Drinking fruit juices and sugary drinks regularly from childhood to adulthood may increase your chances of developing high blood pressure later in life, according to a new study published today in Circulation, the American Heart Association’s flagship journal.
“Eating habits during childhood can have a lasting impact on health,” said lead study author Basanti Malik, Ph.D., MSc, associate professor and Canada Research Chair in Nutrition and Chronic Disease Prevention in the Department of Nutritional Sciences at the University of Toronto’s Temerty Faculty of Medicine and adjunct faculty member in the Department of Nutrition at the Harvard T. H. Chan School of Public Health in Boston.
“Hypertension is occurring early in life and is occurring at increasing rates in young adults, children and adolescents, highlighting the importance of early detection and prevention,” she said.
Why is early blood pressure risk important?
High blood pressure can increase your risk of serious health problems such as heart attack and stroke. Some risk factors cannot be changed, such as family history, age, gender, and race. However, lifestyle factors such as poor diet, smoking, and reduced physical activity levels can also contribute to the development of high blood pressure.
The new analysis included more than 25,000 participants enrolled in a long-term study of U.S. youth. Through surveys completed every 1 to 4 years, participants reported how often they consumed sugar-sweetened beverages such as soda, fruit punch, lemonade, sweet tea, and sports drinks. They also reported information on fruit juice, whole fruit, and other food and beverage intake, anthropometric measurements, physical activity, and smoking.
Researchers examined whether total fructose intake and consumption of sugar-sweetened beverages, fruit juices, and whole fruit were associated with self-reported diagnoses of hypertension. They also created a statistical model to estimate what would happen if participants replaced sugary drinks or fruit juices with whole fruit, milk, or water. Participants were followed for 25 years.
Sugary drinks increase risk by 52%
Participants who consumed two or more sugar-sweetened drinks each day had a 52% higher risk of developing high blood pressure later in life compared to those who drank fewer than three drinks per week. A serving was defined as a 12-ounce can or glass.
Different types of sugary drinks pose different levels of risk. They found that drinking one soda per day increased the risk of high blood pressure by 23%, while drinking one sports drink per day increased the risk of high blood pressure by 36%.
Fruit juices were also associated with an increased risk when consumed in large amounts. Participants who drank 1.5 or more servings of fruit juice per day had a 35% higher risk of developing high blood pressure than those who consumed less than 1 serving per week. One serving of fruit juice was defined as an 8-ounce glass.
Among certain types of juices, one day’s worth of orange juice was found to increase the risk of high blood pressure by 20%. Apple juice and other juices were not associated with the same increase. However, researchers cautioned that some orange-flavored drinks with added sugar may have been incorrectly reported as orange juice.
Whole fruit may be a better choice
An alternative model suggested that replacing one sugar-sweetened beverage per day with a whole fruit could reduce the risk of developing high blood pressure by 22%.
Replacing one serving of fruit juice per day with whole fruit lowered the risk by 19%.
The model also found that replacing sugary drinks with milk or water reduced the risk of high blood pressure by up to 13%. However, replacing fruit juice with milk or water did not significantly change the risk.
Even after researchers took into account overall diet quality, physical activity, and other factors, the association between sugary drinks, fruit juices and high blood pressure remained.
“Sugar-sweetened beverages, such as carbonated soft drinks and sports drinks, which are often promoted as being somewhat healthier, should be limited,” Malik said. “Fruit juice consumption is harmless at low levels, but can be harmful at higher intake levels. Fruit juice should always be 100%, and even then, consumption should be limited to moderation. Whole fruit should be valued over sugary drinks.”
Source of sugar may be important
The American Heart Association’s 2026 Dietary Guidance to Improve Cardiovascular Health scientific statement recommends minimizing added sugars in foods and beverages.
Amit Khera, MD, FAHA, volunteer expert and vice chair of the Dietary Guidance Development Committee for the American Heart Association, said the association between sugary drinks and increased hypertension and cardiovascular risk is generally consistent across studies to date. However, he said the new findings provide some additional insights.
“First, the focus on childhood and the importance of childhood health behaviors along with the development of adult risk factors provides an important opportunity for prevention. As was seen in adults, the total amount of fructose appears to be less important for the development of hypertension than the type of food in which it is consumed. So while sugar-sweetened beverages and fruit juices are associated with increased risk, whole fruit is not.”
“Second, there has been a misconception that fructose, regardless of source, is generally harmful to cardiovascular health and that fruit juices are beneficial. This study shows that neither is likely to be true,” added Kela, chair of preventive cardiology and clinical chief of cardiology at the University of Texas Southwestern Medical Center in Dallas.
Kela also noted that the study population was largely comprised of white children and adults. “However, non-Hispanic blacks and Hispanic Americans consume the highest amount of sugar-sweetened beverages, so these findings may be even more relevant for those groups.”
Policies aimed at reducing sugar-sweetened beverage intake
The American Heart Association supports science-based policies designed to reduce sugar-sweetened beverage consumption. These include enacting a tax on sugar-sweetened beverages, strengthening nutritional standards for school meals, improving “informed eating” in restaurants, and improving the quality of meals within the Supplemental Nutrition Assistance Program (SNAP).
Research highlights
After 25 years of follow-up, researchers found that people who consumed more sugary drinks and fruit juices during childhood had a higher risk of developing high blood pressure than those who consumed less.
It was found that replacing one serving of sugary drinks a day with whole fruit, milk, or water lowers the risk of high blood pressure. Replacing fruit juice with whole fruit was also associated with lower risk.
Study design and participant details
Participants were participants in the Growing Up Today Study (GUTS), which included GUTS I, which began in 1996, and GUTS II, which began in 2004. Children participating in the Nurses’ Health Study II were recruited from across the United States.
The study followed 25,749 participants (approximately 55% female and 96% non-Hispanic white) who were between 9 and 16 years old at enrollment for up to 25 years. By the end of the follow-up period, the median age of participants was 36 years.
Participants completed a 132-item food frequency questionnaire annually from 1996 to 1998, followed by additional questionnaires in 2001, 2004, 2006, 2008, 2011, and 2015. Children who already had hypertension or missing dietary information at the start of the study were excluded from the analysis.
The survey asked participants how often they consumed a standard serving of each food or drink, with responses ranging from “never or less than once a month” to “six or more times a day.” A serving was defined as a 12-ounce can or glass for sugar-sweetened beverages and an 8-ounce glass for fruit juices.
Sugar-sweetened beverages include soda, fruit punch, lemonade, iced tea, sports drinks, and still fruit drinks. Fruit juice includes 100% fruit juice drinks such as orange juice and apple juice. Whole fruits include apples, oranges, bananas, mangoes, grapes, pears, melons, strawberries, and peaches.
For an alternative analysis, researchers compared one daily serving of sugar-sweetened beverages or fruit juices to one serving of fruit juice, milk (1%, 2%, and whole milk, but not chocolate or flavored milk), water, or whole fruit.
Research limitations
Blood pressure results were self-reported in questionnaires completed from 2010 to 2021. Participants were asked whether they had ever been diagnosed with hypertension by a health care professional. In the 2010 survey, the earliest option for year of diagnosis was “before 1996,” with responses extended to “after 2010.”
Because this study was based on questionnaires and self-reported diagnoses, it cannot prove that sugary drinks or fruit juices are a direct cause of high blood pressure. Other factors not included in the analysis may also have influenced the results. Additionally, most participants were non-Hispanic white, so the findings may not apply equally to populations that are underrepresented in the study.
