Diets
ketogenic diet does not improve systolic blood pressure more than other diets
In plain terms: Do other diets lower blood pressure just as well as keto?
Leans support Diets 🔬 Includes disconfirming
Part of: 🥗 ketogenic diet
RefutedContestedStrong support
consensus score 0.45
Yes — keto has no special edge. Any blood-pressure drop on keto is modest and comes mostly from weight loss, and in head-to-head comparisons DASH and intermittent fasting have matched or beaten it.
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
4 support 2 contradict 0 tested null 3 mixed · 9 sources, 6 independent groups
What the evidence shows
Keto has no special advantage for blood pressure. A GRADE-assessed meta-analysis of 23 randomised trials in 1,664 participants found ketogenic diets did not lower blood pressure more than control diets, and where pressure did fall it tracked weight loss or a co-intervention. One non-randomised clinic comparison disagreed.
The evidence (14)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Zhao P, Fu W, Cui L, Lin L 2026 · Front Nutr | meta-analysis | tested-null | low | SR/MA of RCTs in adults with metabolic syndrome, DASH vs non-DASH controls (14 RCTs, 1,062 participants; SBP from 10 RCTs, 766 participants): 'the DASH diet significantly reduced systolic blood pressure compared to the non-DASH group (MD = −5.52 mmHg, 95% CI: −6.83 to −4.21, p < 0.001)'; Egger p = 0.036 for SBP, trim-and-fill MD −5.05 (−5.90 to −4.20); GRADE moderate. Comparators were 'usual diets, conventional diets, routine dietary advice, or other non-specific interventions' - no ketogenic or low-carbohydrate arm; the words ketogenic/keto do not occur in the paper. Off-scope: it measured DASH vs usual diet, not ketogenic diet vs other diets; the earlier 'reinforcing DASH over keto' was asserted, not measured. |
| Pescari D, Mihuta MS, Bena A, Stoian D 2025 · Nutrients | observational | contradicts | low | Non-randomized 12-wk clinic comparison, n=49 adults with obesity: modified KD (n=23, carb <=50 g/d, isocaloric) vs TRE (n=26, 4-10 h window, ad libitum); allocation by voluntary presentation and 'mutual agreement', per-protocol only. Median SBP reduction 8.97% (IQR 3.41, 12.50) on KD vs 1.42% (IQR 0, 2.94) on TRE, between-group Mann-Whitney p<0.001 (Table 3; U=85.0, rank-biserial 0.716, post hoc power only 0.660). Baseline SBP did not differ (122 vs 126 mmHg, p=0.790), but the KD arm started heavier and lost ~3x more weight (BMI -12.71% vs -4.06%), so the SBP gap is confounded with weight loss, not attributable to macronutrient pattern. Internally inconsistent: the Discussion states 'systolic blood pressure, p = 0.10' and that the between-group difference 'did not reach conventional levels of statistical significance', a figure that appears in no table; the Conclusion declines to claim superiority. LDL-C and triglycerides are tabulated at baseline but omitted from the change analysis. |
| Bensaaud A, Seery S, Gibson I, Jones J, Flaherty G, McEvoy JW, Jordan F, Tawfick W, Sultan SA 2025 · Cochrane Database Syst Rev | meta-analysis | supports | high | Cochrane SR/MA (Bensaaud 2025; 5 RCTs, 1,397 randomised, 1,075 in analysed arms; US and Poland, primary prevention). Comparators are DASH vs 'no intervention (including usual care), minimal intervention, or other dietary interventions'; no ketogenic or low-carbohydrate arm is named in the available text. BP is a secondary outcome: 'the DASH diet may reduce blood pressure ... compared to no intervention or usual care' (no BP estimate in the abstract), and 'Evidence comparing the DASH diet to a minimal intervention or alternative dietary approaches remains limited.' Authors: 'The certainty of evidence is low to very low'. Off-scope: the paper measured DASH against usual care, not ketogenic diet against other diets. |
