Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study.

Randomized, phase 2, double-blind, placebo-controlled trial in adults with hypertension and uncontrolled ambulatory blood pressure, without manifest cardiovascular disease, conducted in the United Kingdom. The active dietary nitrate group included 34 drug-naive participants and 34 participants already receiving antihypertensive medication; mean age was 57.6±13.9 years and 16 participants were female.

Participants drank 250 mL beetroot juice orally once daily for 4 weeks. The active juice provided dietary nitrate, with nitrate content reported as 0.028±0.008 mmol/L, giving approximately 0.007 mmol nitrate daily; the comparator was 250 mL nitrate-depleted beetroot juice.

Daily dietary nitrate lowered blood pressure and vascular risk markers over 4 weeks, with no tachyphylaxis and good tolerability. Clinic systolic blood pressure fell by 7.7 mm Hg (95% CI, 3.5-11.8; P<0.001) and diastolic by 2.4 mm Hg (95% CI, 0.0-4.9; P=0.050); 24-hour ambulatory blood pressure fell by 7.7/5.2 mm Hg (both P<0.001) and home blood pressure by 8.1/3.8 mm Hg (both significant). Endothelial function improved by about 20% (P<0.001), pulse wave velocity decreased by 0.59 m/s versus baseline and by 0.58 m/s versus placebo, and augmentation index decreased by 5.2% versus baseline and 6.1% versus placebo. The only reported adverse effect was beeturia, with discoloration of urine and feces.

Follow-up was short at 4 weeks, so durability and long-term cardiovascular outcomes were not assessed. The trial was relatively small and focused on surrogate blood pressure and vascular measures rather than hard clinical endpoints. Generalizability may be limited by the single-center United Kingdom setting and the specific hypertensive population studied.