***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract —Single dose administration of dietary inorganic nitrate acutely reduces blood pressure ( BP ) in normotensive healthy volunteers , via bioconversion to the vasodilator nitric oxide . We assessed whether dietary nitrate might provide sustained BP lowering in patients with hypertension . We r and omly assigned 68 patients with hypertension in a double-blind , placebo-controlled clinical trial to receive daily dietary supplementation for 4 weeks with either dietary nitrate ( 250 mL daily , as beetroot juice ) or a placebo ( 250 mL daily , as nitrate-free beetroot juice ) after a 2-week run-in period and followed by a 2-week washout . We performed stratified r and omization of drug-naive ( n=34 ) and treated ( n=34 ) patients with hypertension aged 18 to 85 years . The primary end point was change in clinic , ambulatory , and home BP compared with placebo . Daily supplementation with dietary nitrate was associated with reduction in BP measured by 3 different methods . Mean ( 95 % confidence interval ) reduction in clinic BP was 7.7/2.4 mm Hg ( 3.6–11.8/0.0–4.9 , P<0.001 and P=0.050 ) . Twenty-four-hour ambulatory BP was reduced by 7.7/5.2 mm Hg ( 4.1–11.2/2.7–7.7 , P<0.001 for both ) . Home BP was reduced by 8.1/3.8 mm Hg ( 3.8–12.4/0.7–6.9 , P<0.001 and P<0.01 ) with no evidence of tachyphylaxis over the 4-week intervention period . Endothelial function improved by ≈20 % ( P<0.001 ) , and arterial stiffness was reduced by 0.59 m/s ( 0.24–0.93 ; P<0.01 ) after dietary nitrate consumption with no change after placebo . The intervention was well tolerated . This is the first evidence of durable BP reduction  with dietary nitrate supplementation in a relevant patient group . These findings suggest a role for dietary nitrate as an affordable , readily-available , adjunctive treatment in the management of patients with hypertension ( funded by The British Heart Foundation ) . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT01405898 A number of vegetables have a high nitrate content which after ingestion can be reduced to nitrite by oral bacteria , and further to vasoprotective NO endogenously . In the present study , two separate r and omly controlled , single-blind , cross-over , postpr and ial studies were performed in normotensive volunteers . Ambulatory blood pressure ( BP ) was measured over a 24 h period following consumption of either four doses of beetroot juice ( BJ ) , 0 , 100 , 250 and 500 g ( n 18 ) , or three bread products , control bread ( 0 g beetroot ) , red beetroot- and white beetroot-enriched breads ( n 14 ) . Total urinary nitrate/nitrite ( NO(x ) ) was measured at baseline , and at 2 , 4 and 24 h post-ingestion . BJ consumption significantly , and in a near dose-dependent manner , lowered systolic BP ( SBP , P < 0·01 ) and diastolic BP ( DBP , P < 0·001 ) over a period of 24 h , compared with water control . Furthermore , bread products enriched with 100 g red or white beetroot lowered SBP and DBP over a period of 24 h ( red beetroot-enriched bread , P < 0·05 ) , with no statistical differences between the varieties . Total urinary NO(x ) significantly increased following the consumption of 100 g ( P < 0·01 ) , 250 g ( P < 0·001 ) and 500 g BJ ( P < 0·001 ) and after red beetroot-enriched bread ingestion ( P < 0·05 ) , but did not reach significance for white beetroot-enriched bread compared with the no-beetroot condition . These studies demonstrated significant hypotensive effects of a low dose ( 100 g ) of beetroot which was unaffected by processing or the presence of betacyanins . These data strengthen the evidence for cardioprotective BP-lowering effects of dietary nitrate-rich vegetables OBJECTIVE Epidemiological studies suggest that green leafy vegetables , which are high in dietary nitrate , are protective against CVD such as stroke . High blood pressure ( BP ) is a major risk factor for stroke and inorganic nitrate has been shown to reduce BP . The objective of the present study was to test the hypothesis that diets containing high-nitrate ( HN ) vegetables would increase plasma nitrate and nitrite concentrations and reduce BP in healthy