Does sugar raise blood pressure?

Sugar on its own, swapped for starch at the same calories, does not. Extra sugar in the diet over weeks may, by an amount the reviews disagree on. A 2017 meta-analysis of 28 studies with 510 volunteers found no rise in blood pressure when free sugars replaced complex carbohydrates. A 2014 meta-analysis of randomized trials found that in trials lasting 8 weeks or more, higher sugar intake raised systolic pressure by 6.9 mmHg (95% CI 3.4 to 10.3). The 2022 Cochrane review put the gap between high and low added sugar diets at 1.44 mmHg systolic, on low certainty evidence. Where the sugar comes from matters more than the sugar itself.

Established. Replacing starch with sugar while keeping calories equal does not raise blood pressure. That is the result of the 2017 meta-analysis of 28 isoenergetic studies in 510 volunteers, and of a 2023 meta-analysis of 147 controlled feeding comparisons in 5,213 adults, where the substitution trials showed a change of -0.33 mmHg (95% CI -1.16 to 0.51).

Unsettled. How much extra sugar raises blood pressure is not settled. The 2014 meta-analysis found 6.9 mmHg in its longer trials, mostly without strict calorie control. The Cochrane review of 21 trials in generally healthy adults found 1.44 mmHg systolic and 1.52 mmHg diastolic, called the clinical relevance uncertain and rated the evidence low certainty. EFSA in 2022 judged the certainty that sugars cause hypertension very low, a 0 to 15% probability.

What the trials found

Sugar in place of other carbohydrate

The cleanest test of sugar itself holds calories still and changes only the type of carbohydrate. Two meta-analyses did that and found nothing. The 2017 one pooled 28 studies with 510 volunteers and saw no significant change in systolic or diastolic pressure, with no heterogeneity, though the trials were short to moderate in length and not all randomized. The 2023 one, 147 comparisons in 5,213 adults with and without hypertension, found no effect of fructose-containing sugars in substitution, subtraction or free-feeding trials. Most of its substitution trials were industry funded. A third review, 25 studies with 1,744 volunteers, found that fructose or high-fructose corn syrup in place of glucose or sucrose did not raise blood pressure either.

More sugar, more calories

The picture changes when sugar is added on top of a diet. In the 2014 meta-analysis, trials of 8 weeks or more raised systolic pressure by 6.9 mmHg and diastolic by 5.6 mmHg (95% CI 2.5 to 8.8), and the authors say the effect was independent of weight change. That review searched to August 2013. The Cochrane review, with 14 weeks as the mean trial length, found a much smaller gap of 1.44 mmHg systolic (95% CI 0.08 to 2.80), with risk of bias mostly unclear.

The food decides

The 2023 meta-analysis split its addition trials by food. Adding fruit lowered systolic pressure by 6.37 mmHg (95% CI -9.21 to -3.52) across 16 trials, and adding 100% fruit juice lowered it by 3.74 mmHg (95% CI -5.28 to -2.20) across 16 more. Fruit and juice bring potassium and polyphenols along with their sugar. The one trial that added mixed sources including sugary drinks raised systolic pressure by 6.90 mmHg (95% CI 2.22 to 11.58), and that is a single trial. Taking sugary drinks away worked the other way: in 2 subtraction trials, removing mixed sources with sugary drinks lowered systolic pressure by 2.26 mmHg (95% CI -2.79 to -1.76), with very high heterogeneity between the two.

Individual trials point the same way. In a 6-month trial of 47 overweight adults drinking a liter a day, milk and diet cola left systolic pressure 10 to 15% lower than regular cola, with blood pressure a secondary endpoint. The trial reports a percentage and no mmHg figure. In a crossover trial of 21 healthy people, 20 g of fructose drunk as pure fructose raised systolic pressure 1.8 mmHg (95% CI 0.02 to 3.5) more than the same fructose in an apple, mashed apple or apple juice. That was an acute response in a small trial. A 6-week double-blind trial in 44 overweight people on a low-fructose diet, a secondary analysis in which 37 completed, found that glucose in place of fructose lowered diastolic pressure by 4.0 mmHg (95% CI -9.5 to -0.5).

