypothesized that this might represent a source of vasoprotective nitric oxide via bioactivation. In healthy volunteers, approximately 3 hours after ingestion of a dietary nitrate load (beetroot juice 500 mL), BP was substantially reduced (Δ max −10.4/8 mm Hg); an effect that correlated with peak increases in plasma nitrite concentration. The dietary nitrate load also prevented endothelial dysfunction induced by an acute ischemic insult in the human forearm and significantly attenuated ex vivo platelet aggregation in response to collagen and ADP. Interruption of the enterosalivary conversion of nitrate to nitrite (facilitated by bacterial anaerobes situated on the surface of the tongue) prevented the rise in plasma nitrite, blocked the decrease in BP, and abolished the inhibitory effects on platelet aggregation, confirming that these vasoprotective effects were attributable to the activity of nitrite converted from the ingested nitrate. These findings suggest that dietary nitrate underlies the beneficial effects of a vegetable-rich diet and highlights the potential of a “natural” low cost approach for the treatment of cardiovascular disease.
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In the citing paper
“For example, Webb et al. (12) showed in healthy participants that 24 h after a single dose of 500 mL beetroot juice, systolic and diastolic BP were reduced by 10.4 and 8.0 mm Hg, respectively.”
From Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis (2013) · cites this paper as [12]
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Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“These dosing amounts appear to be well tolerated when consumed as both supplemental [587] and supplemental sources [588] without significant alterations in hemodynamics or clinical boundaries of hepatorenal and muscle enzyme status [478, 589].”
From ISSN exercise & sports nutrition review update: research & recommendations (2018) · cites this paper as [588]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The NO3-- NO2--NO reduction pathway underpins the discovery that dietary NO3- supplementation through consumption of NO3- salts [27] or vegetable products such as beetroot juice [23], [40] reduces blood pressure (BP) in healthy young and old humans.”
From Nitrate-responsive oral microbiome modulates nitric oxide homeostasis and blood pressure in humans (2018) · cites this paper as [40]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The magnitude of the BP response to NO3-supplementation is correlated with baseline blood pressure [22], [40]”
From Nitrate-responsive oral microbiome modulates nitric oxide homeostasis and blood pressure in humans (2018) · cites this paper as [40]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Dietary nitrate has been demonstrated to have a range of beneficial vascular effects, including reducing blood pressure, inhibiting platelet aggregation, preserving or improving endothelial dysfunction, enhancing exercise performance in healthy individuals and patients with peripheral arterial disease.”
From Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway (2013) · cites this paper as [79]
Experimental — accuracy not yet measured
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In the citing paper
“Andrew Webb (Barts and The London Medical School) and colleagues used beetroot juice as a source of nitrate in healthy volunteers and found a reduction in blood pressure of ~10 mm Hg that coincided with peak plasma levels of nitrite37.”
From Nitrate and nitrite in biology, nutrition and therapeutics (2009) · cites this paper as [37]
The cited source says what the claim attributes to it.
In the citing paper
“Two studies found a significant association between changes in plasma nitrite concentrations and changes in systolic BP after oral inorganic nitrate supplementation (12,33), which supports our hypothesis on the lack of standardization of the measurement protocols.”
From Inorganic Nitrate and Beetroot Juice Supplementation Reduces Blood Pressure in Adults: A Systematic Review and Meta-Analysis (2013) · cites this paper as [12]
The cited source says what the claim attributes to it.
In the citing paper
“while nitrate supplementation prevents or limits ischemia-reperfusion injury and endothelial dysfunction in both animal[98,120–124] and human[97,125] models of ischemia-reperfusion.”
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 [97]
The cited source says what the claim attributes to it.
In the citing paper
“protection from ischemia-reperfusion injury[97,98,272]”
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 [97]
The cited source says what the claim attributes to it.
In the citing paper
“several studies have shown that it has the potential to contribute significantly to nitrite-dependent responses [84, 86-89, 118-121]”
From Current perspectives and challenges in understanding the role of nitrite as an integral player in nitric oxide biology and therapy (2011) · cites this paper as [89]
The cited source says what the claim attributes to it.
In the citing paper
“Indeed, interruption of this process by asking volunteers to spit out all their saliva for 3 h immediately following beetroot juice ingestion completely blocked the rise in plasma nitrite and the reduction BP.”
From Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway (2013) · cites this paper as [79]
The cited source says what the claim attributes to it.
In the citing paper
“The half-life of nitrate is 5-8 h [77,79,111,141,142], which is much longer than that of nitrite, which has been reported as being 1-5 min ex vivo [77,142] and ~20-45 min in vivo [86,112].”
From Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway (2013) · cites this paper as [79]
The cited source says what the claim attributes to it.
In the citing paper
“Webb et al. translated this into a forearm model of ischaemia-reperfusion and demonstrated that nitrate supplementation in the form of beetroot juice attenuated endothelial function impairment following ischaemia-reperfusion injury during FMD of the brachial artery in healthy human subjects [79].”
From Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate-nitrite-nitric oxide pathway (2013) · cites this paper as [79]
In the citing paper
“Dietary nitrate supplementation increases plasma nitrite concentration and reduces resting blood pressure.”
From Dietary Nitrate Supplementation and Exercise Performance (2014) · cites this paper as [13]
In the citing paper
“Following bolus nitrate ingestion, plasma nitrate concentration ([nitrate]) peaks after 1–2 h and plasma [nitrite] peaks after 2–3 h, after which both gradually fall, arriving back at baseline values after about 24 h [13].”
From Dietary Nitrate Supplementation and Exercise Performance (2014) · cites this paper as [13]
In the citing paper
“These reactions can beneficially regulate cardio-metabolic function and will be attenuated or abolished by chemical or physical destruction of the oral microbiota[60,75,76,97–99].”
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 [97]
In the citing paper
“Oral supplementation with either nitrite or nitrate increases circulating nitrite levels and prevents and reverses endothelial dysfunction in a dose-dependent manner both in mice[68,69] and in healthy[70,71,97,111,112], hypertensive[113], and obese individuals[114], or in those with hypercholesterolemia[115] and peripheral arterial disease[116].”
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 [97]
In the citing paper
“Webb et al., studied the blood pressure and flow-mediated dilation of healthy volunteers, and showed that the vasoprotective effects of dietary nitrate (a single dose of 500 mL of beetroot juice containing 45.0 ± 2.6 mmol/L nitrate), were attributable to the activity of nitrite converted from the ingested nitrate [86].”
From NO-Rich Diet for Lifestyle-Related Diseases (2015) · cites this paper as [86]
In the citing paper
“These effects are eliminated and nitrite levels decreased when volunteers either spit or use mouthwash [22, 23]”
From Mechanisms of nitrite bioactivation (2014) · cites this paper as [23]
In the citing paper
“and acute reduction in blood pressure[22–26].”
From Mechanisms of nitrite bioactivation (2014) · cites this paper as [23]
In the citing paper
“thereby implicating the importance of nitrate reduction to nitrite by oral bacteria.”
From Mechanisms of nitrite bioactivation (2014) · cites this paper as [23]
In the citing paper
“Several studies have shown that oral nitrate decreases blood pressure and that this effect is dependent on reduction of nitrate to nitrite by commensal bacteria [22–26].”
From Mechanisms of nitrite bioactivation (2014) · cites this paper as [23]
In the citing paper
“and the reduction in platelet aggregation was reduced when volunteers spit, which interrupts the conversion of nitrate to nitrite [23].”
From Mechanisms of nitrite bioactivation (2014) · cites this paper as [23]
In the citing paper
“Platelet aggregation induced by ADP or collagen measured in blood taken from individuals who consumed a single dose of beetroot juice (containing high nitrate) was reduced compared to a control group”
From Mechanisms of nitrite bioactivation (2014) · cites this paper as [23]
In the citing paper
“in vivo administration of nitrite either via direct infusion [25, 37, 83], dietary supplementation [84-86] or in the form of its two-electron oxidized precursor nitrate [87-89] leads to a decrease in blood pressure in normal and hypertensive patients with a concomitant increase in markers of NO formation”
From Current perspectives and challenges in understanding the role of nitrite as an integral player in nitric oxide biology and therapy (2011) · cites this paper as [89]
In the citing paper
“the diet is an important source of nitrite (largely via secondary reduction from nitrate)”
From Current perspectives and challenges in understanding the role of nitrite as an integral player in nitric oxide biology and therapy (2011) · cites this paper as [89]
In the citing paper
“these effects were ascribed to nitrate bioconversion to nitrite, which ultimately generates NO [28,30].”
