This study aims to determine whether dietary inorganic nitrate (in beetroot juice) is able to reduce overall thickening of the heart (left ventricular hypertrophy or LVH) and stiffness of the arteries when given to patients with persistently raised blood pressure (hypertension). Half the patients will receive the beetroot juice containing inorganic nitrate and half will receive beetroot juice from which the inorganic nitrate has been removed. The volunteers will take the juice every day for 4 months.
In hypertension persistent raised blood pressure (BP) is associated with endothelial dysfunction, arterial stiffness and left ventricular (LV) remodeling that are key phenomena associated with the pathogenesis and complications of hypertension. One of the main substances that the healthy endothelium produces that is responsible for maintaining the patency of blood vessels is nitric oxide (NO). In hypertension, one of the key pathogenic effects is the dysfunction of the endothelium characterized by a decrease in ability to generate nitric oxide (NO). Previous studies have shown that dietary inorganic nitrate supplementation lowers blood pressure (Kapil et al. 2015), however, whether this approach might also improve endothelial function and LV remodeling is unknown. The effects of inorganic nitrate are due to its conversion in the body to inorganic nitrite and thereafter to NO. This study will assess the effects of dietary inorganic nitrate on LVH using cardiac magnetic resonance imaging (NITRATE-LVH arm). In addition, the effects of dietary inorganic nitrate on central aortic blood pressure, arterial stiffness using pulse wave velocity and endothelial function using flow mediated dilatation will be evaluated (NITRATE-CBP arm).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
149
Beetroot juice (70ml daily) with or without inorganic nitrate
Queen Mary University of London
London, United Kingdom
Left ventricular hypertrophy regression
change in LV mass as assessed using cardiac magnetic resonance imaging
Time frame: 4 months
Pulse wave velocity
non-invasive measures of arterial stiffness
Time frame: 4 months
Central blood pressure
non-invasive measure of central blood pressure
Time frame: 4 months
Flow mediated dilatation (FMD)
non-invasive measure of endothelial function using ultrasound
Time frame: 4 months
Brachial blood pressure
brachial blood pressure
Time frame: 4 months
Change in plasma nitrate levels
assessed by chemiluminescence
Time frame: 4 months
Change in plasma nitrite levels
assessed by chemiluminescence
Time frame: 4 months
Change in nitric oxide activity (cGMP)
nitric oxide activity measured by determining plasma concentrations of cyclic guanosine monophosphate (cGMP)
Time frame: 4 months
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