ORIGINAL ARTICLE Improvement of hypertension, endothelial function and systemic inflammation following short-term supplementation with red beet (Beta vulgaris L.) juice: a randomized crossover pilot study S Asgary 1 , MR Afshani 2 , A Sahebkar 3,4 , M Keshvari 1 , M Taheri 5 , E Jahanian 6 , M Rafieian-Kopaei 7 , F Malekian 8 and N Sarrafzadegan 1 Hypertension is a major risk factor for cardiovascular disease and has a prevalence of about one billion people worldwide. It has been shown that adherence to a diet rich in fruits and vegetables helps in decreasing blood pressure (BP). This study aimed to investigate the effect of raw beet juice (RBJ) and cooked beet (CB) on BP of hypertensive subjects. In this randomized crossover study, 24 hypertensive subjects aged 25–68 years old were divided into two groups. One group took RBJ for 2 weeks and the other group took CB. After 2 weeks of treatment, both groups had a washout for 2 weeks then switched to the alternate treatment. Each participant consumed 250 ml day - 1 of RBJ or 250 g day - 1 of CB each for a period of 2 weeks. Body weight, BP, flow-mediated dilation (FMD), lipid profile and inflammatory parameters were measured at baseline and after each period. According to the results, high-sensitivity C-reactive protein (hs-CRP) and tumour necrosis factor alpha (TNF-α) were significantly lower and FMD was significantly higher after treatment with RBJ compared with CB (P o0.05). FMD was significantly (P o0.05) increased, but systolic and diastolic BP, intracellular adhesion molecule-1 (ICAM-1), vascular endothelial adhesion molecule-1 (VCAM-1), hs-CRP, interleukin-6, E-selectin and TNF-α were significantly (P o0.05) decreased with RBJ or CB. Total antioxidant capacity was increased and non-high-density lipoprotein (HDL), low-density lipoprotein (LDL) and total cholesterol (TC) were decreased with RBJ but not with CB. Although both forms of beetroot were effective in improving BP, endothelial function and systemic inflammation, the raw beetroot juice had greater antihypertensive effects. Also more improvement was observed in endothelial function and systemic inflammation with RBJ compared with CB. Journal of Human Hypertension (2016) 30, 627–632; doi:10.1038/jhh.2016.34; published online 9 June 2016 INTRODUCTION Hypertension is a major risk factor for cardiovascular disease with a prevalence of about one billion people worldwide. 1 Hyperten- sion is responsible for the mortality of about nine million people every year and accounts for 45 and 51% of deaths due to ischaemic heart disease and stroke, respectively. 2 Application of proper preventive strategies is of paramount importance for controlling the burden of hypertension. It has been shown that adherence to a diet rich in fruits and vegetables helps in decreasing blood pressure (BP). 3 Certain phytochemicals have been shown to induce vasodilation and lower BP. 4–7 Beetroot (Beta Vulgaris L.) belongs to the Chenopodiaceae family and is originally from temperate climate regions. 8 This plant contains biologically active phytochemicals including betalains (for example, betacyanins and betaxanthins), flavonoids, polyphe- nols and dietary nitrate. 9 Dietary nitrate and nitrite serve as a nitric oxide (NO) source. 10 NO has a vital role in the regulation of vascular tone and BP. 11 Cao et al. suggested that nitrite, a known vasodilator, has an indirect effect in promoting vascular NO synthesis. 12,13 Beetroot has a long ethno-pharmacological background in the treatment of tumours of intestine, breast, stomach and uterus. 14 It has been reported that consumption of beet leaf improves antioxidant capacity, reduces lipid peroxidation and enhances glutathione levels. 15,16 Furthermore, Rahimian and Roughani 17 indicated that chard (B. vulgaris subsp. cicla) attenuates contractile responsiveness of vascular system, thereby preventing the development of hypertension in diabetic rats. Although beetroot juice is a rich source of inorganic nitrate, clinical evidence regarding its hypotensive activity is rare. 18 At the present time, beetroot is usually consumed as a cooked form in different cultures and raw beetroot is not consumed as often. Also, the studies on hypotensive effects of beetroot have been focused on raw beetroot. 11,19,20 Therefore, the present study aimed to fulfill this gap by evaluating the hypotensive, anti-inflammatory, endothelial function-improving and lipid-modifying effects of raw beetroot juice (RBJ) and cooked beetroot (CB) in the setting of a randomized crossover trial. 1 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; 2 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; 3 Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 4 Metabolic Research Centre, Royal Perth Hospital, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; 5 Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran; 6 Department of Animal Science, College of Agriculture, Isfahan University of Technology, Isfahan, Iran; 7 Medical Plants Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran and 8 Southern University Agricultural Research and Extension Center, Baton Rouge, LA, USA. Correspondence: M Keshvari, Isfahan Cardiovascular Research Institute, Seddigheh Tahereh Research Building, Khorram Avenue, Jomhoori Islami Sq., PO Box: 81465-1148, Isfahan, Iran. E-mail: Mahtabkeshvari87@yahoo.com Received 7 December 2015; revised 20 April 2016; accepted 22 April 2016; published online 9 June 2016 Journal of Human Hypertension (2016) 30, 627 – 632 © 2016 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0950-9240/16 www.nature.com/jhh