A fter the effects of body weight, alcohol consumption is one of the strongest potentially modifiable risk factors for hypertension.1 Paradoxically, several cross-sectional epidemiological studies suggest that low-level alcohol consumption (4-7 drinks/wk) associates with lower blood pressure (BP) in women, with curvilinearity of the alcohol-BP relationship more marked in women compared with men.2,3 However, associations between alcohol intake and hypertension have not been as extensively evaluated in women and women are underrepresented in the heavier drinking categories in most crosssectional studies.The Marks and Spencer Cardiovascular Risk Study from the United Kingdom of >14 000 women 4 reported a decreased prevalence of hypertension with ≤14 drinks/wk but suggested this was largely explained by age, body mass index, physical activity, and family history of premature coronary heart disease. The National Health and Nutrition Examination Survey (NHANES) III study with >9 000 women 5 showed associations of alcohol intake with systolic BP and pulse pressure that were considerably smaller in women compared with men. A subsequent NHANES analysis confined to those drinking ≥1 drinks/d 6 and a cross-sectional study from Spain, 7 bothshowed that systolic and diastolic BP significantly associated with alcohol in men but not in women. In contrast, cross-sectional studies from Brazil and Canada showed substantially increased levels of BP in women for the same level of intake compared with men. 8,9 Prospective population studies have not resolved this controversy. The Atherosclerosis Risk in Communities (ARIC) study 10 showed that long-term risks for developing hypertension with ≥210 g alcohol/wk were similar in men and women. The Nurses Health Study II of 70 891 women aged 25 to 42 years 11 found a biphasic effect of alcohol, with a 14% decrease in risk in those consuming 2 to 3.5 drinks/wk and a 20% increase in those drinking >14 drinks/wk. The Hisayama study from Japan showed incidence of hypertension increased 2-fold with light drinking (<23 g/d) in men but not in women. 12 In the US-based Coronary Artery Risk Development in Young Adults (CARDIA) study, the 20-year incidence of hypertension was decreased in women at all levels of alcohol intake.
13A meta-analysis in 2009 identified 12 prospective studies that included 11 male and 9 female data sets.14 The study reported a linear relationship between alcohol and risk of hypertension for men but a modest protective effect in women drinking <15 Abstract--Alcohol has been consistently demonstrated to elevate blood pressure (BP) in intervention studies in men. There are uncertainties, however, as to the nature of the relationship in women. We, therefore, determined in healthy premenopausal women the dose-dependent effects of alcohol on ambulatory BP. Twenty-four participants aged 25 to 49 years, with a mean alcohol intake of 202±94 g alcohol/wk and mean 24-hour systolic and diastolic BP of 110.2±8.9/68.9±5.7 mm Hg, were randomized to a 3-period cross-over study. Each even...