The influence of different forms of apple products on all-cause mortality in patients with hypertension

Publication Date:
2025-01-24

Institutions involved:

The Second Affiliated Hospital of Dalian Medical University, Dalian, China
Ruijin-Hainan Hospital, Shanghai Jiao Tong University School of Medicine (Hainan Boao Research Hospital), Qionghai, China

Participants:
2,368 patients, U.S based adults

Duration:
Minimum follow-up: 10 years

Dosage:
Optimal benefit observed at 3–6 times/week consumption of apples with peels

Key Takeaways:

Eating whole apples 3–6 times per week was linked to a 48% drop in death risk for hypertensive patients, highlighting the power of polyphenols in the peels.

Apple intake remained protective even after adjusting for lifestyle factors, reinforcing its independent contribution to better cardio health and long-term survival.

From the authors: “Moderate consumption of whole apples is associated with a reduced risk of all-cause death in patients with hypertension.”

Apple Poly Summary:

Why Is This Study Important? Here's the headline: apples reduced the risk of death in hypertensive patients by an astonishing 48%. This study tackles a deceptively simple question with profound implications: does the form in which we consume apples matter for longevity? By analyzing long-term data from hypertensive patients, it reveals that whole apples significantly reduce mortality risk, while processed forms like juice and sauce, which are stripped of the apple's most beneficial compounds— polyphenols— do not.

In Plain English: Eating whole apples a few times a week may help people with high blood pressure live longer. But drinking apple juice or eating applesauce doesn’t offer the same benefit — and might even raise the risk of death. So, if you're reaching for apples, don't forget the peels.

For Medical Professionals: In a cohort of 2,368 hypertensive adults followed for ≥10 years, moderate whole apple consumption (3–6 times/week) was associated with a 48% reduction in all-cause mortality (HR = 0.52, p < 0.001). Apple juice and applesauce showed non-significant trends toward increased mortality. The study utilized NHANES data and Cox proportional hazards modeling, adjusting for demographic and clinical covariates. These findings suggest that whole fruit matrix, including fiber and flavonoid polyphenols, may be central to modulating cardiovascular and systemic risk.

Abstract:

Objective: Apple consumption has a positive effect on human health. Some studies have shown that an appropriate amount of apple intake can reduce the incidence of hypertension. However, few studies have investigated whether eating different forms of apples has the same benefits as eating whole apples. This study is aimed to evaluate the effect of different forms of apple on all-cause mortality in patients with hypertension.

Methods: The study included 2,368 patients with hypertension. All participants were followed up for at least 10 years. Cox regression model was constructed to analyze the correlation between apple, apple juice, and apple sauce consumption and all-cause mortality in patients with hypertension.

Results: The consumption of apples 3–6 times/week was associated with a 48% reduction in the risk of all-cause mortality in patients with hypertension (HR = 0.52, 95% CI: 0.37–0.72, p < 0.001). However, the consumption of apple juice (HR = 1.02, 95% CI: 0.67–1.56, p = 0.930) and sauce (HR = 1.28, 95% CI: 0.59–2.74, p = 0.531) tended to increase the risk of death in patients with hypertension, although this study did not obtain a statistically result.

Conclusion: Moderate consumption of whole apples is associated with a reduced risk of all-cause death in patients with hypertension, whereas apple juice and sauce may increase the risk of death.

Sun, Chuang, et al. “The Influence of Different Forms of Apple Products on All-Cause Mortality in Patients with Hypertension.” Frontiers in Nutrition, vol. 11, 2024, 24 Jan. 2025, https://doi.org/10.3389/fnut.2024.1461196.