Beetroot Juice and Blood Pressure: What the Evidence Shows

The NHS says high blood pressure is common, especially in older adults, and many people have it without realising it. It does not usually cause symptoms. Left untreated, it raises the risk of heart attacks, strokes, heart failure and kidney disease.

Beetroot juice is sold as a natural way to lower blood pressure and train harder. This guide covers how beetroot is thought to work, what controlled trials found for blood pressure, why a few points matter, what nitrate does for exercise, and how much the trials used. In the trials, daily beetroot juice gave a small drop in blood pressure, and nitrate gave a small gain in some types of exercise.

How beetroot is thought to work

Beetroot juice is rich in nitrate. A 2022 review by Cicero Benjamim and colleagues explains that the body turns nitrate into nitric oxide, a molecule that helps blood vessels relax and widen. Wider vessels lower the pressure your heart pushes against. The trials in that review measured nitrate and nitrite in blood or saliva, and all of them found these levels rose with beetroot juice.

Nitrate might not explain all of the effect. A 2017 review by Zahra Bahadoran and colleagues found that when the placebo was beetroot juice with the nitrate taken out, the gap between groups was smaller. That suggests the placebo juice lowered blood pressure a little on its own. The review also found a smaller effect with juices that had more nitrate per 100 mL. The authors suggested other compounds in beetroot might also play a part.

What the blood pressure trials show

The Bahadoran review pooled 22 randomised trials of beetroot juice and resting blood pressure. Beetroot juice lowered systolic blood pressure, the top number, by 3.55 mmHg (likely range 2.54 to 4.55) and diastolic pressure, the bottom number, by 1.32 mmHg, compared with control groups. Trials of 14 days or longer showed about twice the drop in systolic pressure of shorter trials, at 5.11 mmHg against 2.67 mmHg. Trials using 500 mL of juice a day showed a larger drop than trials using 70 or 140 mL a day, at 4.78 mmHg against 2.37 mmHg.

The Benjamim review looked only at adults with raised blood pressure, defined as readings above 130/80, a lower cut-off than the NHS uses. Across 7 trials with 218 participants, nitrate-rich beetroot products, mostly juice, lowered systolic pressure by 4.95 mmHg. The likely range ran from about 1 to 9 mmHg, and the trials disagreed with each other a fair amount. The review rated the evidence as moderate quality. In 5 trials that tracked blood pressure over 24 hours, the drop was smaller, at 2.68 mmHg, and was not statistically significant, which means it could be due to chance. The drop in diastolic pressure was not significant either.

At least three trials in the review included people already taking blood pressure medication, and the results were mixed. Two found no drop in those patients. One small 7-day trial found a drop in 24-hour blood pressure in people whose blood pressure stayed high despite treatment. The 4.95 mmHg figure might not apply to you if you are on treatment.

Why a few points matter

A drop of 3 to 5 mmHg sounds small. A 2021 analysis in The Lancet, led by Kazem Rahimi, pooled data from 48 randomised drug trials with 344,716 people, followed for a median of about 4 years. Each 5 mmHg drop in systolic pressure lowered the risk of major cardiovascular events, such as heart attack, stroke and heart failure, by about 10%, in people with and without previous heart disease or stroke.

Those trials used blood pressure medication kept up for years, not food, and beetroot juice is not a substitute for prescribed treatment. The trials in the Benjamim review lasted no longer than 60 days, and the beetroot trials here measured blood pressure, not heart attacks or strokes. In our view, the Lancet figure shows why a steady drop of a few mmHg is worth having, if it lasts.

What nitrate does for exercise

Researchers describe effects as trivial, small or moderate based on how much they shift results compared with normal differences between people. In our view, a small effect is one many people would not notice. Statistically significant means a result is unlikely to be due to chance, not that it is large.

A 2017 review by Nicholas McMahon and colleagues in Sports Medicine included 47 studies of dietary nitrate and endurance exercise in healthy adults. Nitrate had a small to moderate effect on time to exhaustion, how long people kept going at a set effort before stopping. Time-trial performance, where people cover a set distance as fast as possible, showed a trivial effect that was not significant. The authors said the best dose, and who benefits most, are still unclear.