women . DESIGN A r and omized , crossover trial , where participants received HN vegetables ( HN diet ) or avoided HN vegetables ( Control diet ) for 1 week . Before and after each intervention , resting BP and plasma nitrate and nitrite concentrations were measured . SETTING University of Exeter , UK . SUBJECTS Nineteen healthy women ( mean age 20 ( sd 2 ) years ; mean BMI 22·5 ( sd 3·8 ) kg/m2 ) . RESULTS The HN diet significantly increased plasma nitrate concentration ( before HN diet : mean 24·4 ( sd 5·6 ) µmol/l ; after HN diet : mean 61·0 ( sd 44·1 ) µmol/l , P<0·05 ) and plasma nitrite concentration ( before HN diet : mean 98 ( sd 91 ) nmol/l ; after HN diet : mean 185 ( sd 34 ) nmol/l , P<0·05 ) . No significant change in plasma nitrate or nitrite concentration was observed after the Control diet . The HN diet significantly reduced resting systolic BP ( before HN diet : mean 107 ( sd 9 ) mmHg ; after HN diet : mean 103 ( sd 6 ) mmHg , P<0·05 ) . No significant change in systolic BP was observed after the Control diet ( before Control diet : mean 106 ( sd 8) mmHg ; after Control diet : mean 106 ( sd 8) mmHg ) . CONCLUSIONS Consumption of HN vegetables  significantly increased plasma nitrate and nitrite concentrations and reduced BP in normotensive women Although inorganic nitrate and beetroot juice supplementation are associated with decreased systolic blood pressure ( BP ) , these results have primarily been obtained from short-term trials that focused on healthy young adults . Therefore , we hypothesized that oral supplementation of beetroot juice concentrate would decrease systolic BP in overweight older participants but that the decline in BP would not be sustained after a 1-week interruption of the beetroot juice supplementation . For 3 weeks , 24 participants were r and omized to either the beetroot juice concentrate or blackcurrant juice group , with a 1-week postsupplementation phase ( week 4 ) . Changes in systolic and diastolic BP were assessed during the supplementation and postsupplementation phases . Blood pressure was measured using 3 different methods : ( 1 ) resting clinic BP , ( 2 ) 24-hour ambulatory BP monitoring , and ( 3 ) home monitoring of daily resting BP . The first 2 methods were applied at baseline and after weeks 3 and 4 . Daily measurements were conducted throughout the study , with 21 subjects completing the study ( beetroot/blackcurrant = 10/11 ; male/female = 12/9 ; age = 62.0 ± 1.4 years ; body mass index = 30.1 ± 1.2 kg/m(2 ) ) . After 3 weeks , beetroot juice supplementation was not associated with significant changes in resting clinic BP or 24-hour ABPM .  Conversely , beetroot juice concentrate  reduced daily systolic BP after 3 weeks ( -7.3 ± 5.9 mm Hg , P = .02 ) ; however , the effect was not maintained after the interruption of the supplementation ( week 4 , 2.8 ± 6.1 mm Hg , P = .09 ) . In overweight older subjects , beetroot juice concentrate supplementation was associated with beneficial effects on daily systolic BP , although the effects were not significant when measured by 24-hour ABPM or resting clinic BP Background The consumption of beetroot juice on a low nitrate diet may lower blood pressure ( BP ) and therefore reduce the risk of cardiovascular events . However , it is unknown if its inclusion as part of a normal diet has a similar effect on BP . The aim of the study was to conduct a r and omized controlled trial with free-living adults to investigate if consuming beetroot juice in addition to a normal diet produces a measureable reduction in BP . Method Fifteen women and fifteen men participated in a double-blind , r and omized , placebo-controlled , crossover study . Volunteers were r and omized to receive 500 g of beetroot and apple juice ( BJ ) or a placebo juice ( PL ) . Volunteers had BP measured at baseline and at least hourly for 24-h following juice consumption using an ambulatory blood pressure monitor ( ABPM ) . Volunteers remained at the clinic for 1-h before resuming normal non-strenuous daily activities . The identical procedure was repeated 2-wk later with the drink ( BJ or PL ) not consumed on the first visit . Results Overall , there was a trend ( P=0.064 ) to lower systolic blood pressure ( SBP ) at 6-h after drinking BJ relative to PL . Analysis in men only ( n=13 ) after adjustment for baseline differences demonstrated a significant ( P<0.05 ) reduction in SBP of 4 – 5 mmHg at 6-h after drinking BJ . Conclusions Beetroot juice will lower BP in men when consumed as part of a normal diet in free-living healthy adults . Trial registration anzctr.org.au Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more In 2016 , the American College of Cardiology published the first expert consensus decision pathway ( ECDP ) on the role of non-statin therapies for low-density lipoprotein (LDL)-cholesterol lowering in the management of atherosclerotic cardiovascular disease ( ASCVD ) risk . Since the publication of that document , additional evidence and perspectives have emerged from r and omized clinical trials and other sources , particularly considering the longer-term efficacy and safety of proprotein convertase subtilisin/kexin 9 ( PCSK9 ) inhibitors in secondary prevention of ASCVD . Most notably , the FOURIER ( Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk ) trial and SPIRE-1 and -2 ( Studies of PCSK9 Inhibition and the Reduction of Vascular Events ) , assessing evolocumab and bococizumab , respectively , have published final results of cardiovascular outcomes trials in patients with clinical ASCVD and in a smaller number of high-risk primary prevention patients . In addition , further evidence on the types of patients most likely to benefit from the use of ezetimibe in addition to statin therapy after acute coronary syndrome has been published . Based on results from these important analyses , the ECDP writing committee judged that it would be desirable to provide a focused up date to help guide clinicians more clearly on decision making regarding the use of ezetimibe and PCSK9 inhibitors in patients with clinical ASCVD with or without comorbidities . In the following summary table , changes from the 2016 ECDP to the 2017 ECDP Focused Up date are highlighted , and a brief rationale is provided . The content of the full document has been changed accordingly , with more extensive and detailed guidance regarding decision making provided both in the text and in the up date d algorithms . Revised recommendations are provided for patients with clinical ASCVD with or without comorbidities  on statin therapy for secondary prevention . The ECDP writing committee judged that these new data did not warrant changes to the decision pathways and algorithms regarding the use of ezetimibe or PCSK9 inhibitors in primary prevention patients with LDL-C < 190 mg/dL with or without diabetes mellitus or patients without ASCVD and LDL-C ≥190 mg/dL not due to secondary causes . Based on feedback and further deliberation , the ECDP writing committee down- grade d recommendations regarding bile acid sequestrant use , recommending bile acid sequestrants only as optional secondary agents for consideration in patients intolerant to ezetimibe . For clarification , the writing committee has also included new information on diagnostic categories of heterozygous and homozygous familial hypercholesterolemia , based on clinical criteria with and without genetic testing . Other changes to the original document were kept to a minimum to provide consistent guidance to clinicians , unless there was a compelling reason or new evidence , in which case justification is provided Ingestion of dietary ( inorganic ) nitrate elevates circulating and tissue levels of nitrite via bioconversion in the entero-salivary circulation . In addition , nitrite is a potent vasodilator in humans , an effect thought to underlie the 
    Output:
    
This review was able to demonstrate that BRJ supplementation is a cost-effective strategy that might reduce blood pressure in different population s , probably through the nitrate/nitrite/nitric oxide ( NO₃-/NO₂-/NO ) pathway and secondary metabolites found in Beta vulgaris .
This easily found and cheap dietary intervention could significantly decrease the risk of suffering cardiovascular events and , in doing so , would help to diminish the mortality rate associated to this pathology .