Who goes on to develop high blood pressure

The cohort pools on this page measured sugary drinks, and the link is consistent. Across 15 prospective cohorts with 930,677 people, each 12 fl oz (355 mL) of sugary drink a day went with a 10% higher risk of hypertension, a risk ratio of 1.10 (95% CI 1.08 to 1.12), on low certainty evidence. A 2015 pool of 6 cohorts with 240,726 people found 8% per extra daily serving. A 2024 pool of 35 observational studies, some of them cross-sectional, found 26% per 250 g a day for sugary drinks and 10% for artificially sweetened ones. That second figure is the warning: a drink with no sugar should not carry the link if sugar were the whole story, so confounding or reverse causation is likely in part of it. Fruit and yogurt were linked with lower risk in the 2019 pool.

No trial has measured what this means for the heart. The 2022 Cochrane review found no trial of added sugar that recorded heart attacks, strokes or deaths, so the effect on those outcomes is unknown.

Who should be careful

Not for everyone. People who eat a lot of salt may be the ones in whom fructose shows up. In a double-blind crossover trial of 36 healthy young adults, high fructose plus high salt raised 24-hour mean arterial pressure from 81 to 84 mmHg (p = 0.03), while high salt alone did not change it. Each diet lasted one week, so this is a short mechanistic trial.

Children who drink more sugary drinks tend to have slightly higher blood pressure. A 2020 meta-analysis of 14 observational studies in 93,873 children and adolescents linked high intake to systolic pressure 1.67 mmHg higher (95% CI 1.02 to 2.32). Diastolic pressure was not significantly different, and the studies were extremely heterogeneous. This is association in children, and it cannot show cause.

The limits below are for everyone. The American Heart Association sets about 100 calories of added sugar a day for most women and 150 for most men. WHO sets free sugars below 10% of daily energy for adults and children, and ideally below 5%. Free sugars include honey, syrups and fruit juice, and they do not include whole fruit.

What expert bodies say

WHO's 2015 sugar guideline rests its limits on body weight and tooth decay. It lists sugar and blood pressure as a question that still needed systematic reviews, and it predates the 2017 to 2023 meta-analyses on this page. The American Heart Association's 2009 statement based its 100 and 150 calorie limits mainly on energy and nutrient quality and on observational data on soft drinks. EFSA's 2022 opinion weighed randomized trials of systolic pressure and judged the certainty that sugars cause hypertension very low, 0 to 15%. The AHA and the 2014 meta-analysis read the same field as more harmful than EFSA did.

For most people the practical answer sits in the drinks. Sugar inside fruit did not raise blood pressure in the trials, and sugar replacing starch did not either. Sugary drinks are where the trial signal and the cohort signal agree. More on sugar itself is on the sugar page.

How we searched

What would change this answer

• A randomized trial lasting six months or more that cuts free sugar while holding body weight steady and measures 24-hour blood pressure. That would separate sugar from the extra calories it brings.
• Any trial that counts heart attacks, strokes or deaths. The Cochrane review found none.
• More than one trial of adding sugary drinks. The 6.90 mmHg figure from the 2023 pool rests on a single trial.

Sources

1. ev-sgbp-01 · Meta-analysis or systematic review · systematic review and meta-analysis of randomized controlled trials · n = 12 trials (blood pressure)
   The effect of sugar intake on blood pressure was greatest in trials ≥8 wk in duration [MD: 6.9 mm Hg (95% CI: 3.4, 10.3 mm Hg; P < 0.001) for systolic blood pressure and 5.6 mm Hg (95% CI: 2.5, 8.8 mm Hg; P = 0.0005) for diastolic blood pressure].
   
   Who: adults in randomized controlled trials that changed dietary free sugars, minimum 2 weeks
   Effect: trials of 8 weeks or more: SBP +6.9 mmHg (95% CI 3.4 to 10.3), DBP +5.6 mmHg (95% CI 2.5 to 8.8)
   Certainty: Higher versus lower sugar, mostly without strict energy control; authors say the effect is independent of weight change. Search to August 2013.
   Am J Clin Nutr, 2014 · checked 2026-10-07 · we read the abstract
2. ev-sgbp-02 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = 873
   There was minimal effect on diastolic blood pressure (MD 1.52, 95% CI 0.67 to 2.37; I² = 0%; 13 studies; 873 participants) and on systolic blood pressure (MD 1.44, 95% 0.08 to 2.80; I² = 27%, 14 studies; 873 participants; low certainty of evidence), but no evidence of effect on fasting plasma glucose.
   
