Nitrate Derived From Beetroot Juice Lowers Blood Pressure in Patients With Arterial Hypertension: A Systematic Review and Meta-Analysis

Abstract

BackgroundAlthough there are a considerable number of clinical studies on nitrate (NO3) rich beetroot juice (BRJ) and hypertension, it is difficult to indicate the real effects of NO3 from BRJ on the BP of hypertensive patients because there are still no estimates of the effects of NO3 derived from BRJ on the BP of hypertension patients.ObjectiveTo clarify these effects, we developed a systematic literature review with a meta-analysis of randomized clinical trials (RCTs).DesignThe searches were accomplished through EMBASE, Cochrane Library, MEDLINE, CINAHL, Web of Science, and LILACS databases. The study included single or double-blinded RCTs and participants older than 18 years with hypertension [systolic BP (SBP) > 130 mmHg and diastolic BP (DBP) > 80 mmHg]. NO3 BRJ was required to be consumed in a format that possibly blinded participants/researchers. These studies should also report the SBP and DBP values (mmHg) measured before and after the treatment. Risk of Bias tools and GRADE were enforced.ResultsSeven studies were included (218 participants). BRJ intervention time ranged from 3 to 60 days with daily dosages of 70–250 mL of BRJ. After the intervention with NO3 from BRJ, SBP underwent significant changes (p < 0.001) of −4.95 (95% CI: −8.88; −1.01) (GRADE: ⊕⊕⊕○ Moderate), but not for DBP (p = 0.06) −0.90 mmHg (95% CI: −3.16; 1.36) (GRADE: ⊕⊕⊕○ Moderate), compared to the control group.ConclusionsThe NO3 derived from BRJ reduces SBP, but not DBP in patients with arterial hypertension.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269339.

Nitrate-rich beet juice intake on cardiovascular performance in response to exercise in postmenopausal women with arterial hypertension: study protocol for a randomized controlled trial

“…The number of participants in this study considered the most recent meta-analysis study, which found a reduction of 5 mmHg caused by beetroot juice rich in nitrate in patients with SAH as significant with a variation of 4 mmHg [ 10 , 11 ]. We applied these values in the Hedwig Harvard Sample Calculator software online, considering a bilateral 95% confidence interval and a power analysis of 80% that provided a minimum of 11 participants for this clinical trial [ 29 ].…”

“…In addition to the previously described exogenous pathway, NO can also be synthesized endogenously via the l-arginine + O2 pathway, mediated by NO-synthase enzymes [9]. Recent meta-analyses of clinical trials have shown that NO3 consumed through beetroot juice lowers blood pressure more clearly [10,11] than in its salt form (e.g., sodium/ potassium NO3) [12]. There are assumptions that this occurs through the interaction between NO3 and the vitamins, minerals, and phenolic compounds present in beet juice, generating more intense pressure and vascular responses [10].…”

“…Considering that the endogenous production of NO is reduced with aging [ 13 ], it was recently confirmed that the hypotensive effects caused by beetroot juice are more evident in older adults (50 to 70 years of age) when compared to a young population (18 to 30 years of age) [ 14 ]. In addition, a meta-analysis recently published by our group showed that in patients with SAH, NO3-rich beetroot juice supplementation was able to reduce systolic blood pressure by − 4.95 mmHg (95% CI: − 8.88; − 1.01) without significant differences to diastolic blood pressure [ 10 ].…”

Can Beetroot Extract Influence Cardiovascular And Autonomic Recovery From The Effort In Healthy Males? A Randomized Trial

“…Amongst the compounds in beetroot (Beta vulgaris L.), betaine and nitrate have demonstrated promising results on cardiovascular activity 1,2 . Such compounds are able to optimize cardiovascular parameters (e.g., blood pressure and heart rate), both in healthy populations in addition to the cardiovascular diseases (e.g., hypertension, coronary heart disease) [3][4][5] . Of late, some studies have stated that compounds in beetroot can interact and optimize cardiac autonomic control 6,7 .…”

Evidence-based nutritional approaches to enhance exercise adaptations

“…Through digestive processes, nitrite is further reduced to nitric oxide (NO) which subsequently enters systemic circulation. Circulating NO becomes bioactive in tissues and blood primarily under conditions of hypoxia, and can influence blood vessel vasodilation, mitochondrial respiration, and muscle contractile function [45,46].…”