Eating a little more nitrate-rich food each day—like spinach or beets—might help your arteries bounce back better from heartbeats, lowering the pressure in your main arteries and making your heart work a bit less hard.

A double-blind, placebo-controlled RCT in healthy adults and hypertensive individuals (n=150), where participants receive daily dietary nitrate supplementation (1 mmol/day) via beetroot juice or placebo for 8 weeks, with augmentation index, central arterial pressure, and cardiac workload measured via pulse wave analysis and echocardiography at baseline, 4 weeks, and 8 weeks.

A prospective cohort study tracking 500 adults over 6 months, measuring habitual dietary nitrate intake via validated food frequency questionnaires and 24-hour dietary recalls, with augmentation index and central arterial pressure assessed at baseline and 6 months, analyzing whether each 1 mmol/day increase in nitrate intake correlates with a 0.57% AI reduction after adjusting for age, BMI, sodium, and physical activity.

A crossover trial in 30 normotensive adults where each participant receives 1 mmol/day dietary nitrate (beetroot juice) and placebo in randomized order for 2 weeks each, with a 1-week washout, measuring augmentation index and central arterial pressure at the end of each phase to detect within-person changes attributable to nitrate intake.

A small mechanistic study in 20 healthy volunteers receiving 1 mmol/day nitrate for 7 days, measuring plasma nitrite/nitrate, vascular nitric oxide production (via flow-mediated dilation), arterial stiffness (pulse wave velocity), and cardiac workload (echocardiographic strain), to test whether nitrate-induced NO elevation mediates the observed AI reduction.

An observational study analyzing NHANES or similar population data to compare augmentation index across quartiles of dietary nitrate intake, testing whether individuals in the highest quartile (≥1 mmol/day) have a 0.57% lower AI than those in the lowest, after adjusting for confounders.