The effects of non-nutritive sweeteners on blood pressure, heart rate and pulse rate in adults: a systematic review and meta-analysis of randomized controlled clinical trials

Non-nutritive sweeteners (NNS) are widely used as sugar substitutes; however, their effects on different aspects of health are still controversial. This study aimed to determine whether NNS consumption in comparison with water, sugar-sweetener beverages, or a placebo affects blood pressure, heart rate, and pulse rate in adults. We searched electronic databases including PubMed, Scopus, ISI Web of Science, and Google Scholar, up to July 2025. The meta-analysis showed that NNS consumption significantly reduced resting (Weighted mean difference [WMD]= −3.25 mmHg, 95% confidence interval (CI): −5.74, −0.76, p = 0.01, 18 studies, n = 1898) and supine systolic blood pressure (SBP) (WMD= −6.10 mmHg, 95% CI: −11.51, −0.69, p = 0.03, 1 study, n = 37), whereas this effect was not significant for 24-h SBP (p > 0.05). NNS consumption had a significant effect on resting (WMD= −2.34 mmHg, 95% CI: −4.28, −0.40, p = 0.02, 17 studies, n = 1675), supine (WMD= −5.70 mmHg, 95% CI: −10.59, −0.81, p = 0.02, 1 study, n = 37), and 24-h diastolic blood pressure (DBP) (WMD= −2.30 mmHg, 95% CI: −4.14, −0.47, p = 0.01, 2 studies, n = 176). The consumption of NNS had no effect on heart rate and pulse rate (p > 0.05). In summary, NNS reduce SBP and DBP, especially when compared with sugar-sweetened beverages.