Dietary nitrate supplementation enhances exercise capacity in WHO Group 3 pulmonary hypertension: a double-blind, placebo-controlled, randomised crossover study (EDEN-OX2)

Abdullah S Alsulayyim; Ali M Alasmari; Laura C Price; Colm McCabe; Saeed M Alghamdi; Keir Elmslie James Philip; Sara C Buttery; Matthew J Pavitt; Michael I Polkey; Matthew J Rickman; Blerina Ahmetaj-Shala; Jane A Mitchell; Rami A Alyami; Nicholas S Hopkinson

doi:10.1136/thorax-2024-222019

Dietary nitrate supplementation enhances exercise capacity in WHO Group 3 pulmonary hypertension: a double-blind, placebo-controlled, randomised crossover study (EDEN-OX2)

Thorax. 2025 Apr 15;80(5):335-338. doi: 10.1136/thorax-2024-222019.

Authors

Abdullah S Alsulayyim^{1

2}, Ali M Alasmari^{1

3}, Laura C Price^{1

4}, Colm McCabe⁵, Saeed M Alghamdi^{1

6}, Keir Elmslie James Philip¹, Sara C Buttery^{1

7}, Matthew J Pavitt⁸, Michael I Polkey⁸, Matthew J Rickman¹, Blerina Ahmetaj-Shala¹, Jane A Mitchell¹, Rami A Alyami⁹, Nicholas S Hopkinson¹⁰

Affiliations

¹ National Heart and Lung Institute, Imperial College London, London, UK.
² Respiratory Therapy Department, Jazan University, Jazan, Saudi Arabia.
³ College of Medical Rehabilitation, Taibah University, Madinah, Al Madinah, Saudi Arabia.
⁴ National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
⁵ Royal Brompton and Harefield NHS Foundation Trust, London, UK.
⁶ Clinical Technology Department, Umm Al-Qura University, Makkah, Saudi Arabia.
⁷ South London Healthcare NHS Trust, London, UK.
⁸ NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.
⁹ Respiratory Therapy Program, Jazan University College of Nursing and Health Sciences, Jazan, Saudi Arabia.
¹⁰ National Heart and Lung Institute, Imperial College London, London, UK n.hopkinson@ic.ac.uk.

PMID: 39922710
DOI: 10.1136/thorax-2024-222019

Abstract

Dietary nitrate supplementation, which improves skeletal muscle oxygen utilisation, vascular endothelial function and exercise capacity in people with chronic obstructive pulmonary disease, may benefit other lung conditions. In a double-blind, placebo-controlled, crossover study, in 19 adults with Group 3 pulmonary hypertension who desaturated during exercise, 140 mL of nitrate-rich beetroot juice improved endurance shuttle walk time compared with nitrate-depleted beetroot juice placebo (median (IQR) ESWT NR-BRJ 197 (140-273) s vs PL-BRJ 174 (107-229) s; median difference (MD) (95% CI) 30 (6.19 to 91.07) s, p=0.0281), endothelial function, flow-mediated dilatation (+3.40±5.47% vs -1.33±4.78; MD (95% CI) 4.73 (1.44 to 8.02), p=0.007) and lowered mean arterial blood pressure (-3.9 (-7.4 to -0.4) mm Hg, p=0.028).

Keywords: Ambulatory Oxygen Therapy; Dietary Intake; Exercise; Hypoxia; Long Term Oxygen Therapy (LTOT); Pulmonary Rehabilitation; Respiratory Muscles.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Beta vulgaris
Cross-Over Studies
Dietary Supplements*
Double-Blind Method
Exercise Tolerance* / drug effects
Exercise Tolerance* / physiology
Female
Fruit and Vegetable Juices
Humans
Hypertension, Pulmonary* / diet therapy
Hypertension, Pulmonary* / drug therapy
Hypertension, Pulmonary* / physiopathology
Male
Middle Aged
Nitrates* / administration & dosage
Treatment Outcome

Substances

Nitrates