Not all sources of dietary sugar appear to affect cardiovascular health in the same way, and one common drink may be less harmless than many assume.
A child’s everyday drink choices may leave a cardiovascular imprint that lasts for decades.
A long-term study of more than 25,000 people found that frequent consumption of sugar-sweetened beverages and fruit juice from childhood into adulthood was associated with a higher risk of developing high blood pressure. Whole fruit, however, was not linked to the same increase in risk.
The findings, published in the American Heart Association journal Circulation, suggest that the source and form of dietary sugar may matter more than fructose intake alone.
“Dietary habits in early life can have lasting health consequences,” said senior study author Vasanti Malik, Sc.D., M.Sc., an associate professor and Canada Research Chair in Nutrition and Chronic Disease Prevention in the department of nutritional sciences at Temerty Faculty of Medicine at the University of Toronto, and an adjunct faculty member in the department of nutrition at the Harvard T.H. Chan School of Public Health in Boston.
“High blood pressure is also emerging earlier in life, with growing rates being seen in younger adults, in children and adolescents, which highlights the importance of early detection and prevention,” she said.
Why Blood Pressure in Early Adulthood Matters
High blood pressure often causes no obvious symptoms, but over time it can damage blood vessels and place additional strain on the heart. It is a major risk factor for heart attack and stroke.
Age, family history, gender, and race can influence a person’s risk and cannot be changed. Diet, smoking, and physical activity are modifiable factors that may help shape blood pressure over the course of a lifetime.
The new findings focus attention on beverages because drinks can deliver substantial amounts of sugar without the fiber and structure found in whole fruit. Liquids are also generally consumed more quickly than solid foods and may be less filling, making it easier to consume larger amounts.
Tracking Diet From Youth to Adulthood
Researchers analyzed data from more than 25,000 participants in a U.S. study that followed young people for as long as 25 years.
Every 1 to 4 years, participants completed questionnaires about their diets, body measurements, physical activity, smoking, and other habits. They reported how often they consumed soda, fruit punch, lemonade, tea, sports drinks, fruit juice, whole fruit, and other foods and beverages.
The researchers then examined whether consumption of total fructose, sugar-sweetened beverages, fruit juice, or whole fruit was associated with a self-reported diagnosis of high blood pressure.
They also used statistical models to estimate how risk might differ if one daily serving of a sugary drink or fruit juice were replaced with whole fruit, milk, or water.
Sugary Drinks Were Linked to the Largest Increase
Participants who consumed at least two servings of sugar-sweetened beverages per day had a 52% higher risk of developing high blood pressure than those who drank fewer than three servings per week. One serving was defined as a 12-ounce can or glass.
The association varied by beverage type. Each daily serving of soda was linked to a 23% higher risk, while each daily serving of sports drinks was associated with a 36% higher risk.
The sports drink finding is notable because these products are often promoted in connection with exercise and performance. For people engaged in prolonged or intense physical activity, sports drinks may serve a specific purpose. For routine hydration, however, they can function as another source of added sugar.
The observed relationship between sugary drinks and high blood pressure remained after researchers accounted for overall diet quality, physical activity, and other factors.
Fruit Juice Was Not Equivalent to Whole Fruit
Frequent fruit juice consumption was also associated with a higher risk.
Participants who drank at least 1.5 servings of fruit juice per day had a 35% greater risk of developing high blood pressure than those who consumed less than one serving per week. A serving was defined as an 8-ounce glass.
Each daily serving of orange juice was associated with a 20% higher risk. Apple juice and other juices were not linked to a significant increase.
The researchers cautioned that some orange-flavored drinks containing added sugar may have been incorrectly reported as orange juice. That possibility could have influenced the orange juice result.
Whole fruit produced a different pattern. Unlike juice, whole fruit retains fiber and requires chewing, which slows consumption and generally makes it more filling. Its sugars are contained within an intact food structure rather than delivered rapidly in liquid form.
Replacing Drinks With Whole Fruit May Matter
The statistical substitution models suggested that replacing one daily serving of a sugary beverage with whole fruit could be associated with a 22% lower risk of developing high blood pressure.
Replacing fruit juice with whole fruit was associated with a 19% lower risk.
Swapping a sugar-sweetened beverage for milk or water was linked to as much as a 13% reduction in risk. However, replacing fruit juice with milk or water did not produce a statistically significant association.
