Alcohol and Hypertension

The relationship between regular alcohol consumption and blood pressure elevation is now firmly established. Outstanding issues which will be discussed relate to the nature of the dose response curve, interactions between alcohol and other dietary and behavioural factors, mechanisms involved and the question of any protective influence of alcohol on atherosclerotic and ischaemic cardiovascular disease associated with hypertension.

Alcohol is an important contributory to the prevalence of hypertension, and resistance to drug therapy in drinking communities. Heavy drinking and binge drinking increases the risk of stroke.     

Alcohol and Hypertension

Although a link between excessive alcohol consumption and hypertension was first suggested early this century, little attention was paid to this and it is only in the last decade that the association has become established. Support for the concept of alcohol as a cause of hypertension derives from (1) the demonstration in general population samples that blood pressure is significantly correlated with alcohol intake, (2) the high prevalence of hypertension in alcohol–dependent subjects which is reversible on abstinence, (3) the high frequency with which elevated MCV, serum transaminase and serum γGT levels are found in hypertensive patients and (4) the recent finding that alcohol has a direct pressor effect in such patients. There are probably at least two different mechanisms underlying alcohol–induced hypertension. In alcohol–dependent patients, hypertension is particularly common during withdrawal from alcohol and this may reflect stimulation of corticosteroid, catecholamine and vasopressin production. The direct pressor effect may be due to alcohol induced arteriolar vasoconstriction. Alcohol–induced hypertension is a common clinical problem. More emphasis should be placed on its detection, for with reduction or cessation of alcohol consumption, blood pressure will return to normal in many patients and antihypertensive drug therapy can thus be avoided.     

Alcohol Consumption and Self-disclosure

The relationship between self-disclosure and alcohol consumption was investigated in two samples (total N=344) drawn from an Edinburgh general practice. For the abstainer up to moderate drinker categories, self-disclosure increases with consumption for both men and women. In the heavy drinker category (which contains only 1 woman) the men do not conform to this pattern and tend to be somewhat low in self-disclosure. Some possible relationships between heavy drinking, extroversion and self-disclosure are discussed.     

Diet,Alcohol and Hypertension

Obesity, diet and alcohol consumption constitute major environmental determinations of blood pressure elevation. The long term setting of blood pressure in response to these factors will be determined by genetic susceptibility, and interactions with effects of physical fitness and smoking. Dietary changes which independently influence both atherosclerosis and hypertension are likely to be of greatest value in helping to control morbidity and mortality from hypertensive cardiovascular disease.

Recommendations should focus on diets low in total and saturated fat intake and high in fruit and vegetables, containing potassium and fibre, coupled with weight control, alcohol moderation to less than two drinks per day in drinkers and regular physical exercise. Sodium restriction will help lower blood pressure in older hypertensives in particular. The role of dietary calcium or fish oils in blood pressure regulation is still uncertain.

Dietary and related recommendations on smoking and exercise should be ‘first line’ treatment in mild hypertensives, and complimentary to therapy in all patients requiring drugs.     

Alcohol Consumption and Cardiovascular Health

BackgroundStudies evaluating alcohol consumption and cardiovascular diseases have shown inconsistent results.MethodsWe performed a systematic review of peer-reviewed publications from an extensive query of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception to March 2022 for all studies that reported the association between alcohol consumption in terms of quantity (daily or weekly amounts) and type of beverage (wine, beer or spirit) and cardiovascular disease events.ResultsThe study population included a total of 1,579,435 individuals based on 56 cohorts from several countries. We found that moderate wine consumption defined as 1-4 drinks per week was associated with a reduction in risk for cardiovascular mortality when compared with beer or spirits. However, higher risk for cardiovascular disease mortality was typically seen with heavier daily or weekly alcohol consumption across all types of beverages.ConclusionsIt is possible that the observational studies may overestimate the benefits of alcohol for cardiovascular disease outcomes. Although moderate wine consumption is probably associated with low cardiovascular disease events, there are many confounding factors, in particular, lifestyle, genetic, and socioeconomic associations with wine drinking, which likely explain much of the association with wine and reduced cardiovascular disease events. Further prospective study of alcohol and all-cause mortality, including cancer, is needed.     

