Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study
Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A
Hypertension (Dallas, Tex. : 1979) · 381 citations
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
- Intake measured by
- Not stated
Who paid for it
- Funding
- Independent funding
- Government
- National Institute for Health and Care Research
- Nonprofit
- British Heart Foundation
- Government
- Medical Research Council
- Government
- National Institute for Health Research (NIHR)
- Grants
- British Heart Foundation (SP/08/006/25110); Medical Research Council (MR/K006584/1); National Institute for Health and Care Research (NF-SI-0512-10113); British Heart Foundation (PG/10/28/28320); National Institute for Health and Care Research (CL-2013-19-003)
Based on 4 listed funder(s).
Publication
- Published
- 2014-11-24 · Hypertension · vol. 65 · issue 2 · pp. 320–327
- Publisher
- Lippincott Williams & Wilkins
- Cited
- 508 citations · more than 100% of similar papers · 21.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 50 works
- Access
- Free to read
- Research areas
- Nitric Oxide and Endothelin Effects · Sodium Intake and Health · Blood Pressure and Hypertension Studies
- Keywords
- Medicine, Placebo, Blood pressure, Ambulatory, Ambulatory blood pressure, Internal medicine, Confidence interval, Nitric oxide, Randomization, Nitrate, Animal science, Randomized controlled trial, Chemistry
- MeSH
- humans, beta vulgaris, hypertension, nitrates, nitrites, nitric oxide, plant extracts, blood pressure monitoring, ambulatory, combined modality therapy, phytotherapy, prospective studies, double-blind method, biotransformation, blood pressure, vasodilation, beverages, dietary supplements, adolescent, adult, aged, aged, 80 and over, middle aged, female, male, young adult
5 authors
From GB
- Vikas KapilQueen Mary University of London; William Harvey Research Institute
- Rayomand S. KhambataQueen Mary University of London; William Harvey Research Institute
- Amy RobertsonQueen Mary University of London; William Harvey Research Institute
- Mark J. CaulfieldQueen Mary University of London; William Harvey Research Institute
- Amrita AhluwaliaQueen Mary University of London; William Harvey Research Institute
Abstract
Unlabelled
Single dose administration of dietary inorganic nitrate acutely reduces blood pressure (BP) in normotensive healthy volunteers, via bioconversion to the vasodilator nitric oxide. We assessed whether dietary nitrate might provide sustained BP lowering in patients with hypertension. We randomly assigned 68 patients with hypertension in a double-blind, placebo-controlled clinical trial to receive daily dietary supplementation for 4 weeks with either dietary nitrate (250 mL daily, as beetroot juice) or a placebo (250 mL daily, as nitrate-free beetroot juice) after a 2-week run-in period and followed by a 2-week washout. We performed stratified randomization of drug-naive (n=34) and treated (n=34) patients with hypertension aged 18 to 85 years. The primary end point was change in clinic, ambulatory, and home BP compared with placebo. Daily supplementation with dietary nitrate was associated with reduction in BP measured by 3 different methods. Mean (95% confidence interval) reduction in clinic BP was 7.7/2.4 mm Hg (3.6-11.8/0.0-4.9, P<0.001 and P=0.050). Twenty-four-hour ambulatory BP was reduced by 7.7/5.2 mm Hg (4.1-11.2/2.7-7.7, P<0.001 for both). Home BP was reduced by 8.1/3.8 mm Hg (3.8-12.4/0.7-6.9, P<0.001 and P<0.01) with no evidence of tachyphylaxis over the 4-week intervention period. Endothelial function improved by ≈20% (P<0.001), and arterial stiffness was reduced by 0.59 m/s (0.24-0.93; P<0.01) after dietary nitrate consumption with no change after placebo. The intervention was well tolerated. This is the first evidence of durable BP reduction with dietary nitrate supplementation in a relevant patient group. These findings suggest a role for dietary nitrate as an affordable, readily-available, adjunctive treatment in the management of patients with hypertension (funded by The British Heart Foundation).
Clinical trial registration url
http://www.clinicaltrials.gov. Unique identifier: NCT01405898.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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