Association of urinary nitrate with blood pressure and cardiovascular outcomes in hypertensive population

Abstract

Aim: The protective effects of inorganic nitrate in hypertensive patients remain uncertain. Therefore, this study investigated the associations of urinary nitrate with blood pressure, the prevalence of cardiovascular disease (CVD), and cardiovascular mortality among the hypertensive population.

Methods: A total of 6,130 hypertensive adults from the 2005-2014 NHANES (The National Health and Nutrition Examination Survey) were included. Piecewise linear regression, logistic regression, and Cox proportional hazards regression models were performed to evaluate the associations of urinary nitrate with blood pressure, CVD prevalence, and cardiovascular mortality, respectively. Mediation and subgroup analyses were further conducted to explore the potential mechanisms and the consistency of the association between urinary nitrate and cardiovascular mortality.

Results: Within the range of 0-4.40 mg/dL, an inverse linear correlation between urinary nitrate and systolic blood pressure (SBP) was observed [β = -0.60; 95% confidence interval (95%CI): -0.99 to -0.21; P < 0.001]. Higher urinary nitrate levels were associated with a reduced prevalence of heart failure [odds ratio (OR): 0.942; 95%CI: 0.905 to 0.981; P = 0.004] and lower cardiovascular mortality [hazard ratio (HR): 0.921; 95%CI, 0.867 to 0.977; P = 0.006]. Mediation analyses indicated that neither SBP nor baseline heart failure mediated the association between urinary nitrate and cardiovascular mortality. Subgroup analyses showed that the inverse association between urinary nitrate and cardiovascular mortality was modified by the presence of coronary heart disease.

Conclusion: Among hypertensive individuals, higher urinary nitrate levels were associated with lower SBP, heart failure prevalence, and cardiovascular mortality. These findings suggest that urinary nitrate may serve as a potential biomarker for cardiovascular risk stratification.

Keywords

Urinary nitrate / blood pressure / cardiovascular mortality / hypertension / NHANES

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