Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials

Cicero Jonas R. Benjamim; Leonardo S. Lopes da Silva; Vitor E. Valenti; Leonardo S. Gonçalves; Andrey A. Porto; Márcio Fernando Tasinafo Júnior; Jean Philippe Walhin; David M. Garner; Bruno Gualano; Carlos R. Bueno Júnior

doi:10.1016/j.freeradbiomed.2024.02.011

Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials

Cicero Jonas R. Benjamim, Leonardo S. Lopes da Silva, Vitor E. Valenti, Leonardo S. Gonçalves, Andrey A. Porto, Márcio Fernando Tasinafo Júnior, Jean Philippe Walhin, David M. Garner, Bruno Gualano, Carlos R. Bueno Júnior

Research output: Contribution to journal › Review article › peer-review

3 Citations (SciVal)

10 Downloads (Pure)

Abstract

Objectives: A systematic review with meta-analysis was completed to study the effects of dietary inorganic nitrate (NO₃⁻) oral ingestion from vegetables and salts on blood pressure responses during and following exercise.

Background: NO₃⁻ is a hypotensive agent with the potential to reduce blood pressure peaks during exercise and amplify exercise-induced hypotensive effects. Several randomized and controlled trials have investigated the effects of NO₃⁻ on hemodynamic responses to physical exercise, however this still has yet to be studied systematically.

Methods: The searches were conducted on EMBASE, Medline, and SPORTSDiscus databases. The study included masked randomized controlled trials (RCTs) with participants ≥18 years old. The NO₃⁻intervention group received at least 50 mg NO₃⁻/day with similar sources amid NO₃⁻ and placebo conditions. Included studies reported systolic blood pressure (SBP) or diastolic blood pressure (DBP) values during or following exercise performance.

Results: 1903 studies were identified, and twenty-six achieved the inclusion criteria. NO₃⁻ daily dosages ranged from 90 to 800 mg/day. Throughout exercise, SBP had smaller increases in the NO₃⁻ group (−2.81 mmHg (95%CI: −5.20 to −0.41), p=0.02. DBP demonstrated lower values in the NO₃⁻ group (−2.41 mmHg (95%CI: −4.02 to −0.79), p=0.003. In the post-exercise group, the NO₃⁻ group presented lower SBP values (−3.53 mmHg (95%CI: −5.65 to 1.41), p=0.001, while no changes were identified in DBP values between NO₃⁻ and placebo groups (p=0.31). Subgroup meta-analysis revealed that SBP baseline values, exercise type, duration of NO₃⁻ ingestion, and its dosages mediated blood pressure responses during and following exercise.

Conclusions: NO₃⁻ ingestion prior to exercise attenuated the increases in SBP and DBP during exercise, and increased the decline in SBP after exercise. These results are dependent on factors that moderate the blood pressure responses (e.g., health status, type of exercise, resting blood pressure values).

Original language	English
Pages (from-to)	25-36
Number of pages	12
Journal	Free Radical Biology and Medicine
Volume	215
Early online date	23 Feb 2024
DOIs	https://doi.org/10.1016/j.freeradbiomed.2024.02.011
Publication status	Published - 31 Mar 2024

Funding

CJRB thanks the scholarship that allowed the performing of this project provided by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Process number: 001) and by Conselho Nacional de Desenvolvimento Científico e Tecnológico (Process number: 200595/2022–9).

Funders	Funder number
Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior	001
Conselho Nacional de Desenvolvimento Cientifico e Tecnologico	200595/2022–9

Keywords

Cardiovascular responses to exercise
Hemodynamic monitoring
Nitric oxide
Nitrite
Post-exercise hypotension

ASJC Scopus subject areas

Biochemistry
Physiology (medical)

Access to Document

10.1016/j.freeradbiomed.2024.02.011

Effects of dietary inorganic nitrate on blood pressure during and post-exercise recoveryAccepted author manuscript, 558 KBLicence: CC BY-NC-ND

Cite this

Benjamim, C. J. R., Lopes da Silva, L. S., Valenti, V. E., Gonçalves, L. S., Porto, A. A., Tasinafo Júnior, M. F., Walhin, J. P., Garner, D. M., Gualano, B., & Bueno Júnior, C. R. (2024). Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials. Free Radical Biology and Medicine, 215, 25-36. https://doi.org/10.1016/j.freeradbiomed.2024.02.011

Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials. / Benjamim, Cicero Jonas R.; Lopes da Silva, Leonardo S.; Valenti, Vitor E. et al.
In: Free Radical Biology and Medicine, Vol. 215, 31.03.2024, p. 25-36.