   Who: generally healthy adults aged 22 to 57 years, without diabetes or previous cardiovascular disease, mean trial duration 14 weeks
   Effect: DBP MD 1.52 mmHg (95% CI 0.67 to 2.37), 13 studies; SBP MD 1.44 mmHg (95% CI 0.08 to 2.80), 14 studies; low certainty (GRADE)
   Certainty: Low certainty (GRADE); risk of bias mostly unclear; authors call the clinical relevance uncertain.
   Cochrane Database Syst Rev, 2022 · checked 2026-10-07 · we read the abstract
3. ev-sgbp-03 · Meta-analysis or systematic review · Cochrane systematic review and meta-analysis of randomized controlled trials · n = 21 RCTs
   No trials investigating the effect of added sugar on cardiovascular events or all-cause mortality were identified in our searches.
   
   Who: randomized trials of high versus low added sugar intake in adults
   Effect: 0 trials reporting cardiovascular events or all-cause mortality
   Certainty: Absence of evidence on outcomes, search to July 2021.
   Cochrane Database Syst Rev, 2022 · checked 2026-10-07 · we read the abstract
4. ev-sgbp-04 · Meta-analysis or systematic review · systematic review and meta-analysis of isoenergetic intervention trials · n = 510
   When free sugars were substituted for complex carbohydrates, no significant increases were detected in systolic or diastolic blood pressure, and no heterogeneity was observed.
   
   Who: volunteers in isoenergetic intervention trials comparing free sugars with complex carbohydrates
   Effect: no significant change in systolic or diastolic blood pressure, no heterogeneity
   Certainty: Short to moderate term trials; not all randomized.
   Am J Clin Nutr, 2017 · checked 2026-10-07 · we read the abstract
5. ev-sgbp-05 · Meta-analysis or systematic review · systematic review and meta-analysis of controlled feeding trials · n = 5213
   We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05).
   
   Who: adults with and without hypertension or at risk for hypertension, controlled feeding trials of 7 days or more
   Effect: SBP substitution -0.33 mmHg (95% CI -1.16 to 0.51); subtraction -1.16 (95% CI -2.90 to 0.57); ad libitum +0.98 (95% CI -0.43 to 2.39); addition -2.23 (95% CI -3.40 to -1.06)
   Certainty: GRADE generally moderate; most substitution trials industry funded; the drop in addition trials is driven by fruit and juice.
   PLoS One, 2023 · checked 2026-10-07 · we read the abstract
6. ev-sgbp-06 · Meta-analysis or systematic review · systematic review and meta-analysis of controlled feeding trials · n = 16 trials (fruit), 16 trials (juice), 1 trial (mixed with SSBs)
   mixed sources (with SSBs) resulted in an increase in systolic BP (1 trial; MD: 6.90mmHg; 95% CI: 2.22, 11.58; PMD = 0.004), while 100% fruit juice resulted in a reduction in systolic BP (16 trials; MD: -3.74mmHg; 95% CI: -5.28, -2.20mmHg; PMD<0.001; substantial heterogeneity, I2 = 53.5%, PQ = 0.006) and fruit resulted in a reduction in systolic BP (16 trials; MD: -6.37mmHg; 95% CI: -9.21, -3.52mmHg; PMD<0.001; substantial heterogeneity, I2 = 68.7%, PQ<0.001)
   
   Who: addition trials (extra energy from sugars added to the diet), by food source
   Effect: fruit SBP -6.37 mmHg (95% CI -9.21 to -3.52); 100% juice -3.74 mmHg (95% CI -5.28 to -2.20); mixed sources with SSBs +6.90 mmHg (95% CI 2.22 to 11.58)
   Certainty: Fruit and juice bring potassium and polyphenols with their sugar; the SSB arm is a single trial.
   PLoS One, 2023 · checked 2026-10-07 · we read the fulltext
7. ev-sgbp-07 · Meta-analysis or systematic review · systematic review and meta-analysis of controlled feeding trials · n = 2 trials
   In subtraction trials, the removal of mixed sources (with SSBs) resulted in a reduction in systolic BP (2 trials; MD: -2.26mmHg; 95% CI: -2.79, -1.76mmHg; PMD<0.001; substantial heterogeneity, I2 = 96.7%, PQ<0.001).
   
