Popular childhood drinks may raise blood pressure decades later

"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 Early Blood Pressure Risk Matters

High blood pressure can increase the risk of serious health problems, including heart attack and stroke. Some risk factors, such as family history, age, gender and race, cannot be changed. However, lifestyle factors including 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-running study of U.S. youths. Through questionnaires completed every 1 to 4 years, participants reported how often they consumed sugar-sweetened beverages such as soda, fruit punch, lemonade, sweetened tea and sports drinks. They also reported their consumption of fruit juice, whole fruit and other foods and beverages, along with information about body measurements, physical activity and smoking.

Researchers examined whether total fructose intake and the consumption of sugar-sweetened beverages, fruit juice and whole fruit were associated with self-reported diagnoses of high blood pressure. They also created statistical models to estimate what might happen if participants replaced sugary beverages or fruit juice with whole fruit, milk or water. Participants were followed for as long as 25 years.

Sugary Drinks Linked to a 52% Higher Risk

Participants who consumed two or more servings of sugar-sweetened beverages each day had a 52% higher risk of developing high blood pressure later in life compared with those who drank fewer than three servings per week. One serving was defined as a 12-ounce can or glass.

Different types of sugary drinks showed varying levels of risk. Each daily serving of soda was associated with a 23% higher risk of high blood pressure, while each daily serving of sports drinks was linked to a 36% higher risk.

Fruit juice was also associated with increased risk when consumed in larger 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 one serving per week. A serving of fruit juice was defined as an 8-ounce glass.

Among specific juice types, each daily serving of orange juice was associated with a 20% higher risk of high blood pressure. Apple juice and other juices were not associated with the same increase. However, the researchers cautioned that some orange-flavored beverages containing added sugar may have been incorrectly reported as orange juice.

Whole Fruit May Be a Better Choice

The 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 one daily serving of fruit juice with whole fruit was associated with a 19% lower risk.

The models also found that replacing sugar-sweetened beverages 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 juice and high blood pressure remained even after researchers considered overall diet quality, physical activity and other factors.

"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."

The Source of Sugar May Matter

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 association between sugar-sweetened beverages and higher hypertension and cardiovascular risk has been generally consistent across 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 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.

Khera also pointed out that the study population consisted mostly of White children and adults. "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."

Policies Aimed at Reducing Sugary Drink Intake

The American Heart Association supports science-based policies designed to reduce the consumption of sugary drinks. These include establishing taxes on sugary beverages, strengthening nutrition standards for school meals, improving "informed dining" in restaurants and raising diet quality within the Supplemental Nutrition Assistance Program (SNAP).

Research Highlights

Over a follow-up period lasting as long as 25 years, people who consumed more sugary beverages and fruit juice beginning in childhood had a greater risk of developing high blood pressure than those who consumed less.

Replacing one daily serving of a sugary beverage 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 lower risk.

Study Design and Participant Details

Participants came 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 from across the United States.

The study followed 25,749 participants who were ages 9 to 16 at enrollment, (about 55% female and 96% non-Hispanic White participants) for up to 25 years. By the end of the follow-up period, the median participant age was 36.

Participants completed 132-item food frequency questionnaires annually from 1996 through 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 beginning of the study were excluded from the analysis.

The questionnaires asked participants how often they consumed a standard serving of each food or beverage, with responses ranging from "never or less than once per month" to "6 or more per day." A serving was defined as a 12-ounce can or glass for sugar-sweetened beverages and an 8-ounce glass for fruit juice.

Sugar-sweetened beverages included sodas, fruit punches, lemonades, iced teas, sports drinks and non-carbonated fruit drinks. Fruit juice included orange juice, apple juice and other 100% fruit juice beverages. Whole fruits included apples, oranges, bananas, mangos, grapes, pears, melons, strawberries and peaches.

For the substitution analysis, researchers compared one daily serving of a sugar-sweetened beverage 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.

Study Limitations

Blood pressure outcomes were self-reported in questionnaires completed from 2010 through 2021. Participants were asked whether a healthcare professional had ever diagnosed them with high blood pressure. In the 2010 questionnaire, the earliest option for the year of diagnosis was "before 1996" and responses extended through "2010+."

Because the study relied on questionnaires and self-reported diagnoses, it cannot prove that sugary drinks or fruit juice directly caused high blood pressure. Other factors not included in the analysis may also have influenced the results. In addition, because most participants were non-Hispanic White, the findings may not apply equally to populations that were not well represented in the study.