Sugar intake and risk of hypertension: a systematic review and dose–response meta-analysis of cohort and cross-sectional studies

Abstract

Several epidemiological studies have investigated the association between sugar intake, the levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the risk of hypertension, but findings have been inconsistent. We carried out a systematic review and meta-analysis of observational studies to examine the associations between sugar intake, hypertension risk, and BP levels. Articles published up to February 2, 2021 were sourced through PubMed, EMBASE and Web of Science. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated using a fixed- or random-effects model. Restricted cubic splines were used to evaluate dose-response associations. Overall, 35 studies were included in the present meta-analysis (23 for hypertension and 12 for BP). Sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) were positively associated with hypertension risk: 1.26 (95% CI, 1.15–1.37) and 1.10 (1.07–1.13) per 250-g/day increment, respectively. For SBP, only SSBs were significant with a pooled β value of 0.24 mmHg (95% CI, 0.12–0.36) per 250 g increase. Fructose, sucrose, and added sugar, however, were shown to be associated with elevated DBP with 0.83 mmHg (0.07–1.59), 1.10 mmHg (0.12–2.08), and 5.15 mmHg (0.09–10.21), respectively. Current evidence supports the harmful effects of sugar intake for hypertension and BP level, especially SSBs, ASBs, and total sugar intake.

Keywords:

• Fructose
• sucrose
• hypertension
• meta-analysis
• sugar
• sweetened beverages

Acknowledgement

We acknowledge all the authors and Prof. Ming Zhang for methodological advice and help to modify the meta-analysis.

Author contributions

Yang Zhao and Yifei Feng conceived, designed, and performed the work; Yang Zhao and Yifei analyzed the data; while Yunhong Zeng, Wencheng Di, Xinping Luo, Xiaojing Wu, Ruiyun Guan, Lidan Xu, Xingjin Yang, Yang Li, Yuying Wu, Xiaoyan Wu, Yanyan Zhang, Xi Li, Pei Qin, Fulan Hu, Dongsheng Hu, Honghui Li, Ming Zhang revised the manuscript.

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (grant nos. 82073646, 81973152, and 82273707), the Natural Science Foundation of Guangdong Province (grant no. 2021A1515012503), the Natural Science Foundation of Shenzhen, China (grant no. JCYJ20210324093612032), and the Guangdong Provincial Key Laboratory of Regional Immunity and Diseases (grant no. 2019B030301009).