title: One Week of Daily Dosing With Beetroot Juice Improves Submaximal Endurance and Blood Pressure in Older Patients With Heart Failure and Preserved Ejection Fraction.
abstract: This study sought to determine whether a relatively low single dose or a week-long dosage of dietary inorganic nitrate could improve exercise tolerance in patients with heart failure with preserved ejection fraction (HFpEF).
  
  
  
  Exercise intolerance is the primary manifestation of HFpEF and is largely due to noncardiac factors that reduce oxygen delivery to active skeletal muscles. A recent study showed improved exercise capacity in patients with HFpEF after a single, acute dose of beetroot juice (BRJ) (12.9 mmol inorganic nitrate) while another recent study showed neutral and negative effects of an organic nitrate.
  
  
  
  Twenty HFpEF patients (69 ± 7 years of age ) were enrolled in an initial cross-over design comparing a single, acute dose of BRJ (6.1 mmol nitrate) to a nitrate-depleted placebo BRJ. A second phase, 1 week of daily doses, used an all-treated design in which patients consumed BRJ for an average of 7 days. The primary outcome of the study was submaximal aerobic endurance, measured as cycling time to exhaustion at 75% of measured maximal power output.
  
  
  
  No adverse events were associated with the intervention. Submaximal aerobic endurance improved 24% after 1 week of daily BRJ dosing (p = 0.02) but was not affected by the single, acute dose of the BRJ compared to placebo. Consumption of BRJ significantly reduced resting systolic blood pressure and increased plasma nitrate and nitrite in both of the dosing schemes.
  
  
  
  One week of daily dosing with BRJ (6.1 mmol inorganic nitrate) significantly improves submaximal aerobic endurance and blood pressure in elderly HFpEF patients.
authors.affiliation: Sections of Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Joel
authors.initials: J
authors.lastname: Eggebeen
authors.affiliation: Department of Physics, Wake Forest University, Winston-Salem, North Carolina; Translational Science Center, Wake Forest University, Winston-Salem, North Carolina. Electronic address: shapiro@wfu.edu.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Kim-Shapiro
authors.affiliation: College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas.
authors.forename: Mark
authors.initials: M
authors.lastname: Haykowsky
authors.affiliation: Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Department of Physics, Wake Forest University, Winston-Salem, North Carolina; Translational Science Center, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Swati
authors.initials: S
authors.lastname: Basu
authors.affiliation: Translational Science Center, Wake Forest University, Winston-Salem, North Carolina; Health and Exercise Science Department, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Peter
authors.initials: P
authors.lastname: Brubaker
authors.affiliation: Translational Science Center, Wake Forest University, Winston-Salem, North Carolina; Health and Exercise Science Department, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Jack
authors.initials: J
authors.lastname: Rejeski
authors.affiliation: Sections of Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina; Translational Science Center, Wake Forest University, Winston-Salem, North Carolina. Electronic address: dkitzman@wakehealth.edu.
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
mesh_terms: D000368:Aged; D027461:Beta vulgaris / Q000737:chemistry; D001794:Blood Pressure; D018592:Cross-Over Studies; D004311:Double-Blind Method; D017079:Exercise Tolerance; D005260:Female; D000067030:Fruit and Vegetable Juices; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009566:Nitrates; D010101:Oxygen Consumption; D010807:Physical Endurance; D013318:Stroke Volume
chemical_list: D009566:Nitrates
keywords: exercise; heart failure with preserved ejection fraction; nitrate; nitric oxide; nitrite