Nutrition Research · Aug 6, 2025

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

By Forster D, Waclawovsky G, Stefani GP

This systematic review and meta-analysis investigated the chronic effects of sodium nitrate (NO₃⁻) supplementation on systolic blood pressure (SBP), diastolic blood pressure (DBP), and resting heart rate (RHR) in adults. Placebo-controlled randomized clinical trials (RCTs) involving participants aged ≥18 years and lasting at least one week were included. Studies with beetroot juice as an intervention and studies with animals were excluded. Searches in PubMed, Cochrane, LILACS, Web of Science, SCOPUS, and grey literature were conducted in June 2025. Effect estimates were pooled as mean differences (MD) with 95% CIs using a random-effects model with Hartung-Knapp adjustment and the inverse variance method. All analyses were performed using RStudio with the meta package. Risk of bias assessment was conducted using the PEDro scale. Six studies (n = 181 participants; 59% male; > 50 years of age) were eligible for analysis. Compared to the placebo condition, NO₃⁻ supplementation did not result in significant reductions in DBP (MD: -2.00 mm Hg; 95% CI: -4.37 to 0.38 mm Hg); SBP (MD: -3.81 mm Hg; 95% CI: -10.05 to 2.43 mm Hg); and RHR (MD: 0.34 bpm; 95% CI: -5.68 to 6.36 bpm). The average PEDro score indicated a low risk of bias (8.16 points). In conclusion, the current evidence does not support reductions in blood pressure levels in older adults following NO₃⁻ supplementation. Nevertheless, due to the limited number of available randomized controlled trials, further research is necessary to confirm these findings and to better understand the long-term effects of this compound on blood pressure.

doi.org/10.1016/j.nutres.2025.08.002PubMed 41619653Interventions