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Dynamic cerebral autoregulation (dCA) maintains cerebral blood flow and may involve NO\u2010related vascular mechanisms. Whether dietary nitrate supplementation influences dCA in MetS remains unclear. This pilot trial evaluated feasibility and explored effects of nitrate supplementation on dCA. Twenty\u2010two older adults with MetS (55\u201375\u2009years) were randomized in a double\u2010blind, placebo\u2010controlled design to receive nitrate\u2010rich beetroot juice (BRJ; 6.4\u2009mmol NO\n                    <jats:sub>3<\/jats:sub>\n                    <jats:sup>\u2212<\/jats:sup>\n                    \u00b7day\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) or nitrate\u2010depleted placebo for 4\u2009week. dCA was assessed using transfer function analysis (TFA) of beat\u2010to\u2010beat blood pressure and functional near\u2010infrared spectroscopy\u2010derived cerebral oxygenation. Primary analyses examined frontal dCA holistically, with exploratory regional and cognitive outcomes. dCA was indexed by TFA phase and gain. The intervention was well tolerated, adherence was high, and BRJ increased plasma nitrate concentrations versus placebo (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). No significant effects were observed for frontal dCA or cognition. Exploratory analyses indicated region\u2010specific differences in dCA in select frontal areas, characterized by improvements in TFA phase and gain. This pilot trial demonstrates the feasibility of dietary nitrate supplementation in MetS. While no effects were observed in primary outcomes, exploratory analyses suggest potential region\u2010specific improvements in dCA.\n                  <\/jats:p>","DOI":"10.14814\/phy2.71073","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T04:59:06Z","timestamp":1787720346000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A pilot randomized controlled trial of the effects of dietary nitrate supplementation on dynamic cerebral autoregulation in older adults with metabolic syndrome"],"prefix":"10.14814","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1378-230X","authenticated-orcid":false,"given":"Jigar","family":"Gosalia","sequence":"first","affiliation":[{"name":"Department of Medicine, Division Renal Diseases and Hypertension The University of Colorado Anschutz Medical Campus  Aurora Colorado 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