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

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Dietary nitrate supplementation enhances exercise capacity in WHO Group 3 pulmonary hypertension: a double-blind, placebo-controlled, randomised crossover study (EDEN-OX2)
  1. Abdullah S Alsulayyim1,2,
  2. Ali M Alasmari1,3,
  3. Laura C Price1,4,
  4. Colm McCabe5,
  5. Saeed M Alghamdi1,6,
  6. Keir Elmslie James Philip1,
  7. Sara C Buttery1,7,
  8. Matthew J Pavitt8,
  9. Michael I Polkey8,
  10. Matthew J Rickman1,
  11. Blerina Ahmetaj-Shala1,
  12. Jane A Mitchell1,
  13. Rami A Alyami9,
  14. Nicholas S Hopkinson1
  1. 1 National Heart and Lung Institute, Imperial College London, London, UK
  2. 2 Respiratory Therapy Department, Jazan University, Jazan, Saudi Arabia
  3. 3 College of Medical Rehabilitation, Taibah University, Madinah, Al Madinah, Saudi Arabia
  4. 4 National Pulmonary Hypertension Service, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  5. 5 Royal Brompton and Harefield NHS Foundation Trust, London, UK
  6. 6 Clinical Technology Department, Umm Al-Qura University, Makkah, Saudi Arabia
  7. 7 South London Healthcare NHS Trust, London, UK
  8. 8 NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
  9. 9 Respiratory Therapy Program, Jazan University College of Nursing and Health Sciences, Jazan, Saudi Arabia
  1. Correspondence to Professor Nicholas S Hopkinson; n.hopkinson@ic.ac.uk

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).

  • Exercise
  • Long Term Oxygen Therapy (LTOT)
  • Hypoxia
  • Dietary Intake
  • Ambulatory Oxygen Therapy
  • Pulmonary Rehabilitation
  • Respiratory Muscles

Data availability statement

Individual participant data that underlie the results in the article, after de-identification (text, tables, figures and appendices) will be made available from the corresponding author upon request, as well as the study protocol. Data will be made immediately available to anyone who wishes to access the data, for any purpose, following publication. Data will be available indefinitely.

https://doi.org/10.1136/thorax-2024-222019

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    Data availability statement

    Individual participant data that underlie the results in the article, after de-identification (text, tables, figures and appendices) will be made available from the corresponding author upon request, as well as the study protocol. Data will be made immediately available to anyone who wishes to access the data, for any purpose, following publication. Data will be available indefinitely.

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    Footnotes

    • X @pulmvasculardoc, @saeedmordy, @keirphilip, @DrMattPav, @RamiAlyamii, @COPDdoc

    • Contributors NSH and MIP developed the original idea for the research study and wrote the study protocol. ASA, SCB, AMA, SMA, KEJP and MJP planned and undertook patient visits and collected trial data. MJR, ASA and BAS undertook lab analyses. ASA and RAA analysed the data and ASA wrote the first draft of the manuscript. All authors edited and contributed to the final manuscript. NSH is the guarantor. The work presented here was included in ASA’s PhD thesis (https://spiral.imperial.ac.uk/handle/10044/1/102673).

    • Funding The study was funded by a grant from the Moulton Charitable Foundation and the Saudi Arabia Cultural Bureau. The funders played no role in the conduct or analysis of this study.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Author note Professor Hopkinson affirms that this manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.