For muscular work, a 2022 review by Thiago Alvares and colleagues of 34 studies found a trivial but significant effect on strength and a small, significant effect on muscular endurance. A 2024 review by Jefferson Evangelista and colleagues of 27 studies in healthy men found beetroot supplements gave a modest increase in reps to failure or time to exhaustion. Strength improved when it was measured in tired muscles, but not at rest. In the Evangelista review, nitrate doses ranged from 316 mg to 985 mg a day, taken 2 to 3 hours before exercise.

How much the trials used

In the Benjamim review, the blood pressure trials used between 70 mL and 250 mL of juice a day, carrying between 6.2 and 12.8 mmol (millimoles) of nitrate a day, with most trials between 6.2 and 7.5 mmol. By our calculation, that is between about 385 mg and 795 mg (milligrams) of nitrate, with most trials between about 385 mg and 465 mg. In the Bahadoran review, 500 mL a day showed a larger drop than 70 or 140 mL. As noted above, juices with more nitrate per 100 mL showed a smaller effect, so no source here shows that a higher-nitrate product works better.

Most of the trials in the Benjamim review asked participants not to use mouthwash during the study, and the review rated trials that did not as at higher risk of bias. The review does not explain the reason. If you want to copy the trials, skip mouthwash while you take beetroot juice.

How to put it into practice

These steps are ours, built from the trials above.

Common mistakes

These are our views, based on the trials above.

• •Expecting a large drop. The average drop in the trials was a few mmHg.
• •Expecting the full effect after a few days. Trials of 14 days or longer showed about twice the drop of shorter trials.
• •Treating beetroot as a replacement for the basics. Less salt, more vegetables, regular exercise and steady sleep come first, and beetroot is an add-on after those.

Frequently asked questions

The bottom line

Across 22 trials, beetroot juice lowered systolic blood pressure by 3.55 mmHg on average, and by 4.95 mmHg in adults with raised blood pressure, with a wide likely range. The drops were larger in longer trials and with larger daily amounts of juice, and results in people on medication were mixed. For exercise, the reviews found small gains in how long people held an effort and in muscular endurance, and little or no change in time-trial performance. In our view, daily beetroot juice at the trial amounts is a reasonable add-on to low salt, more vegetables, regular exercise and good sleep, not a replacement for them or for medication.

Related reading

• •The DASH (Dietary Approaches to Stop Hypertension) diet
• •Potassium and blood pressure
• •Japanese walking and blood pressure
• •Caffeine for exercise: dose and timing

Sources

• •Bahadoran Z, Mirmiran P, Kabir A, Azizi F, Ghasemi A. The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis. Advances in Nutrition 2017. pubmed.ncbi.nlm.nih.gov/29141968
• •Benjamim CJR, Porto AA, Valenti VE, et al. Nitrate Derived From Beetroot Juice Lowers Blood Pressure in Patients With Arterial Hypertension: A Systematic Review and Meta-Analysis. Frontiers in Nutrition 2022. pubmed.ncbi.nlm.nih.gov/35369064
• •Rahimi K, Bidel Z, Nazarzadeh M, et al. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. The Lancet 2021. pubmed.ncbi.nlm.nih.gov/33933205
• •McMahon NF, Leveritt MD, Pavey TG. The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis. Sports Medicine 2017. pubmed.ncbi.nlm.nih.gov/27600147
• •Alvares TS, Oliveira GV, Volino-Souza M, Conte-Junior CA, Murias JM. Effect of dietary nitrate ingestion on muscular performance: a systematic review and meta-analysis of randomized controlled trials. Critical Reviews in Food Science and Nutrition 2022. pubmed.ncbi.nlm.nih.gov/33554654
• •Evangelista JF, Meirelles CM, Aguiar GS, Alves R, Matsuura C. Effects of Beetroot-Based Supplements on Muscular Endurance and Strength in Healthy Male Individuals: A Systematic Review and Meta-Analysis. Journal of the American Nutrition Association 2024. pubmed.ncbi.nlm.nih.gov/37167368
• •NHS. High blood pressure (hypertension). nhs.uk/conditions/high-blood-pressure