Impact of Sugar-Sweetened Beverages on Blood Pressure

Published:February 14, 2014DOI:https://doi.org/10.1016/j.amjcard.2014.01.437
      The impact of sugar-sweetened beverages (SSBs) on blood pressure (BP) has been debated, with some evidence suggesting that their increased intake is related to higher risk of developing hypertension. We conducted a systematic review exploring the relation between consumption of SSB and BP. A comprehensive search in 5 electronic databases along with a bibliography search was performed. The keywords “sugar sweetened beverages,” “sugary drinks,” “added sugars,” “blood pressure,” and “hypertension” were indexed in all combinations. Studies were included that reported the effects of intake of SSBs on BP. We excluded studies with <100 subjects and those involving subjects aged <12 years. Of 605 potentially relevant studies, a total of 12 studies (409,707 participants) met our inclusion criteria; 6 were cross sectional studies, whereas the rest were prospective cohort studies. All 12 studies showed positive relation between increased SSB intake and hypertension; however, statistical significance was reported in 10 of these studies. Of the 12 studies, 5 reported an increase in mean BP whereas 7 reported an increase in the incidence of high BP. In conclusion, our systematic review shows that the consumption of SSBs is associated with higher BP, leading to increased incidence of hypertension. Restriction on SSB consumption should be incorporated in the recommendations of lifestyle modifications for the treatment of hypertension. Interventions to reduce intake of SSBs should be an integral part of public health strategy to reduce the incidence of hypertension.
      To read this article in full you will need to make a payment

      References

        • Vuilleumier S.
        Worldwide production of high-fructose syrup and crystalline fructose.
        Am J Clin Nutr. 1993; 58: S733-S736
        • Rebollo A.
        • Roglans N.
        • Alegret M.
        • Laguna J.C.
        Way back for fructose and liver metabolism: bench side to molecular insights.
        World J Gastroenterol. 2012; 18: 6552-6559
        • Havel P.J.
        Dietary fructose: implications for dysregulation of energy homeostasis and lipid/carbohydrate metabolism.
        Nutr Rev. 2005; 63: 133-157
        • Bleich S.N.
        • Wang Y.C.
        • Wang Y.
        • Gortmaker S.L.
        Increasing consumption of sugar-sweetened beverages among US adults: 1988-1994 to 1999-2004.
        Am J Clin Nutr. 2009; 89: 372-381
        • Wang Y.C.
        • Bleich S.N.
        • Gortmaker S.L.
        Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004.
        Pediatrics. 2008; 121: e1604-e1614
        • Singh G.M.
        • Micha R.
        • Katibzadeh S.
        • Lim S.
        • Ezzati M.
        • Mozaffarian D.
        Mortality due to sugar-sweetened beverage consumption: a global, regional, and national comparative risk assessment.
        Circulation. 2013; 127: AMP22
        • Malik V.S.
        • Popkin B.M.
        • Bray G.A.
        • Despres J.P.
        • Willett W.C.
        • Hu F.B.
        Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis.
        Diabetes Care. 2010; 33: 2477-2483
        • Schulze M.B.
        • Manson J.E.
        • Ludwig D.S.
        • Colditz G.A.
        • Stampfer M.J.
        • Willett W.C.
        • Hu F.B.
        Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women.
        JAMA. 2004; 292: 927-934
        • Fung T.T.
        • Malik V.
        • Rexrode K.M.
        • Manson J.E.
        • Willett W.C.
        • Hu F.B.
        Sweetened beverage consumption and risk of coronary heart disease in women.
        Am J Clin Nutr. 2009; 89: 1037-1042
        • Choi H.K.
        • Willett W.
        • Curhan G.
        Fructose-rich beverages and risk of gout in women.
        JAMA. 2010; 304: 2270-2278
        • Malik V.S.
        • Schulze M.B.
        • Hu F.B.
        Intake of sugar-sweetened beverages and weight gain: a systematic review.
        Am J Clin Nutr. 2006; 84: 274-288
        • Vartanian L.R.
        • Schwartz M.B.
        • Brownell K.D.
        Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis.
        Am J Public Health. 2007; 97: 667-675
        • Forman J.P.
        • Choi H.
        • Curhan G.C.
        Fructose and vitamin C intake do not influence risk for developing hypertension.
        J Am Soc Nephrol. 2009; 20: 863-871
        • Madero M.
        • Arriaga J.C.
        • Jalal D.
        • Rivard C.
        • McFann K.
        • Perez-Mendez O.
        • Vazquez A.
        • Ruiz A.
        • Lanaspa M.A.
        • Jimenez C.R.
        • Johnson R.J.
        • Lozada L.G.
        The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: a randomized controlled trial.
        Metabolism. 2011; 60: 1551-1559
        • Lowndes J.
        • Kawiecki D.
        • Pardo S.
        • Nguyen V.
        • Melanson K.J.
        • Yu Z.
        • Rippe J.M.
        The effects of four hypocaloric diets containing different levels of sucrose or high fructose corn syrup on weight loss and related parameters.
        Nutr J. 2012; 11: 55
        • Mark S.
        • Wang J.
        • Gray-Donald K.
        • Henderson M.
        • O'Loughlin J.
        • Tremblay A.
        • Lambert M.
        Sugar-sweetened beverage intake and metabolic syndrome components among children at high risk of obesity.
        Can J Diabetes. 2011; 35: 142
        • Perichart-Perera O.
        • Balas-Nakash M.
        • Rodriguez-Cano A.
        • Munoz-Manrique C.
        • Monge-Urrea A.
        • Vadillo-Ortega F.
        Correlates of dietary energy sources with cardiovascular disease risk markers in Mexican school-age children.
        J Am Diet Assoc. 2010; 110: 253-260
        • Shang X.W.
        • Liu A.L.
        • Zhang Q.
        • Hu X.Q.
        • Du S.M.
        • Ma J.
        • Xu G.F.
        • Li Y.
        • Guo H.W.
        • Du L.
        • Li T.Y.
        • Ma G.S.
        Report on childhood obesity in China (9): sugar-sweetened beverages consumption and obesity.
        Biomed Environ Sci. 2012; 25: 125-132
        • Brown C.M.
        • Dulloo A.G.
        • Yepuri G.
        • Montani J.P.
        Fructose ingestion acutely elevates blood pressure in healthy young humans.
        Am J Physiol Regul Integr Comp Physiol. 2008; 294: R730-R737
        • Maersk M.
        • Belza A.
        • Stodkilde-Jorgensen H.
        • Ringgaard S.
        • Chabanova E.
        • Thomsen H.
        • Pedersen S.B.
        • Astrup A.
        • Richelsen B.
        Sucrose-sweetened beverages increase fat storage in the liver, muscle, and visceral fat depot: a 6-mo randomized intervention study.
        Am J Clin Nutr. 2012; 95: 283-289
        • Le M.T.
        • Frye R.F.
        • Rivard C.J.
        • Cheng J.
        • McFann K.K.
        • Segal M.S.
        • Johnson R.J.
        • Johnson J.A.
        Effects of high-fructose corn syrup and sucrose on the pharmacokinetics of fructose and acute metabolic and hemodynamic responses in healthy subjects.
        Metabolism. 2012; 61: 641-651
      1. Wells G, Shea B, O'connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed Jan 15, 2014.

