Beet Chews for Blood Pressure Management
Beet chews (beetroot supplements) are not recommended as a primary intervention for blood pressure control, as major cardiovascular guidelines categorize them among interventions that are "insufficiently proved" for blood pressure management. 1
Guideline-Recommended First-Line Interventions
The 2024 ESC Guidelines and ACC/AHA prioritize proven dietary interventions that should be implemented before or alongside any consideration of beetroot supplements: 2
- DASH diet: Reduces systolic BP by 8-14 mmHg 1, 3
- Sodium restriction to <5-6 g/day: Lowers systolic BP by 4-5 mmHg 2, 1
- Weight loss: Achieves 5-20 mmHg reduction per 10 kg lost if BMI >25 kg/m² 2
- Regular aerobic exercise ≥150 min/week: Decreases BP by 4-9 mmHg 1
- Alcohol moderation: Reduces BP by 2-4 mmHg 2
Evidence for Beetroot Supplements
While guidelines don't endorse beetroot products, research trials show modest effects:
- Systolic BP reduction: Beetroot juice (containing 200-800 mg nitrate daily) may reduce systolic BP by approximately 5.3 mmHg in hypertensive individuals 4
- Diastolic BP: No significant effect demonstrated 4
- Duration: Effects appear sustained over 4 weeks without tolerance development 5
- Population-specific effects: Greater benefits observed in patients with uncontrolled hypertension compared to those with controlled BP 6, 7
Clinical Application Algorithm
For patients with elevated BP or hypertension, follow this approach: 2, 1
Stage 2 hypertension (≥140/90 mmHg): Initiate pharmacotherapy immediately (ACE inhibitors, ARBs, dihydropyridine CCBs, or thiazide/thiazide-like diuretics) targeting BP 120-129/<80 mmHg 2
Stage 1 hypertension or prehypertension: Implement proven lifestyle modifications first (DASH diet, sodium restriction, weight loss, exercise) 2
Adjunctive consideration only: Beetroot supplements may be considered as an adjunct to—never a replacement for—proven interventions in motivated patients with uncontrolled hypertension already on lifestyle modifications 1, 3
Critical Safety Warnings
Patients on antihypertensive medications must consult their healthcare provider before adding beetroot supplements due to potential additive BP-lowering effects that could cause symptomatic hypotension. 1, 3
- Chronic kidney disease patients: Exercise caution with high-nitrate supplements due to potential potassium content and impaired nitrate metabolism 1
- Never delay pharmacotherapy: Beetroot supplements should never delay or replace indicated antihypertensive medication in patients with stage 2 hypertension or cardiovascular risk factors requiring drug treatment 1
Key Limitations
The certainty of evidence for beetroot products remains low with moderate-to-high heterogeneity across studies, and no major cardiovascular guideline recommends them as standard therapy. 4 The magnitude of effect (5 mmHg systolic reduction) is substantially less than proven interventions like the DASH diet (8-14 mmHg reduction). 1, 3
Bottom line: Prioritize guideline-recommended dietary patterns (DASH diet, sodium restriction, weight management) and pharmacotherapy when indicated, rather than relying on beetroot chews for blood pressure control. 2