Beetroot is not contraindicated with lisinopril, and most people taking the medication can eat beets or drink beetroot juice without harm. The real concern is that both beetroot and lisinopril lower blood pressure through different pathways, and combining them could push your pressure lower than intended. That additive effect is worth understanding, especially if your blood pressure is already well controlled or on the low side. A few other interactions deserve attention too, including potassium levels and kidney stone risk.
Why Both Lower Blood Pressure, but in Different Ways
Lisinopril belongs to a class of drugs called ACE inhibitors. It works by blocking an enzyme that produces angiotensin II, a hormone that tightens blood vessels and signals your kidneys to retain sodium. With less angiotensin II around, blood vessels relax and fluid volume drops, bringing blood pressure down.1PubMed. The clinical pharmacology of lisinopril It also reduces aldosterone, a hormone that drives potassium excretion, which is why ACE inhibitors tend to raise potassium levels in the blood.
Beetroot lowers blood pressure through an entirely separate route. Beets are rich in inorganic nitrate, which your body converts into nitric oxide (NO) after you eat them.2PubMed. The benefits and risks of beetroot juice consumption: a systematic review Nitric oxide is a signaling molecule that tells smooth muscle in artery walls to relax, widening the vessels. This vasodilatory effect reduces the resistance your heart pumps against, which lowers blood pressure and improves blood flow to organs.3PubMed Central. The potential benefits of red beetroot supplementation in health and disease Dietary nitrate, found abundantly in beetroot and leafy greens, is now recognized as an important natural source of NO through what researchers call the nitrate-nitrite-NO pathway.4PubMed Central. It is rocket science – why dietary nitrate is hard to ‘beet’! Part I: twists and turns in the realization of the nitrate-nitrite-NO pathway
Because these two mechanisms are independent, their blood-pressure-lowering effects can stack. Lisinopril is working on the hormonal side (less angiotensin II, less aldosterone, less fluid retention), while beetroot is working on the vascular side (more nitric oxide, wider blood vessels). Neither one cancels the other out. For someone whose blood pressure is still too high on medication alone, that stacking might actually be welcome. For someone whose pressure is already close to normal, it raises the question of whether the combined drop could go too far.
How Much Blood Pressure Drop Beetroot Actually Produces
The effect of beetroot juice on blood pressure is real but modest. A meta-analysis of eleven trials involving people with hypertension found that beetroot juice lowered systolic blood pressure by about 5 mmHg compared with placebo.5ScienceDirect (Elsevier) / Nutrition, Metabolism and Cardiovascular Diseases. Effects of beetroot juice on blood pressure in hypertension according to European Society of Hypertension Guidelines: A systematic review and meta-analysis The effect on diastolic blood pressure was not statistically significant in that analysis, and the results across studies were fairly variable. A 5-point systolic drop is meaningful in population health terms but is unlikely to cause a dangerous plunge on its own in most people.
For context, lisinopril at a standard dose typically lowers systolic pressure by roughly 10 to 15 points, depending on the person and the dose. Adding a 5-point reduction from beetroot juice on top of that is noticeable but not dramatic for most people. The risk of going too low is highest in people who are on multiple blood pressure medications, who are dehydrated, who have low blood pressure at baseline, or who are elderly and prone to orthostatic hypotension (feeling lightheaded when standing up). If you fall into any of those categories, talking to your doctor before adding regular beetroot juice is a good idea.
Importantly, the blood-pressure-lowering effect of beetroot appears dose-related, meaning a glass of concentrated beetroot juice will have a much bigger impact than eating a few slices of roasted beet in a salad.6British Journal of Clinical Pharmacology. Nutraceuticals with a clinically detectable blood pressure-lowering effect: a review of available randomized clinical trials and their meta-analyses The concentrated “shots” marketed to athletes pack far more nitrate than a typical serving of whole beets. If you are eating beets as a normal part of your diet, the effect is mild. If you are downing concentrated beetroot juice daily as a supplement, the blood pressure interaction becomes more relevant.
The Potassium Question
This is the less-discussed but potentially more important concern. ACE inhibitors like lisinopril reduce your kidneys’ ability to excrete potassium, which means potassium levels can creep upward in some people taking the drug. In most cases, this slight rise is harmless and even beneficial. But when potassium climbs too high, a condition called hyperkalemia, it can cause dangerous heart rhythm problems.7PubMed. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
Beetroot is a moderately potassium-rich food. A cup of raw beets contains roughly 440 mg of potassium, and concentrated beetroot juice can deliver more in a smaller volume. For someone whose potassium levels are normal and whose kidneys function well, this is unlikely to push the needle into dangerous territory. But if you already have borderline-high potassium, impaired kidney function, or are taking other medications that raise potassium (certain diuretics, potassium supplements, or other drugs acting on the renin-angiotensin system), the added potassium from heavy beetroot consumption could matter.
