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Coffee, tea, caffeine, and risk of hypertension: The Singapore Chinese Health Study

European Journal of Nutrition volume 57, pages 1333–1342 (2018)Cite this article

Abstract

Purpose

The relationship between coffee and tea, and risk of hypertension remains controversial in Western populations. We investigated these associations in an Asian population.

Methods

The Singapore Chinese Health Study is a population-based prospective cohort that recruited 63,257 Chinese aged 45–74 years and residing in Singapore from 1993 to 1998. Information on consumption of coffee, tea, and other lifestyle factors was collected at baseline, and self-reported physician-diagnosed hypertension was assessed during two follow-up interviews (1999–2004, 2006–2010).

Results

We identified 13,658 cases of incident hypertension after average 9.5 years. Compared to those who drank one cup of coffee/day, the hazard ratios (HR) and 95% confidence intervals (CI) were 0.87 (0.83–0.91) for <weekly drinkers and 0.93 (0.86–1.00) for ≥3 cups/day drinkers. Compared to <weekly drinkers, daily drinkers of black or green tea had slight increase in risk, but these risk estimates were attenuated and became non-significant after adjustment for caffeine. After adjusting for coffee, there was a stepwise dose–response relationship between caffeine intake and hypertension risk; compared to the lowest intake (<50 mg/day), those in the highest intake (≥300 mg/day) had a 16% increase in risk; HR 1.16, 95% CI 1.04–1.31 (p trend = 0.02).

Conclusions

Drinking coffee <1 cup/week or ≥3 cups/day had lower risk than drinking one cup/day. Caffeine may account for increased risk in daily tea drinkers and in those who drank one cup of coffee/day. The inverse U-shaped association with coffee suggests that at higher doses, other ingredients in coffee may offset the effect of caffeine and confer benefit on blood pressure.

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References

  1. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. The Lancet 365:217–223. doi:10.1016/S0140-6736(05)17741-1

    Article  Google Scholar 

  2. Slama M, Susic D, Frohlich ED (2002) Prevention of hypertension. Curr Opin Cardiol 17:531–536

    Article  PubMed  Google Scholar 

  3. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL (2002) Selected major risk factors and global and regional burden of disease. The Lancet 360:1347–1360. doi:10.1016/S0140-6736(02)11403-6

    Article  Google Scholar 

  4. FAO Commodities and Trade Division (2003) Medium-term prospects for agricultural commodities: Projections to the year 2010. In:Food and Agriculture Organization of the United Nations, Rome

  5. Uiterwaal CS, Verschuren WM, Bueno-de-Mesquita HB, Ocke M, Geleijnse JM, Boshuizen HC, Peeters PH, Feskens EJ, Grobbee DE (2007) Coffee intake and incidence of hypertension. Am J Clin Nutr 85:718–723

    Article  CAS  PubMed  Google Scholar 

  6. Hu G, Jousilahti P, Nissinen A, Bidel S, Antikainen R, Tuomilehto J (2007) Coffee consumption and the incidence of antihypertensive drug treatment in Finnish men and women. Am J Clin Nutr 86:457–464

    Article  CAS  PubMed  Google Scholar 

  7. Palatini P, Dorigatti F, Santonastaso M, Cozzio S, Biasion T, Garavelli G, Pessina AC, Mos L (2007) Association between coffee consumption and risk of hypertension. Ann Med 39:545–553. doi:10.1080/07853890701491018

    Article  CAS  PubMed  Google Scholar 

  8. Winkelmayer WC, Stampfer MJ, Willett WC, Curhan GC (2005) Habitual caffeine intake and the risk of hypertension in women. JAMA 294:2330–2335. doi:10.1001/jama.294.18.2330

    Article  CAS  PubMed  Google Scholar 

  9. Rhee JJ, Qin F, Hedlin HK, Chang TI, Bird CE, Zaslavsky O, Manson JE, Stefanick ML, Winkelmayer WC (2016) Coffee and caffeine consumption and the risk of hypertension in postmenopausal women. Am J Clin Nutr 103:210–217. doi:10.3945/ajcn.115.120147

    Article  CAS  PubMed  Google Scholar 

  10. Klag MJ, Wang NY, Meoni LA, Brancati FL, Cooper LA, Liang KY, Young JH, Ford DE (2002) Coffee intake and risk of hypertension: the Johns Hopkins precursors study. Arch Intern Med 162:657–662

