Beets and beet juice are high in nitrates, substances that turn into nitric oxide inside your body. Your body naturally produces nitric oxide, which is crucial for blood vessel health. Nitric oxide relaxes and widens your arteries, allowing more blood to flow through and significantly lowering blood pressure.

While beets are one of the best sources of nitrates, you can also boost your nitric oxide with spinach, celery, and radishes. Oats are packed with two nutrients that reduce blood pressure: soluble fiber and magnesium.

Magnesium helps blood vessels relax, while soluble fiber protects your blood vessels by reducing levels of damaging cholesterol. As cholesterol builds up in your arteries, the fatty plaque enlarges and hardens. Soluble fiber also helps keep blood sugar in the normal range.

High blood sugar leads to hypertension as the excess sugar inhibits nitric oxide production. Leafy greens such as spinach, Swiss chard, kale, beet greens, and collards pack a punch when it comes to lowering high blood pressure.

Potassium eliminates sodium, a mineral that dramatically raises your blood pressure. Most people get way too much sodium and too little potassium in their daily diets, a double blow to your health that causes hypertension.

The more potassium you eat, the more your sodium levels drop. Higher levels of nitrate in the blood can increase the availability of nitric oxide, a chemical that helps blood vessels relax. It also increases the efficiency of muscles, meaning they need less oxygen to do the same work.

The new study included 81 people with COPD who were being treated at the Royal Brompton Hospital, London, UK, and whose systolic blood pressure measured higher than millimetres of mercury mmHg.

Systolic blood pressure is the highest level your blood pressure reaches when your heart beats and the ideal range is between 90 and mmHg. Participants were randomly allocated to either receive the month course of nitrate-rich beetroot supplement 70 millilitres of concentrated beetroot juice containing milligrams of nitrate once a day or the placebo.

Researchers found that those taking the nitrate-rich supplement experienced an average reduction in systolic blood pressure of 4.

There was also an average increase of around 30 meters in how far patients could walk in six minutes for those taking the nitrate-rich beetroot juice. The juice also increased how far people with COPD could walk in six minutes compared to placebo.

An advantage of LME models is that they can automatically tolerate missing values by adjusting the respective covariance estimates. Moreover, missing data for the primary outcome is expected to be minimal as this BP data will be collected at the study visits by the investigators. All participants will receive a unique study ID for data collection and analysis.

Visit forms, screening pathology, home BP readings, protocol deviations and adverse outcome reports will be de-identified with the participant study ID and stored on a database on the same secure server. Any identifying information will be stored separately and securely with controlled access.

BRJ is a food supplement that is readily available for consumption from commercial food outlets. Reported side effects are non-harmful pigmentation of faeces and urine beeturia [ 17 ].

Previous clinical trials have not reported any serious adverse effects SAEs and thus they are anticipated to be rare in this trial and no interim analyses will be undertaken [ 17 , 25 ].

Due to the nature of the intervention and the size of the trial, the data monitoring will be undertaken by the trial investigators who have no competing interests to declare and there are no interim analyses or audits planned.

All data will be stored securely in the Western Sydney Local Health District and will be available for audit as requested by the Human Research Ethics Committee. The funding body has no role in the data monitoring. The trial staff will monitor for adverse effects or other trial issues at each study visit systematically by asking participants if they have experienced any symptoms, and these will be reviewed in at least fortnightly meetings between the principal investigator PI and trial staff.

All SAEs will be reported immediately to the PI and the WSLHD HREC, investigated in detail and documented in accordance with the ICH-GCP guidelines. In the setting where the intervention is changed, it is reported as a protocol deviation. The decision to terminate the trial will be taken by the PI and WSLHD HREC and will be based on the review of SAEs.

Any reported adverse events related or not related to the intervention will be reported in the publication of trial results. As all participants currently receive specialist care within public hospitals and given the nature of BRJ, with its limited and mild side effect profile reported in previous clinical trials beet-coloured pigmentation of urine and faeces , the investigators do not anticipate a need for additional special provisions for post-trial care [ 17 ].

Ethics approval for this study was obtained in May A submission to the clinical trials registry ClinicalTrials. gov was uploaded on 5th April , pre-dating the recruitment of the first participant on 5th May , but was not finalised pending HREC approval of a minor amendment.

