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Nitrate-rich beetroot juice selectively lowers ambulatory pressures and LDL cholesterol in uncontrolled but not controlled hypertension: a pilot study

Abstract

Background

Dietary nitrate has been shown to increase nitrate/nitrite levels in multiple populations, with potential blood pressure lowering effects. However, there are few reports among hypertensives.

Aims

We aimed to assess the effect of daily nitrate in subjects with controlled hypertension vs. uncontrolled hypertension.

Methods

On day 0, hypertensives wore an ambulatory BP monitor (ABPM) for 24 h and fasting blood was taken. Subjects then consumed concentrated beetroot juice (12.9 mmol nitrate) for 14 consecutive days. On day 14 subjects consumed their last nitrate dose after fasting blood was drawn and again had an ABPM for 24 h.

Results

According to baseline ABPM, 11 subjects had controlled BP while 8 had uncontrolled BP. There were similar, significant increases in serum nitrate/nitrite in both groups. We observed little change in BP variables among controlled hypertensives. However, there were reductions in BP variables in uncontrolled hypertensives where decreases in nighttime DBP (−6 ± 4.8 mmHg), arterial stiffness (−0.08 ± 0.03 ambulatory arterial stiffness index) and LDL (−0.36 ± 0.42 mmol/L) reached significance (p = 003, 0.05 and 0.046, respectively).

Conclusions

Our results support the existing data suggesting an anti-hypertensive effect of nitrate-containing beetroot juice, but only among those with uncontrolled hypertension.

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Abbreviations

AASI:

Ambulatory arterial stiffness index

ABPM:

Ambulatory blood pressure

BMI:

Body mass index

BP:

Blood pressure

BRJ:

Beetroot juice

FMD:

Flow mediated dilation

HTN:

Hypertension

NO:

Nitric oxide

NOS:

Nitric oxide synthase

References

  1. 1.

    Moncada S, Higgs EA (2006) Nitric oxide and the vascular endothelium. Handb Exp Pharmacol 176:213–254

  2. 2.

    Rees DD, Palmer RM, Moncada S (1989) Role of endothelium-derived nitric oxide in the regulation of blood pressure. Proc Natl Acad Sci USA 86:3375–3378

  3. 3.

    Kleinbongard P, Dejam A, Lauer T et al (2003) Plasma nitrite reflects constitutive nitric oxide synthase activity in mammals. Free Radic Biol Med 35:790–796

  4. 4.

    Linder L, Kiowski W, Bühler FR et al (1990) Indirect evidence for release of endothelium-derived relaxing factor in human forearm circulation in vivo. Blunted response in essential hypertension. Circulation 81:1762–1767

  5. 5.

    Forte P, Copland M, Smith LM et al (1997) Basal nitric oxide synthesis in essential hypertension. Lancet 349:837–842

  6. 6.

    Shiekh GA, Ayub T, Khan SN et al (2011) Reduced nitrate level in individuals with hypertension and diabetes. J Cardiovasc Dis Res. 2:172–176

  7. 7.

    Ghasemi A, Zahediasl S, Syedmoradi L et al (2011) Association between serum nitric oxide metabolites and hypertension in a general population. Int Angiol 30:380–387

  8. 8.

    Gumanova NG, Teplova NV, Ryabchenko AU et al (2015) Serum nitrate and nitrite levels in patients with hypertension and ischemic stroke depend on diet: a multicenter study. Clin Biochem 48:29–32

  9. 9.

    Lundberg JO, Gladwin MT, Ahluwalia A et al (2009) Nitrate and nitrite in biology, nutrition and therapeutics. Nat Chem Biol 5:865–869

  10. 10.

    Bondonno CP, Croft KD, Puddey IB et al (2012) Nitrate causes a dose-dependent augmentation of nitric oxide status in healthy women. Food Funct. 3:522–527

  11. 11.

    Lundberg JO, Feelisch M, Björne H et al (2006) Cardioprotective effects of vegetables: is nitrate the answer? Nitric Oxide 4:359–362

  12. 12.

    Lidder S, Webb AJ (2013) Vascular effects of dietary nitrate (as found in green leafy vegetables and beetroot) via the nitrate–nitrite–nitric oxide pathway. Br J Clin Pharmacol 75:677–696

  13. 13.

    Rathod KS, Velmurugan S, Ahluwalia A (2016) A ‘green’ diet-based approach to cardiovascular health? Is inorganic nitrate the answer? Mol Nutr Food Res 60:185–202

  14. 14.

    Siervo M, Lara J, Ogbonmwan I et al (2013) Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis. J Nutr 143:818–826

  15. 15.

    Kapil V, Khambata RS, Robertson A et al (2015) Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension 65:320–327

  16. 16.

    Bondonno CP, Liu AH, Croft KD et al (2015) Absence of an effect of high nitrate intake from beetroot juice on blood pressure in treated hypertensive individuals: a randomized controlled trial. Am J Clin Nutr 102:368–375

  17. 17.

    Sobko T, Marcus C, Govoni M et al (2010) Dietary nitrate in Japanese traditional foods lowers diastolic blood pressure in healthy volunteers. Nitric Oxide 22:136–140

  18. 18.

    Petersson J, Carlström M, Schreiber O et al (2009) Gastroprotective and blood pressure lowering effects of dietary nitrate are abolished by an antiseptic mouthwash. Free Radic Biol Med 46:1068–1075

  19. 19.

    Mancia G, Fagard R, Narkiewicz K et al (2013) 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 31:1281–1357

  20. 20.

    Kerley CP, Cahill K, Bolger K et al (2015) Dietary nitrate supplementation in COPD: an acute, double-blind, randomized, placebo-controlled, crossover trial. Nitric Oxide 44:105–111

  21. 21.