    Article  Google Scholar 

  11. Steffen M, Kuhle C, Hensrud D, Erwin PJ, Murad MH (2012) The effect of coffee consumption on blood pressure and the development of hypertension: a systematic review and meta-analysis. J Hypertens 30:2245–2254. doi:10.1097/HJH.0b013e3283588d73

    Article  CAS  PubMed  Google Scholar 

  12. Grosso G, Stepaniak U, Polak M, Micek A, Topor-Madry R, Stefler D, Szafraniec K, Pajak A (2016) Coffee consumption and risk of hypertension in the Polish arm of the HAPIEE cohort study. Eur J Clin Nutr 70:109–115. doi:10.1038/ejcn.2015.119

    Article  CAS  PubMed  Google Scholar 

  13. Graham HN (1992) Green tea composition, consumption, and polyphenol chemistry. Prev Med 21:334–350

    Article  CAS  PubMed  Google Scholar 

  14. Hodgson JM, Croft KD (2010) Tea flavonoids and cardiovascular health. Mol Aspects Med 31:495–502. doi:10.1016/j.mam.2010.09.004

    Article  CAS  PubMed  Google Scholar 

  15. Huxley RR, Neil HA (2003) The relation between dietary flavonol intake and coronary heart disease mortality: a meta-analysis of prospective cohort studies. Eur J Clin Nutr 57:904–908. doi:10.1038/sj.ejcn.1601624

    Article  CAS  PubMed  Google Scholar 

  16. Harbowy ME, Balentine DA (1997) Tea Chemistry. Clin Rev Plant Sci 16:415–480

    Article  CAS  Google Scholar 

  17. Hartley L, Flowers N, Holmes J, Clarke A, Stranges S, Hooper L, Rees K (2013) Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. doi:10.1002/14651858.CD009934.pub2.

    Article  PubMed  Google Scholar 

  18. Arab L, Liu W, Elashoff D (2009) Green and black tea consumption and risk of stroke: a meta-analysis. Stroke 40:1786–1792. doi:10.1161/strokeaha.108.538470

    Article  CAS  PubMed  Google Scholar 

  19. Peters U, Poole C, Arab L (2001) Does tea affect cardiovascular disease? A meta-analysis. Am J Epidemiol 154:495–503

    Article  CAS  PubMed  Google Scholar 

  20. Cheng TO (2006) All teas are not created equal: the Chinese green tea and cardiovascular health. Int J Cardiol 108:301–308. doi:10.1016/j.ijcard.2005.05.038

    Article  PubMed  Google Scholar 

  21. Hankin JH, Stram DO, Arakawa K, Park S, Low SH, Lee HP, Yu MC (2001) Singapore Chinese Health Study: development, validation, and calibration of the quantitative food frequency questionnaire. Nutr Cancer 39:187–195. doi:10.1207/S15327914nc392_5

    Article  CAS  PubMed  Google Scholar 

  22. Zhang Z, Hu G, Caballero B, Appel L, Chen L (2011) Habitual coffee consumption and risk of hypertension: a systematic review and meta-analysis of prospective observational studies. Am J Clin Nutr 93:1212–1219. doi:10.3945/ajcn.110.004044

    Article  CAS  PubMed  Google Scholar 

  23. Stensvold I, Tverdal A, Solvoll K, Foss OP (1992) Tea consumption. relationship to cholesterol, blood pressure, and coronary and total mortality. Prev Med 21:546–553

    Article  CAS  PubMed  Google Scholar 

  24. Yang YC, Lu FH, Wu JS, Wu CH, Chang CJ (2004) The protective effect of habitual tea consumption on hypertension. Arch Intern Med 164:1534–1540. doi:10.1001/archinte.164.14.1534

    Article  PubMed  Google Scholar 

  25. Yarmolinsky J, Gon G, Edwards P (2015) Effect of tea on blood pressure for secondary prevention of cardiovascular disease: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 73:236–246. doi:10.1093/nutrit/nuv001

    Article  PubMed  Google Scholar 

  26. Stangl V, Lorenz M, Stangl K (2006) The role of tea and tea flavonoids in cardiovascular health. Mol Nutr Food Res 50:218–228. doi:10.1002/mnfr.200500118

    Article  CAS  PubMed  Google Scholar 

  27. Hodgson JM, Puddey IB, Burke V, Beilin LJ, Jordan N (1999) Effects on blood pressure of drinking green and black tea. J Hypertens 17:457–463

