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

Cicero Jonas R Benjamim; Andrey Alves Porto; Vitor Engrácia Valenti; Andressa Crystine da Silva Sobrinho; David M Garner; Bruno Gualano; Carlos Roberto Bueno Júnior

doi:10.3389/fnut.2022.823039

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

Front Nutr. 2022 Mar 15:9:823039. doi: 10.3389/fnut.2022.823039. eCollection 2022.

Authors

Cicero Jonas R Benjamim¹, Andrey Alves Porto², Vitor Engrácia Valenti², Andressa Crystine da Silva Sobrinho¹, David M Garner^{2

3}, Bruno Gualano⁴, Carlos Roberto Bueno Júnior^{1

5}

Affiliations

¹ Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
² Autonomic Nervous System Center, UNESP, Marilia, Brazil.
³ Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom.
⁴ Applied Physiology and Nutrition Research Group, School Medicine, University of São Paulo, São Paulo, Brazil.
⁵ School of Physical Education of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.

Abstract

Background: Although 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.

Objective: To clarify these effects, we developed a systematic literature review with a meta-analysis of randomized clinical trials (RCTs).

Design: The 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.

Results: Seven 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.

Conclusions: The NO₃ derived from BRJ reduces SBP, but not DBP in patients with arterial hypertension.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=269339.

Keywords: Beta vulgaris L.; dietary supplementation; hypertension; nitrates; nitric oxide.

Publication types

Systematic Review