From Sodium nitrite downregulates vascular NADPH oxidase and exerts antihypertensive effects in hypertension (2011) · cites this paper as [28]
In the citing paper
“inorganic nitrate supplementation, as well as a nitraterich meal, reduced blood pressure in healthy humans [28,30]”
From Sodium nitrite downregulates vascular NADPH oxidase and exerts antihypertensive effects in hypertension (2011) · cites this paper as [28]
In the citing paper
“Elevations in [NO3−] and [NO2−] following NO3− supplementation have been observed in skeletal muscle [88,89,90,91] and plasma [53,64,92], and are associated with positive physiological effects [41,64,74,93] that facilitate a greater capacity for muscular work [51,53,59] and/or improved muscle contractile efficiency (i.e., a lower high-energy phosphate cost of force production) [51,94].”
From Effects of Dietary Nitrate Supplementation on Weightlifting Exercise Performance in Healthy Adults: A Systematic Review (2020) · cites this paper as [92]
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Ashmore, T., Fernandez, B. O., Branco‐Price, C., West, J. A., Cowburn, A. S., Heather, L. C., Griffin, J. L., Johnson, R. S., Feelisch, M., & Murray, A. J. (2014) · The Journal of Physiology · doi:10.1113/jphysiol.2014.275263 · Cited by 58
From nitrate to NO: potential effects of nitrate-reducing bacteria on systemic health and disease
Liu, H., Huang, Y., Huang, M., Wang, M., Ming, Y., Chen, W., Chen, Y., Tang, Z., & Jia, B. (2023) · European Journal of Medical Research · doi:10.1186/s40001-023-01413-y · Cited by 58
Nitrite as a mediator of ischemic preconditioning and cytoprotection
Murillo, D., Kamga, C., Mo, L., & Shiva, S. (2011) · Nitric Oxide · doi:10.1016/j.niox.2011.01.003 · Cited by 57
Siervo, M., Shannon, O., Kandhari, N., Prabhakar, M., Fostier, W., Köchl, C., Rogathi, J., Temu, G., Stephan, B. C., Gray, W. K., et al. (2020) · The Journal of Nutrition · doi:10.1093/jn/nxaa170 · Cited by 57
Effects of chronic dietary nitrate supplementation on the hemodynamic response to dynamic exercise
Lee, J.-S., Stebbins, C. L., Jung, E., Nho, H., Kim, J.-K., Chang, M.-J., & Choi, H.-M. (2015) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00099.2015 · Cited by 56
Can elite athletes benefit from dietary nitrate supplementation?
Jonvik, K. L., Nyakayiru, J., van Loon, L. J. C., & Verdijk, L. B. (2015) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00232.2015 · Cited by 55
Thompson, C., Wylie, L. J., Blackwell, J. R., Fulford, J., Black, M. I., Kelly, J., McDonagh, S. T. J., Carter, J., Bailey, S. J., Vanhatalo, A., et al. (2017) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00909.2016 · Cited by 51
Dietary nitrate supplementation in cardiovascular health: an ergogenic aid or exercise therapeutic?
Woessner, M. N., McIlvenna, L. C., Ortiz de Zevallos, J., Neil, C. J., & Allen, J. D. (2018) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00414.2017 · Cited by 50
Shannon, O. M., Duckworth, L., Barlow, M. J., Woods, D., Lara, J., Siervo, M., & O'Hara, J. P. (2016) · Nitric Oxide · doi:10.1016/j.niox.2016.08.001 · Cited by 51
Machha, A., & Schechter, A. N. (2012) · Nutrition Reviews · doi:10.1111/j.1753-4887.2012.00477.x · Cited by 51
Sundqvist, M. L., Lundberg, J. O., & Weitzberg, E. (2016) · Nitric Oxide · doi:10.1016/j.niox.2016.10.003 · Cited by 46
Single-Dose Pharmacokinetics of Different Oral Sodium Nitrite Formulations in Diabetes Patients
Greenway, F. L., Predmore, B. L., Flanagan, D. R., Giordano, T., Qiu, Y., Brandon, A., Lefer, D. J., Patel, R. P., & Kevil, C. G. (2012) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2011.0291 · Cited by 43
Galvan, E., Walker, D. K., Simbo, S. Y., Dalton, R., Levers, K., O’Connor, A., Goodenough, C., Barringer, N. D., Greenwood, M., Rasmussen, C., et al. (2016) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-016-0124-0 · Cited by 42
A “green” diet-based approach to cardiovascular health? Is inorganic nitrate the answer?