Alcohol, Hypertension, and Stroke

The authors compared the drinking habits of stroke patients and controls who were matched for the variables of age, sex, race, and day of the week admitted to the hospital. Rates of alcoholism were similar in the two groups. However, stroke patients were more likely to be current drinkers than controls, and were more likely to have been drinking within 24 hr of admission to the hospital, most of them rather heavily. Among the stroke patients, alcoholism was associated with hypertension, with being a current drinker, and with drinking at index, i.e., within 24 hr of the first symptoms of stroke. Of those stroke patients who were drinking at index, there were significant associations with being black, alcoholic, and hypertensive. The implications of these findings are discussed.     

Alcohol Reinforcement and Voluntary Ethanol Consumption

This article represents the proceedings of a symposium at the 2000 ISBRA Meeting in Yokohama, Japan. The organizer/chair was Ting-Kai Li and the co-chair was Rainer Spanagel. The presentations were (1) Genetic differences in alcohol drinking and reinforcement: The sP and sNP Rats, by Giancarlo Colombo; (2) Ventral tegmental area—Neuroanatomical substrate for alcohol reinforcement, by William J. McBride; (3) Metabolic mapping of alcohol reinforcement, by Linda J. Porrino; (4) Role of opioid receptors in the ethanol-induced place preference in rats exposed to conditioned fear stress, by Tsutomu Suzuki; and (5) Repeated deprivations enhance the reinforcing properties of ethanol in alcohol preferring (P) rats, by Zachary A. Rodd-Henricks.     

Alcohol Consumption and the Diet-Heart Controversy

The effectiveness of dietary changes as a means of reducing blood lipid levels and ultimately controlling the development of coronary heart disease has been debated for many years. The possible effects of alcohol consumption on blood lipids were usually not considered. Our findings indicate a significant positive correlation between the extent of coronary artery occlusion and total plasma cholesterol levels and a negative association between the coronary occlusion and high density lipoprotein (HDL) cholesterol. Since moderate alcohol consumption increases the HDL cholesterol levels, one can also postulate that it affects coronary artery lesions. The attenuating effect of alcohol on the coronary occlusion was negated by sporadic drinking of large amounts of alcohol. In evaluating the possible effect of alcohol on coronary artery disease, it is also necessary to consider its addictive potential as well as other untoward sequelae of alcohol consumption such as hypertension, damage to the myocardium, and increased prevalence of malignancies.     

Risk Perception of Alcohol Consumption

A review is given of general principles of risk perception, with some historical highlights of the field. It is pointed out that the risk target is of great importance (i.e., that personal risks are almost always perceived as smaller than risks to others). The implications of perceived personal and general risks are different, with general risks being more important for policy attitudes. The concepts needed to investigate risk perception are different, depending on what kind of risk is studied. Alcohol consumption risks give rise to uniquely strong risk denial, closely tied to control notions. Consumption of alcohol is found to be related to personal alcohol risk in a positive manner; the larger the consumption, the larger is the perceived risk. However, no such relationship is found for general risk. At the societal level, alcohol was the most common explanation that people gave for the prevalence of violence.     

Will Restrictions on Alcohol Advertising Reduce Alcohol Consumption?

The effects of restrictions of alcohol advertisements in Manitoba, Canada and in the United States are examined using statistical data on alcohol consumption. The relationships between consumption and alcoholism rates for the U.S. and advertising regulations were very weak and not statistically significant. Subsequent to a restriction on beer advertising in Manitoba, beer consumption in that province rose at a similar rate as in a control province of Alberta. It is considered unlikely that restrictions on advertising will reduce consumption.     

Alcohol Consumption and Alcohol Pharmacokinetics: Interactions Within the Normal Population

We have analyzed the interrelationships between habitual alcohol consumption, peak blood alcohol concentration after a standard dose, and rate of alcohol metabolism in a group of 199 male and 213 female twins. Both peak concentration and rate of metabolism are strongly associated with alcohol consumption levels, even in the range of 0-10 g of alcohol/day. The peak concentration and rate of metabolism were strongly correlated in both men and women; this is not due to their common dependence on alcohol intake nor to experimental error. These results show that the threshold for effects of habitual consumption on alcohol pharmacokinetics is much lower than previously suspected, and that there are factors that reduce preabsorptive or first-pass metabolism but increase postabsorptive metabolism.     

