The Effects of Chronic Nitrate Supplementation and the Use of Strong and Weak Antibacterial Agents on Plasma Nitrite Concentration and Exercise Blood Pressure.

Chlorhexidine-containing mouthwash (STRONG), which disturbs oral microflora, has been shown to diminish the rise in plasma nitrite concentration ([NO2-]) and attenuate the reduction in resting blood pressure (BP) typically seen after acute nitrate (NO3-) ingestion. We aimed to determine whether STRONG and weaker antiseptic agents attenuate the physiological effects of chronic NO3- supplementation using beetroot juice (BR). 12 healthy volunteers mouth-rinsed with STRONG, non-chlorhexidine mouthwash (WEAK) and deionised water (CON) 3 times a day, and ingested 70 mL BR (6.2 mmol NO3-), twice a day, for 6 days. BP (at rest and during 10 min of treadmill walking) and plasma and salivary [NO3-] and [NO2-] were measured prior to and on day 6 of supplementation. The change in salivary [NO3-] 4 h post final ingestion was higher (P<0.05) in STRONG (8.7±3.0 mM) compared to CON (6.3±0.9 mM) and WEAK (6.0±3.0 mM). In addition, the rise in plasma [NO2-] at 2 h was lower in STRONG compared with WEAK (by 89±112 nM) and CON (by 200±174 nM) and in WEAK compared with CON (all P<0.05). Changes in resting BP were not different between conditions (P>0.05). However, during treadmill walking, the increase in systolic and mean arterial BP was higher 4 h after the final nitrate bolus in STRONG compared with CON (P<0.05) but not WEAK. The results indicate that both strong and weak antibacterial agents suppress the rise in plasma [NO2-] observed following the consumption of a high NO3- diet and the former can influence the BP response during low-intensity exercise.

Do the right thing. When it comes to your community, do you know what that is? Roundtable discussion.

What is the health care organization's responsibility to maintaining a healthy community, and how does the board fit into that role? Has the field's understandable fixation on costs and the penetration of managed care into most markets affected that role? Leaders of both for-profit and not-for-profit organizations often believe that they are fulfilling their community obligations as long as they provide uncompensated care to the indigent and the uninsured. But is that really being accountable to the community? And if it's not, then what is community accountability? The American Hospital Association's Division of Trustee Leadership and Trustee magazine posed these questions to 13 health care and community leaders last December. Their different perspectives provide for some surprising answers.