    Article  CAS  PubMed  Google Scholar 

  28. Bingham SA, Vorster H, Jerling JC, Magee E, Mulligan A, Runswick SA, Cummings JH (1997) Effect of black tea drinking on blood lipids, blood pressure and aspects of bowel habit. Br J Nutr 78:41–55

    Article  CAS  PubMed  Google Scholar 

  29. Nurminen ML, Niittynen L, Korpela R, Vapaatalo H (1999) Coffee, caffeine and blood pressure: a critical review. Eur J Clin Nutr 53:831–839

    Article  CAS  PubMed  Google Scholar 

  30. Geleijnse JM (2008) Habitual coffee consumption and blood pressure: an epidemiological perspective. Vasc Health Risk Manag 4:963–970

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ekmekcioglu C, Elmadfa I, Meyer AL, Moeslinger T (2016) The role of dietary potassium in hypertension and diabetes. J Physiol Biochem 72:93–106. doi:10.1007/s13105-015-0449-1

    Article  CAS  PubMed  Google Scholar 

  32. Haddy FJ, Vanhoutte PM, Feletou M (2006) Role of potassium in regulating blood flow and blood pressure. Am J Physiol Regul Integr Comp Physiol 290:R546–R552. doi:10.1152/ajpregu.00491.2005

    Article  CAS  PubMed  Google Scholar 

  33. Zhou MS, Kosaka H, Yoneyama H (2000) Potassium augments vascular relaxation mediated by nitric oxide in the carotid arteries of hypertensive Dahl rats. Am J Hypertens 13:666–672

    Article  CAS  PubMed  Google Scholar 

  34. Suzuki A, Yamamoto N, Jokura H, Yamamoto M, Fujii A, Tokimitsu I, Saito I (2006) Chlorogenic acid attenuates hypertension and improves endothelial function in spontaneously hypertensive rats. J Hypertens 24:1065–1073. doi:10.1097/01.hjh.0000226196.67052.c0

    Article  CAS  PubMed  Google Scholar 

  35. Watanabe T, Arai Y, Mitsui Y, Kusaura T, Okawa W, Kajihara Y, Saito I (2006) The blood pressure-lowering effect and safety of chlorogenic acid from green coffee bean extract in essential hypertension. Clin Exp Hypertens 28:439–449. doi:10.1080/10641960600798655

    Article  CAS  PubMed  Google Scholar 

  36. Kozuma K, Tsuchiya S, Kohori J, Hase T, Tokimitsu I (2005) Antihypertensive effect of green coffee bean extract on mildly hypertensive subjects. Hypertens Res 28:711–718. doi:10.1291/hypres.28.711

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study is supported by the National Institutes of Health, USA (NCI R01 CA144034 and UM1 CA182876). Woon-Puay Koh is supported by the National Medical Research Council, Singapore (NMRC/CSA/0055/2013). We thank Siew-Hong Low of the National University of Singapore for supervising the field work of the Singapore Chinese Health Study and Renwei Wang for the maintenance of the cohort study database. Finally, we acknowledge the founding Principal Investigator of the Singapore Chinese Health Study—Mimi C. Yu.

Authors contributions

WPK and JMY designed and conducted the research; WPK and AS analyzed the data; CLC and JKL wrote the paper; CLC, JKL, JMY, and WPK interpreted the statistical analysis and data; WPK had primary responsibility for final content. All authors revised the manuscript for important intellectual content and read and approve the final manuscript.

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    Authors and Affiliations

    1. Office of Clinical Sciences, Duke-NUS Medical School, Singapore, 169857, Singapore

      Choy-Lye Chei & Woon-Puay Koh

    2. National Heart Center Singapore, Singapore, 169609, Singapore

      Julian Kenrick Loh

    3. Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore

      Avril Soh & Woon-Puay Koh

    4. Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

      Jian-Min Yuan

    5. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA

      Jian-Min Yuan

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    1. Choy-Lye Chei
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    Correspondence to Woon-Puay Koh.

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    Choy-Lye Chei and Julian Kenrick Loh have contributed equally to the work.

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    Chei, CL., Loh, J.K., Soh, A. et al. Coffee, tea, caffeine, and risk of hypertension: The Singapore Chinese Health Study. Eur J Nutr 57, 1333–1342 (2018). https://doi.org/10.1007/s00394-017-1412-4

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    Keywords

    • Hypertension
    • Coffee
    • Tea
    • Caffeine
    • Prospective study