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Apr 16, 2013
LONDON, UK A small, proof-of-principle study has demonstrated that the blood-pressure lowering effects of
dietary nitrates--already documented in normotensives--are also seen in subjects with established hypertension
[1]
.
Dr Amrita Ahluwalia (Barts and the London School of Medicine and Dentistry, UK) and colleagues have a track
record of studying the interaction between dietary sources of biologically inert nitrate (NO
3
) and oral microflora,
which converts the NO
3
into bioactive nitrite (NO
2
). Circulating NO
2
is known to cause vasodilation and lower
blood pressure. Ahluwalia et al have previously proposed a pathway for nitrate-nitrite conversion, showing that
beet juice, after coming into contact with human saliva, increases levels of plasma nitrate and nitrite and leads to
significant blood-pressure decreases in healthy volunteers.
In their latest study, published online April 15, 2013 in Hypertension, Ahluwalia and colleagues, including senior
author Dr Suborno Ghosh (Queen Mary University of London, UK) turned again to beetroot, which, along with
green leafy vegetables, has high concentrations of inorganic nitrate. In a mouse model of hypertension,
investigators first established a threshold nitrite dose at which blood pressure decreased in the hypertensive mice,
but not in normotensive control mice. At higher doses, however, both strains of mice saw blood-pressure
decreases.
The authors then tested the beet-juice effects in 15 hypertensive, drug-naive patients, randomized to either 250
mL of inorganic nitrate-rich beetroot juice or an equal volume of water. The "dose" of juice elevates nitrite levels
approximately 1.5 fold--a rise previously shown to have no significant BP-lowering effect in subjects with normal
blood pressure.
In patients who drank the juice, systolic blood pressure dropped by a mean of 11.2 mm Hg between three and six
hours after consumption (vs 0.7 mm Hg in subjects who drank water). By 24 hours, clinic systolic BP remained
significantly lower in the beet-juice group and roughly 7.2 mm Hg lower than baseline. Peak drop in diastolic BP
also occurred within the first six hours, dropping by a mean of 9.6 mm Hg. Pulse-wave velocity also decreased in
the beet-juice group, but not in the controls.
"Our observations . . . support the concept of dietary nitrate supplementation as an effective, but simple and
inexpensive, antihypertensive strategy," the authors conclude.
To heartwire , Ahluwalia underscored the finding that nitrate in beets appears to be even more potent in
hypertensives than in normotensives. "In this new study we used a dose that had little to no effect upon blood
pressure in healthy volunteers; in contrast, this dose caused a substantial decrease in blood pressure (~12 mm
Hg) in the patients, suggesting that dietary nitrate is more potent, and therefore potentially one needs less to
produce an important blood-pressurelowering effect."
She added: "It is also true that while we all know that eating fruits and vegetables is good for the cardiovascular
system, exactly why this is the case is not certain. Studies have shown that of all the different fruit and
vegetables out there it is the green leafy vegetables that provide the greatest protection against heart attacks and
strokes. What is true about these vegetables is that they represent the major source of nitrate in our diet."
She also stressed the limitations of the study: while "impressive," the BP-lowering effects of beet juice
consumption were measured only over 24 hours and in very small numbers. "Whether this effect can be sustained
in the long term is not yet known, and further clinical studies that assess the effects over longer periods of time
and in larger cohorts are needed," she said.
Beet This: More Evidence of BP-Lowering Effects Of Dietary
Nitrate
Shelley Wood
References

Heartwire 2013 Medscape, LLC
Cite this article: Beet This: More Evidence of BP-Lowering Effects Of Dietary Nitrate. Medscape. Apr 16, 2013.
1. Ahluwalia A, Ghosh S, Kapil V, et al. Enhanced vasodilator activity of nitrite in hypertension: Critical role
for erythrocytic xanthine oxidoreductase and translational potential. Hypertension 2013;
DOI:10.1161/HYPERTENSIONAHA.111.00933. Available at: http://hyper.ahajournals.org.