Rathod, K. S., Velmurugan, S., & Ahluwalia, A. (2016) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.201500313 · Cited by 42
Self-citationDe Smet, S., Van Thienen, R., Deldicque, L., James, R., Sale, C., Bishop, D. J., & Hespel, P. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00233 · Cited by 39
The relationship between plasma and salivary NOx
Clodfelter, W. H., Basu, S., Bolden, C., Dos Santos, P. C., King, S. B., & Kim-Shapiro, D. B. (2015) · Nitric Oxide · doi:10.1016/j.niox.2015.04.003 · Cited by 39
Nitrite reduction to nitric oxide in the vasculature
Lundberg, J. O., & Weitzberg, E. (2008) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.00611.2008 · Cited by 39
Supplementation with nitrate and nitrite salts in exercise: a word of caution
Lundberg, J. O., Larsen, F. J., & Weitzberg, E. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00521.2011 · Cited by 37
Nitrate supplement benefits contractile forces in fatigued but not unfatigued muscle
TILLIN, N. A., MOUDY, S., NOURSE, K. M., & TYLER, C. J. (2018) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001655 · Cited by 37
The effects of nitrate on the oral microbiome: a systematic review investigating prebiotic potential
Moran, S. P., Rosier, B. T., Henriquez, F. L., & Burleigh, M. C. (2024) · Journal of Oral Microbiology · doi:10.1080/20002297.2024.2322228 · Cited by 37
San Juan, A. F., Dominguez, R., Lago-Rodríguez, Á., Montoya, J. J., Tan, R., & Bailey, S. J. (2020) · Nutrients · doi:10.3390/nu12082227 · Cited by 36
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Akrawinthawong, K., Park, J. W., Piknova, B., Sibmooh, N., Fucharoen, S., & Schechter, A. N. (2014) · PLoS ONE · doi:10.1371/journal.pone.0092435 · Cited by 32
Nitrate causes a dose-dependent augmentation of nitric oxide status in healthy women
Bondonno, C. P., Croft, K. D., Puddey, I. B., Considine, M. J., Yang, X., Ward, N. C., & Hodgson, J. M. (2012) · Food & Function · doi:10.1039/c2fo10206d · Cited by 31
Dietary Nitrate from Plant Foods: A Conditionally Essential Nutrient for Cardiovascular Health
Pinaffi-Langley, A. C. D. C., Dajani, R. M., Prater, M. C., Nguyen, H. V. M., Vrancken, K., Hays, F. A., & Hord, N. G. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2023.100158 · Cited by 30
Rocha, B. S. (2021) · Frontiers in Aging · doi:10.3389/fragi.2021.778467 · Cited by 30
Role of sGC-dependent NO signalling and myocardial infarction risk
Wobst, J., Kessler, T., Dang, T. A., Erdmann, J., & Schunkert, H. (2015) · Journal of Molecular Medicine · doi:10.1007/s00109-015-1265-3 · Cited by 28
Levitt, E. L., Keen, J. T., & Wong, B. J. (2015) · Experimental Physiology · doi:10.1113/ep085061 · Cited by 27
The Cardioprotective Role of Nitrate-Rich Vegetables
Olas, B. (2024) · Foods · doi:10.3390/foods13050691 · Cited by 26
Wootton-Beard, P. C., & Ryan, L. (2012) · Plant Foods for Human Nutrition · doi:10.1007/s11130-012-0287-z · Cited by 25
28 days of creatine nitrate supplementation is apparently safe in healthy individuals
Joy, J. M., Lowery, R. P., Falcone, P. H., Mosman, M. M., Vogel, R. M., Carson, L. R., Tai, C.-Y., Choate, D., Kimber, D., Ormes, J. A., et al. (2014) · Journal of the International Society of Sports Nutrition · doi:10.1186/s12970-014-0060-9 · Cited by 19
