Response to Fructose Likely Does Have a Role in Hypertension
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We thank Madero et al1 for their letter regarding our systematic review and meta-analysis of the effect of fructose on blood pressure (BP).2 The authors expressed concern with excluding trials of high-fructose corn syrup and sucrose while including a trial of fructose in fruit form. The fructose moiety of sucrose and high-fructose corn syrup has been singled out as the main dietary driver of cardiometabolic disease. We, therefore, designed our systematic review to isolate the effect of fructose intake on BP relative to other carbohydrates. To this end, we did not include trials in which fructose was administered as sucrose or high-fructose corn syrup, unless these sweeteners were the comparators. As comparators, we found that sucrose and high-fructose corn syrup behaved no differently than fructose.1 Furthermore, to assess the effect of naturally occurring fructose, we also included the study by Madero et al,3 in which fruit was the main fructose source. Despite the concerns that it might skew the results of our systematic review, sensitivity analyses did not identify this trial as a confounder.2
A further point raised was our focus on office BP rather than postprandial BP end points. Fructose may certainly have a BP-raising effect in acute postprandial studies; …