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 4 April 2026 for prospective cohort studies with adjusted relative risk (RR) estimates published in English on the association between nut consumption and hypertension risk. Random-effects models were used to estimate summary RRs and 95 % CIs. We used World Cancer Research Fund (WCRF) criteria to assess the strength of the evidence. Eight studies (20 665 cases, 143 380 participants) were included in the meta-analysis. The summary RR for the highest v . lowest category of nut intake was 0·84 (95 % CI 0·77–0·91, I 2 = 50 %, p heterogeneity = 0·05, n 8) and per 28 g/d was 0·80 (95 % CI 0·71–0·89, I 2 = 75 %, p heterogeneity < 0·0001, n 8). There was no indication of publication bias. There was some indication of non-linearity ( p non-linearity = 0·07), and there was a 26 % reduction in risk when comparing 30 g/d v . 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.