Physicians' Academy for Cardiovascular Education

Higher consumption of sugar-sweetened beverages associated with hypertension

Literature - Malik et al., Am J Cardiol, 2014 - American Journal of Cardiology, online 14 February 2014


Impact of Sugar-Sweetened Beverages on Blood Pressure

Malik A, Akram Y, Shet S et al.
American Journal of Cardiology, online 14 February 2014


Sugar-sweetened beverages (SSB) are the largest source of added sugar in our diet. High fructose corn syrup (HFCS) is the major source of caloric sweetener that is added to beverages. According to the American Heart Association consumption should be limited to a maximum of 450 calories per week from SSB, as it is predicted that 180000 American deaths per year can be attributed to consumption of SSB [1].
Consumption of SSB leads to a higher risk of obesity, the metabolic syndrome, type II diabetes mellitus, heart disease, gout and kidney stones [2-6]. A recent meta-analysis showed that SSB are associated with 26% higher risk of diabetes mellitus and 20% increased risk of the metabolic syndrome [2,7]. No systematic review has been done to examine studies on the effect of SSB on blood pressure (BP). To that extent, this study reviewed 12 analyses of 6 cross-sectional and 6 prospective observational cohort studies.

Main results

  • Overall, a positive relation was seen between SSB consumption and BP in the cross-sectional studies. Three studies reported that the odds of becoming hypertensive range from 26-70% with increased consumption of SSB. The other 3 studies reported an increase in mean BP (0.16-1.6 mmHg increase of mean systolic BP).
  • The prospective studies also showed an overall positive trend of having higher BP with increased intake of SSBs. Two studies reported a mean BP difference of 1.8 and 1.9 mmHg increase in average systolic BP with more than 1 serving of SSB per day. Three prospective studies reported an increase in the incidence of hypertension associated with higher SSB consumption (OR range 1.13-1.6). Another study showed only a marginal increase in the incidence of hypertension with >1 serving per day (OR: 1.18, 95%CI: 0.96-1.44).
    Only one study showed conflicting results, in that no difference in BP was seen in a much younger cohort, after multivariate adjustment.
  • In an 18-month behavioural randomised controlled trial, systolic BP was reduced with 1.8 mmHg and diastolic BP with 1.1 mmHg when SSB consumption was reduced with 0.9 servings per day.
  • Different associations of SSB consumption and increased incidence of hypertension have been described, in a wide range of ages. The positive association becomes stronger after longer periods of high consumption of SSB.


Overall, a positive association was observed between SSB consumption and BP. HFCS specifically has been linked to high blood pressure. Since even modest reductions of systolic BP at a population level have been shown to translate into substantial reductions in deaths from stroke and coronary heart disease, these findings are important at a population level. It is unclear at which dose increased SSB intake leads to development of hypertension, although these results suggests that intake of over 1 serving per day is associated with an increased risk.
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