The practical takeaway is straightforward: if your doctor checks your potassium levels as part of routine bloodwork while you are on lisinopril (and they should), and those levels are normal, moderate beetroot intake is unlikely to cause trouble. If your potassium has been flagged as elevated, go easy on high-potassium foods including beets, and mention your beetroot habits at your next appointment.
Vascular Benefits Beyond Blood Pressure
One reason some people on blood pressure medication are drawn to beetroot in the first place is that its cardiovascular benefits extend beyond simple blood pressure reduction. Research has found that beetroot nitrate supplementation improves endothelial function, meaning the lining of your blood vessels responds better and more flexibly to changes in blood flow. A meta-analysis of randomized trials found that beetroot supplementation significantly increased flow-mediated dilation (a measure of how well arteries relax in response to blood flow) and reduced arterial stiffness.8Nitric Oxide. The effect of beetroot inorganic nitrate supplementation on cardiovascular risk factors: A systematic review and meta-regression of randomized controlled trials
A pilot crossover study in people with hypertension reported similar findings: beetroot juice improved endothelial function and reduced markers of systemic inflammation, including C-reactive protein and TNF-alpha.9PubMed. Improvement of hypertension, endothelial function and systemic inflammation following short-term supplementation with red beet (Beta vulgaris L.) juice: a randomized crossover pilot study That study also found that raw beetroot juice had greater effects than cooked beet, which makes sense given that cooking and processing can reduce nitrate content.
These vascular benefits could, in theory, complement what lisinopril is already doing. ACE inhibitors themselves have some antioxidant and endothelial-protective effects through mechanisms like reducing oxidative stress and improving nitric oxide availability in the vasculature.10PubMed Central. A Narrative Review on Nitrate-Rich Diets as Adjuncts to Antihypertensive Therapy: Enhancing Treatment Efficacy via Oxidative Stress Modulation So there is a plausible biological rationale for the combination being beneficial for vascular health, not just a blood pressure concern. That said, “plausible rationale” is different from proven benefit, and there are no large trials specifically testing the combination of lisinopril and beetroot juice as a cardiovascular strategy.
Oxalates and Kidney Stones
Beets are one of the highest-oxalate foods commonly eaten. Oxalates bind to calcium in the body and can form kidney stones in susceptible people. Research has identified beets as one of eight foods most strongly linked to increased urinary oxalate excretion, alongside spinach, rhubarb, nuts, tea, chocolate, strawberries, and wheat bran.11Journal of the American Dietetic Association. Effect of dietary oxalate and calcium on urinary oxalate and risk of formation of calcium oxalate kidney stones People who absorb oxalate at higher-than-average rates, whether due to gut conditions or individual biology, face the greatest risk.
Beetroot juice concentrates the problem. Analyses of commercially available vegetable juices found that beetroot juice contained between 60 and 70 mg of oxalate per 100 ml, far exceeding almost every other fruit or vegetable juice tested.12Journal of Food Composition and Analysis. The oxalate content of fruit and vegetable juices, nectars and drinks If you drink several hundred milliliters daily, you could be consuming a substantial portion of the day’s oxalate intake from that single source alone. Researchers have specifically noted that calcium oxalate stone formers should pay attention not just to the oxalate content of these juices but also to the volume consumed.
This is relevant to lisinopril users because kidney health matters more when you are on an ACE inhibitor. ACE inhibitors are processed by the kidneys, and kidney function affects how the drug is cleared from your body. If you have a history of kidney stones or any degree of impaired kidney function, loading up on high-oxalate beetroot juice adds a risk that has nothing to do with blood pressure but is still clinically important. Eating moderate amounts of whole beets occasionally is much less of an issue than drinking concentrated juice daily.
Mouthwash Can Block the Effect
Here is something most people do not expect: antibacterial mouthwash can largely disable the blood-pressure-lowering effect of beetroot. The conversion of dietary nitrate to nitrite, which is a necessary step before your body can produce nitric oxide, depends on bacteria that live on your tongue. These bacteria reduce nitrate to nitrite in your saliva, and your stomach then further converts nitrite to nitric oxide. Strong antibacterial mouthwash kills off those bacteria and disrupts the entire chain.13Nitric Oxide. A stepwise reduction in plasma and salivary nitrite with increasing strengths of mouthwash following a dietary nitrate load
Studies have shown a stepwise reduction in both salivary and blood nitrite levels with increasing mouthwash strength after a nitrate-rich meal. In practical terms, if you are drinking beetroot juice specifically for the cardiovascular benefits, using chlorhexidine-based mouthwash shortly before or after may undermine the whole point. This does not affect lisinopril at all, since ACE inhibitors work through a completely different mechanism. But it is worth knowing if you are hoping the beetroot adds something on top of your medication.
Not all mouthwash has this effect. Mild alcohol-free rinses are less disruptive than full-strength antibacterial products. If you use a prescription mouthwash (common after dental procedures), it might be worth timing your beetroot juice a few hours apart, though no formal guidelines exist on this.
