---
type: source
title: "Ultra-Processed Food Consumption and Hypertension Risk in the REGARDS Cohort Study"
author: "American Heart Association (Hypertension journal, REGARDS investigators)"
url: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.22341
date: 2024-10-01
domain: health
secondary_domains: []
format: article
status: unprocessed
priority: high
tags: [ultra-processed-food, hypertension, REGARDS-cohort, food-environment, chronic-inflammation, CVD, SDOH, mechanism]
---

## Content

Published October 2024 in *Hypertension* (American Heart Association). PMC full text: PMC11578763.

**Study design:** Prospective cohort analysis from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study.

**Population:** 5,957 participants from REGARDS who were **free from hypertension at baseline** (visit 1: 2003–2007), had complete dietary data, and completed visit 2 (2013–2016). Mean follow-up: **9.3 years** (±0.9).

**Dietary measurement:** Nova classification system — UPF consumption measured as % of total kilocalories AND % of total grams.

**Primary finding:** Participants in the **highest UPF consumption quartile had 23% greater odds** of incident hypertension compared with the lowest quartile. Positive **linear dose-response** relationship confirmed.

**Outcome rate:** 36% of participants developed hypertension at follow-up visit.

**Racial disparity in mechanism:**
- UPF as % kilocalories: statistically significant only among **White adults**
- UPF as % grams: statistically significant only among **Black adults**
- This suggests the metric matters — mass vs. caloric density of UPF may differentially reflect food patterns in these populations

**Companion finding (JAHA 2024 — separate study):** Ultra-processed food consumption and risk of incident hypertension in US middle-aged adults — confirms association across multiple cohort analyses.

**Mechanistic pathways** (from broader 2024 UPF literature):
- UPF → elevated CRP and IL-6 → systemic inflammation → endothelial dysfunction → BP elevation
- Each 100g/day additional UPF intake increases hypertension risk by 14.5% (2024 meta-analysis)
- Brazilian ELSA-Brasil cohort (4-year follow-up): 23% greater risk with high UPF consumption (matching REGARDS finding across different populations and timeframes)
- Refined sugars, unhealthy fats, chemical additives trigger inflammatory processes that damage vessel walls independently of caloric intake

**Structural implication:** In food-insecure households, the mechanism is circular:
1. Food insecurity → access limited to energy-dense, cheap UPF
2. UPF → chronic systemic inflammation → hypertension onset or progression
3. Hypertension treatment prescribed (ACE inhibitors, CCBs)
4. BUT: UPF exposure continues → inflammation regenerated continuously → antihypertensive medication effect partially overwhelmed
5. Result: 76.6% of treated hypertensives fail to achieve BP control despite "effective" drugs

## Agent Notes

**Why this matters:** This is the mechanistic chain that explains WHY the SDOH-hypertension failure is so intractable. It's not just that food-insecure people skip medications. The food environment generates continuous chronic inflammation that partially counteracts antihypertensive pharmacology. You can take your lisinopril every day and still fail to control BP if you're eating UPF three times daily because that's what's affordable and available. This is the most important single mechanism for the "behavioral/SDOH ceiling" layer of the CVD triple ceiling.

**What surprised me:** The linear dose-response relationship and the 9.3-year follow-up — this isn't a short-term dietary study. The risk accumulates continuously. And 36% developed hypertension in 9 years among hypertension-free adults at baseline — the incidence rate is alarming for a population that started without the condition.

**What I expected but didn't find:** Direct evidence that UPF-driven inflammation reduces antihypertensive drug efficacy in already-hypertensive patients (this study is about INCIDENT hypertension, not treatment resistance in existing patients). The mechanism is plausible but the treatment-resistance link needs a separate source.

**KB connections:**
- `Big Food companies engineer addictive products by hacking evolutionary reward pathways creating a noncommunicable disease epidemic` — general claim; this source provides the specific hypertension-UPF causal chain
- `hypertension-related-cvd-mortality-doubled-2000-2023-despite-available-treatment...` — UPF → inflammation → persistent HTN is the mechanism behind the treatment failure
- `only-23-percent-of-treated-us-hypertensives-achieve-blood-pressure-control...` — same mechanism
- `the epidemiological transition marks the shift from material scarcity to social disadvantage as the primary driver of health outcomes` — UPF economics (cheap, engineered, available in food deserts) is the material expression of this transition
- `semaglutide-cardiovascular-benefit-is-67-percent-independent-of-weight-loss-with-inflammation-as-primary-mediator.md` — GLP-1 works through hsCRP anti-inflammatory pathway; same inflammatory mechanism that UPF drives; this creates a complementary therapeutic/preventive pair

**Extraction hints:**
- New claim: "Ultra-processed food consumption increases incident hypertension risk by 23% over 9 years in the REGARDS cohort, establishing food environment as a mechanistic driver of hypertension through chronic inflammation — not merely a correlate of poverty"
- Companion claim: "The chronic inflammation generated by ultra-processed food diets creates a continuous re-generation of vascular risk that partially explains why antihypertensive drugs fail to achieve BP control in 76.6% of treated patients despite adequate pharmacological availability"
- Note: second claim is inferential (mechanism) and should be rated speculative-experimental until treatment-resistance-specific evidence found

**Context:** REGARDS is a rigorous, established NIH-funded cohort of ~30,000 adults designed specifically to study Black-White health disparities. The 9.3-year follow-up is unusually long for dietary studies. This is among the strongest prospective evidence available for UPF-hypertension causation.

## Curator Notes

PRIMARY CONNECTION: `hypertension-related-cvd-mortality-doubled-2000-2023-despite-available-treatment-indicating-behavioral-sdoh-failure.md`

WHY ARCHIVED: Provides the specific mechanistic link between food environment and hypertension treatment failure — filling the "why doesn't medication work?" gap identified in Session 15. The GLP-1 anti-inflammatory connection (hsCRP pathway) creates a cross-claim bridge worth noting.

EXTRACTION HINT: Extract the UPF-hypertension incidence claim (strong evidence, 9.3 years, REGARDS). Hold the treatment-resistance inference as speculative until a direct study is found. Flag the GLP-1/anti-inflammatory bridge claim to Life for cross-domain extraction.
