Beetroot extract has emerged as a popular natural supplement for cardiovascular health, particularly for its potential to lower blood pressure. Rich in dietary nitrate, beetroot extract works through a well-established biological pathway that produces nitric oxide, a molecule that helps relax blood vessels and improve blood flow. Whilst clinical research demonstrates modest blood pressure reductions, it's essential to understand how beetroot extract fits within evidence-based hypertension management. This article examines the mechanisms, clinical evidence, appropriate use, and safety considerations surrounding beetroot extract for blood pressure control.

How Beetroot Extract May Affect Blood Pressure

Beetroot extract has gained considerable attention in cardiovascular research due to its high concentration of inorganic nitrate. When consumed, dietary nitrate undergoes a two-step reduction process: first, commensal bacteria in the oral cavity convert nitrate to nitrite, which is then further reduced to nitric oxide (NO) in the stomach and bloodstream. Nitric oxide is a crucial signalling molecule that promotes vasodilation—the widening of blood vessels—which can lead to reduced vascular resistance and lower blood pressure.

The mechanism centres on the nitrate-nitrite-nitric oxide pathway, which represents an alternative route to endogenous nitric oxide production beyond the traditional L-arginine pathway. This is particularly relevant for individuals with endothelial dysfunction, where conventional nitric oxide synthesis may be impaired. The bioactive compounds in beetroot, including betalains and flavonoids, may also have antioxidant properties that could support vascular health, though the primary blood pressure-lowering effect is attributed to the nitrate content.

Key physiological effects may include:

• Relaxation of vascular smooth muscle

• Improved endothelial function

• Increased blood flow

• Potential effects on vascular compliance

The magnitude of blood pressure reduction appears dose-dependent and varies between individuals. Factors such as baseline blood pressure, gut microbiome composition, and concurrent use of antibacterial mouthwash (particularly chlorhexidine-containing products) can disrupt the oral bacteria necessary for nitrate conversion and may influence the effectiveness of beetroot extract. It is important to note that whilst the biological mechanism is well-established, beetroot extract should not be considered a replacement for prescribed antihypertensive medications without medical supervision.

Clinical Evidence for Beetroot Extract and Hypertension

A substantial body of clinical research has examined the blood pressure-lowering effects of beetroot extract and beetroot juice. Systematic reviews and meta-analyses have consistently demonstrated modest but statistically significant reductions in both systolic and diastolic blood pressure following beetroot supplementation. A 2013 meta-analysis published in the journal Hypertension found that inorganic nitrate and beetroot juice supplementation resulted in a significant reduction in blood pressure, with effects observed within 24 hours of consumption.

More recent meta-analyses have confirmed these findings, with most randomised controlled trials reporting reductions in systolic blood pressure ranging from 4 to 10 mmHg, with smaller decreases in diastolic pressure (typically 1 to 5 mmHg). These effects appear most pronounced in individuals with elevated baseline blood pressure, whilst normotensive individuals may experience minimal changes. The duration of effect varies, with acute studies showing peak reductions 2 to 3 hours post-consumption, whilst longer-term studies (spanning several weeks) suggest sustained benefits with regular intake.

Important research considerations:

• Study populations have varied widely in age, baseline blood pressure, and cardiovascular risk

• Dosing protocols differ substantially between trials (from 70 mg to over 500 mg of nitrate)

• Most studies have been relatively short-term (days to weeks rather than months or years)

• Long-term cardiovascular outcome data remain limited

Whilst the evidence is encouraging, it is crucial to recognise that beetroot extract has not undergone the rigorous regulatory approval process required for pharmaceutical antihypertensive agents. NICE guidelines (NG136) for hypertension management do not currently include beetroot extract as a recommended intervention, and it should be viewed as a potential adjunct to, rather than replacement for, evidence-based medical treatment and lifestyle modifications such as reduced sodium intake, regular physical activity, and weight management.

Recommended Dosage and Forms of Beetroot Extract

Beetroot extract is available in several formulations, including concentrated juice, powdered supplements, capsules, and whole beetroot. The active component—dietary nitrate—varies considerably between products, making standardisation challenging. Research studies have typically used doses containing approximately 300 to 500 mg of nitrate, which may equate to roughly 500 ml of beetroot juice or 200 to 250 grams of whole beetroot, though content can vary significantly depending on growing conditions, processing methods and beetroot variety.

Concentrated beetroot juice shots (typically 70 ml) have become popular due to convenience and relatively standardised nitrate content, often providing 300 to 400 mg of nitrate per serving. Powdered beetroot supplements vary widely in nitrate concentration, and consumers should check product labels for nitrate content rather than relying solely on beetroot weight, though many UK products do not specify nitrate levels. Some manufacturers provide nitrate-depleted beetroot products as placebos for research, highlighting that the nitrate content is the crucial active component.