Research output: Contribution to journal › Review article › peer-review

Benjamim, CJR, Lopes da Silva, LS, Valenti, VE, Gonçalves, LS, Porto, AA, Tasinafo Júnior, MF, Walhin, JP, Garner, DM, Gualano, B & Bueno Júnior, CR 2024, 'Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials', Free Radical Biology and Medicine, vol. 215, pp. 25-36. https://doi.org/10.1016/j.freeradbiomed.2024.02.011

Benjamim CJR, Lopes da Silva LS, Valenti VE, Gonçalves LS, Porto AA, Tasinafo Júnior MF et al. Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials. Free Radical Biology and Medicine. 2024 Mar 31;215:25-36. Epub 2024 Feb 23. doi: 10.1016/j.freeradbiomed.2024.02.011

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title = "Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials",

abstract = "Objectives: A systematic review with meta-analysis was completed to study the effects of dietary inorganic nitrate (NO3−) oral ingestion from vegetables and salts on blood pressure responses during and following exercise.Background: NO3− is a hypotensive agent with the potential to reduce blood pressure peaks during exercise and amplify exercise-induced hypotensive effects. Several randomized and controlled trials have investigated the effects of NO3− on hemodynamic responses to physical exercise, however this still has yet to be studied systematically. Methods: The searches were conducted on EMBASE, Medline, and SPORTSDiscus databases. The study included masked randomized controlled trials (RCTs) with participants ≥18 years old. The NO3−intervention group received at least 50 mg NO3−/day with similar sources amid NO3− and placebo conditions. Included studies reported systolic blood pressure (SBP) or diastolic blood pressure (DBP) values during or following exercise performance. Results: 1903 studies were identified, and twenty-six achieved the inclusion criteria. NO3− daily dosages ranged from 90 to 800 mg/day. Throughout exercise, SBP had smaller increases in the NO3− group (−2.81 mmHg (95%CI: −5.20 to −0.41), p=0.02. DBP demonstrated lower values in the NO3− group (−2.41 mmHg (95%CI: −4.02 to −0.79), p=0.003. In the post-exercise group, the NO3− group presented lower SBP values (−3.53 mmHg (95%CI: −5.65 to 1.41), p=0.001, while no changes were identified in DBP values between NO3− and placebo groups (p=0.31). Subgroup meta-analysis revealed that SBP baseline values, exercise type, duration of NO3− ingestion, and its dosages mediated blood pressure responses during and following exercise. Conclusions: NO3− ingestion prior to exercise attenuated the increases in SBP and DBP during exercise, and increased the decline in SBP after exercise. These results are dependent on factors that moderate the blood pressure responses (e.g., health status, type of exercise, resting blood pressure values).",

keywords = "Cardiovascular responses to exercise, Hemodynamic monitoring, Nitric oxide, Nitrite, Post-exercise hypotension",

author = "Benjamim, {Cicero Jonas R.} and {Lopes da Silva}, {Leonardo S.} and Valenti, {Vitor E.} and Gon{\c c}alves, {Leonardo S.} and Porto, {Andrey A.} and {Tasinafo J{\'u}nior}, {M{\'a}rcio Fernando} and Walhin, {Jean Philippe} and Garner, {David M.} and Bruno Gualano and {Bueno J{\'u}nior}, {Carlos R.}",

year = "2024",

month = mar,

day = "31",

doi = "10.1016/j.freeradbiomed.2024.02.011",

language = "English",

volume = "215",

pages = "25--36",

journal = "Free Radical Biology and Medicine",

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T1 - Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery

T2 - A systematic review and meta-analysis of randomized placebo-controlled trials

AU - Benjamim, Cicero Jonas R.

AU - Lopes da Silva, Leonardo S.

AU - Valenti, Vitor E.

AU - Gonçalves, Leonardo S.

AU - Porto, Andrey A.

AU - Tasinafo Júnior, Márcio Fernando

AU - Walhin, Jean Philippe

AU - Garner, David M.

