Drinking fruit juices and sugary drinks regularly from childhood to adulthood may increase the likelihood of developing high blood pressure later in life, according to new research published today in the American Heart Association’s flagship journal, Circulation.
“Dietary habits in the first years of life can have long-lasting health consequences,” said the study’s senior author, Vasanti Malik, Sc.D., M.Sc., 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 School of Medicine, and an adjunct faculty member in the department of nutrition at the Harvard TH Chan School of Public Health in Boston.
“High blood pressure is also emerging at earlier ages in life, with increasing rates seen in younger adults, children and adolescents, highlighting the importance of early detection and prevention,” he said.
Why early blood pressure risk is important
High blood pressure can increase your risk of serious health problems, including heart attacks and strokes. Some risk factors, such as family history, age, sex, and race, cannot be changed. However, lifestyle factors such as poor diet, smoking, and low levels of physical activity 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 young Americans. Through questionnaires completed every 1 to 4 years, participants reported how often they consumed sugary beverages such as soda, fruit punch, lemonade, sweetened tea, and sports drinks. They also reported their consumption of fruit juices, whole fruits, and other foods and beverages, along with information on body measurements, physical activity, and smoking.
The researchers examined whether total fructose intake and consumption of sugary drinks, fruit juices, and whole fruits were associated with self-reported diagnoses of high blood pressure. They also created statistical models to estimate what might happen if participants replaced sugary drinks or fruit juice with whole fruit, milk or water. Participants were followed for up to 25 years.
Sugary drinks linked to 52% higher risk
Participants who consumed two or more servings of sugary drinks each day had a 52% higher risk of developing high blood pressure in the future compared to those who drank fewer than three servings per week. A serving was defined as one 12-ounce can or glass.
Different types of sugary drinks showed different levels of risk. Each daily serving of soda was associated with a 23% increased risk of high blood pressure, while each daily serving of sports drinks was associated with a 36% increased risk.
Fruit juice was also associated with an increased risk when consumed in larger quantities. 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 one serving per week. One serving of fruit juice was defined as one 8-ounce glass.
Among specific types of juice, each daily serving of orange juice was associated with a 20% increased risk of high blood pressure. Apple juice and other juices were not associated with the same increase. However, researchers warned that some orange-flavored drinks containing added sugar may have been incorrectly reported as orange juice.
Whole fruit may be a better option
Substitution models suggested that replacing one daily serving of a sugary drink with whole fruit could be associated with a 22% lower risk of developing high blood pressure.
Replacing one daily serving of fruit juice with whole fruit was associated with a 19% lower risk.
The models also found that replacing sugary drinks with milk or water was associated with up to a 13% lower risk of high blood pressure. However, replacing fruit juice with milk or water was not associated with a significant change in risk.
The connection between sugary drinks, fruit juices and high blood pressure remained even after researchers considered overall diet quality, physical activity and other factors.
“Sugary drinks, such as soda and sports drinks, which are often marketed as healthy, should be limited,” Malik said. “Fruit juice intake can be harmless at low levels, but harmful at higher levels. They should always be 100% fruit juices and even then consumed only in moderation. Whole fruit should be emphasized over sugary drinks.”
Sugar Source May Matter
A scientific statement from the American Heart Association’s 2026 Dietary Guidelines for Improved Cardiovascular Health recommends minimizing added sugar in foods and beverages.
American Heart Association volunteer expert Amit Khera, MD, FAHA, vice chair of the dietary guidelines writing committee, said the association between sugary drinks and higher hypertension and cardiovascular risk has been generally consistent in previous research. However, he said the new findings provide several additional insights.
“First, the focus on childhood and the importance of health behaviors in childhood with the development of risk factors in adulthood provides a critical opportunity for prevention. As has been observed in adults, the total amount of fructose appears less important for the development of hypertension than the type of food in which it is consumed, so sugary drinks and fruit juices are associated with increased risk, while whole fruit is not.
“Second, there has been a misconception that fructose in general is harmful to cardiovascular health regardless of its source, and that fruit juices are beneficial to health. This study shows that neither of those seem to be correct,” added Khera, director of preventive cardiology and clinical chief of cardiology at the University of Texas Southwestern Medical Center in Dallas.
Khera also noted that the study population was primarily white children and adults. “However, non-Hispanic black and Hispanic American populations have the highest consumption of sugary drinks, so these findings may be even more relevant for those groups.”
Policies aimed at reducing the consumption of sugary drinks
The American Heart Association supports science-based policies designed to reduce consumption of sugary drinks. These include establishing taxes on sugary drinks, strengthening nutritional standards for school meals, improving “informed eating” in restaurants, and improving diet quality within the Supplemental Nutrition Assistance Program (SNAP).
Research Highlights
During a follow-up period lasting up to 25 years, people who consumed the most sugary drinks and fruit juices since childhood had a higher risk of developing high blood pressure than those who consumed less.
Replacing one daily serving of a sugary drink with whole fruit, milk or water was associated with a lower risk of high blood pressure. Replacing fruit juice with whole fruit was also associated with a lower risk.
Study design and participant details
Participants were from the Growing Up Today Study (GUTS), which included GUTS I, launched in 1996, and GUTS II, launched in 2004. Children of participants in the Nurses’ Health Study II were recruited throughout the United States.
The study followed 25,749 participants who were between 9 and 16 years old at enrollment (approximately 55% female and 96% non-Hispanic white participants) for up to 25 years. At the end of the follow-up period, the mean age of the participants was 36 years.
Participants completed 132-item food frequency questionnaires annually from 1996 to 1998, followed by additional questionnaires in 2001, 2004, 2006, 2008, 2011, and 2015. Children who already had high blood pressure or lacked dietary information at the start of the study were excluded from the analysis.
The questionnaires 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 “6 or more per day.” A serving was defined as one 12-ounce can or glass for sugary drinks and one 8-ounce glass for fruit juice.
Sugary drinks included sodas, fruit punches, lemonades, iced teas, sports drinks, and still fruit drinks. Fruit juices included orange juice, apple juice, and other 100% fruit juice drinks. Whole fruits included apples, oranges, bananas, mangoes, grapes, pears, melons, strawberries, and peaches.
For the substitution analysis, the researchers compared one daily serving of a sugary drink or fruit juice with one serving of fruit juice, milk (1%, 2%, and whole milk, but not chocolate or flavored milk), water, or whole fruit.
Limitations of the study
Blood pressure results were self-reported in questionnaires completed between 2010 and 2021. Participants were asked if they had ever been diagnosed with high blood pressure by a healthcare professional. In the 2010 questionnaire, the earliest option for year of diagnosis was “before 1996” and responses extended to “2010+.”
Because the study relied on questionnaires and self-reported diagnoses, it cannot prove that sugary drinks or fruit juices directly caused high blood pressure. Other factors not included in the analysis may also have influenced the results. Additionally, because most participants were non-Hispanic white, the findings may not apply equally to populations that were not well represented in the study.