February is Heart Health Month
Follow Along for a Better Understanding of Nitric Oxide, Blood Pressure, and Vessel Health.
Cardiovascular disease remains the leading cause of death for both men and women in the United States, driven largely by uncontrolled blood pressure and damage to the blood vessel lining. Nitric oxide, a substance the body makes to help blood vessels relax and blood flow more easily, can be supported through food or supplements, offering a promising way to help address both. To understand why nitric oxide matters, it helps to first look at how blood pressure is defined, and how common hypertension really is.
BLOOD PRESSURE BASICS
Hypertension is defined as blood pressure that is consistently at or above 130/80, according to current American College of Cardiology/American Heart Association guidelines. While 140/90 and higher is often used as a treatment threshold in clinical practice, lower readings can still signal increased risk. What was once called “prehypertension,” now often referred to as elevated blood pressure, includes readings between 120–129 systolic or 80–89 diastolic. Nearly half of U.S. adults have hypertension, and many more fall into this elevated range, yet fewer than half have it adequately controlled. That means many friends, neighbors, and relatives are walking around with a silent, but very real strain on their hearts and blood vessels.
ENDOTHELIAL DAMAGE AND EVENTS
The endothelium is the thin inner lining of every blood vessel and plays a key role in how vessels relax, clot, and respond to inflammation. When this lining becomes damaged, cholesterol-rich plaque and inflammatory cells can build up, increasing the risk of blood clots that block coronary arteries (leading to heart attack) or arteries supplying the brain (causing stroke).
Each year in the United States, roughly 800,000 people experience a stroke, and hundreds of thousands more have a heart attack, reflecting the enormous impact of endothelial injury and plaque buildup. While these events often occur suddenly, the underlying lining damage and plaque buildup typically develop slowly over many years.
WHAT NITRIC OXIDE DOES
Over the last four decades, research has shown that nitric oxide is a crucial chemical messenger for a healthy cardiovascular system. It helps blood vessels relax, supports healthy blood flow, and plays a role in blood clotting and inflammation along the vessel wall.
The body produces nitric oxide in two main ways: through an enzyme system called nitric oxide synthase and through converting dietary nitrate from foods like leafy greens and beets into nitric oxide. As we age, the body’s natural production of nitric oxide declines, making diet and lifestyle choices increasingly important for maintaining healthy levels.
BLOOD PRESSURE AND NITRATE
Nitric oxide helps regulate how tight or relaxed blood vessels are, and higher availability, either from the body’s own production or from dietary nitrate, has been linked to lower blood pressure in multiple studies. In both animal studies and human trials, nitrate-rich beetroot juice and similar dietary intervention have been shown to reduce systolic blood pressure by approximately 4–10 mmHg, with smaller effects on diastolic pressure.
In older adults and in people with hypertension or peripheral artery disease, daily beetroot juice providing roughly 350–500 mg of nitrate has been associated in some trials with meaningful reductions in blood pressure, as well as improvements in blood vessel function. In certain hypertensive groups, systolic reduction of 4–8 mmHg has been observed, similar to what may be seen with a single blood pressure medication, suggesting dietary nitrate could be a useful complementary strategy when used alongside standard care and under medical supervision.
ENDOTHELIAL AND MUSCLE BENEFITS
Nitric oxide also helps protect the endothelium, or inner lining of blood vessels, by reducing unwanted clotting, limiting inflammation, and supporting normal muscle relaxation within the vessel wall. In one clinical trial, a single serving of nitrate-rich beetroot juice lowered blood pressure and helped preserve healthy vessel relaxation.
Beyond blood vessels, some studies suggest that dietary nitrate can reduce the amount of oxygen muscles need during exercise, improving efficiency and potentially placing less strain on the heart at a given workload. Other research suggests that nitrate may improve the strength and efficiency of both heart and skeletal muscle by activating chemical signals that help muscle cells perform better.
PRACTICAL FOOD AND SUPPLEMENT CHOICES
Common nitrate-rich vegetables include leafy greens such as arugula, spinach, collard greens, and various lettuces, along with celery, red beets, leeks, chervil, and watercress. The DASH (Dietary Approaches to Stop Hypertension) eating pattern, which emphasizes whole fruits and vegetables, typically provides about 1,000–1,200 mg of nitrate per day when followed as designed and has long been associated with lower blood pressure.
For those who prefer a more concentrated option, beetroot juice or beetroot concentrates, including commercially available powdered beet products such as Super Beets by HumanN, often provide 300–800 mg of nitrate per serving, amounts commonly used in clinical research and generally well tolerated in healthy adults. Because nitrate can interact with certain medications and medical conditions, and because individual responses vary, it’s important to discuss any nitrate supplement plan with a personal physician before starting.
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Dr. Kendall D. Wagner, MD is a board-certified physician with expertise in lifestyle and functional medicine. He is a regular contributor to Do South. These articles are for educational purposes only and do not constitute medical advice or establish a physician–patient relationship.