These estimates do not prove that making a specific substitution will produce the same reduction for every person. They illustrate how risk differed within the study data when researchers modeled alternative dietary choices.
The Food Source May Matter More Than Fructose Alone
The results challenge the idea that all fructose-containing foods affect cardiovascular health in the same way.
“Sugar-sweetened beverages, such as soda and sports drinks, which are often marketed as somewhat healthy, should be limited,” Malik said. “Fruit juice intake may be harmless at low levels yet harmful at higher intake levels. They should always be 100% fruit juice, and even so, consumed only in moderation. Whole fruit should be emphasized over sugary beverages.”
A 2026 Dietary Guidance to Improve Cardiovascular Health scientific statement from the American Heart Association recommends minimizing added sugar in foods and beverages.
American Heart Association volunteer expert Amit Khera, M.D., FAHA, vice chair of the dietary guidance writing committee, said the connection between sugar-sweetened beverages, hypertension, and cardiovascular risk is broadly consistent with previous research. He said the study adds important evidence about when these habits begin and how the source of sugar may influence health.
“First, the focus on childhood and the importance of health behaviors in childhood with adult risk factor development provides a critical opportunity for prevention. As has been seen in adults, the total amount of fructose seems less important for the development of hypertension than the type of food where it is consumed, so sugar-sweetened beverages and fruit juice relate to increased risk, while whole fruit does not.
“Secondly, there has been a misconception about fructose in general being harmful for cardiovascular health regardless of the source, and that fruit juices are beneficial for health. This study demonstrates that neither seems to be correct,” added Khera, the director of preventive cardiology and clinical chief of cardiology at the University of Texas Southwestern Medical Center in Dallas.
Important Limits of the Findings
The study identifies associations rather than proving that sugary drinks or fruit juice directly caused high blood pressure.
Dietary intake was self-reported, which can introduce errors in memory, portion estimates, and beverage classification. High blood pressure diagnoses were also self-reported rather than confirmed through standardized blood pressure measurements in the analysis.
Even with adjustments for diet quality, exercise, and other variables, unmeasured differences between participants may have affected the results.
The study population also consisted mainly of white children and adults, which may limit how broadly the findings can be applied.
Khera noted that the results could still be especially relevant to communities with high consumption of sugary drinks.
“However, non-Hispanic Black and Hispanic American populations have the highest sugar-sweetened beverages intake, so these findings may be even more relevant for those groups.”
Reference: “Consumption of Fructose-Containing Food and Beverage Sources in Childhood Through to Adulthood and Risk of Hypertension: A Prospective Cohort Study” by Michelle Nguyen, Hala B. AlEssa, Andrea J. Glenn, Deirdre K. Tobias, Jorge E. Chavarro, Walter C. Willett, Frank B. Hu, Anthony J. Hanley, Catherine S. Birken, John L. Sievenpiper and Vasanti S. Malik, 22 June 2026, Circulation.
DOI: 10.1161/CIRCULATIONAHA.125.077666
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1 Comment
As a now eighty-two year old still sugar loving lay American male with mostly untreated (bad side effects) high blood pressure (HPT) since 1992, who previously tried to share his personal findings and practices with the American Heart Association, in-vain, I can mostly agree with their basic findings and suggestions about sugary drinks but not with their incomplete, ignorant and incompetent facts, causes and reasoning. More specifically, I believe most sugary drinks and fruit drinks are not sweetened with real sugar but with HFCS. And, unlike dextrose and glucose, fructose (even in real fruit juices) has long been known to raise the blood serum level of uric acid, unregulated. What I have found, mostly on-my-own in my own case, is that it’s not calories, carbohydrates, fats, oils, sugars or sedentary living that mostly cause my HPT. Since early 1981 it’s FDA approved added MSG aggravating my very, very mild allergy reactions to good quality proteins like beef, cow’s milk, cheese, eggs, pork, etc. (which I began to partially avoid for more than a decade in late 1981, before I was first diagnosed with high blood pressure, cholesterol and triglycerides in 1992). Then, it still took me until 2001 to learn of the true toxicity and timing of added MSG (FDA approved for expanded use in 1980). Mainstream medicine and the AHA are still so ‘dark-ages.’