The trial registration was finalised on 27th May registration no: NCT The study was approved by the Western Sydney Local Health District Human Research Ethics Committee Approval no.

The investigators will seek approval of the WSLHD HREC prior to the implementation of any changes to the study protocol and notify the health authorities in accordance with local regulations if required.

Trial participants, trial registries, journals, and study investigators will be notified as appropriate. Minor changes and clarifications of the protocol that have no impact on the conduct of the study will be documented in a memorandum.

The results of the study will be disseminated at national and international scientific meetings and submitted for publication in peer-reviewed journals. Participants will be notified when results of the study are available to the public. There is currently no cure for ADPKD and the search for therapies that will slow disease progression is a major priority for PKD patients, community groups and healthcare providers [ 31 , 32 ].

In particular, there is interest in developing dietary and lifestyle interventions for ADPKD, and this was highlighted in a recent patient priorities survey, where it was ranked 7 out 17 of major research priorities [ 32 ]. BRJ is an attractive novel therapy in the treatment of hypertension as it is all-natural, accessible and has no adverse side effects in human studies to date.

There are no expected or reported drug interactions with beetroot juice [ 28 , 29 , 46 ]. There has only been one RCT describing the effects of BRJ in CKD and no studies on an ADPKD cohort [ 19 ]. As described earlier, there is an inherent reduction in NO and endothelial NOS activity in ADPKD, which could potentially be corrected by dietary nitrate supplementation via the entero-salivary NO-nitrite-nitrate pathway [ 6 , 8 ].

Previous studies have shown that supplementation with BRJ increases NO metabolites in healthy volunteers and chronic diseases including essential hypertension, diabetes, heart failure, and COPD [ 16 , 20 , 36 , 47 ].

Of particular interest, BRJ increases NO metabolites in hypercholesterolemia, which is associated with decreased NO endothelial production, via this alternate entero-salivary pathway [ 22 ]. This pathway appears to be attenuated in other conditions such as active smoking, likely due to direct inhibitory effects [ 37 ].

This trial aims to investigate if NO metabolites can be increased using BRJ in ADPKD, given its intrinsic decreased NO state, and furthermore, if that will result in a reduction in BP. In conclusion, this study will be the first RCT investigating the efficacy of BRJ in reducing BP in hypertensive participants with ADPKD.

If the results show a significant decrease in BP, a follow-up study would be warranted to test the efficacy of BRJ over a longer time course and evaluate the potential impacts on chronic cardiovascular outcomes in ADPKD.

Moreover, if the results show that NO can be increased with BRJ supplementation, other sources of dietary nitrate e. spinach, rocket, lettuce could also be explored for BP-lowering effects.

Additionally, this study will contribute to the existing evidence on the impacts of dietary interventions in managing chronic kidney diseases, an area of keen interest from the patient community.

The current study protocol version 7 was accepted on 27th June by the Western Sydney Local Health District Human Research Ethics Committee. Trial recruitment commenced on 5th May and was completed on 24th March The trial was registered on 27th May with ClinicalTrials.

The results of the datasets have not been reported in this manuscript. Details of data accessibility including the public access to the full protocol, model consent form, participant datasets and statistical code will be included in the publication containing the final results of the study.

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Int J Mol Sci. Zhang JQJ, Saravanabavan S, Cheng KM, Raghubanshi A, Chandra AN, Munt A, et al. Long-term dietary nitrate supplementation does not reduce renal cyst growth in experimental autosomal dominant polycystic kidney disease.

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Am J Clin Nutr. Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study.

Bonilla Ocampo DA, Paipilla AF, Marín E, Vargas-Molina S, Petro JL, Pérez-Idárraga A. Dietary nitrate from beetroot juice for hypertension: a systematic review.

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One week of daily dosing with beetroot juice improves submaximal endurance and blood pressure in older patients with heart failure and preserved ejection fraction.

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It also increases the risk of heart attacks and strokes. The new research tested a week course of a concentrated beetroot juice supplement that is high in nitrate against a beetroot juice placebo that looked and tasted the same but had the nitrate removed.

Higher levels of nitrate in the blood can increase the availability of nitric oxide, a chemical that helps blood vessels relax.