Alcohol Consumption and the Risk of Hypertension in Men and Women: A Systematic Review and Meta‐Analysis

J Clin Hypertens (Greenwich). 2012;14:792–798. ©2012 Wiley Periodicals, Inc. Heavy alcohol intake increases the risk of hypertension, but the relationship between light to moderate alcohol consumption and incident hypertension remains controversial. The authors sought to analyze the dose‐response relationship between average daily alcohol consumption and the risk of hypertension via systematic review and meta‐analysis. Electronic databases were searched for prospective control studies examining quantitative measurement of alcohol consumption and biological measurement of outcome. The primary endpoint was the risk of developing hypertension based on alcohol consumption. The level of alcohol consumption from each study was assigned to categorical groups based on the midpoint of their alcohol consumption classes to make possible the comparison of heterogeneous classification of alcohol intake. A total of 16 prospective studies (33,904 men and 193,752 women) were included in the analysis. Compared with nondrinkers, men with alcohol consumption with <10 g/d and 11 to 20 g/d had a trend toward increased risk of hypertension (relative risk [RR], 1.03; 95% confidence interval [CI], 0.94–1.13; P=.51) and (RR, 1.15; 95% CI, 0.99–1.33; P=.06), respectively, whereas a significantly increased risk of hypertension was found with heavy alcohol consumption of 31 to 40 g/d (RR, 1.77; 95% CI, 1.39–2.26; P<.001) and >50 g/d (RR, 1.61; 95% CI, 1.38–1.87; P<.001). Among women, the meta‐analysis indicated protective effects at <10 g/d (RR, 0.87; 95% CI, 0.82–0.92; P<.001) and a trend toward decreased risk of hypertension with alcohol consumption 11 to 20 g/d (RR, 0.9; 95% CI, 0.87–1.04; P=.17), whereas a significantly increased risk of hypertension was indicated with heavy alcohol consumption of 21 to 30 g/d (RR, 1.16; 95% CI, 0.91–1.46; P=.23) and 31 to 40 g/d (RR, 1.19; 95% CI, 1.07–1.32; P=.002). In men, heavy alcohol consumption is associated with increased risk of hypertension, whereas there is a trend toward increased risk of hypertension with low and moderate alcohol consumption. The relationship between alcohol consumption and hypertension is J‐shaped in women. Limiting alcohol intake should be advised for both men and women.     

Trends in Alcohol Consumption and Violent Deaths

Alcohol intoxication plays a significant role in many kinds of violent deaths. In the present study an attempt is made to test the hypothesis that the strong increase in alcohol consumption in Norway after World War II has had a significant effect on rates of violent deaths. The method used is indirect, and consists of analysing trends in alcohol consumption in relation to trends in rates of violent deaths. The data were obtained from official statistics. Rates of violent deaths turned out to have increased only slightly during this period. It is shown that this does not necessarily contradict the hypothesis. When modern statistical techniques for time series analysis are utilized, a significant correlation between changes in alcohol consumption and rates of violent deaths is uncovered. The data suggest that there has been a fairly strong increase in rates of alcohol-related violent deaths, and hence that non-alcoholic violent deaths, have been decreasing. As a partial test of the validity of this result, age- and sex-specific mortality rates are analysed in relation to per capita alcohol consumption in order to see how the alleged increase was distributed across strata, As was expected, the increase turned out to be particularly strong among males, while among females the relationship was much weaker, and not statistically significant in the adult female population at large. Also according to expectations, there were no significant effects in the older age groups. For females, a significant effect could be demonstrated in the age group 15–60 years, and the effect was about one fourth of the effect among males. This difference corresponds to the sex differences with respect to consumption levels, according to survey data. In the younger age groups the effect was stronger than expected, and this may be due to the fact that the increase in alcohol consumption has been higher among adolescents and young adults than in the rest of the population. From the model fitted to the data it was calculated that among adult Norwegian males alcohol related deaths have increased from about (standard errors in parentheses) 25 (8)% of all violent deaths in the early 1950's to about 50 (15)% in the late 1970's. Independent evidence from several prevalence studies is compatible with these results, but suggests that the true figures are probably closer to the lower limits than the higher limits. The decrease in non-alcoholic violent deaths implied by this result is corroborated by the fact that industrial accidents have gone down from one third to one sixth of all violent deaths during this period, and in Norway 90–95% of these accidents are non-alcoholic.     

Population Consumption of Alcohol and Proportion Drinking

Data on the relationship between population average alcohol consumption and the proportion of the population that drinks alcohol is limited. Nevertheless a quite large and statistically significant positive correlation between them is demonstrated with the six data sets presented here. Part of this relationship is probably the result of confounding variables, but evidence is presented that it could also be of a direct cause and effect nature whose directionality could lie both ways. The importance of a direct relationship lies in the possibilities for prevention of alcohol related problems that might derive from a policy of abstention.