Sugar and Hypertension

From Medscape Education Clinical Briefs

Is Sugar the Real Culprit Behind Hypertension? CME/CE

News Author: Lara C. Pullen, PhD
CME Author: Charles P. Vega, MD

Faculty and Disclosures

CLINICAL CONTEXT

Dietary salt has traditionally been held responsible for increasing blood pressure and, therefore, the risk for cardiovascular disease. In their current review, DiNicolantonio and Lucan challenge this assumption. They note that there has been limited change in sodium consumption in Western diets for the past 50 years, with an average intake of 3.5 to 4 g/day. They also report that low-salt diets reduce systolic blood pressure by a paltry 5 mm Hg at most among adults with hypertension, and probably to a lesser degree among adults with normal blood pressure levels. The average reduction in diastolic blood pressure associated with a low-salt diet among adults with hypertension is 2.5 mm Hg.

In fact, some research has found that low-salt diets are associated with a higher rate of hospitalizations and mortality among adults with heart failure, and a higher risk for cardiovascular mortality among patients with diabetes. On the other hand, an increasing amount of evidence suggests that sugars, particularly those found in processed foods, are more significant than salt in promoting hypertension and cardiovascular disease. The current study by DiNicolantanio and Lucan summarizes what is known about the relationship between sugars and these outcomes.

STUDY SYNOPSIS AND PERSPECTIVE

A reduction in the consumption of added sugars and, in particular, processed foods may translate into decreased rates of hypertension as well as decreased cardiometabolic disease. In particular, a new review article suggests that sugar, not salt, appears to contribute to the majority of the hypertension risk associated with processed food.

James J. DiNicolantanio, PharmD, from Saint Luke's Mid America Heart Institute in Kansas City, Missouri, and Sean C. Lucan, MD, MPH, from Albert Einstein College of Medicine in Bronx, New York, published their review of epidemiologic and experimental studies in Open Heart. The authors conclude that high-sugar diets may make a significant contribution to cardiometabolic risk. They also suggest that future dietary guidelines recommend that highly refined processed foods be replaced by natural whole foods.