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Meta-Analysis
. 2017 Nov 15;8(6):830-838.
doi: 10.3945/an.117.016717. Print 2017 Nov.

The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis

Zahra Bahadoran  1 , Parvin Mirmiran  2 , Ali Kabir  3 , Fereidoun Azizi  4 , Asghar Ghasemi  5
Affiliations
Meta-Analysis

The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis

Zahra Bahadoran et al. Adv Nutr. .

Erratum in

Abstract

Beetroot is considered a complementary treatment for hypertension because of its high content of inorganic NO3 This systematic review and meta-analysis aimed to clarify several aspects of beetroot juice supplementation on systolic blood pressure (SBP) and diastolic blood pressure (DBP). We searched PubMed, Scopus, and Embase databases, and the reference lists of previous reviews. Randomized clinical trials that investigated the effects of beetroot juice on resting blood pressure in humans were recruited for quality assessment, meta-analyses, subgroup analyses, and meta-regressions; of these, 22 were conducted between 2009 and 2017 and included a total of 47 intervention (n = 650) and 43 control (n = 598) groups. Overall, SBP (-3.55 mm Hg; 95% CI: -4.55, -2.54 mm Hg) and DBP (-1.32 mm Hg; 95% CI: -1.97, -0.68 mm Hg) were significantly lower in the beetroot juice-supplemented groups than in the control groups. The mean difference of SBP was larger between beetroot juice-supplemented and control groups in the longer than in the shorter (≥14 compared with <14 d) study durations (-5.11 compared with -2.67 mm Hg) and the highest compared with the lowest (500 compared with 70 and 140 mL/d) doses of beetroot juice (-4.78 compared with -2.37 mm Hg). A positive correlation was observed between beetroot juice doses and the mean differences of blood pressures. In contrast, a smaller effect size of blood pressures was observed after supplementation with higher NO3 (milligrams per 100 mL beetroot juice). A weak effect size was observed in a meta-analysis of trials that used NO3-depleted beetroot juice as a placebo compared with other interventions (-3.09 compared with -4.51 mm Hg for SBP and -0.81 compared with -2.01 mm Hg for DBP). Our results demonstrate the blood pressure-lowering effects of beetroot juice and highlight its potential NO3-independent effects.

Keywords: NO; beetroot; blood pressure; hypertension; nitrate.

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Conflict of interest statement

Author disclosures: ZB, PM, AK, FA, and AG, no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of the literature search.
FIGURE 2
FIGURE 2
Forest plot of mean differences of systolic blood pressure in beetroot juice–supplemented groups and controls. Ref, reference; WMD, weighted mean difference.
FIGURE 3
FIGURE 3
Forest plot of mean differences of diastolic blood pressure in beetroot juice–supplemented groups and controls. Ref, reference; WMD, weighted mean difference.
FIGURE 4
FIGURE 4
Forest plot of trials that investigated the effects of beetroot juice supplementation on systolic blood pressure in relation to baseline values. Ref, reference; WMD, weighted mean difference.
FIGURE 5
FIGURE 5
Forest plot of trials that investigated the effects of beetroot juice supplementation on diastolic blood pressure in relation to baseline values. Ref, reference; WMD, weighted mean difference.
See this image and copyright information in PMC

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