***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: This blinded placebo-controlled crossover study evaluated the acute effects of an orally disintegrating lozenge that generates nitric oxide ( NO ) in the oral cavity on blood pressure ( BP ) response , endothelial function , and vascular compliance in unmedicated hypertensive patients . Thirty patients with clinical hypertension were recruited and enrolled in a blinded placebo-controlled clinical trial in an outpatient setting . Average baseline BP in 30 patients was 144±3/91±1 mm Hg . NO supplementation result ed in a significant decrease of 4 mm Hg in resting systolic BP ( P<.003 ) and a significant decrease of 5 mm Hg in diastolic BP ( P<.002 ) from baseline and placebo after 20 minutes . In addition , there was a further statistically significant reduction by 6 mm Hg in both systolic and diastolic pressure after 60 minutes ( P<.0001 vs baseline ) . After a half hour of a single dose , there was a significant improvement in vascular compliance as measured by augmentation index and , after 4 hours , a statistically significant improvement in endothelial function as measured by the EndoPAT ( Itamar Medical , Franklin , MA ) . A single administration of an oral active NO supplement appears to acutely lower BP , improve vascular compliance , and restore endothelial function in patients with hypertension 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 Evidence for a beneficial effect of dietary nitrate , through the nitrate-nitrite-NO pathway , on measures of cardiovascular function in healthy individuals is accumulating . It is less clear whether increased dietary nitrate intake from green leafy vegetables would have similar beneficial vascular effects in those at increased risk of developing hypertension . Our aim was to assess the effects of short-term regular consumption of increased nitrate from green leafy vegetables on blood pressure and arterial stiffness in individuals with high-normal blood pressure . Thirty-eight men and women ages 30 - 70 years with systolic blood pressure 120 to 139 mm Hg were recruited to a r and omized controlled crossover trial . The effects of a 7-day high-nitrate diet intervention ( increased nitrate intake by at least 300 mg/day from green leafy vegetables ) were compared to a 7-day low-nitrate diet intervention . Outcome measures included pre- and postintervention salivary and plasma nitrate and nitrite concentrations ; ambulatory , home , and office blood pressure ; augmentation index ; and carotid-femoral pulse wave velocity . The high-nitrate diet intervention result ed in at least a fourfold increase in salivary and plasma nitrate and nitrite ( P<0.001 ) . Ambulatory , home , and office blood pressure and arterial stiffness were not different between the high-nitrate diet and the low-nitrate diet . Increasing dietary nitrate intake in those with high-normal blood pressure and at increased risk of hypertension may not be an effective short-term strategy to lower blood pressure BACKGROUND Dietary nitrate , which is in green leafy vegetables and beetroot , decreases blood pressure through the enterosalivary nitrate-nitrite-nitric oxide pathway in healthy individuals . Whether similar effects would occur in individuals with treated hypertension and , therefore , at increased risk of cardiovascular disease is unclear . OBJECTIVE We assessed whether increased dietary nitrate intake by using beetroot juice for 1 wk lowers blood pressure in treated hypertensive men and women . DESIGN Participants ( n = 27 ) were recruited to a r and omized , placebo-controlled , double-blind crossover trial . The effect of 1-wk intake of nitrate-rich beetroot juice was compared with 1-wk intake of nitrate-depleted beetroot juice ( placebo ) . The primary outcome was blood pressure assessed by measuring home blood pressure during the intervention and 24-h ambulatory blood pressure on day 7 of the intervention . Other outcomes included nitrate metabolism assessed by measuring nitrate and nitrite in plasma , saliva , and urine . RESULTS Relative to the placebo , 1-wk intake of nitrate-rich beetroot juice result ed in a 3-fold increase in plasma nitrite and nitrate , a 7-fold increase in salivary nitrite , an 8-fold higher salivary nitrate , and a 4-fold increase in both urinary nitrite and nitrate ( P < 0.001 ) . However , no differences in home blood pressure and 24-h ambulatory blood pressure were observed with 1-wk intake of nitrate-rich beetroot juice in comparison with the placebo . CONCLUSION An increase in dietary nitrate intake may not be an effective short-term approach to further lower blood pressure in treated hypertensive subjects Hypertension is a major risk factor for cardiovascular disease and has a prevalence of about one billion people worldwide . It has been shown that adherence to a diet rich in fruits and vegetables helps in decreasing blood pressure ( BP ) . This study aim ed to investigate the effect of raw beet juice ( RBJ ) and cooked beet ( CB ) on BP of hypertensive subjects . In this r and omized crossover study , 24 hypertensive subjects aged 25–68 years old were divided into two groups . One group took RBJ for 2 weeks and the other group took CB . After 