Practical considerations for supplementation:

• Timing: Effects typically peak 2 to 3 hours after consumption; some individuals take beetroot extract in the morning for daytime benefit

• Consistency: Regular daily intake appears necessary to maintain blood pressure effects

• Food interactions: Beetroot extract can be consumed with or without food

• Storage: Beetroot juice should be refrigerated and consumed within recommended timeframes to preserve nitrate content

• Sugar content: Beetroot juice and shots contain natural sugars, which may be relevant for people with diabetes or those monitoring calorie intake

It is important to note that there is no officially approved therapeutic dose for beetroot extract in hypertension management, as it is regulated as a food supplement under UK food law, not as a medicine. Individuals considering beetroot supplementation should discuss appropriate dosing with their GP or pharmacist, particularly if taking prescribed antihypertensive medications. Quality varies between manufacturers, and choosing products from reputable suppliers with third-party testing may help ensure consistent nitrate content and absence of contaminants.

Safety Considerations and Potential Side Effects

Beetroot extract is generally well-tolerated, with most adverse effects being mild and transient. The most commonly reported side effect is beeturia—the passage of red or pink urine—which occurs in approximately 10 to 14% of the population and is harmless. This phenomenon results from the excretion of betalain pigments and may be more noticeable in individuals with iron deficiency. Similarly, beetroot consumption can cause red discolouration of stools, which should not be confused with gastrointestinal bleeding.

Some individuals experience mild gastrointestinal symptoms, including bloating, flatulence, or loose stools, particularly when first introducing beetroot extract or at higher doses. These effects often diminish with continued use as the digestive system adapts. Rarely, individuals may experience allergic reactions to beetroot, manifesting as skin rash, itching, or in very rare cases, anaphylaxis.

Important safety considerations include:

• Hypotension risk: Individuals already taking antihypertensive medications should exercise caution, as beetroot extract may cause additive blood pressure-lowering effects, potentially leading to symptomatic hypotension (dizziness, light-headedness, fainting)

• Kidney stones: Beetroot is high in oxalates, which may increase the risk of calcium oxalate kidney stone formation in susceptible individuals

• Potassium content: People with chronic kidney disease or those on potassium-restricted diets should consult their healthcare provider, as beetroot contains potassium

• Blood sugar: Beetroot juice and shots contain natural sugars; individuals with diabetes should monitor blood glucose and consider the carbohydrate content

• Drug interactions: Beetroot extract may have additive blood pressure-lowering effects when taken with antihypertensive medications or PDE-5 inhibitors (e.g., sildenafil), potentially causing symptomatic hypotension

Pregnant and breastfeeding women should consult their healthcare provider before using concentrated beetroot supplements, although dietary beetroot consumption is generally considered safe. Food supplements are regulated as foods under UK food law, not as medicines, so product quality and purity may vary. Individuals with pre-existing medical conditions should seek medical advice before commencing supplementation.

If you experience any adverse effects that you suspect may be related to beetroot extract, report them through the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

When to Seek Medical Advice About Blood Pressure

Whilst beetroot extract may offer modest blood pressure benefits, it is crucial to recognise when professional medical assessment and treatment are necessary. Hypertension is often asymptomatic but significantly increases the risk of serious cardiovascular events, including stroke, myocardial infarction, heart failure, and chronic kidney disease. Self-management with supplements alone is inappropriate for individuals with established hypertension requiring medical treatment.

You should consult your GP if:

• Your blood pressure readings consistently exceed 140/90 mmHg (or 135/85 mmHg with home monitoring)

• You experience symptoms potentially related to high blood pressure, such as severe headaches, visual disturbances, chest pain, or shortness of breath

• You have been diagnosed with hypertension but are not achieving target blood pressure levels with current treatment

• You are considering beetroot extract alongside prescribed antihypertensive medications

• You experience symptoms of hypotension (dizziness, fainting, unusual fatigue) after starting beetroot supplementation

NICE guidelines (NG136) recommend that suspected hypertension should be confirmed with ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) before diagnosis.

Seek immediate medical attention (call 999 or attend A&E) if you experience:

• Severe chest pain or pressure

• Sudden severe headache with confusion or altered consciousness

• Sudden vision loss or severe visual disturbance

• Difficulty breathing or speaking

• Weakness or numbness, particularly on one side of the body

• Blood pressure readings exceeding 180/120 mmHg, even without symptoms (requires same-day medical assessment)

NICE guidelines recommend that hypertension management should be individualised based on cardiovascular risk assessment, target organ damage, and comorbidities. Lifestyle modifications—including dietary changes, regular physical activity, weight management, reduced alcohol intake, and smoking cessation—form the foundation of hypertension management. Whilst beetroot extract may complement these approaches, it should not delay or replace evidence-based medical treatment. Regular blood pressure monitoring, either at home or through your GP surgery, is essential for anyone with elevated readings or cardiovascular risk factors. Your healthcare provider can help determine whether beetroot supplementation is appropriate as part of a comprehensive management plan.

Frequently Asked Questions