AU - Gualano, Bruno

AU - Bueno Júnior, Carlos R.

PY - 2024/3/31

Y1 - 2024/3/31

N2 - Objectives: A systematic review with meta-analysis was completed to study the effects of dietary inorganic nitrate (NO3−) oral ingestion from vegetables and salts on blood pressure responses during and following exercise.Background: NO3− is a hypotensive agent with the potential to reduce blood pressure peaks during exercise and amplify exercise-induced hypotensive effects. Several randomized and controlled trials have investigated the effects of NO3− on hemodynamic responses to physical exercise, however this still has yet to be studied systematically. Methods: The searches were conducted on EMBASE, Medline, and SPORTSDiscus databases. The study included masked randomized controlled trials (RCTs) with participants ≥18 years old. The NO3−intervention group received at least 50 mg NO3−/day with similar sources amid NO3− and placebo conditions. Included studies reported systolic blood pressure (SBP) or diastolic blood pressure (DBP) values during or following exercise performance. Results: 1903 studies were identified, and twenty-six achieved the inclusion criteria. NO3− daily dosages ranged from 90 to 800 mg/day. Throughout exercise, SBP had smaller increases in the NO3− group (−2.81 mmHg (95%CI: −5.20 to −0.41), p=0.02. DBP demonstrated lower values in the NO3− group (−2.41 mmHg (95%CI: −4.02 to −0.79), p=0.003. In the post-exercise group, the NO3− group presented lower SBP values (−3.53 mmHg (95%CI: −5.65 to 1.41), p=0.001, while no changes were identified in DBP values between NO3− and placebo groups (p=0.31). Subgroup meta-analysis revealed that SBP baseline values, exercise type, duration of NO3− ingestion, and its dosages mediated blood pressure responses during and following exercise. Conclusions: NO3− ingestion prior to exercise attenuated the increases in SBP and DBP during exercise, and increased the decline in SBP after exercise. These results are dependent on factors that moderate the blood pressure responses (e.g., health status, type of exercise, resting blood pressure values).

AB - Objectives: A systematic review with meta-analysis was completed to study the effects of dietary inorganic nitrate (NO3−) oral ingestion from vegetables and salts on blood pressure responses during and following exercise.Background: NO3− is a hypotensive agent with the potential to reduce blood pressure peaks during exercise and amplify exercise-induced hypotensive effects. Several randomized and controlled trials have investigated the effects of NO3− on hemodynamic responses to physical exercise, however this still has yet to be studied systematically. Methods: The searches were conducted on EMBASE, Medline, and SPORTSDiscus databases. The study included masked randomized controlled trials (RCTs) with participants ≥18 years old. The NO3−intervention group received at least 50 mg NO3−/day with similar sources amid NO3− and placebo conditions. Included studies reported systolic blood pressure (SBP) or diastolic blood pressure (DBP) values during or following exercise performance. Results: 1903 studies were identified, and twenty-six achieved the inclusion criteria. NO3− daily dosages ranged from 90 to 800 mg/day. Throughout exercise, SBP had smaller increases in the NO3− group (−2.81 mmHg (95%CI: −5.20 to −0.41), p=0.02. DBP demonstrated lower values in the NO3− group (−2.41 mmHg (95%CI: −4.02 to −0.79), p=0.003. In the post-exercise group, the NO3− group presented lower SBP values (−3.53 mmHg (95%CI: −5.65 to 1.41), p=0.001, while no changes were identified in DBP values between NO3− and placebo groups (p=0.31). Subgroup meta-analysis revealed that SBP baseline values, exercise type, duration of NO3− ingestion, and its dosages mediated blood pressure responses during and following exercise. Conclusions: NO3− ingestion prior to exercise attenuated the increases in SBP and DBP during exercise, and increased the decline in SBP after exercise. These results are dependent on factors that moderate the blood pressure responses (e.g., health status, type of exercise, resting blood pressure values).

KW - Cardiovascular responses to exercise

KW - Hemodynamic monitoring

KW - Nitric oxide

KW - Nitrite

KW - Post-exercise hypotension

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Effects of dietary inorganic nitrate on blood pressure during and post-exercise recovery: A systematic review and meta-analysis of randomized placebo-controlled trials

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