Health benefits of beetroot supplementation in older adults: A systematic review of blood pressure and functional implications

The global population aged >65 years is increasing, posing challenges for healthcare systems and aging strategies. Beetroot extract (BE), derived from Beta vulgaris, is rich in inorganic nitrate (NO3-), nitrite (NO2-), betalains, and polyphenols, and has been proposed as an intervention to mitigate age-related physiological decline. We conducted a review of PubMed, Web of Science, and Scopus up to April 2025 to evaluate effects of BE supplementation on nitric oxide (NO) bioavailability, blood pressure, and functional outcomes. BE consistently increased NO3- and NO2- concentrations, confirming activation of nitric oxide pathways. Evidence on blood pressure outcomes was heterogeneous: some studies reported acute reductions in systolic pressure (up to -8 mmHg), while others observed no significant changes after short-term interventions. Functional measures including knee extension velocity, maximal power, and post-exercise recovery improved in several studies, even after single doses. Nevertheless, these findings are based on a limited number of small and methodologically heterogeneous trials, restricting comparability and statistical power. BE supplementation may exert modest, short-term effects on vascular and functional outcomes. However, robust cardiovascular benefits, particularly regarding blood pressure, cannot be firmly established because of heterogeneity in study designs, intervention durations, dosing protocols, participant characteristics, and small sample sizes. Furthermore, most trials have been conducted in younger or mixed-age cohorts, with limited evidence in older adults. Therefore, randomized controlled trials in aging populations are required to establish the clinical relevance of BE supplementation. The available evidence is preliminary and hypothesis-generating rather than sufficient to support BE as a strategy for healthy ageing.