        • Jalal D.I.
        • Smits G.
        • Johnson R.J.
        • Chonchol M.
        Increased fructose associates with elevated blood pressure.
        J Am Soc Nephrol. 2010; 21: 1543-1549
        • Tayel D.I.
        • El-Sayed N.A.
        • El-Sayed N.A.
        Dietary pattern and blood pressure levels of adolescents in Sohag, Egypt.
        J Egypt Public Health Assoc. 2013; 88: 97-103
        • Kim Y.H.
        • Abris G.P.
        • Sung M.K.
        • Lee J.E.
        Consumption of sugar-sweetened beverages and blood pressure in the United States: the National Health and Nutrition Examination Survey 2003-2006.
        Clin Nutr Res. 2012; 1: 85-93
        • Nguyen S.
        • Choi H.K.
        • Lustig R.H.
        • Hsu C.Y.
        Sugar-sweetened beverages, serum uric acid, and blood pressure in adolescents.
        J Pediatr. 2009; 154: 807-813
        • Bremer A.A.
        • Auinger P.
        • Byrd R.S.
        Relationship between insulin resistance-associated metabolic parameters and anthropometric measurements with sugar-sweetened beverage intake and physical activity levels in US adolescents: findings from the 1999-2004 National Health and Nutrition Examination Survey.
        Arch Pediat Adolesc Med. 2009; 163: 328-335
        • Brown I.J.
        • Stamler J.
        • Van Horn L.
        • Robertson C.E.
        • Chan Q.
        • Dyer A.R.
        • Huang C.C.
        • Rodriguez B.L.
        • Zhao L.
        • Daviglus M.L.
        • Ueshima H.
        • Elliott P.
        • International Study of Macro/Micronutrients and Blood Pressure Research Group
        Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: International Study of Macro/Micronutrients and Blood Pressure.
        Hypertension. 2011; 57: 695-701
        • Chen L.
        • Caballero B.
        • Mitchell D.C.
        • Loria C.
        • Lin P.H.
        • Champagne C.M.
        • Elmer P.J.
        • Ard J.D.
        • Batch B.C.
        • Anderson C.A.
        • Appel L.J.
        Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: a prospective study among United States adults.
        Circulation. 2010; 121: 2398-2406
        • Ambrosini G.L.
        • Oddy W.H.
        • Huang R.C.
        • Mori T.A.
        • Beilin L.J.
        • Jebb S.A.
        Prospective associations between sugar-sweetened beverage intakes and cardiometabolic risk factors in adolescents.
        Am J Clin Nutr. 2013; 98: 327-334
        • Dhingra R.
        • Sullivan L.
        • Jacques P.F.
        • Wang T.J.
        • Fox C.S.
        • Meigs J.B.
        • D'Agostino R.B.
        • Gaziano J.M.
        • Vasan R.S.
        Soft drink consumption and risk of developing cardiometabolic risk factors and the metabolic syndrome in middle-aged adults in the community.
        Circulation. 2007; 116: 480-488
        • Winkelmayer W.C.
        • Stampfer M.J.
        • Willett W.C.
        • Curhan G.C.
        Habitual caffeine intake and the risk of hypertension in women.
        JAMA. 2005; 294: 2330-2335
        • Duffey K.J.
        • Gordon-Larsen P.
        • Steffen L.M.
        • Jacobs Jr., D.R.
        • Popkin B.M.
        Drinking caloric beverages increases the risk of adverse cardiometabolic outcomes in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
        Am J Clin Nutr. 2010; 92: 954-959
        • Cohen L.
        • Curhan G.
        • Forman J.
        Association of sweetened beverage intake with incident hypertension.
        J Gen Intern Med. 2012; 27: 1127-1134
        • Reedy J.
        • Krebs-Smith S.M.
        Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States.
        J Am Diet Assoc. 2010; 110: 1477-1484
        • Lewington S.
        • Clarke R.
        • Qizilbash N.
        • Peto R.
        • Collins R.
        Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
        Lancet. 2002; 360: 1903-1913
        • Ford E.S.
        • Ajani U.A.
        • Croft J.B.
        • Critchley J.A.
        • Labarthe D.R.
        • Kottke T.E.
        • Giles W.H.
        • Capewell S.
        Explaining the decrease in U.S. deaths from coronary disease, 1980-2000.
        N Engl J Med. 2007; 356: 2388-2398
        • Cook N.R.
        • Cohen J.
        • Hebert P.R.
        • Taylor J.O.
        • Hennekens C.H.
        Implications of small reductions in diastolic blood pressure for primary prevention.
        Arch Intern Med. 1995; 155: 701-709
        • Brownell K.D.
        • Frieden T.R.
        Ounces of prevention—the public policy case for taxes on sugared beverages.
        N Engl J Med. 2009; 360: 1805-1808
        • Lin W.T.
        • Huang H.L.
        • Huang M.C.
        • Chan T.F.
        • Ciou S.Y.
        • Lee C.Y.
