Table 2.

Characteristics of studies selected for present review (n = 9).

First Author (Year)	Study Design (Study Period)/Country	Population (Sample Size/Age)	Food Consumption Assessment Method	Dietary Components	Diagnostic Criteria for Hypertension	Energy Contribution of PFs/UPFs (%)	Statistical Analysis Association between Food Processing and Hypertension
Conceição et al., (2018) [19]	Cross-sectional (2014–2015) Brazil	64 adults 25–57 years	One-day 24 hR/ NOVA classification (Monteiro, 2010)	PFs UPFs	Measurement of BP using digital meter according to 6th Brazilian Arterial Hypertension Guidelines (2010).	PFs: 6.5% UPFs: 7.7%	Student’s t-test No significant difference in mean SBP or DBP in comparison of individuals based on consumption of food groups (p > 0.05)
Martinez-Peres et al., (2021) [24]	Transversal (2020) Spain	5636 adults and older people 55–75 years (mean age: 65 years)	Semi-quantitative FFQ with 143 items (validated *)/NOVA classification (Monteiro, 2010)	UPFs	Use of anti-hypertensive agent and BP equal to or higher than 130/85 mmHg.	UPF: 7.9% **	Linear regression. No significant association between consumption of UPFs and SBP and DBP in adjusted models (β = −0.17 mmHg; CI = −0.5, 0.16; p = −0.08 e β = 0.08 mmHg; CI = −0.1, 0.26; p = 0.383, respectively).
Mendonça et al., (2017) [1]	Cohort (1999–2015) Spain	14790 middle-aged adults	Self-administered semi-quantitative FFQ with 136 items (validated *)/NOVA (servings/day and caloric contribution)	UPFs	Self-declared medical diagnosis.	UPFs: 2.1 to 5 servings/day ***	Cox regression Positive association between consumption of UPFs and AH. Highest tercile of consumption of UPFs had greater risk of developing AH compared to lowest tercile (HR adjusted by multivariable analysis = 1.21 [95% CI: 1.06–137]).
Monge et al., (2021) [23]	Cohort (2006–2010) Mexico	64 934 women 41.7 (SD: 7.2) years	Semi-quantitative FFQ with 140 items (validated *)/NOVA (caloric contribution)	UPFs	Self-declared medical diagnosis or use of antihypertensive.	UPFs: Total—29.8% (SD: 9.4) Liquid—6.4% (SD: 4.8) Solid—23.4% (SD: 8.9)	Poisson regression Total consumption of UPFs and consumption of solid UPFs not associated with AH (IRR = 0.96, 95% CI: 0.79, 1.16; IRR = 0.91, 95% CI: 0.82, 1.01, respectively). Ultra-processed beverages and processed meats associated with increase in incidence of AH (IRR = 1.32, 95% CI: 1.10, 1.65; IRR = 1.17, 95% CI: 1.01, 1.36, respectively).
Nardocci et al., (2020) [3]	Cross-sectional (2015) Canada	13,608 adults ≥ 19 years	24 hR/NOVA classification (Monteiro, 2010), caloric contribution	UPFs	Self-declared AH—answer to question on long-term health conditions diagnosed by healthcare provider: “Do you have diabetes/high blood pressure?”	UPFs: 47%	Linear regression UPFs significantly associated with greater likelihood of developing AH. In adjusted models, 10 percentage point increase in relative energy from UPFs associated with 9% increase in likelihood of AH. Adults in highest tercile of consumption of UPFs 60% more likely to have AH (OR = 1.60, 95% CI: 1.26–2.03) compared to those in lower terciles. Odds ratio used for 10% increase in relative intake of UPFs (% of total energy intake)
Rezende-Alves et al., (2020) [2]	Cohort (2016–2018) Brazil	1221 Adults (mean age: 35.2 years)	FFQ (validated *)/ NOVA classification (caloric contribution)	PFs UPFs	Self-declared medical diagnosis or use of antihypertensive or self-declared high BP (≥130/80 mmHg) according to recent cutoff points proposed by ACC/AHA.	PFs: 9.9% (SD: 5.8) UPFs: 25.8% (SD: 11)	Poisson regression Highest quintile of consumption of UPFs had increased risk of AH (RR: 1.35; 95% CI: 1.01, 1.81). When alcohol intake was excluded from caloric percentage of UPFs, greater consumption of these foods remained independently associated with increase in incidence of AH (RR: 1.35; 95% CI: 1.01, 1.82). No association identified between PFs and AH.
Scaranni et al., (2021) [20]	Cohort (2008–2010) Brazil	8171 adults and older people 35–74 years (mean: 49 years)	FFQ with 114 items (validated *)/ NOVA (caloric contribution)	UPFs	Measurement of BP (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg) and use of anti-hypertensive in previous two weeks.	UPFs: 25.2% (14.5–35.4%)	Mixed-effects linear regression to evaluate changes in BP and logistic regression to evaluated incidence of AH Greater consumption of UPFs associated with 23% greater risk of developing AH (OR = 1.23, 95% CI: 1.06, 1.44). No association between consumption of UPFs and changes in BP (mean SBP and DBP increased over time and varied slightly with consumption of UPFs).
Smiljanec et al., (2020) [21]	Cross-sectional USA	40 adults 18–45 years	Three-day food record/ NOVA classification (Monteiro, 2010)	UPFs	BP measured by outpatient monitoring. Central and peripheral BP measured by SBP, DBP, MBP, PP and aortic pressure. Monitoring outside clinic followed recommendations of Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement (2015).	UPFs: 50.0 ± 2.4%	Multiple linear regression Positive association between UPFs and general and diurnal SBP (B = 0.25, 95% CI: 0.03, 0.46, p = 0.029; B = 0.32, 95% CI: 0.09, 0.56, p = 0.008, respectively), diurnal DBP (B = 0.18, 95% CI: 0.01, 0.36, p = 0.049) and diurnal peripheral PP (B = 0.22, 95% CI: 0.03, 0.41, p = 0.027). After adjustments, UPFs positively associated with SBP (1% increase in consumption of UPFs associated with 0.25 mmHg and 0.32 mmHg increase in general and diurnal SBP, respectively), peripheral and central DBP. No significant association between consumption of UPFs and BP in men, but tendency toward positive association between UPFs and BP. 95% CI and p < 0.05 used.
Steele et al., (2019) [22]	Cross-sectional (2009–2014) USA	6385 adults ≥ 20 years and older people	Two-day R24/NOVA classification (Monteiro, 2010) (caloric contribution)	UPFs	Measurement of BP (SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg based on Centers for Disease Control and Prevention 2009–2010; 2011–2012; 2013–2014) or use of antihypertensive.	UPFs: 55.5%	Poisson regression Significant association between consumption quintiles of UPFs and increase in BP (PR = 1.19; 95% CI: 1.03, 1.38) in adjusted multivariate models.

Data expressed as mean ± standard deviation (SD); CI, confidence interval; 24 hR, 24-h recall; AH, arterial hypertension; FFQ, food frequency questionnaire; PFs, processed foods; UPFs, ultra-processed foods; BP, blood pressure; SBP, systolic blood pressure; DBP, diastolic blood pressure; MBP, mean blood pressure; PP, pulse pressure. * FFQ validated for population analyzed but not validated for analysis of food intake according to degree of processing. ** The percentage indicates mean consumption of foods and beverages in UPFs group over total intake in grams per day. *** Article did not provide energy contribution of UPFs in percentage.