It also increases the efficiency of muscles, meaning they need less oxygen to do the same work. The new study included 81 people with COPD who were being treated at the Royal Brompton Hospital, London, UK, and whose systolic blood pressure measured higher than millimetres of mercury mmHg.

Systolic blood pressure is the highest level your blood pressure reaches when your heart beats and the ideal range is between 90 and mmHg. Participants were randomly allocated to either receive the month course of nitrate-rich beetroot supplement 70 millilitres of concentrated beetroot juice containing milligrams of nitrate once a day or the placebo.

Researchers found that those taking the nitrate-rich supplement experienced an average reduction in systolic blood pressure of 4. Data were analyzed by means of linear mixed models with random intercepts and common slopes to study the treatment effect, adjusting for baseline measures immediately prior to ingestion.

The assessment of period effects and interactions between period and treatment was done within the models by including a covariate for the period in which the treatment was given, and a covariate representing the interaction between the period and the treatment.

When no evidence of period effects or interactions between period and treatment was found, these covariates were excluded using an analysis of deviance, which led to a final, more parsimonious, model. Model assumptions were verified by analyzing residuals plots, and robust linear mixed models were used when assumptions were violated.

Participant characteristics are shown in Table 1 ; volunteers were predominantly young females, only two individuals smoked, body mass index was in the healthy range and alcohol intake was moderate. Aortic systolic BP remained lower at 60 min after beetroot juice ingestion, although the difference was smaller [ Table 2.

In contrast brachial systolic BP did not differ noticeably between active and placebo groups at 30 or 60 min post-ingestion, BP in the active group was slightly lower [ There was no evidence of either a period effect or a treatment x period interaction for either aortic or brachial systolic pressure.

Effects on heart rate and cfPWV are shown in Table 2. None of these measurements differed between active and placebo drink at 30 or 60 min post-ingestion. Average h aortic systolic BP was Differences between treatments were small and confidence intervals included zero for all other ambulatory BP variables, including iPWV Table 3.

Supplementary Figures S1 — S6 show the ambulatory measurements over the h period, for active treatment and placebo. Table 3. There were no major adverse events.

All participants were asked if they experienced any headaches, flushing or light-headedness; one participant complained of headache after consuming beetroot juice containing nitrate active. This headache lasted for approximately 10 min.

No other symptoms were reported by any of the participants. The effect of beetroot juice containing inorganic nitrate was more marked on aortic than brachial systolic BP and there was little or no effect of ingestion of inorganic nitrate on subsequent h aortic BP.

Previous studies have examined the effect of dietary nitrate on brachial BP. Kapil et al. It is possible that differences in drink composition or participant characteristics contributed to the greater effect on brachial BP seen in their study.

Also, ingestion of water has been reported to increase brachial BP Jordan et al. We found minimal effects of nitrate-containing beetroot juice on brachial systolic BP, so our data suggest that measurement of brachial BP as opposed to aortic BP is likely to have underestimated the effect of inorganic nitrate in some previous studies.

Siervo et al. In the meta-regression these researchers carried out, the mean differences in systolic BP were not correlated with study duration. In keeping with our findings, ambulatory BP was not lowered by beetroot juice in the two studies of normotensive individuals included in the systematic review Coles and Clifton, ; Hobbs et al.

Our study has strengths and limitations. A randomized double-blind placebo control study is a robust design; the sample size is small but adequate to detect a clinically important reduction in BP. Many previous studies have not been blinded as low-nitrate water or isomolar potassium and sodium chloride solutions have been used as the placebo Larsen et al.

Our data are limited in that they were conducted in young healthy individuals receiving a single dose of beetroot juice and may not generalize to older people with or without high BP, or to other dosing regimens or durations of administration.

Additionally, our study only considered the hypotensive effect of inorganic nitrate in beetroot juice. A recent meta-analysis Bahadoran et al.

It has been suggested that beetroot juice may have value as a population-based intervention to lower BP, although our data showing an apparently short duration of BP lowering raise questions regarding its usefulness in younger normotensive individuals.

Nevertheless, even small reductions in BP could lead to a large reduction in incident cardiovascular disease on a population level Strachan and Rose, Dietary approaches to BP reduction could be useful in the face of the rising incidences of both obesity and diabetes.

