DASH Diet, Dietary Nitrate, and Nitric Oxide Bioavailability: Implications for Endothelial Dysfunction and Hypertension in Older Adults
Ruhui Zhong, Yuxin Guo, Xinyi You, Junjie Fu, Jingyi Liu, Yuxi Wen, Jiahui Wen, Chao ZhaoABSTRACT
Hypertension in the elderly is closely associated with vascular aging, characterized by endothelial dysfunction (ED) and a progressive decline in nitric oxide (NO) bioavailability. Age‐related dysfunction of endothelial nitric oxide synthase (eNOS), compounded by increased oxidative stress, creates a vicious cycle of oxidative–nitrosative imbalance, leading to chronic inflammation and arterial stiffness. The Dietary Approaches to Stop Hypertension (DASH) diet was developed as a primary intervention to restore NO balance by protecting endogenous pathways and supplying alternative nitrate–nitrite–NO precursors. However, its cardiovascular benefits are often diminished by age‐related alterations in nitrate metabolism and the extensive use of multiple medications in the elderly. Thus, while restoring balance remains a key therapeutic goal, future clinical strategies must evolve from broad dietary recommendations to more personalized, precise nutritional approaches, considering the unique physiological and pharmacological challenges faced by older adults.