Repeated administration of inorganic nitrate on blood pressure and arterial stiffness: a systematic review and meta-analysis of RCTs
Main caveat: High heterogeneity (I²=76-78% for peripheral BP)
Key Results
47 RCTs, n=1101; inorganic nitrate intake ≥3 days
SBP: −2.91 mmHg (95% CI −3.92 to −1.89)
DBP: −1.45 mmHg (95% CI −2.22 to −0.68)
Central SBP: −1.56; central DBP: −1.99 mmHg
Reductions reported in both healthy and hypertensive participants (subgroup detail not checked against the abstract)
GRADE: moderate (central BP) / low (peripheral BP)
Practical Application (not medical advice)
Masters athlete on antihypertensive therapy adding a nitrate/beetroot load: discuss the possible additive hypotensive effect with a physician; watch for orthostatic symptoms (dizziness on standing)
Nitrate effect size is modest (~3/1.5 mmHg) — not abrupt, but with polypharmacy BP effects sum
Mouthwash abolishes the nitrate→NO conversion (see REF-353) — dual meaning: it reduces both the ergogenic and the hypotensive effect
Limitations
High heterogeneity (I²=76-78% for peripheral BP)
Not all studies in athletes; the direct "nitrate + a specific antihypertensive class" interaction was not tested
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How this entry was checked and changed
Why this level
regraded 2026-11-03 from A (scale v2): the abstract rates certainty low (GRADE) for the headline peripheral blood pressure result (SBP -2.91, DBP -1.45 mmHg; I2 76-78%) and moderate for central blood pressure; low certainty caps a review at A-; 47 RCTs, n = 1101
Content correction 2026-09-27
Resync 2026-09-28: Unhedged 'effect driven by both healthy AND hypertensive' -> hedged as reported in both groups, subgroup detail not checked.