Signs Your Blood Pressure May Be Too Low
If you do combine beetroot with lisinopril, the main thing to watch for is symptoms of excessive blood pressure lowering. These include dizziness or lightheadedness, especially when standing up quickly from sitting or lying down. Feeling faint, unusually fatigued, or having blurred vision can also signal that your pressure has dropped too far. In rare cases, a significant blood pressure drop can cause fainting or falls, which is a real concern for older adults.
These symptoms are most likely to occur during the first few days of combining the two, when your body has not yet adjusted. They are also more likely if you are dehydrated (hot weather, exercise, illness with vomiting or diarrhea), because dehydration itself lowers blood pressure and compounds the effect. If you notice these symptoms, the sensible response is to sit or lie down, drink water, and mention it to your doctor. You probably do not need to swear off beets entirely, but you might need to reduce the amount of juice or adjust your medication timing.
It is also worth noting that many people on lisinopril eat beets regularly without any issue at all. The interaction is dose-dependent on both sides: a higher lisinopril dose and a larger daily intake of concentrated beetroot juice increase the chance of a meaningful blood pressure drop. A low-dose ACE inhibitor and a normal dietary amount of beets is the lowest-risk combination.
Whole Beets Versus Concentrated Juice
The form in which you consume beetroot matters substantially. Whole cooked beets contain less nitrate per serving than raw beets, and far less than concentrated beetroot juice products. Cooking reduces some of the nitrate content, and a typical serving of roasted beets (half a cup or so) delivers a fraction of the nitrate in a 70-ml concentrated shot marketed for athletic performance. The pilot study on hypertensive patients noted that raw beetroot juice produced greater blood pressure and endothelial improvements than cooked beetroot.9PubMed. Improvement of hypertension, endothelial function and systemic inflammation following short-term supplementation with red beet (Beta vulgaris L.) juice: a randomized crossover pilot study
This distinction matters for the lisinopril interaction question. If you enjoy beet salad a few times a week, the additive blood-pressure-lowering effect is likely small enough to be clinically irrelevant. If you have started a daily regimen of concentrated beetroot juice for exercise performance or cardiovascular health, the effect is larger and more consistent. The concentrated products are where the interaction story becomes more than theoretical.
Oxalate follows the same pattern. Whole beets have significant oxalate, but juice concentrates it. The studies measuring oxalate content in beetroot juice found levels high enough that even moderate daily consumption could meaningfully increase urinary oxalate, particularly in people prone to kidney stones. Eating a few roasted beets at dinner is a different proposition from drinking 500 ml of raw beetroot juice every morning.
When to Loop In Your Doctor
For the average person on lisinopril who eats beets as a normal part of their diet, there is no need to treat this as a crisis or avoid beets entirely. But a conversation with your doctor is worthwhile in a few specific situations:
- Multiple blood pressure drugs: If you are on two or more antihypertensive medications in addition to lisinopril, adding a concentrated nitrate source increases the cumulative risk of your blood pressure dipping too low.
- Elevated potassium: If your bloodwork has shown potassium levels at the high end of normal or above, increasing potassium-rich food intake including beets deserves a heads-up to your prescriber.
- Kidney problems: Impaired kidney function affects both potassium clearance and oxalate excretion. If your kidney function is reduced, both of those concerns are amplified.
- History of kidney stones: Calcium oxalate stones in particular warrant caution with high-oxalate foods and juices.
- Daily concentrated juice: If you plan to drink beetroot juice daily, especially the concentrated “shots,” mention it. Your doctor may want to check your blood pressure and potassium after a couple of weeks to see how the combination is landing.
For what it is worth, the overall tolerability of beetroot as a blood-pressure-lowering supplement has been rated as good in reviews of the evidence.6British Journal of Clinical Pharmacology. Nutraceuticals with a clinically detectable blood pressure-lowering effect: a review of available randomized clinical trials and their meta-analyses The interaction with ACE inhibitors is not dangerous in principle. It just requires the same awareness you would apply to any two things that lower blood pressure at the same time: know the signs that it has gone too far, and keep your doctor in the loop if you are going beyond casual dietary amounts.
Beeturia and Other Harmless Surprises
One last thing that catches many people off guard: eating beets or drinking beet juice can turn your urine and stool pink or reddish. This is called beeturia, and it is completely harmless. Roughly 10 to 14 percent of the general population experiences it regularly, though the percentage seems to be higher in people with iron deficiency. The pigments responsible are betalains, water-soluble compounds that pass through some people’s digestive systems without being fully broken down.
The reason this is worth mentioning in the context of lisinopril is that unexplained red urine can be alarming, and some people assume it signals a kidney or bladder problem, especially when they are already on a medication that affects kidney function. If you recently ate beets or drank beet juice, the most likely explanation for pink urine is beeturia, not hematuria (blood in the urine). The color change typically appears within a few hours of eating beets and clears within a day or two. If the discoloration persists well beyond when you last consumed beets, that is a different story and worth a call to your doctor.