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Beetroot (dietary nitrate) and blood pressure: grade C

Limited evidence. Direction: Benefit.

C LimitedShort-term only

Educational guidance, not medical advice

Why this grade

Rubric condition met: Several meta-analyses of RCTs show lower systolic pressure, but none gives an estimate confirmed to be in healthy adults only: the 16-trial analysis does not describe its participants' health in the abstract and its full text is subscription-only, the others pool mixed, older-only or hypertensive adults, so the grade is capped at C. the rubric also applies: a 2026 meta-analysis of chronic sodium nitrate trials and a 16-week trial were null

A meta-analysis of 16 crossover trials (254 adults, 2 hours to 15 days) found a 4.4 mmHg fall in systolic pressure, and later meta-analyses in mixed, older and hypertensive adults found similar reductions with a dose-response relationship; none reported an estimate for healthy adults alone. A 2026 meta-analysis of six chronic sodium nitrate trials (181 adults, mostly over 50) found no significant reduction, a 16-week exploratory trial of high-nitrate vegetable powder in people with raised blood pressure found no difference from a low-nitrate control, and ambulatory measures were often unchanged. Most trials were short.

How we grade evidence

Studies this grade rests on

EffectMixedNo effectSize shows participants (n)20102015202020252030Meta-analysisSystematic reviewRCTNorouzzadeh 2025, 2025: meta-analysis, n = 1,823, result not recordedGr 2024, 2024: meta-analysis, n = 349, result not recordedSiervo 2013, 2013: meta-analysis, n = 254, result not recordedForster 2026, 2026: meta-analysis, n = 181, result not recordedLi 2024, 2024: RCT, n = 66, result not recordedHe 2021, 2021: meta-analysis, n not recorded, result not recordedJackson 2018, 2018: systematic review, n not recorded, result not recorded
each study this grade rests on, by publication year and design. Solid: effect versus the comparator; half-filled: mixed; hollow: no effect; dashed: result not recorded yet. Larger marks had more participants.
Show the numbers
StudyYearDesignParticipantsResult
Siervo 20132013meta-analysis254result not recorded
Jackson 20182018systematic reviewnot recordedresult not recorded
He 20212021meta-analysisnot recordedresult not recorded
Li 20242024RCT66result not recorded
Gr 20242024meta-analysis349result not recorded
Norouzzadeh 20252025meta-analysis1823result not recorded
Forster 20262026meta-analysis181result not recorded

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

Norouzzadeh M, Hasan Rashedi M, Ghaemi S. Plasma nitrate, dietary nitrate, blood pressure, and vascular health biomarkers: a GRADE-Assessed systematic review and dose-response meta-analysis of randomized controlled trials Nutr J, 2025. PMID 40128734

Result not recorded
Design
GRADE-assessed systematic review and dose-response meta-analysis of 75 randomized controlled trials
Sample
n = 1,823
Population
Adults (mixed populations)
Funding
not stated in the PubMed or Crossref record; full text not read

Effects of chronic nitrate supplementation on blood pressure in adults: a systematic review and meta-analysis of randomized clinical trials.

Forster D, Waclawovsky G, Stefani GP. Effects of chronic nitrate supplementation on blood pressure in adults: a systematic review and meta-analysis of randomized clinical trials Nutr Res, 2026. PMID 41619653

Result not recorded
Design
Systematic review and meta-analysis of 6 randomized, placebo-controlled trials of sodium nitrate (at least 1 week)
Sample
n = 181
Population
Adults (mostly over 50 years)
Funding
not stated in the PubMed or Crossref record; full text not read

No Difference between the Efficacy of High-Nitrate and Low-Nitrate Vegetable Supplementation on Blood Pressure after 16 Weeks in Individuals with Early-Stage Hypertension: An Exploratory, Double-Blinded, Randomized, Controlled Trial.

Li D, Jovanovski E, Zurbau A. No Difference between the Efficacy of High-Nitrate and Low-Nitrate Vegetable Supplementation on Blood Pressure after 16 Weeks in Individuals with Early-Stage Hypertension: An Exploratory, Double-Blinded, Randomized, Controlled Trial Nutrients, 2024. PMID 39275333

Result not recorded
Design
Multicenter, double-blind, parallel randomized controlled trial, 16 weeks
Sample
n = 66
Population
Adults with elevated blood pressure (early-stage hypertension)
Funding
Canadian Institutes of Health Research (CIHR 377787)

Effects of beetroot juice on blood pressure in hypertension according to European Society of Hypertension Guidelines: A systematic review and meta-analysis.

Grönroos R, Eggertsen R, Bernhardsson S. Effects of beetroot juice on blood pressure in hypertension according to European Society of Hypertension Guidelines: A systematic review and meta-analysis Nutr Metab Cardiovasc Dis, 2024. PMID 39069465

Result not recorded
Design
Systematic review and meta-analysis of 11 randomized controlled trials (GRADE-assessed)
Sample
n = 349
Population
Adults with hypertension (a clinical population)
Funding
Västra Götalandsregionen (Crossref funder list)

Effect of inorganic nitrate supplementation on blood pressure in older adults: A systematic review and meta-analysis.

He Y, Liu J, Cai H. Effect of inorganic nitrate supplementation on blood pressure in older adults: A systematic review and meta-analysis Nitric Oxide, 2021. PMID 33905826

Result not recorded
Design
Systematic review and meta-analysis of 22 randomized controlled trials
Population
Older adults
Funding
not stated in the PubMed or Crossref record; full text not read

The role of inorganic nitrate and nitrite in cardiovascular disease risk factors: a systematic review and meta-analysis of human evidence.

Jackson JK, Patterson AJ, MacDonald-Wicks LK. The role of inorganic nitrate and nitrite in cardiovascular disease risk factors: a systematic review and meta-analysis of human evidence Nutr Rev, 2018. PMID 29506204

Result not recorded
Design
Systematic review of 34 experimental studies, 23 meta-analyzed
Population
Adults (mixed healthy and at-risk samples)
Funding
not stated in the PubMed or Crossref record; full text not read

Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis.

Siervo M, Lara J, Ogbonmwan I. Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis J Nutr, 2013. PMID 23596162

Result not recorded
Design
Systematic review and meta-analysis of 16 randomized crossover trials
Sample
n = 254
Population
Adults (trials published 2006-2012)
Funding
Medical Research Council (Europe PMC grant list)

Search and history

Search (): (nitrate[ti] OR beetroot[ti]) AND ("blood pressure"[tiab]) AND (meta-analysis[pt] OR systematic review[pt])

  • Graded C (proposed): Proposed in the monograph draft
  • C to C (approved): Editor sign-off November 13, 2026: grade matches the editor-approved final page