    Li Y, Wang JG, Dolan E, Gao PJ, Guo HF, Nawrot T, Stanton AV, Zhu DL, O’Brien E, Staessen JA (2006) Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring. Hypertension 47(3):359–364

  22. 22.

    Webb AJ, Patel N, Loukogeorgakis S et al (2008) Acute blood pressure lowering, vasoprotective, and antiplatelet properties of dietary nitrate via bioconversion to nitrite. Hypertension 51:784–790

  23. 23.

    Ghosh SM, Kapil V, Fuentes-Calvo I et al (2013) Enhanced vasodilator activity of nitrite in hypertension: critical role for erythrocytic xanthine oxidoreductase and translational potential. Hypertension 61:1091–1102

  24. 24.

    Jajja A, Sutyarjoko A, Lara J et al (2014) Beetroot supplementation lowers daily systolic blood pressure in older, overweight subjects. Nutr Res 34:868–875

  25. 25.

    Casey DP, Beck DT, Braith RW (2007) Systemic plasma levels of nitrite/nitrate (NOx) reflect brachial flow-mediated dilation responses in young men and women. Clin Exp Pharmacol Physiol 34:1291–1293

  26. 26.

    Jin RC, Loscalzo J (2010) Vascular nitric oxide: formation and function. J. Blood Med. 1:147–162

  27. 27.

    Bondonno CP, Yang X, Croft KD et al (2012) Flavonoid-rich apples and nitrate-rich spinach augment nitric oxide status and improve endothelial function in healthy men and women: a randomized controlled trial. Free Radic Biol Med 52:95–102

  28. 28.

    Hobbs DA, Goulding MG, Nguyen A et al (2013) Acute ingestion of beetroot bread increases endothelium-independent vasodilation and lowers diastolic blood pressure in healthy men: a randomized controlled trial. J Nutr 143:1399–1405

  29. 29.

    Liu AH, Bondonno CP, Croft KD et al (2013) Effects of a nitrate-rich meal on arterial stiffness and blood pressure in healthy volunteers. Nitric Oxide 35:123–130

  30. 30.

    Jovanovski E, Bosco L, Khan K et al (2015) Effect of spinach, a high dietary nitrate source, on arterial stiffness and related hemodynamic measures: a randomized, controlled trial in healthy adults. Clin Nutr Res. 4:160–167

  31. 31.

    Joris PJ, Mensink RP (2013) Beetroot juice improves in overweight and slightly obese men postprandial endothelial function after consumption of a mixed meal. Atherosclerosis 231:78–83

  32. 32.

    Bondonno CP, Liu AH, Croft KD et al (2014) Short-term effects of nitrate-rich green leafy vegetables on blood pressure and arterial stiffness in individuals with high-normal blood pressure. Free Radic Biol Med 77:353–362

  33. 33.

    Expert Panel on Detection (2001) Evaluation, and treatment of high blood cholesterol in adults. executive summary of the Third Report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285:2486–2497

  34. 34.

    Tanaka S, Yashiro A, Nakashima Y et al (1997) Plasma nitrite/nitrate level is inversely correlated with plasma low-density lipoprotein cholesterol level. Clin Cardiol 20:361–365

  35. 35.

    Drexler H, Zeiher AM, Meinzer K et al (1991) Correction of endothelial dysfunction in coronary microcirculation of hypercholesterolaemic patients by l-arginine. Lancet 338:1546–1550

  36. 36.

    Flavahan NA (1992) Atherosclerosis or lipoprotein-induced endothelial dysfunction. Potential mechanisms underlying reduction in EDRF/nitric oxide activity. Circulation 85:1927–1938

  37. 37.

    Liao JK, Shin WS, Lee WY et al (1995) Oxidized low-density lipoprotein decreases the expression of endothelial nitric oxide synthase. J Biol Chem 270:319–324

  38. 38.

    Chen LY, Mehta P, Mehta JL (1996) Oxidized LDL decreases l-arginine uptake and nitric oxide synthase protein expression in human platelets: relevance of the effect of oxidized LDL on platelet function. Circulation 93:1740–1746

  39. 39.

    Kaesemeyer WH, Caldwell RB, Huang J et al (1999) Pravastatin sodium activates endothelial nitric oxide synthase independent of its cholesterol-lowering actions. J Am Coll Cardiol 33:234–241

  40. 40.

    Khalifi S, Rahimipour A, Jeddi S et al (2015) Dietary nitrate improves glucose tolerance and lipid profile in an animal model of hyperglycemia. Nitric Oxide 44:24–30

  41. 41.

    Stokes KY, Dugas TR, Tang Y et al (2009) Dietary nitrite prevents hypercholesterolemic microvascular inflammation and reverses endothelial dysfunction. Am J Physiol Heart Circ Physiol 296:H1281–H1288

  42. 42.

    Carlström M, Larsen FJ, Nyström T et al (2010) Dietary inorganic nitrate reverses features of metabolic syndrome in endothelial nitric oxide synthase-deficient mice. Proc Natl Acad Sci USA 107:17716–17720

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Acknowledgements

This work was funded by the Irish Heart Foundation. The authors also wish to acknowledge Dr. Jamie Blackwell (BSc) of the University of Exeter, who analyzed serum samples for nitrate and nitrite.

Author information

Correspondence to C. P. Kerley.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Kerley, C.P., Dolan, E. & Cormican, L. Nitrate-rich beetroot juice selectively lowers ambulatory pressures and LDL cholesterol in uncontrolled but not controlled hypertension: a pilot study. Ir J Med Sci 186, 895–902 (2017). https://doi.org/10.1007/s11845-016-1551-2

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Keywords

  • Dietary nitrate
  • Nitrite
  • Nitric oxide
  • Hypertension
  • Blood pressure