Purpose Dietary nitrate supplementation increases nitric oxide (NO) bioavailability and reduces blood pressure (BP). Inter-individual differences in these responses are suspected but have not been investigated using robust designs, e.g., replicate crossover, and appropriate statistical models. We examined the within-individual consistency of the effects of dietary nitrate supplementation on NO biomarkers and BP, and quantified inter-individual response differences.

Methods Fifteen healthy males visited the laboratory four times. On two visits, participants consumed 140ml nitrate-rich beetroot juice (∼14.0mmol nitrate) and, on the other two visits, they consumed 140ml nitrate-depleted beetroot juice (∼0.03mmol nitrate). Plasma nitrate and nitrite concentrations were measured 2.5 hours post-supplementation. BP was measured pre– and 2.5 hours post-supplementation. Between-replicate correlations were quantified for the placebo-adjusted post-supplementation plasma nitrate and nitrite concentrations and pre-to-post changes in BP. Within-participant linear mixed models (LLM) and a meta-analytic approach estimated participant-by-condition treatment response variability.

Results Nitrate-rich beetroot juice supplementation elevated plasma nitrate and nitrite concentrations and reduced systolic (mean:-7mmHg, 95%CI: –3 to –11mmHg) and diastolic (mean:-6mmHg, 95%CI: –2 to –9mmHg) BP versus placebo. The LLM participant-by-condition interaction response variability was ±7mmHg (95%CI: 3 to 9mmHg) for systolic BP and consistent with the treatment effect heterogeneity τ=± 7mmHg (95%CI: 5 to 12mmHg) derived from the meta-analytic approach. The between-replicate correlations were moderate-to-large for plasma nitrate, nitrite and systolic BP (r=0.55 to 0.91).

Conclusions The effects of dietary nitrate supplementation on NO biomarkers and systolic BP varied significantly from participant to participant. The causes of this inter-individual variation deserve further investigation. Trial registration: https://clinicaltrials.gov/study/NCT05514821.

The authors have declared no competing interest.

NCT05514821

https://clinicaltrials.gov/study/NCT05514821

This study was funded by a grant from the Wellcome Trust Translational Partnership. The salary of MS is supported by a Royal Perth Hospital Career Advancement Fellowship and an Emerging Leader Fellowship from the Future Health Research and Innovation Fund, Department of Health (Western Australia).

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The Faculty of Medical Sciences Research Ethics Committee of Newcastle University gave ethical approval for this work (REF: 2345/23609)

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