Patients Managing Severe Hypertension Should Avoid Drinking Too Much Coffee
By Martin S. Lipsky, MD
Chancellor, South Jordan Campus, Roseman University of Health Sciences, South Jordan, UT
SYNOPSIS: Among patients with severe hypertension, drinking two or more cups of coffee a day was associated with twice the risk of death from cardiovascular disease, while green tea did not increase risk.
SOURCE: Teramoto M, Yamagishi K, Muraki I, et al. Coffee and green tea consumption and cardiovascular disease mortality among people with and without hypertension. J Am Heart Assoc 2023;12:e026477.
Coffee and green tea are among the most widely consumed beverages. In Asian populations, coffee and green tea consumption are associated with lower all-cause mortality and cardiovascular death.1 However, while coffee consumption can lower the risk of incident hypertension, it also may cause a short-term increase in blood pressure (BP) among patients with hypertension.2,3 In contrast, caffeinated green tea consumption lowers BP in patients with prehypertension and stage 1 hypertension. Such consumption also can lower the mortality risk from all causes and cardiovascular disease (CVD).4
Teramoto et al examined the effects of coffee and green tea consumption on CVD mortality among patients with severe hypertension. The study group consisted of 18,609 participants (6,574 men and 12,035 women) age 40 to 79 years from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk. Participants completed a lifestyle, diet, and medical history questionnaire, and underwent health exams. Individuals were classified into four BP categories: optimal and normal BP, high-normal BP, grade 1 hypertension, and severe hypertension (defined as grade 2-3 hypertension).
During 18.9 years of median follow-up, the authors documented 842 CVD deaths. Coffee consumption was associated with a higher risk of CVD mortality among subjects with grade 2-3 hypertension. The multivariable hazard ratios (95% CI) of CVD mortality were 0.98 (0.67-1.43) for less than one cup per day, 0.74 (0.37-1.46) for one cup per day, and 2.05 (1.17-3.59) for two or more cups per day vs. those who did not drink coffee. Green tea consumption was not associated with a higher risk of CVD across any BP category.
The authors concluded heavy coffee consumption was associated with a higher risk of CVD mortality among patients with severe hypertension, but not among normotensive individuals or those with grade 1 hypertension. In contrast, green tea consumption was not associated with a higher risk of CVD mortality across all categories of BP.
My love of coffee keeps me on the lookout for related studies. While some still argue about the evils of coffee, especially in large quantities, epidemiology studies link coffee consumption with lower rates of mortality and lower rates of neurological and metabolic diseases, including Parkinson’s disease and type 2 diabetes. There also is evidence indicating drinking more coffee lowers the risk for some cancers.5 Green tea is touted for anti-cancer, anti-diabetes, anti-inflammatory, anti-neurodegenerative, and other health benefits.6-8 However, less is known about whether the protective effect of coffee exists for individuals with severe hypertension, and no one has examined the association between green tea consumption and the risk of CVD mortality across BP categories.
Using a large, long-term cohort of Japanese men and women, Teramoto et al found heavy coffee consumption raised the risk of CVD mortality among individuals with severe hypertension, but not for those without hypertension or with grade 1 hypertension. Those with severe hypertension who drank more than two cups of coffee could double their risk of dying from a heart attack or stroke. In contrast, green tea consumption was not linked to a higher risk of CVD mortality across all BP categories.
One limitation was these study participants were Japanese, so these findings may not extend to other countries and nationalities. However, based on the results, it seems prudent at this time to recommend patients with higher BP avoid heavy coffee consumption. Perhaps suggest green tea as a viable alternative, although this might be a hard sell to a hardened, inveterate coffee drinker.
1. Shin S, Lee JE, Loftfield E, et al. Coffee and tea consumption and mortality from all causes, cardiovascular disease and cancer: A pooled analysis of prospective studies from the Asia Cohort Consortium. Int J Epidemiol 2022;51:626-640.
2. Chei CL, Loh JK, Soh A, et al. Coffee, tea, caffeine, and risk of hypertension: The Singapore Chinese Health Study. Eur J Nutr 2018;57:1333-1342.
3. Mesas AE, Leon-Muñoz LM, Rodriguez-Artalejo F, Lopez-Garcia E. The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: A systematic review and meta-analysis. Am J Clin Nutr 2011;94:1113-1126.
4. Peng X, Zhou R, Wang B, et al. Effect of green tea consumption on blood pressure: A meta-analysis of 13 randomized controlled trials. Sci Rep 2014;4:6251.
5. Safe S, Kothari J, Hailemariam A, et al. Health benefits of coffee consumption for cancer and other diseases and mechanisms of action. Int J Mol Sci 2023;24:2706.
6. Pervin M, Unno K, Ohishi T, et al. Beneficial effects of green tea catechins on neurodegenerative diseases. Molecules 2018;23:1297.
7. Carlson JR, Bauer BA, Vincent A, et al. Reading the tea leaves: Anticarcinogenic properties of (-)-epigallocatechin-3-gallate. Mayo Clin Proc 2007;82:725-732.
8. Chen SQ, Wang ZS, Ma YX, et al. Neuroprotective effects and mechanisms of tea bioactive components in neurodegenerative diseases. Molecules 2018;23:512.
Among patients with severe hypertension, drinking two or more cups of coffee a day was associated with twice the risk of death from cardiovascular disease, while green tea did not increase risk.
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