Childhood consumption of sweetened drinks, including fruit juice and fizzy pop, may increase the risk of developing high blood pressure in adulthood by as much as 52%, according to a major new study published by the American Heart Association.
The Study
The research, which appears in the association’s journal Circulation, followed more than 25,000 Americans aged 9–16 for 25 years. Those who drank two or more 12-ounce servings of sugary beverages daily in childhood were 52% more likely to develop hypertension as adults compared with those who consumed fewer than three servings a week.
The findings break down risks by drink type. Drinking 12 ounces of fruit juice each day was linked to a 35% higher risk of adult hypertension; soda raised the risk by 23%; and sports drinks were associated with a 36% increase. Orange juice stood out: each daily serving was tied to a 20% higher risk. However, the researchers cautioned that “orange-flavoured drinks with added sugars may have been misreported as orange juice”, suggesting the problem may lie with added sugars rather than pure juice.
Hypertension, or persistently high blood pressure, is a major contributor to heart disease, kidney disease, stroke and dementia. The American Heart Association notes that more than 125 million American adults currently live with the condition.
The Fructose Factor
Dr. Amit Khera, a volunteer expert for the American Heart Association and Director of Preventive Cardiology at UT Southwestern Medical Center, stressed that the source of fructose matters more than the total amount. “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,” he said.
He added that there has been a widespread misconception that all fructose is harmful for cardiovascular health and that fruit juices are automatically beneficial. “This study demonstrates that neither seems to be correct,” he said. The key difference, according to experts, is that whole fruit contains fibre, which slows sugar absorption and blunts the metabolic impact, whereas juicing removes fibre and releases free sugars that enter the bloodstream rapidly.
Dr. Vasanti Malik, an adjunct faculty member at the Harvard T.H. Chan School of Public Health and senior author of the study, emphasised that dietary habits formed early in life carry lasting consequences. “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.
This pattern is not confined to the United States. Globally, the prevalence of high blood pressure in children and adolescents under 19 has risen from 3% in 2000 to over 6% in 2020. In the UK, some reports indicate a near doubling of childhood hypertension rates over the past two decades, driven in part by rising obesity. Nearly one in five obese children and teenagers now has high blood pressure — eight times the rate seen in healthy-weight children.
A separate “natural experiment” using UK dietary surveys from the 1950s and linked health records found that individuals born after the end of sugar rationing in 1953 had a significantly higher risk of type 2 diabetes and hypertension later in life compared with those born during the rationing period. The first 1,000 days of life — from conception to age two — are considered a critical window for metabolic development.
The UK government currently advises that “free sugars” — including added sugars and those in honey, syrups and unsweetened fruit and vegetable juices — should make up no more than 5% of daily energy intake. For children aged 4–6, that is a maximum of 19g per day; for 7–10 year olds, 24g; and for those 11 and older, 30g. Sugar-sweetened drinks are a major source, contributing 17% of the free sugar intake of 11- to 18-year-olds in Britain.
Prevention and Substitution
The study’s authors point to clear steps that can lower risk. Replacing one daily serving of a sugary beverage with whole fruit was associated with a 22% lower risk of developing high blood pressure. Substituting fruit juice with whole fruit reduced risk by 19%. Milk and water also make effective swaps: replacing a sugary drink with either was tied to a 13% lower risk. However, substituting fruit juice with milk or water did not show a significant association with risk reduction.
For UK families, the NHS advises limiting fruit juice to a maximum of 150ml per day and consuming it with meals to reduce the risk of tooth decay, as juicing releases sugars and strips away fibre. Water and milk remain the most suitable everyday drinks for children. Reading labels for “free sugars” and avoiding sweetened juice drinks, sodas and sports drinks is also recommended.
The researchers noted that participants in the study self-reported their food and drink intake every one to four years, along with their blood pressure readings. Statistical models were then used to isolate the effects of different beverages, adjusting for other health factors.