The Role of Dietary Nitrate on Blood Pressure and Cardiovascular Risk Factors
Bibliographic record
Abstract
Hypertension remains the leading attributable cause of mortality worldwide. Effective dietary approaches are needed for individuals with early-stage hypertension, who are not yet candidates for pharmacological therapy or who have unmet blood pressure (BP) targets. Clinical data has demonstrated BP-lowering effects and vascular benefits following acute or short-term ingestion of dietary inorganic nitrate with evidence of enhanced nitric oxide (NO) bioavailability. The objectives of this thesis were three-fold. The first objective was to conduct a systematic review and meta-analysis (SRMA) of randomized controlled trials (RCT) >3 days to generate an effect estimate of inorganic nitrate on BP and measures of arterial stiffness. The second objective was to determine the efficacy of dietary nitrate (NO3) on BP and CVD risk factors in individuals with early-stage hypertension over 16 weeks through a multi-centre, double-blinded, RCT (DINO3 Trial). The third objective was to assess effect modification of nitrate treatment by common genetic polymorphisms in the NO-cyclic guanosine monophosphate (cGMP) signaling pathway. Results from the SRMA pooling 47 trials (n=1,101) indicated that administration of inorganic nitrate significantly lowered systolic BP (-2.91 mmHg, 95% CI: -3.92, -1.89), diastolic BP (-1.45 mmHg, 95%CI: -2.22, -0.68), and central BP without effects on ambulatory BP or arterial stiffness. Results from the 16-week RCT (n=66) showed no difference between nitrate-rich versus low-nitrate vegetable supplementation on the primary endpoint office systolic BP (3.91 3.52 mmHg, p=0.27). No differences were observed on office diastolic BP, ambulatory BP, arterial stiffness, inflammation or lipids. In exploratory analysis, results showed significant effect modification of dietary nitrate on arterial stiffness according to NOS1 rs7314935 genotype (p<0.0001). Carriers of the A allele had lower augmentation index after 16 weeks of dietary nitrate vegetable treatment compared to low-nitrate vegetable control (p<0.0001). Although promising BP effects of dietary nitrate have been demonstrated in healthy individuals, more research is necessary to discern the long-term efficacy of dietary nitrate treatment for individuals with hypertension and elevated CVD risk. Given the variability of results, investigations into genotype-treatment interactions may identify individuals with greater response to dietary nitrate and serve to improve the precision of hypertension treatments.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".