2 weeks of treatment , both groups had a washout for 2 weeks then switched to the alternate treatment . Each participant consumed 250 ml day−1 of RBJ or 250 g day−1 of CB each for a period of 2 weeks . Body weight , BP , flow-mediated dilation ( FMD ) , lipid profile and inflammatory parameters were measured at baseline and after each period . According to the results , high-sensitivity C-reactive protein ( hs-CRP ) and tumour necrosis factor alpha ( TNF-α ) were significantly lower and FMD was significantly higher after treatment with RBJ compared with CB  ( P<0.05 ) . FMD was significantly ( P<0.05 ) increased , but systolic and diastolic BP , intracellular adhesion molecule-1 ( ICAM-1 ) , vascular endothelial adhesion molecule-1 ( VCAM-1 ) , hs-CRP , interleukin-6 , E-selectin and TNF-α were significantly ( P<0.05 ) decreased with RBJ or  CB . Total antioxidant capacity was increased and non-high-density lipoprotein ( HDL ) , low-density lipoprotein ( LDL ) and total cholesterol ( TC ) were decreased with RBJ but not with CB . Although both forms of beetroot were effective in improving BP , endothelial function and systemic inflammation , the raw beetroot juice had greater antihypertensive effects . Also more improvement was observed in endothelial function and systemic inflammation  with RBJ compared with CB Diets rich in green , leafy vegetables have been shown to lower blood pressure ( BP ) and reduce the risk of cardiovascular disease .  Green , leafy vegetables and beetroot are particularly rich in inorganic nitrate . Dietary nitrate supplementation , via sequential reduction to nitrite and NO , has previously been shown to lower BP and improve endothelial function in healthy humans . We sought to determine if supplementing dietary nitrate with beetroot juice , a rich source of nitrate , will lower BP and improve endothelial function and insulin sensitivity in individuals with type 2 diabetes ( T2DM ) . Twenty-seven patients , age 67.2±4.9 years ( 18 male ) , were recruited for a double-blind , r and omized , placebo-controlled crossover trial . Participants were r and omized to begin , in either order , a 2-week period of supplementation with 250ml beetroot juice daily ( active ) or 250ml nitrate-depleted beetroot juice ( placebo ) . At the conclusion of each intervention period 24-h ambulatory blood pressure monitoring , tests of macro- and microvascular endothelial function , and a hyperinsulinemic isoglycemic clamp were performed . After 2 weeks administration of beetroot juice mean ambulatory systolic BP was unchanged : 134.6±8.4mmHg versus 135.1±7.8mmHg ( mean±SD ) , placebo vs active-mean difference of -0.5mmHg ( placebo-active ) , p=0.737 ( 95 % CI -3.9 to 2.8 ) . There were no changes in macrovascular or microvascular endothelial function or insulin sensitivity . Supplementation of the diet with 7.5mmol of nitrate per day for 2 weeks caused an increase in plasma nitrite and nitrate concentration , but did not lower BP , improve endothelial function , or improve insulin sensitivity in individuals with T2DM Aerobic exercise training is an effective therapy to improve peak aerobic power ( peak VO2 ) in individuals with hypertension ( HTN , AHA/ACC class A ) and heart failure patients with preserved ejection fraction ( HFpEF ) .  High nitrate containing beetroot juice ( BRJ ) also improves sub-maximal endurance and decreases blood pressure in both HTN and HFpEF . We hypothesized that combining an aerobic exercise and dietary nitrate intervention would result in additive or even synergistic positive effects on exercise tolerance and blood pressure in HTN or HFpEF . We report results from two pilot studies examining the effects of supervised aerobic exercise combined with dietary nitrate in patients with controlled HTN ( n = 26 , average age 65 ± 5 years ) and in patients with HFpEF ( n = 20 , average age 69 ± 7 years ) . All patients underwent an aerobic exercise training regimen ; half were r and omly assigned to consume a high nitrate-containing beet juice beverage ( BRJ containing 6.1 mmol nitrate for the HFpEF study consumed three times a week and 8 mmol nitrate for the HTN study consumed daily ) while the other half consumed a beet juice beverage with the nitrate removed ( placebo ) . The main result was that there was no added benefit observed for any outcomes when comparing BRJ to placebo in either HTN or HFpEF patients undergoing exercise training ( p ≥ 0.14 ) . There were within-group benefits . In the pilot study in patients with HFpEF , aerobic endurance ( primary outcome ) , defined as the exercise time to volitional exhaustion during submaximal cycling at 75 % of maximal power output , improved during exercise training within each group from baseline to end of study , 369 ± 149 s vs 520 ± 257 s ( p = 0.04 ) for the placebo group and 384 ± 129 s vs 483 ± 258 s for the BRJ group ( p = 0.15 ) . Resting systolic blood pressure in patients with HFpEF also improved during exercise training in both groups , 136 ± 16 mm Hg vs 122 ± 3 mm Hg for the placebo group ( p < 0.05 ) and 132 ± 12 mm Hg 
    Output:
    
There is insufficient evidence to support or refute the use of inorganic nitrate for any effect on blood pressure at this time .