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Cutting Intake of Sugar-Sweetened Drinks Lowers BP in Observational Study

News Author: Steve Stiles
CME Author: Hien T. Nghiem, MD


June 1, 2010 — Cutting back on consumption of beverages that contain added sugar can lower blood pressure, but not only because it may reduce body weight, according to a prospective cohort study that also found no influence on blood pressure (BP) from caffeine or consumption of diet soft drinks [1]. The analysis also suggested that change in overall intake of sugar, whether added to or naturally occurring in food and drink, had an effect on BP.

The study found--in its population of >800 adults participating in a hypertension trial of dietary and behavioral interventions--that drinking one less sugar-sweetened beverage a day was independently associated with declines of about 1.2 mm Hg and 1.1 mm Hg in systolic and diastolic BP, respectively, over 18 months. The relationships remained significant after researchers further controlled for weight change.

"Our study is observational in nature, but our data show that if you reduce sugary drink consumption, you will reduce blood pressure," lead author Dr Liwei Chen (Louisiana State University Health Science Center, New Orleans) told heartwire . The analysis was published online May 24, 2010 in Circulation.

The findings, she said, are consistent with studies using different animal models that show increased sugar intake can induce hypertension, even after controlling for weight. They also complement other observational studies suggesting links between dietary added sugar, including in soft drinks, and hypertension, dyslipidemia, and the metabolic syndrome, as heartwire has reported, but conflict with some of their data suggesting that the link between soft drinks and blood pressure extends to artificially sweetened soft drinks.

In the current study, a third of participants cut their consumption by 1.3 servings per day over 18 months, and systolic BP dropped 1.5 mm Hg more than it did in participants who didn't change their intake of sugar-sweetened beverages, Chen et al write. So intake reduced to at least that degree "should be achievable and could be beneficial."

In the current analysis, which included 810 participants in the randomized, multicenter PREMIER trial with prehypertension or stage 1 hypertension, daily intake of calories, different nutrients, and beverages (derived from the average of two 24-hour dietary recalls) was determined at baseline, six months, and 18 months.

Sugar-sweetened beverages, defined as any drinks with added sucrose or high-fructose corn syrup, included "soft drinks, fruit drinks, lemonade, fruit punch, and other sweetened beverages but excluded diet drinks. Diet beverages were defined as carbonated or noncarbonated drinks that were sweetened with [noncaloric] artificial sweeteners."

After a variety of potential influences on blood pressure, including body-mass index but not body weight, were controlled for, changes in sweetened beverage intake over 18 months were significantly related to changes in systolic and diastolic BP (p<0.001 for both). Adding weight change to the covariates attenuated both the effect of such intake on BP and its significance, although p values remained <0.05, "suggesting that reducing sugar-sweetened beverage intake has a BP-lowering effect that is independent of weight loss."

Relationship Between Blood Pressure Changes and Changes in Intake of One Serving (12 Ounces) of Sugar-Sweetened Beverage After 18 Months in PREMIER

Change in BP (mm Hg) per 1-serving difference Model 1a Model 2b
Systolic 1.76 (p<0.001) 0.70 (p=0.01)
Diastolic 1.08 (p<0.001) 0.38 (p=0.04)

a. Adjusted for sex, race, family history of hypertension, PREMIER treatment group, PREMIER site, age, alcohol intake, body-mass index, baseline sugar-sweetened beverage intake, baseline fitness, change in fitness, baseline physical activity, change in physical activity, baseline urinary sodium excretion, change in urinary sodium excretion, and adherence to DASH diet

b. Further adjusted for change in body weight

In the non–weight-adjusted model, systolic and diastolic pressures, respectively, changed 0.30 mm Hg (p<0.001) and 0.24 mm Hg (p<0.001), for every 10-g/day difference in total consumption of sugars from all food and beverages. The BP changes over 18 months were still significant when weight change was added to the model, at 0.17 mm Hg (p=0.003) and 0.15 mm Hg (p<0.001). Intake of caffeine or artificially sweetened drinks showed no significant relationships with blood pressure in either model.