        • Chiu Y.W.
        • Duh T.H.
        • Lin P.L.
        • Wang T.N.
        • Liu T.Y.
        • Lee C.H.
        Effects on uric acid, body mass index and blood pressure in adolescents of consuming beverages sweetened with high-fructose corn syrup.
        Int J Obes (Lond). 2013; 37: 532-539
        • Lustig R.H.
        Fructose: metabolic, hedonic, and societal parallels with ethanol.
        J Am Diet Assoc. 2010; 110: 1307-1321
        • Sanchez-Lozada L.G.
        • Tapia E.
        • Jimenez A.
        • Bautista P.
        • Cristobal M.
        • Nepomuceno T.
        • Soto V.
        • Avila-Casado C.
        • Nakagawa T.
        • Johnson R.J.
        • Herrera-Acosta J.
        • Franco M.
        Fructose-induced metabolic syndrome is associated with glomerular hypertension and renal microvascular damage in rats.
        Am J Physiol Ren Physiol. 2007; 292: F423-F429
        • Nakagawa T.
        • Hu H.
        • Zharikov S.
        • Tuttle K.R.
        • Short R.A.
        • Glushakova O.
        • Ouyang X.
        • Feig D.I.
        • Block E.R.
        • Herrera-Acosta J.
        • Patel J.M.
        • Johnson R.J.
        A causal role for uric acid in fructose-induced metabolic syndrome.
        Am J Physiol Ren Physiol. 2006; 290: F625-F631
        • Perez-Pozo S.E.
        • Schold J.
        • Nakagawa T.
        • Sanchez-Lozada L.G.
        • Johnson R.J.
        • Lillo J.L.
        Excessive fructose intake induces the features of metabolic syndrome in healthy adult men: role of uric acid in the hypertensive response.
        Int J Obes (Lond). 2010; 34: 454-461
        • Brito J.O.
        • Ponciano K.
        • Figueroa D.
        • Bernardes N.
        • Sanches I.C.
        • Irigoyen M.C.
        • De Angelis K.
        Parasympathetic dysfunction is associated with insulin resistance in fructose-fed female rats.
        Braz J Med Biol Res. 2008; 41: 804-808
        • Rebello T.
        • Hodges R.E.
        • Smith J.L.
        Short-term effects of various sugars on antinatriuresis and blood pressure changes in normotensive young men.
        Am J Clin Nutr. 1983; 38: 84-94
        • Singh A.K.
        • Amlal H.
        • Haas P.J.
        • Dringenberg U.
        • Fussell S.
        • Barone S.L.
        • Engelhardt R.
        • Zuo J.
        • Seidler U.
        • Soleimani M.
        Fructose-induced hypertension: essential role of chloride and fructose absorbing transporters PAT1 and Glut5.
        Kidney Int. 2008; 74: 438-447
        • Kurbel S.
        Arterial hypertension due to fructose ingestion: model based on intermittent osmotic fluid trapping in the small bowel.
        Theor Biol Med Model. 2010; 7: 27
        • Feig D.I.
        • Mazzali M.
        • Kang D.H.
        • Nakagawa T.
        • Price K.
        • Kannelis J.
        • Johnson R.J.
        Serum uric acid: a risk factor and a target for treatment?.
        J Am Soc Nephrol. 2006; 17: S69-S73
        • He F.J.
        • Marrero N.M.
        • MacGregor G.A.
        Salt intake is related to soft drink consumption in children and adolescents: a link to obesity?.
        Hypertension. 2008; 51: 629-634
        • Grimes C.A.
        • Riddell L.J.
        • Campbell K.J.
        • Nowson C.A.
        Dietary salt intake, sugar-sweetened beverage consumption, and obesity risk.
        Pediatrics. 2013; 131: 14-21
        • Eufinger S.C.
        • Votaw J.
        • Faber T.
        • Ziegler T.R.
        • Goldberg J.
        • Bremner J.D.
        • Vaccarino V.
        Habitual dietary sodium intake is inversely associated with coronary flow reserve in middle-aged male twins.
        Am J Clin Nutr. 2013; 95: 572-579
        • Brymora A.
        • Flisinski M.
        • Johnson R.J.
        • Goszka G.
        • Stefanska A.
        • Manitius J.
        Low-fructose diet lowers blood pressure and inflammation in patients with chronic kidney disease.
        Nephrol Dial Transpl. 2012; 27: 608-612
        • Halldorsson T.I.
        • Strom M.
        • Petersen S.B.
        • Olsen S.F.
        Intake of artificially sweetened soft drinks and risk of preterm delivery: a prospective cohort study in 59,334 Danish pregnant women.
        Am J Clin Nutr. 2010; 92: 626-633
        • Borgen I.
        • Aamodt G.
        • Harsem N.
        • Haugen M.
        • Meltzer H.M.
        • Brantsaeter A.L.
        Maternal sugar consumption and risk of preeclampsia in nulliparous Norwegian women.
        Eur J Clin Nutr. 2012; 66: 920-925
      2. USA causes of death by age and gender; CDC Official Final Deaths 2010. Available at: http://www.worldlifeexpectancy.com/usa-cause-of-death-by-age-and-gender. Accessed January 15, 2014.