   Who: subtraction trials removing excess energy from mixed sources with sugar-sweetened beverages
   Effect: SBP -2.26 mmHg (95% CI -2.79 to -1.76), I2 96.7%
   Certainty: Two highly heterogeneous trials.
   PLoS One, 2023 · checked 2026-10-07 · we read the fulltext
8. ev-sgbp-08 · Meta-analysis or systematic review · systematic review and meta-analysis of isoenergetic intervention trials · n = 1744
   No significant effects were found when fructose or HFCS was substituted for glucose, except for a slight decrease in diastolic blood pressure when fructose was substituted for glucose.
   
   Who: volunteers in isoenergetic intervention trials replacing glucose or sucrose with fructose or high-fructose corn syrup
   Effect: no significant effect on SBP or DBP; slight DBP decrease when fructose replaced glucose
   Certainty: Authors note heterogeneity and studies at high or unclear risk of bias.
   Nutr Rev, 2021 · checked 2026-10-07 · we read the abstract
9. ev-sgbp-09 · Randomized controlled trial(s) · randomized crossover trial · n = 21
   The systolic blood pressure response was higher after pure fructose compared to the other matrices (+1.8 mmHg, 95%CI 0.02; 3.5).
   
   Who: healthy individuals given 20 g fructose from apple, mashed apple, apple juice or fructose in water
   Effect: SBP response +1.8 mmHg (95% CI 0.02 to 3.5) for pure fructose vs other matrices
   Certainty: Acute response in a small trial; the same paper's cohort arm is observational.
   Clin Nutr, 2025 · checked 2026-10-07 · we read the abstract
10. ev-sgbp-10 · Randomized controlled trial(s) · randomized controlled trial · n = 47
    Milk and diet cola reduced systolic blood pressure by 10-15% compared with regular cola (P < 0.05).
    
    Who: overweight subjects randomized to 1 L/d of regular cola, semiskim milk, diet cola or water for 6 months
    Effect: SBP 10-15% lower with milk and diet cola than with regular cola (P < 0.05)
    Certainty: Small trial; blood pressure a secondary endpoint.
    Am J Clin Nutr, 2012 · checked 2026-10-07 · we read the abstract
11. ev-sgbp-11 · Randomized controlled trial(s) · double-blind randomized controlled trial, secondary analysis · n = 44
    In contrast, diastolic blood pressure decreased significantly in the intervention group in comparison to controls (difference: -4.0 mmHg; 95%CI:-9.5,-0.5).
    
    Who: overweight individuals on a fructose-restricted diet, randomized to glucose or fructose powder three times daily
    Effect: DBP -4.0 mmHg (95% CI -9.5 to -0.5) vs fructose control; high-salt subgroup -9.0 mmHg (95% CI -14.5 to -2.5)
    Certainty: Secondary analysis; 37 of 44 completed; salt subgroup is post hoc.
    Clin Nutr ESPEN, 2022 · checked 2026-10-07 · we read the abstract
12. ev-sgbp-12 · Randomized controlled trial(s) · randomized double-blind crossover trial · n = 36
    Compared to the recommended diet, high salt alone did not significantly change 24 h. MAP; however, high fructose plus high salt modestly raised 24 h MAP (81 ± 6 vs. 84 ± 7 mmHg, p = 0.03).
    
    Who: healthy adults in a randomized double-blind crossover trial of three diets varying in fructose and sodium
    Effect: 24-h MAP 81 vs 84 mmHg (p = 0.03) for high fructose plus high salt vs recommended diet
    Certainty: One week per diet; a short mechanistic trial.
    Physiol Rep, 2025 · checked 2026-10-07 · we read the abstract
13. ev-sgbp-13 · Observational data · systematic review and dose-response meta-analysis of prospective cohort studies · n = 930677
    Sugar-sweetened beverages showed harmful (RRper-355-mL, 1.10 [95% CI, 1.08, 1.12]) whereas fruit (RRper-240-g, 0.94 [95% CI, 0.96, 0.99]) and yogurt showed protective associations (RRper-125-g, 0.95 [95% CI, 0.94, 0.97]) with incident hypertension throughout the dose range.
    
