Oral nitrate supplementation improves cardiovascular risk markers in COPD: ON-BC, a randomised controlled trial

Background Short-term studies suggest that dietary nitrate (NO 3 − ) supplementation may improve the cardiovascular risk profile, lowering blood pressure (BP) and enhancing endothelial function. It is not clear if these beneficial effects are sustained and whether they apply in people with COPD, who have a worse cardiovascular profile than those without COPD. Nitrate-rich beetroot juice (NR-BRJ) is a convenient dietary source of nitrate. Methods The ON-BC trial was a randomised, double-blind, placebo-controlled parallel group study in stable COPD patients with home systolic BP (SBP) measurement ≥130 mmHg. Participants were randomly allocated (1:1) using computer-generated, block randomisation to either 70 mL NR-BRJ (400 mg NO 3 − ) (n=40) or an otherwise identical nitrate-depleted placebo juice (0 mg NO 3 − ) (n=41), once daily for 12 weeks. The primary end-point was between-group change in home SBP measurement. Secondary outcomes included change in 6-min walk distance (6MWD) and measures of endothelial function (reactive hyperaemia index (RHI) and augmentation index normalised to a heart rate of 75 beats·min −1 (AIx75)) using an EndoPAT device. Plasma nitrate and platelet function were also measured. Results Compared with placebo, active treatment lowered SBP (Hodges–Lehmann treatment effect −4.5 (95% CI −5.9– −3.0) mmHg), and improved 6MWD (30.0 (95% CI 15.7–44.2) m; p<0.001), RHI (0.34 (95% CI 0.03–0.63); p=0.03) and AIx75 (−7.61% (95% CI −14.3– −0.95%); p=0.026). Conclusions In people with COPD, prolonged dietary nitrate supplementation in the form of beetroot juice produces a sustained reduction in BP, associated with an improvement in endothelial function and exercise capacity.