        • Forman J.P.
        • Stampfer M.J.
        • Curhan G.C.
        Diet and lifestyle risk factors associated with incident hypertension in women.
        JAMA. 2009; 302: 401-411
        • Ambrosini G.L.
        • de Klerk N.H.
        • O'Sullivan T.A.
        • Beilin L.J.
        • Oddy W.H.
        The reliability of a food frequency questionnaire for use among adolescents.
        Eur J Clin Nutr. 2009; 63: 1251-1259
        • Emond J.A.
        • Patterson R.E.
        • Jardack P.M.
        • Arab L.
        Using doubly labeled water to validate associations between sugar-sweetened beverage intake and body mass among White and African-American adults.
        Int J Obes (Lond). 2013;

      Linked Article

      • Salt Intake, Sugar-Sweetened Soft Drink Consumption, and Blood Pressure
        American Journal of CardiologyVol. 114Issue 3
        • In Brief
          In their interesting review article, Malik et al1 do not seem to consider the underlying mechanism by which sugar-sweetened soft drink consumption is associated with increased blood pressure. For instance, there is clear evidence for a causal relation between salt intake and total fluid consumption,2 as well as sugar-sweetened soft drink consumption,3 an important and very relevant point that Malik et al failed to acknowledge. A carefully controlled metabolic study in adult humans in which salt intake was changed has quantified the relation between the change in salt intake and the subsequent change in fluid consumption.
        • Full-Text
        • PDF