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Plasma nitrate, dietary nitrate, blood pressure, and vascular health biomarkers: a GRADE-Assessed systematic review and dose-response meta-analysis of randomized controlled trials

Mostafa Norouzzadeh, Minoo Hasan Rashedi, Shadi Ghaemi, Niloufar Saber, Artemiss Mirdar Harijani, Hamzeh Habibi, Soroush Mostafavi, Fatemeh Sarv, Hossein Farhadnejad, Farshad Teymoori, Mohsen Khaleghian, Parvin Mirmiran
Nutrition Journal 2025 24(1):47

Bibliography

PubMed
PMID 40128734
PubMed Central
PMC11931885
Funding
Publication funding statement: None. The authors acknowledge support from the Student Research Committee at Iran University of Medical Sciences.
Competing interests
Authors declare no competing interests (journal publication).

Study snapshot

DesignSystematic review and dose-response meta-analysis of 75 randomized controlled trials
ModelHuman participants in dietary nitrate trials
Sample75 RCTs; 1,823 participants
InterventionAcute and sustained dietary nitrate supplementation across intervention formats
DurationAcute, short-term, and medium-term protocols across included trials
EndpointsPlasma nitrate and nitrite; Systolic and diastolic blood pressure; Flow-mediated dilation; Pulse-wave velocity; Augmentation index

What the study showed, in plain terms

Across 75 randomized trials, dietary nitrate increased circulating nitrate/nitrite and was associated with modest dose-dependent blood pressure and vascular biomarker effects. Trial formulations, populations, and follow-up differed.

Key findings

Reported per-mmol nitrate increases were associated with modest changes in systolic blood pressure; the paper also reported medium-term changes in pulse-wave velocity and flow-mediated dilation.

What this study can and cannot tell us

Dose-response synthesis spans heterogeneous populations and products, and trials often use surrogate rather than cardiovascular event endpoints. Do not transfer these estimates directly to the proprietary Nitralis formulation.

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