Dietary nitrate prevents progression of carotid subclinical atherosclerosis through blood pressure-independent mechanisms in patients with or at risk of type 2 diabetes mellitus

Franca Morselli, Luca Faconti, Charlotte E. Mills, Steven Morant, Philip J. Chowienczyk, Joshua Au Yeung, Alessandro Cavarape, J. Kennedy Cruickshank, Andrew J. Webb (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

2 Downloads (Pure)

Abstract

Aims: To test if 6 months' intervention with dietary nitrate and spironolactone could affect carotid subclinical atherosclerosis and stiffness, respectively, vs. placebo/doxazosin, to control for blood pressure (BP).

Methods: A subgroup of participants in our double-blind, randomized-controlled, factorial VaSera trial had carotid imaging. Patients with hypertension and with/at risk of type 2 diabetes were randomized to active nitrate-containing beetroot juice or placebo nitrate-depleted juice, and spironolactone or doxazosin. Vascular ultrasound for carotid diameter (CD, mm) and intima–media thickness (CIMT, mm) was performed at baseline, 3- and 6-months. Carotid local stiffness (CS, m/s) was estimated from aortic pulse pressure (Arteriograph) and carotid lumen area. Data were analysed by modified intention to treat and using mixed-model effect, adjusted for confounders.

Results: In total, 93 subjects had a baseline evaluation and 86% had follow-up data. No statistical interactions occurred between the juice and drug arms and BP was similar between the juices and between the drugs. Nitrate-containing vs. placebo juice significantly lowered CIMT (−0.06 [95% confidence interval −0.12, −0.01], P =.034), an overall difference of ~8% relative to baseline; but had no effect on CD or CS. Doxazosin appeared to reduce CS from baseline (−0.34 [−0.62, −0.06]) however, no difference was detected vs. spironolactone (−0.15 [−0.46, 0.16]). No differences were detected between spironolactone or doxazosin on CIMT and CD.

Conclusions: Our results show that 6 months' intervention with dietary nitrate influences vascular remodelling, but not carotid stiffness or diameter. Neither spironolactone nor doxazosin had a BP-independent effect on carotid structure and function.

Original languageEnglish
Number of pages11
JournalBritish Journal of Clinical Pharmacology
Early online date13 May 2021
DOIs
Publication statusE-pub ahead of print - 13 May 2021

Keywords

  • beetroot juice
  • dietary nitrate
  • blood pressure
  • intima media thickness
  • carotid
  • arterial stiffness
  • Pharmacology (medical)
  • Pharmacology

Fingerprint

Dive into the research topics of 'Dietary nitrate prevents progression of carotid subclinical atherosclerosis through blood pressure-independent mechanisms in patients with or at risk of type 2 diabetes mellitus'. Together they form a unique fingerprint.

Cite this