    Who: participants of 15 prospective cohorts
    Effect: SSBs RR 1.10 per 355 mL/d (95% CI 1.08 to 1.12); fruit RR 0.94 per 240 g; yogurt RR 0.95 per 125 g; low certainty (GRADE)
    Certainty: GRADE low for SSBs; the fruit CI is printed as 0.96 to 0.99 in the abstract.
    J Am Heart Assoc, 2019 · checked 2026-10-07 · we read the abstract
14. ev-sgbp-14 · Observational data · dose-response meta-analysis of prospective cohort studies · n = 240726
    The summary RR for incident hypertension was 1·08 (95 % CI 1·04, 1·12) for every additional one serving/d increase in SSB consumption.
    
    Who: participants of six prospective cohort studies, 80,411 incident cases of hypertension
    Effect: RR 1.08 (95% CI 1.04 to 1.12) per serving/day
    Certainty: Observational; residual confounding by diet and weight possible.
    Br J Nutr, 2015 · checked 2026-10-07 · we read the abstract
15. ev-sgbp-15 · Observational data · systematic review and dose-response meta-analysis of cohort and cross-sectional studies · n = 35 studies
    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.
    
    Who: participants of cohort and cross-sectional studies
    Effect: SSBs RR 1.26 (95% CI 1.15 to 1.37) per 250 g/d; ASBs RR 1.10 (95% CI 1.07 to 1.13)
    Certainty: The ASB signal points to confounding or reverse causation; cross-sectional studies included.
    Crit Rev Food Sci Nutr, 2024 · checked 2026-10-07 · we read the abstract
16. ev-sgbp-16 · Observational data · systematic review and dose-response meta-analysis of observational studies · n = 93873
    As presented, high SSB consumption was associated with 1.67 mmHg increase in SBP in children and adolescents (WMD: 1.67; CI 1.021–2.321; P < 0.001).
    
    Who: children and adolescents in observational studies
    Effect: SBP WMD +1.67 mmHg (95% CI 1.02 to 2.32); DBP not significant; OR hypertension 1.37 (95% CI 1.15 to 1.63)
    Certainty: Very high heterogeneity for SBP (I2 99.8%); observational.
    Journal of Translational Medicine, 2020 · checked 2026-10-07 · we read the fulltext
17. ev-sgbp-17 · Position of an expert body · WHO guideline · n = —
    In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake2 (strong recommendation). WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation3).
    
    Who: adults and children
    Effect: free sugars <10% of energy (strong), <5% (conditional)
    Certainty: Upper limit for intake; free sugars include those in honey, syrups and fruit juice, not whole fruit.
    WHO, 2015, Guideline: sugars intake for adults and children · checked 2026-10-07 · we read the section
18. ev-sgbp-18 · Position of an expert body · WHO guideline · n = —
    Need for systematic reviews and meta-analyses relating free sugars intake to blood lipid levels, blood pressure and diabetes-related outcomes
    
    Who: adults and children
    Effect: research need named: free sugars and blood lipids, blood pressure, diabetes outcomes
    Certainty: WHO 2015 predates the 2017 to 2023 meta-analyses above.
    WHO, 2015, Guideline: sugars intake for adults and children · checked 2026-10-07 · we read the section
19. ev-sgbp-19 · Position of an expert body · scientific statement · n = —
    A prudent upper limit of intake is half of the discretionary calorie allowance, which for most American women is no more than 100 calories per day and for most American men is no more than 150 calories per day from added sugars.
    
    Who: American women and men
    Effect: added sugars upper limit about 100 calories/d (women), 150 calories/d (men)
    Certainty: 2009 statement; based mainly on energy and nutrient quality, observational data on soft drinks.
    Circulation, 2009 · checked 2026-10-07 · we read the abstract
20. ev-sgbp-20 · Position of an expert body · EFSA scientific opinion based on a systematic review · n = —
    low for NAFLD/NASH and T2DM (> 15–50% probability) and very low for hypertension (0–15% probability)
    
    Who: adults in randomized trials of high versus low sugar intake, surrogate endpoints
    Effect: certainty of a causal link: hypertension very low (0-15%); NAFLD and type 2 diabetes low (15-50%); obesity and dyslipidemia moderate (50-75%)
    Certainty: EFSA weighs RCT surrogate data on systolic pressure; AHA and the 2014 meta-analysis read the same field as more harmful.
    EFSA Journal, 2022, Tolerable upper intake level for dietary sugars (EFSA NDA Panel) · checked 2026-10-07 · we read the fulltext