Alcohol and Hypertension—New Insights and Lingering Controversies
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Purpose of Review
To examine outstanding issues in the relationship of alcohol to hypertension. These include whether the increase in BP with alcohol is causally related, the nature of the relationship in women, the contribution of alcohol-related increases in BP to cardiovascular disease and the aetiology of alcohol-related hypertension.
Intervention studies and Mendelian randomisation analyses confirm the alcohol–BP relationship is causal. The concept that low-level alcohol intake reduces BP in women is increasingly unsustainable. Alcohol-related hypertension is in the causal pathway between alcohol use and increased risk for several cardiovascular outcomes. The aetiology of alcohol-related hypertension is multifactorial with recent data highlighting the effects of alcohol on the vasoconstrictor 20-HETE and oxidative stress.
The high prevalence of both alcohol use and hypertension mandates a careful alcohol history in every patient with elevated BP. Early intervention for excessive alcohol use offers the promise of lower levels of BP and reduced risk of adverse cardiovascular outcomes.
KeywordsAlcohol Blood pressure Hypertension
Compliance with Ethical Standards
Conflict of Interest
The authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.• Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health. 2017;2:e108–20. The largest meta-analysis to date of randomized controlled trials of the effects of change in alcohol intake on BP demonstrated an apparent threshold effect for an increase in BP at > 2 drinks/day. PubMedPubMedCentralCrossRefGoogle Scholar
- 3.• Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, et al. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. Br Med J. 2014;349:g4164. A large Mendelian randomisation meta-analysis which showed that carriers of the A allele of ADH1B rs1229984 had significantly lower SBP and significantly lower odds of hypertension. CrossRefGoogle Scholar
- 8.• Millwood IY, Walters RG, Mei XW, Guo Y, Yang L, Bian Z, et al. Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet. 2019;393:1831–42. A large Mendelian randomisation analysis which used both the rs1229984 variant of ADH1 and the rs671 of ALDH2 as indicator variables for alcohol intake and showed SBP increased in men by 4·8mmHg per 280g/week genotype-predicted alcohol intake. PubMedPubMedCentralCrossRefGoogle Scholar
- 9.Hui P, Nakayama T, Morita A, Sato N, Hishiki M, Saito K, et al. Common single nucleotide polymorphisms in Japanese patients with essential hypertension: aldehyde dehydrogenase 2 gene as a risk factor independent of alcohol consumption. Hypertens Res. 2007;30:585–92.PubMedCrossRefPubMedCentralGoogle Scholar
- 12.• Roerecke M, Tobe SW, Kaczorowski J, Bacon SL, Vafaei A, Hasan OSM, et al. Sex-specific associations between alcohol consumption and incidence of hypertension: a systematic review and meta-analysis of cohort studies. J Am Heart Assoc. 2018;7:e008202. A large dose-response sex-specific meta-analysis of 18 prospective studies of alcohol and BP showing an increase in risk of hypertension in women at high intakes and a linear increase in risk across all levels of intake in men. PubMedPubMedCentralCrossRefGoogle Scholar
- 13.• Mori TA, Burke V, Beilin LJ, Puddey IB. Randomized controlled intervention of the effects of alcohol on blood pressure in premenopausal women. Hypertension. 2015;66:517–23. A trial of low level versus higher level alcohol intake on 24hr ambulatory BP in women which demonstrated effects of higher level intake to increase BP. PubMedCrossRefPubMedCentralGoogle Scholar
- 15.• Bell S, Daskalopoulou M, Rapsomaniki E, George J, Britton A, Bobak M, et al. Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. Br Med J. 2017;356:j909. A retrospective cohort study of ~ 2 million adults seen in general practices throughout England linking alcohol consumption and initial presentation of 12 cardiovascular diseases. CrossRefGoogle Scholar
- 17.• Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391:1513–23. An analysis across 83 prospective studies from 19 countries which characterised dose-response associations of alcohol with CVD and indicated that elevated SBP could be a mediator of the positive association of alcohol with stroke, coronary disease excluding MI, and heart failure. PubMedPubMedCentralCrossRefGoogle Scholar
- 25.Hu EA, Lazo M, Rosenberg SD, Grams ME, Steffen LM, Coresh J, et al. Alcohol consumption and incident kidney disease: results from the Atherosclerosis Risk in Communities Study. J Ren Nutr. 2019;In press. https://doi.org/10.1053/j.jrn.2019.01.011.