It remains to be established whether dietary supplementation with beetroot juice or other nitrate-rich vegetables, extracts or juices, is an effective, safe and acceptable method of population-scale BP reduction.

In conclusion, nitrate-contained in beetroot juice lowered aortic systolic BP in normotensive individuals 30 min post-ingestion with minimal effects on brachial BP. This effect was of comparatively short duration and did not persist over h.

Previous studies only measuring brachial BP and not aortic BP may have underestimated the effects of inorganic nitrates on BP. The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher. AH and NC conceived and designed the study.

SK and EC collected the data. SK, EC, and TT performed the analysis of the data. H-MD and TT undertook the statistical analysis.

SK and AH wrote the paper with critical revisions from all authors. All authors provided approval for publication of the content and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. We are extremely grateful to all the people who took part in the study, and past and present members of the SABRE team who helped to recruit participants.

We thank Daniel Key for his assistance with data management. Bahadoran, Z. The nitrate-independent blood pressure-lowering effect of beetroot juice: a systematic review and meta-analysis. doi: PubMed Abstract CrossRef Full Text Google Scholar. Bahra, M. Inorganic nitrate ingestion improves vascular compliance but does not alter flow-mediated dilatation in healthy volunteers.

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Hemodynamic patterns of age-related changes in blood pressure. Williams B, Mancia G, Spiering W, AgabitiRosei E, Azizi M, Burnier M, et al. Eur Heart J.

Australia HFo. Measuring your blood pressure at home INFC. online resource. Accessed 25 July Bushra R, Aslam N, Khan AY.

Food-drug interactions. Oman Med J. Shepherd AI, Wilkerson DP, Dobson L, Kelly J, Winyard PG, Jones AM, et al. The effect of dietary nitrate supplementation on the oxygen cost of cycling, walking performance and resting blood pressure in individuals with chronic obstructive pulmonary disease: A double blind placebo controlled, randomised control trial.

Download references. Figure 1 was created using Biorender. The funders have no role in the design of the study, interventions, data collection, data management, statistical analysis, interpretation of the results, writing the manuscripts, or in the decision to submit the manuscripts for publication.

The PKD Australia community newsletter contained a flyer advertising recruitment for the trial and will assist in dissemination of published study results, once available.

Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, , Australia. Priyanka S. Sagar, Alexandra Munt, Sayanthooran Saravanabavan, Farnoosh Asghar Vahedi, Beatrice Nguyen, David C.

Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, , Australia. Sagar, Alexandra Munt, Sayanthooran Saravanabavan, Farnoosh Asghar Vahedi, David C.

Research and Education Network, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, , Australia. Department of Renal Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, , Australia. Blacktown Clinical School, Western Sydney University, Blacktown, NSW, , Australia.

Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, , Australia. Department of Renal Medicine, Nepean Hospital, Nepean Blue Mountains Local Health District, Sydney, NSW, , Australia. You can also search for this author in PubMed Google Scholar. GR is the chief investigator and conceived the idea for the study.

GR and PS designed the study and developed the protocol. GR, PS, AM and FV are involved in the implementation of the trial, participant study visits and safety and data monitoring.

SS and JE are involved in the randomisation and blinding. PS, FV, BN and JE are involved in the data curation or data analysis. PS and GR drafted the initial version of the manuscript and all authors contributed to editing, critically revising and finalisation of the manuscript.

All authors read and approved the final manuscript. Authors for any future publications including the results manuscript will include all those who have contributed to the trial implementation and production of the manuscript.

Those who have been involved in the development of the study protocol but not the implementation of the trial will be listed in the acknowledgements of future publications.

The investigators do not intend to use professional writers. Correspondence to Gopala K. Adequate information will be provided to all participants in both oral and written form by the study doctors or senior study investigators present at the study visits, and participants must provide consent in writing prior to commencing any study procedures.

At the time of initial consent, participants will be informed of the potential for sharing or re-use of deidentified participant data for the means of future research relating to ADPKD or other related medical conditions and given the option to provide extended consent.

The data will be stored in a secure web-based platform and room at WSLHD and will be retained for a minimum of 15 years, as specified in the consent form. Not applicable as this manuscript does not contain any details, images or videos related to an individual person.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Standardised clinic measurement of blood pressure in the BEET-PKD clinical trial. Description: Table describing the standardisation of blood pressure measurement in the BEET-PKD trial.

