If you have early high blood pressure and eat a lot of salt, the good effects of eating nitrate-rich foods (like beets or spinach) on lowering blood pressure might be hidden — because too much salt could be canceling them out.

In individuals with early-stage hypertension, participants would be randomized to receive high-sodium (≥3,900 mg/day) and low-sodium (<1,500 mg/day) diets in two 4-week phases, with dietary nitrate supplementation (e.g., 6.2 mmol/day from beetroot juice) administered in both phases. Blood pressure would be measured at baseline and end of each phase. The primary outcome is the difference in systolic/diastolic BP reduction between low-sodium + nitrate vs. high-sodium + nitrate conditions.

Two groups of individuals with early-stage hypertension would be assigned to identical dietary nitrate supplementation (e.g., 6.2 mmol/day) but differ in sodium intake: one group on high sodium (mean 3,937 mg/day), the other on low sodium (<1,500 mg/day). Blood pressure would be measured at baseline and after 6 weeks. The primary outcome is the difference in BP reduction between the two groups, with urinary sodium excretion used to confirm adherence.

A prospective cohort of individuals with early-stage hypertension would be followed for 12 weeks with repeated 24-hour dietary recalls and urinary sodium excretion measurements. Dietary nitrate intake would be quantified via food diaries and biomarkers. The primary outcome is the association between urinary sodium excretion levels and the magnitude of systolic BP reduction attributable to dietary nitrate intake, adjusting for confounders.

Within a subset of participants from the RCT above, plasma nitrite, cGMP, and endothelial function (flow-mediated dilation) would be measured during high- and low-sodium phases with nitrate supplementation. The goal is to determine whether high sodium blunts nitrate-derived nitric oxide bioavailability, providing a biological mechanism for the observed BP effect.