Alcohol consumption and hypertension.

Abstract

SUMMARY An increased prevalence of hypertension in groups with high alcohol consumption has been recognized for a number of years. More recently, several studies have suggested an independent association between alcohol consumption and blood pressure levels in samples from general populations. Of 30 cross-sectional population studies reviewed, the majority reported small but significant elevations in blood pressure in those consuming three drinks or more per day in comparison with nondrinkers. In 25% of studies, elevations in blood pressure were also reported at lower levels of consumption; in about 40%, the blood pressure of nondrinkers was greater than that of those consuming one to two drinks per day. In two studies, one from the United States and one from Australia, the maximum contribution to the prevalence of hypertension of alcohol consumption greater than two drinks per day was estimated to be 5 to 7%; the contribution in men (11%) was greater than that in women because of their greater alcohol consumption. A prospective association of alcohol consumption with change in blood pressure was observed in five studies. In a small number of experimental studies, short-term falls in blood pressure accompanied alcohol restriction in both normotensive and hypertensive subjects. Uncontrolled observations in heavy drinking populations suggest that the effect on blood pressure of alcohol withdrawal may be lasting. However, firm conclusions about the long-term effects of alcohol restriction, particularly in moderate consumers who represent a large proportion in many populations, must await long-term controlled trials. In the past 20 years attention has focused on the question of whether an association exists between alcohol consumption and blood pressure levels in wider populations not selected on the basis of alcohol intake. This question has been addressed in a large number of cross-sectional studies and in a smaller number of prospective studies conducted in populations from a variety of geographic regions, including North America, Europe, Australia, New Zealand, and Japan.The present report reviews the epidemiological evi- dence for the existence of an association between blood pressure and levels of alcohol consumption. Evidence is also considered concerning the nature of the association, that is, whether the association is linear or nonlinear and whether a consumption threshold exists for blood pressure elevation. These issues bear on the important public health question of the extent to which alcohol consumption contributes to blood pressure elevation in the population.Two other questions are also considered. The first concerns the effects on blood pressure of modification of alcohol intake. This issue has been investigated in a small number of recent trials in hypertensive and normotensive subjects. The second question concerns the mechanism(s) by which alcohol affects blood pressure; a small number of studies in animals and in humans have attempted to address this question. For neither question are the avai...

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