The effect of fructose on risk of incident hypertension: a systematic review and meta‐analysis of 3 large U.S. prospective cohorts

Background There is concern that fructose contributes to the development of hypertension. Aims To determine the association between fructose and incident hypertension, we performed a systematic review and meta‐analysis of prospective cohort studies. Methods We searched MEDLINE, EMBASE, CINAHL and the Cochrane Library (through November 1, 2012) for relevant prospective cohort studies. We pooled relative risks (RR) using a generic inverse variance random effects model, and assessed (Q‐statistic) and quantified (I 2 ) between‐cohort heterogeneity. The Newcastle‐Ottawa scale assessed study quality. Results Three prospective cohort studies (n=37,375 men & 185,855 women) were included with 58,162 confirmed cases of incident hypertension (11,192 in men; 46,970 in women) over 2,502,357 person‐years follow‐up. Median energy‐adjusted fructose intake was 13.9 to 14.3% of total calories in the highest quintiles and 5.7 to 6.0% in the lowest quintiles, assessed by validated semi‐quantitative food‐frequency questionnaires. The RR of incident hypertension (highest vs. lowest quintile) was 1.02 (95% CI: 0.99 to 1.04), with no evidence of heterogeneity (I 2 =0%; P=0.59). Limitations Only 3 cohorts from a single country (U.S.) were represented. Conclusion Fructose was not associated with risk of hypertension in 3 large U.S. prospective cohorts. Funding: CIHR, Calorie Control Council