Cut Salt or Sugar for High Blood Pressure?

Hypertension, the most important risk factor in cardiovascular disease, is most commonly controlled through the restriction of dietary sodium. The Dietary Approaches to Stop Hypertension (DASH) diet has been shown to be extremely effective in controlling hypertension. This is been attributed to its focus on whole foods and low sodium content. A significant source of sodium in the standard American diet, highly processed foods, also happen to be very high in refined carbohydrates. These foods are eliminated in the DASH diet.

Sugar, particularly fructose, has begun to overshadow salt as the major dietary cause of high blood pressure due to its role in “metabolic dysfunction and increasing blood pressure variability, myocardial oxygen demand, heart rate, and inflammation”. 

Hyperinsulinaemia due to insulin resistance seems to be directly correlated with hypertension. In a study comparing added sugar in diets, those who consumed a higher percentage of added sugars were three times more likely to die of cardiovascular disease. A study of 2700 showed that consuming sugar-sweetened beverages is directly related to increased blood pressure. However, naturally occurring sugar, such as in whole fruits, does not appear to have the same effect.

Although added fructose seems to be the most damaging monosaccharide, there are no specific recommendations regarding its consumption from the American Heart Association (AHA), World Health Organization (WHO), or Institute of Medicine (IOM). In fact, IOM allows up to 25% of the daily total calories to be made up of added sugars, enough to increase the risk of cardiovascular mortality three times. Typically for blood pressure control, recommendations are based on sodium consumption rather than sugar. Future recommendations would do well to address this issue to best address and prevent hypertension through diet.

Brown, I., Stamler, J., Van Horn, L., Robertson, C., Chan, Q., & Dyer, A. et al. (2011). Sugar-Sweetened Beverage, Sugar Intake of Individuals, and Their Blood Pressure: International Study of Macro/Micronutrients and Blood Pressure. Hypertension, 57(4), 695-701. http://dx.doi.org/10.1161/hypertensionaha.110.165456

DiNicolantonio, J., & Lucan, S. (2014). The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease. Open Heart, 1(1), e000167-e000167. http://dx.doi.org/10.1136/openhrt-2014-000167

Mayoclinic.org,. (2016). DASH diet: Healthy eating to lower your blood pressure - Mayo Clinic. Retrieved 12 February 2016, from http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456

Yang, Q., Zhang, Z., Gregg, E., Flanders, W., Merritt, R., & Hu, F. (2014). Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Internal Medicine, 174(4), 516. http://dx.doi.org/10.1001/jamainternmed.2013.13563