Dietary nitrate supplementation has shown positive effects on systolic blood pressure and endothelial function, but the effect size appears to decline in older patients at higher cardiovascular risk.
Does dietary nitrate supplementation improve blood pressure and endothelial function in patients with or at risk for cardiovascular disease?
While dietary nitrate supplementation shows potential for improving blood pressure and endothelial function, current evidence is limited by small, short-term studies, necessitating larger robust trials.
CVD are characterised by a multi-factorial pathogenesis. Key pathogenetic steps in the development of CVD are the occurrence of endothelial dysfunction and formation of atherosclerotic lesions. Reduced nitric oxide (NO) bioavailability is a primary event in the initiation of the atherosclerotic cascade. NO is a free radical with multiple physiological functions including the regulation of vascular resistance, coagulation, immunity and oxidative metabolism. The synthesis of NO proceeds via two distinct pathways identified as enzymatic and non-enzymatic. The former involves the conversion of arginine into NO by the NO synthases, whilst the latter comprises a two-step reducing process converting inorganic nitrate into nitrite and subsequently NO.Inorganic is present in water and food, particularly beetroot and green leafy vegetables. Several investigations have therefore used the non-enzymatic NO pathway as a target for nutritional supplementation ( salts) or dietary interventions (high- foods) to increase NO bioavailability and impact on cardiovascular outcomes. Some studies have reported positive effects of dietary on systolic blood pressure and endothelial function in patients with hypertension and chronic heart failure. Nevertheless, results have been inconsistent and the size of the effect appears to be declining in older individuals. Additionally, there is a paucity of studies for disorders such as diabetes, CHD and chronic kidney failure. Thus, whilst dietary supplementation could represent an effective and viable strategy for the primary and secondary prevention of age-related cardiovascular and metabolic diseases, more large-scale, robust studies are awaited to confirm or refute this notion.
Siervo et al. (Tue,) conducted a review in Cardiovascular disease. Dietary nitrate was evaluated. Dietary nitrate supplementation has shown positive effects on systolic blood pressure and endothelial function, but the effect size appears to decline in older patients at higher cardiovascular risk.
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