ReviewOpen heart
The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease.
Review in Open heart. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 113 citations in OpenAlex.
- Associations between the use of caries preventive methods and ECC experience in Ile-Ife, Nigeria: a cross-sectional study.BMC oral health · 2025Article
- Dietary modulation for the hypertension risk group in Koreans: a cross-sectional study.Nutrition & metabolism · 2025Article
- Ketosis suppression and ageing (KetoSAge): the effect of suppressing ketosis on SHBG and sex hormone profiles in healthy premenopausal women, and its implications for cancer risk and therapy.Frontiers in nutrition · 2025Article
- Plant-based diets and cardiovascular risk factors: a comparison of flexitarians, vegans and omnivores in a cross-sectional study.BMC nutrition · 2024Article
- Obesity and hypertension: Obesity medicine association (OMA) clinical practice statement (CPS) 2023.Obesity pillars · 2023Article
- Article
- Diabetes websites lack information on dietary causes, risk factors, and preventions for type 2 diabetes.Frontiers in public health · 2023Article
- Intake of sucrose-sweetened beverages and risk of developing pharmacologically treated hypertension in women: cohort study.BMJ nutrition, prevention & health · 2022Article
- Perspective: Darwinian Applications to Nutrition-The Value of Evolutionary Insights to Teachers and Students.Advances in nutrition (Bethesda, Md.) · 2022Article
- Nutritional status in pulmonary arterial hypertension.Pulmonary circulation · 2022Article
- Efficacy of Glucose Starvation of Cancer Cells in the Progress of Oral Squamous Cell Carcinoma Induced in Hamster.Asian Pacific journal of cancer prevention : APJCP · 2022Article
- Article
- Periodontitis and Hypertension: Is the Association Causal?High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2020Review
- Metabolites and Hypertension: Insights into Hypertension as a Metabolic Disorder: 2019 Harriet Dustan Award.Hypertension (Dallas, Tex. : 1979) · 2020Review
- Sugar-free Workplace: A Step for Fighting Obesity.Cureus · 2019Review
- Malnutrition in pulmonary arterial hypertension: a possible role for dietary intervention.Current opinion in pulmonary medicine · 2019Review
- Quantity, Quality, and Timing of Carbohydrate Intake and Blood Pressure.Current nutrition reports · 2019Review
- Following in the footsteps of tobacco and alcohol? Stakeholder discourse in UK newspaper coverage of the Soft Drinks Industry Levy.Public health nutrition · 2019Article
- Sugary beverages are associated with cardiovascular risk factors in diabetic patients.Journal of diabetes and metabolic disorders · 2019Article
- The effect of Chinese famine exposure in early life on dietary patterns and chronic diseases of adults.Public health nutrition · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Cardiovascular disease is the leading cause of premature mortality in the developed world, and hypertension is its most important risk factor. Controlling hypertension is a major focus of public health initiatives, and dietary approaches have historically focused on sodium. While the potential benefits of sodium-reduction strategies are debatable, one fact about which there is little debate is that the predominant sources of sodium in the diet are industrially processed foods. Processed foods also happen to be generally high in added sugars, the consumption of which might be more strongly and directly associated with hypertension and cardiometabolic risk. Evidence from epidemiological studies and experimental trials in animals and humans suggests that added sugars, particularly fructose, may increase blood pressure and blood pressure variability, increase heart rate and myocardial oxygen demand, and contribute to inflammation, insulin resistance and broader metabolic dysfunction. Thus, while there is no argument that recommendations to reduce consumption of processed foods are highly appropriate and advisable, the arguments in this review are that the benefits of such recommendations might have less to do with sodium-minimally related to blood pressure and perhaps even inversely related to cardiovascular risk-and more to do with highly-refined carbohydrates. It is time for guideline committees to shift focus away from salt and focus greater attention to the likely more-consequential food additive: sugar. A reduction in the intake of added sugars, particularly fructose, and specifically in the quantities and context of industrially-manufactured consumables, would help not only curb hypertension rates, but might also help address broader problems related to cardiometabolic disease.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.