- 41.Gepner Y, Henkin Y, Schwarzfuchs D, Golan R, Durst R, Shelef I, et al. Differential effect of initiating moderate red wine consumption on 24-h blood pressure by alcohol dehydrogenase genotypes: randomized trial in type 2 diabetes. Am J Hypertens. 2016;29:476–83.PubMedCrossRefPubMedCentralGoogle Scholar
- 42.• Mori TA, Burke V, Zilkens RR, Hodgson JM, Beilin LJ, Puddey IB. The effects of alcohol on ambulatory blood pressure and other cardiovascular risk factors in type 2 diabetes: a randomized intervention. J Hypertens. 2016;34:421–8. An intervention trial which addressed the balance of effects on ambulatory BP, diabetic control and CV risk factors in participants with type II diabetes. PubMedCrossRefGoogle Scholar
- 46.• Feitosa MF, Kraja AT, Chasman DI, Sung YJ, Winkler TW, Ntalla I, et al. Novel genetic associations for blood pressure identified via gene-alcohol interaction in up to 570K individuals across multiple ancestries. PLoS One. 2018;13:e0198166. A genome-wide association study in which a large number of potential genes or single nucleotide polymorphisms were identified as determinants of alcohol-related increases in BP. PubMedPubMedCentralCrossRefGoogle Scholar
- 50.Oda N, Kajikawa M, Maruhashi T, Iwamoto Y, Kishimoto S, Matsui S, et al. Endothelial function is impaired in relation to alcohol intake even in the case of light alcohol consumption in Asian men; Flow-mediated Dilation Japan (FMD-J) Study. Int J Cardiol. 2017;230:523–8.PubMedCrossRefPubMedCentralGoogle Scholar
- 56.• Barden AE, Chavez V, Phillips M, Mas E, Beilin LJ, Croft KD, et al. A randomised trial in men of effects of alcohol on cytochrome P450 eicosanoids, mediators of inflammation resolution and blood pressure in men. Alcohol Clin Exp Res. 2017;41:1666–74. An intervention trial which examined the balance of effects of alcohol on 24hr ambulatory BP, 20-HETE, oxidative stress and markers of both inflammation and specialized pro-resolving mediators of inflammation. PubMedCrossRefPubMedCentralGoogle Scholar
- 65.• Piano MR, Burke L, Kang M, Phillips SA. Effects of repeated binge drinking on blood pressure levels and other cardiovascular health metrics in young adults: National Health and Nutrition Examination Survey, 2011–2014. J Am Heart Assoc. 2018;7:e008733. A cross-sectional study indicating that binge drinking in men aged 18-45yr associates with higher levels of SBP. PubMedPubMedCentralCrossRefGoogle Scholar
- 66.• Hayibor LA, Zhang J, Duncan A. Association of binge drinking in adolescence and early adulthood with high blood pressure: findings from the National Longitudinal Study of Adolescent to Adult Health (1994-2008). J Epidemiol Community Health. 2019;73:652–9. A prospective study indicating that binge drinking in adolescence may increase risk of hypertension in early adulthood. PubMedCrossRefPubMedCentralGoogle Scholar
- 78.• Rehm J, Prieto JA, Beier M, Duhot D, Rossi A, Schulte B, et al. The role of alcohol in the management of hypertension in patients in European primary health care practices - a survey in the largest European Union countries. BMC Fam Pract. 2016;17:130. An internet-based survey from Europe indicating that in hypertensive patients only one-third of general practitioners sufficiently screen for alcohol intake and only one in 5 deliver brief interventions to reduce hazardous alcohol intake. PubMedPubMedCentralCrossRefGoogle Scholar
- 90.Shimbo D, Levitan EB, Booth JN, Calhoun DA, Judd SE, Lackland DT, et al. The contributions of unhealthy lifestyle factors to apparent resistant hypertension: findings from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study. J Hypertens. 2013;31:370–6.PubMedCrossRefPubMedCentralGoogle Scholar