| Wang Z, Chen T, Wu S, Dong X, Zhang M, Ma G 2024 · Am J Clin Nutr | meta-analysis | mixed | high | SR/MA of RCTs, ketogenic diet vs 'control diets' (27 RCTs, 1,278 participants; PROSPERO CRD42023491853): 'A total of 27 RCTs with 1278 participants were analyzed.' The abstract reports NO systolic-blood-pressure estimate - SBP is simply absent from both the increases and the reductions lists, so the SBP result is cannot-tell from available text (full text not open access). It does report a keto DIASTOLIC reduction: 'diastolic blood pressure (mean differences: -1.41 mmHg; 95% CI: -2.57, -0.26; I2: 49.1%)', and the authors conclude keto 'demonstrates benefits in terms of triglyceride, blood pressure, weight, and glycemic control'. The earlier extract's 'did not significantly lower systolic or diastolic blood pressure' is wrong for DBP and unsupported for SBP. Comparator composition (whether controls were other active diets) and whether estimates are between-group or pre-post ('changes in CVD risk factors pre- and postketogenic diet intervention') are cannot-tell from the abstract; the BP denominator is not given. Stance left mixed pending the SBP figure: DBP is off-object for this SBP claim and cannot move the sign. Abstract only. |
| Schiavo L, Pierro R, Asteria C, Calabrese P, Di Biasio A, Coluzzi I, Severino L, Giovanelli A, Pilone V, Silecchia G 2022 · Obes Surg | RCT | mixed | low | Low-calorie ketogenic diet did lower systolic/diastolic BP but via weight loss combined with CPAP, not a keto-specific antihypertensive effect. |
| Amini MR, Askarpour M, Ghalandari H, Gholizadeh M, Pouraram H 2024 · Nutr Metab Cardiovasc Dis | meta-analysis | supports | moderate | GRADE-assessed SR/MA of 23 RCTs (1,664 participants) of ketogenic diets vs trial control diets: 'KDs did not exert any significant impacts on SBP (WMD: -0.87 mmHg, 95% CI: -2.05, 0.31) nor DBP (WMD: -0.11 mmHg, 95% CI -1.14, 0.93).' Authors: 'KDs do not seem to be effective in improving BP.' A precise null (interval excludes an SBP advantage larger than ~2 mmHg) for keto against its comparators supports the negated claim that keto does not improve SBP more than other diets. Control-diet composition and the GRADE rating are not given in the abstract (cannot-tell whether every comparator was an active diet). Abstract only. |
| Gómez-Pérez AM, Bandera-Merchán B, Martínez-Montoro JI, Gutiérrez-Bedmar M, Díaz-Perdigones C, Subiri-Verdugo A, Moreno-Indias I, Tinahones FJ 2025 · Eur J Prev Cardiol | RCT | mixed | moderate | Sub-analysis of an RCT using 24-h ambulatory BP found ketogenic potential of the diet was not the key driver of BP change among hypocaloric interventions. |
| Lv J, Jiao S, Li W, Ding S, Ma L, Zhang Q 2025 · Front Nutr | meta-analysis | contradicts | low | Network meta-analysis of 26 RCTs / 2,255 MetS patients comparing six dietary patterns plus control. On SBP the KETOGENIC diet ranked FIRST: 'The results of SUCRA ranking were as follows: the ketogenic diet (SUCRA = 95.8%) > DASH diet (SUCRA = 70.8%) > low-carbohydrate diet (SUCRA = 61.2%) > low-fat diet (SUCRA = 56.9%) > Mediterranean diet (SUCRA = 43.6%) > control diet (SUCRA = 17.2%) > vegan diet (SUCRA = 4.4%).' Keto vs control MD = -11.00 (-17.56, -4.44) vs DASH's -5.99 (-10.32, -1.65); keto significantly beat vegan (13.38; 5.25, 21.52) and Mediterranean (8.13; 0.22, 16.04). Authors' own summary: 'With regard to lowering blood pressure and triglyceride levels, the ketogenic diet proved to be the most effective.' WHAT THE HEADLINE n DOES NOT COVER: the ketogenic node for blood pressure rests on ONE trial. Two keto RCTs were included - Volek 2009 (20 vs 20, 12 wk, keto vs low-fat) and Pinsawas 2017 (26 vs 22, 52 wk, keto vs typical Thai control) - and the blood-pressure article list ('Eighteen articles ( 22 , 24 - 28 , 32 , 34 - 37 , 39 - 41 , 43 , 45 - 47 ) reported on blood pressure') excludes Volek (ref 31). So 48 randomised participants in a single Thai trial carry the entire keto BP node, and every keto-vs-other-diet contrast above is INDIRECT via the control node. Keto was NOT significantly better than DASH (5.01; -2.85, 12.87), low-carbohydrate (6.46; -2.33, 15.25) or low-fat (6.89; -0.90, 14.68). Reliability caveats the authors state themselves: 'There remained a possibility of publication bias within the research network'; control diets were heterogeneous and poorly specified; 'Among the 26 studies reviewed, 14 used an energy-restricted design, 8 studies were non-energy-restricted, and 4 studies did not report whether they were energy-restricted', so energy restriction confounds the diet contrast; 5 of 26 trials were at high risk of bias; no GRADE or CINeMA certainty rating is reported. Pinsawas is 52 weeks and therefore falls outside the 12-48-week sensitivity window; what became of the keto BP estimate there is the available text does not say (Supplementary File 2 is not in the drop). |
| Kazeminasab F, Baharlooie M, Bagheri R, Rosenkranz SK, Santos HO 2025 · Eur J Clin Nutr | meta-analysis | supports | moderate | SR/MA of RCTs, hypocaloric low-carb (LCD) vs low-fat (LFD) diets in overweight/obesity (FMD pool 10 studies, n = 475; BP denominator not in abstract): 'LCDs did not change anthropometric and body composition measurements, nor CRP, blood pressure, HDL, or TC when compared with LFDs.' No BP advantage for low-carb over low-fat confirms the negated claim. Indirect: exposure is low-carb generally (VLCD subgroup reported only for FMD, which VLCDs reduced: WMD -2.12%, -3.35 to -0.9). Abstract only. |
| Ge L, Sadeghirad B, Ball GDC, da Costa BR, Hitchcock CL, Svendrovski A, Kiflen R, Quadri K, Kwon HY, Karamouzian M, Adams-Webber T, Ahmed W, Damanhoury S, Zeraatkar D, Nikolakopoulou A, Tsuyuki RT, Tian J, Yang K, Guyatt GH, Johnston BC 2020 · BMJ | meta-analysis | supports | high | Network meta-analysis of 14 named diets found blood-pressure advantages largely disappeared by 12 months, with no keto superiority. ⚠️ correction-on-file (Crossref) - kept, corrigendum not retraction |
| Sun Y, Shang M, Zhang Y, Hu J, Wang H 2025 · Sci Rep | meta-analysis | supports | moderate | Network MA of 21 RCTs: 'DASH diet significantly reduced both systolic and diastolic blood pressure compared to CD (Table S7-8). IF also significantly reduced SBP. Other dietary patterns did not show statistically significant effects on blood pressure.' The SBP/DBP tables (S7-S8) compare CD, IF, MED, LFD, LCD, HPD and DASH only - ketogenic diet is absent from the blood-pressure network, so KD 'not ranking' reflects no data. Off-scope. |
| Arnotti K, Bamber MD, Brewer V 2022 · Clin Nutr | meta-analysis | supports | moderate | SR/MA of 10 RCTs (6,862 overweight/obese adults) of increased fruit-and-vegetable-consumption interventions: 'Overall, effects of FVC interventions on systolic blood pressure (SBP) was 2.16 mmHg (p < 0.001) and -0.55 mmHg (p = 0.39) for diastolic blood pressure (DBP).' (sign reported as in the abstract; authors conclude FVC 'decreased SBP'). No ketogenic or low-carbohydrate arm; comparators are the trials' controls. Authors: 'limited by the small number of studies ... significant heterogeneity, possible publication bias'. Off-scope: measured fruit/vegetable interventions, not ketogenic diet vs other diets. |
| Du Y, Wang J, Li S, Meireles C, Saliba A, Castillo A, Goros M, Gelfond J, Choi BY, Qi L, Li C, Sharma K 2025 · Diabetes, obesity & metabolism | RCT | supports | low | Keto vs low-fat diet RCT, n=60: 'no significant differences in clinical or metabolic outcomes between groups' except ketone levels; keto-arm SBP within-group 131.2->123.1 (p=0.006) but not a between-group comparison |
| Aljuraiban GS, Gibson R, Chan DS, Van Horn L, Chan Q 2024 · Adv Nutr | meta-analysis | supports | moderate | Umbrella review of syntheses: 'This is an umbrella review of published meta-analyses'; '175 publications reporting 341 meta-analyses of randomized controlled trials ... and 70 meta-analyses of observational studies'. Recommends DASH/Mediterranean; its high-quality list includes a very-low-carbohydrate ketogenic vs low-fat DBP meta-analysis. Review — zero weight. |
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