Nut consumption and the risk of hypertension: a systematic review and dose response meta-analysis of prospective studies.

Abstract

Previous studies have suggested that a high intake of nuts may reduce the risk of hypertension, however, the available data have been limited. Several additional studies have recently been published on the topic. We therefore conducted a systematic review and meta-analysis of cohort studies on nut consumption and hypertension to provide an updated assessment of the evidence. PubMed and Embase databases were searched up to 4th April 2026 for prospective cohort studies with adjusted relative risk estimates published in the English language on the association between nut consumption and hypertension risk. Random effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between nut consumption and hypertension. We used World Cancer Research Fund (WCRF) criteria to assess the strength of the evidence. Eight studies (20,665 cases, x) were included in the meta-analysis. The summary RR for the highest vs. lowest category of nut intake was 0.84 (95% CI: 0.77-0.91, I2=50%, pheterogeneity=0.05, n=8) and per 28 g/d was 0.80 (95% CI: 0.71-0.89, I2=75%, pheterogeneity<0.0001, n=8). There was no indication of publication bias with Begg's test (p=0.71) or Egger's test (p=0.10) or by visual inspection of the funnel plot. There was some indication of nonlinearity (pnonlinearity=0.07) and there was a 26% reduction in risk when comparing 30g/d vs. 0 g/d. Using WCRF criteria to assess the strength of evidence, we graded the likelihood of causality as probable. In this meta-analysis of prospective cohort studies, we found further evidence for a reduced risk of hypertension with higher intake of nuts. These findings support dietary guideline recommendations to include a serving of nuts per day.