Photo of nitrate-replete and nitrate-deplete beetroot juice bottles. Description: Photo of nitrate-replete and nitrate-deplete beetroot juice bottles. Storage and analysis of biological samples in the BEET-PKD clinical trial. Description: Document describing the storage and analysis of biological samples in the BEET-PKD clinical trial.

BEET-PKD Adverse Event Reporting Guide and Example form. Description: Adverse event reporting guide used by Investigators and Blank adverse event reporting form. Flowchart to guide unblinding in the BEET-PKD study. Description: Flowchart to guide unblinding in the BEET-PKD study adapted from the University of Leicester, United Kingdom.

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Reprints and permissions. Sagar, P. et al. Efficacy of beet root juice on reducing blood pressure in hypertensive adults with autosomal dominant p olycystic k idney d isease BEET-PKD : study protocol for a double-blind, randomised, placebo-controlled trial.

Trials 24 , Download citation. Received : 14 September Accepted : 17 July Published : 29 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. Study protocol Open access Published: 29 July Efficacy of beet root juice on reducing blood pressure in hypertensive adults with autosomal dominant p olycystic k idney d isease BEET-PKD : study protocol for a double-blind, randomised, placebo-controlled trial Priyanka S.

Sagar ORCID: orcid. Rangan 1 , 2 Show authors Trials volume 24 , Article number: Cite this article Accesses Metrics details. Abstract Background In autosomal dominant polycystic kidney disease ADPKD impaired nitric oxide NO synthesis, in part, contributes to early-onset hypertension.

Discussion The effect of BRJ in ADPKD has not been previously tested. Trial registration ClinicalTrials. gov NCT Retrospectively registered on 27th May Administrative information This table and the following study protocol contain all administrative information as required by the SPIRIT reporting guidelines and World Health Organization Trial Registration Data Set for clinical trial registration [ 1 ].

Data category Information Public and Scientific Title Double-blind, randomised, placebo-controlled study to determine the effect of beetroot juice on reducing blood pressure in hypertensive adults with autosomal dominant polycystic kidney disease Primary registry and trial identifying number NCT [ClinicalTrials.

Registered on 27th May There are no secondary identifying numbers Protocol Version Version 7 approved on 27 th June Funding This study was funded by a grant from PKD Australia to GR. The funding bodies have no role in the study design, execution, analyses, interpretation of the data, or decision to submit results Author details 1.

James Elhindi, Research and Education Network, Westmead Hospital, WSLHD, Australia 6. Beatrice Nguyen, Michael Stern Laboratory for Polycystic Kidney Disease, WIMR, USyd, Australia 7. au Role of the trial sponsor The study sponsor has oversight of human ethics research committee and trial governance but no role in the design, execution, analyses, interpretation of the data or the decision to submit results Contact for public and scientific enquires GR [g.

rangan sydney. au] Health conditions studies Autosomal Dominant Polycystic Kidney Disease and Hypertension. Background Autosomal dominant polycystic kidney disease ADPKD is the most common monogenic cause of kidney failure in adults and is due to pathogenic variants in either PKD1 or PKD2 [ 2 ].

Study sites The study sites will be Westmead Hospital and Westmead Institute for Medical Research, Sydney, NSW, Australia. Table 1 Inclusion and exclusion criteria Full size table. Schema of the BEET-PKD trial design.

Abbreviation: BP , blood pressure. Full size image. SPIRIT figure for the BEET-PKD trial. Discussion There is currently no cure for ADPKD and the search for therapies that will slow disease progression is a major priority for PKD patients, community groups and healthcare providers [ 31 , 32 ].

Trial status The current study protocol version 7 was accepted on 27th June by the Western Sydney Local Health District Human Research Ethics Committee. Availability of data and materials The results of the datasets have not been reported in this manuscript. References Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, et al.

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Acknowledgements Figure 1 was created using Biorender. Funding This study was funded by a grant from PKD Australia to GR. Author information Authors and Affiliations Michael Stern Laboratory for Polycystic Kidney Disease, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, , Australia Priyanka S.

Rangan Department of Renal Medicine, Westmead Hospital, Western Sydney Local Health District, Sydney, NSW, , Australia Priyanka S. Sagar View author publications.