Yang, Z., Du, C., Chang, Z., Yang, Y., & Hu, L. (2025) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2025.1612223 · Cited by 19
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Corti, P., Tejero, J., & Gladwin, M. T. (2013) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2013.09.020 · Cited by 13
Saltpetre in Early and Medieval Chinese Medicine
Butler, A., & Moffett, J. (2009) · Asian Medicine · doi:10.1163/157342109x568982 · Cited by 6
Heiland, E. G., Lindh, F., Regan, C., Ekblom, Ö., Kjellenberg, K., Larsen, F. J., Fernström, M., Nyberg, G., Ekblom, M. M., & Helgadóttir, B. (2024) · npj Science of Food · doi:10.1038/s41538-024-00308-4 · Cited by 7
Reply to Lundberg, Larsen, and Weitzberg
Jones, A. M., Bailey, S. J., Vanhatalo, A., Fulford, J., Gilchrist, M., Benjamin, N., & Winyard, P. G. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00614.2011 · Cited by 5
Self-citationBasaqr, R., & Babateen, A. (2025) · Frontiers in Nutrition · doi:10.3389/fnut.2025.1648219 · Cited by 4
Kurhaluk, N., Kołodziejska, R., Buyun, L., Kamiński, P., & Tkaczenko, H. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27083461 · Cited by 3
“Meta-analyses indicate that dietary nitrate significantly improves FMD following both acute and chronic intake, reflecting enhanced endothelial function [147–150].”
Salivary-Gland-Mediated Nitrate Recirculation as a Modulator for Cardiovascular Diseases
Pang, B., Qi, X., & Zhang, H. (2025) · Biomolecules · doi:10.3390/biom15030439 · Cited by 3
Li, D., Jovanovski, E., Zurbau, A., Sievenpiper, J., Milicic, D., El-Sohemy, A., & Vuksan, V. (2024) · Nutrients · doi:10.3390/nu16173018 · Cited by 3
McLellan, A. G., Ahmad, N. S. B., Acton, J. P., Punni, H. K., O'Donnell, E., Shepherd, A. I., Perissiou, M., James, L. J., Clifford, T., & Bailey, S. J. (2026) · Food & Function · doi:10.1039/d6fo02338j
Shepherd, A. I., Wilkerson, D. P., Dobson, L., Kelly, J., Winyard, P. G., Jones, A. M., Benjamin, N., Shore, A. C., & Gilchrist, M. (2015) · Nitric Oxide · doi:10.1016/j.niox.2015.01.002 · Cited by 88
Self-citation
Metadata
- Authors
- Webb, A. J., Patel, N., Loukogeorgakis, S., Okorie, M., Aboud, Z., Misra, S., Rashid, R., Miall, P., Deanfield, J., Benjamin, N., MacAllister, R., Hobbs, A. J., & Ahluwalia, A.
- Affiliations
- Queen Mary University of London (GB)
- ORCID
- Venue
- Hypertension
- Published
- 2008-03
- Volume
- 51
- Issue
- 3
- Pages
- 784-790
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC2839282
- OpenAlex
- W2161221966
- Cited by
- 1,078
- References
- 51
- Citations by year
- 2026: 35 · 2025: 33 · 2024: 47 · 2023: 59 · 2022: 59 · 2021: 55 · 2020: 73 · 2019: 69 · 2018: 78 · 2017: 80 · 2016: 73 · 2015: 74 · 2014: 79 · 2013: 59 · 2012: 65
- FWCI
- 30.49
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust (067422)
- 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 › Medicine › Biochemistry (medical) › Phytochemicals and Antioxidant Activities
- Keywords
- dietary nitrate, beetroot juice, blood pressure reduction, nitric oxide, endothelial dysfunction, platelet aggregation, cardiovascular disease
- MeSH terms
- Adolescent, Adult, Blood Pressure, Diet, Endothelium, Vascular, Humans, Hypertension, Middle Aged, Nitrates, Nitrites, Platelet Aggregation, Saliva, Tongue, Reperfusion Injury, Cross-Over Studies, Beta vulgaris
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