"Our study has important public-health implications," observe Chen et al. "For example, it has been estimated that a 3-mm-Hg reduction in systolic BP should reduce stroke mortality by 8% and coronary heart disease mortality by 5%. Such reductions in systolic BP would be anticipated by reducing sugar-sweetened beverage consumption by an average of two servings per day."

PREMIER was funded by the National, Heart, Lung, and Blood Institute; the current analysis was partially supported by grants from Louisiana State University and Johns Hopkins University (Baltimore, MD). None of the coauthors had disclosures.

References

  1. Chen L, Caballero B, Mitchell DC, et al. Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure. A prospective study among United States adults. Circulation2010; DOI: 10.1161/CIRCULATIONAHA.109.911164. Available at: http://circ.ahajournals.org. Abstract

Clinical Context

Elevated BP is an important health problem in the United States, affecting more than 72 million US adults. Elevated BP is a known risk factor for cardiovascular disease, stroke, kidney disease, all-cause mortality, and shortened life expectancy. Currently, the average intake of sugar-sweetened beverages is 2.3 servings per day for US adults. Sugar-sweetened beverages are the most consumed caloric beverage and the leading source of added sugars in the United States. Increased consumption of sugar-sweetened beverages has been associated with an elevated risk for obesity, metabolic syndrome, and type 2 diabetes mellitus. However, the effects of sugar-sweetened beverage consumption on BP are uncertain.

The aim of this study was to determine the relationship between changes in sugar-sweetened beverage consumption and changes in BP among US adults.

Study Highlights

  • In this prospective analysis, 810 adults who participated in the PREMIER Study (an 18-month behavioral intervention trial) were recruited.
  • BP and dietary intake (by two 24-hour recalls) were measured at baseline and at 6 and 18 months.
  • Sugar-sweetened beverages were defined as carbonated or uncarbonated drinks that were sweetened with sugars. These included regular soft drinks, fruit drinks, lemonade, fruit punch, and other sweetened beverages but excluded diet drinks.
  • Mixed-effects models were applied to estimate the changes in BP in responding to changes in sugar-sweetened beverage consumption.
  • At baseline, mean sugar-sweetened beverage intake was 0.9 ± 1.0 servings per day (10.5 ± 11.9 fl oz per day), and mean systolic BP/diastolic BP was 134.9 ± 9.6/84.8 ± 4.2 mm Hg.
  • After potential confounders were controlled for, a reduction in sugar-sweetened beverages of 1 serving per day was associated with a 1.8-mm Hg (95% confidence interval, 1.2 - 2.4) reduction in systolic BP and a 1.1-mm Hg (95% confidence interval, 0.7 - 1.4) reduction in diastolic BP for 18 months.
  • After additional adjustment for weight change during the same period, a reduction in intake of sugar-sweetened beverages was still significantly associated with reductions in systolic and diastolic BPs (P < .05).
  • A dose-response relationship demonstrated that the greatest reduction in sugar-sweetened beverage consumption led to a greater reduction in systolic BP and diastolic BP vs those with a lesser reduction in sugar-sweetened beverages.
  • A trend of increase in the proportion of individuals who moved from hypertension at baseline to no hypertension at 18 months was also observed.
  • Change in the consumption of diet beverages was not associated with either systolic BP or diastolic BP in both age-adjusted and multivariate-adjusted models.
  • Also, reduced intake of sugars was significantly associated with reduced BP.
  • There was no significant relationship between change in caffeine consumption and change in BP.
  • Limitations of this study were that few Hispanics and Asians were recruited. Also, because of the observational nature of the study, it cannot prove causality or rule out residual confounding.

Clinical Implications

  • US adults consume an average of 2.3 (28 ± 1 oz per day) servings of sugar-sweetened beverages per day.
  • Reduced consumption of sugar-sweetened beverages and sugars was significantly associated with reduced BP.

Views: 97

Comment by Veeraraghavan A.R. on April 30, 2011 at 11:12am
It is new. Thank you.

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