Randomized Controlled Intervention of the Effects of Alcohol on Blood Pressure in Premenopausal Women

Abstract

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...

The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis

“…We judged 12 studies from 11 trials to be of high technical quality. 9–11,23,24,26,29,30,32,33,40,41 Only three trials presented data for women, 28,50,53 making pooled effect estimates uncertain. One trial reported office blood pressure in one report, 9 and ambulatory blood pressure monitoring in a much smaller substudy.…”

“…Because only three trials reported results for women, 28,50,53 we have less confidence in the pooled effect estimates. Similarly, there was only one trial in people with hypertension who consumed three or fewer drinks per day.…”

Alcohol and coronary artery calcification: an investigation using alcohol flushing as an instrumental variable

“…1 The causal impact of alcohol consumption on coronary heart disease and conditions related to atherosclerosis has not yet established, despite its public health importance and the numerous studies that have addressed this issue. [2][3][4][5] Although randomized controlled trials on the effects of alcohol consumption on cardiovascular risk factors have been conducted, 4,6,7 it is difficult to implement such trials in a way that produces sustained large differences in alcohol consumption. Studies using genetic information as instrumental variables (IVs), such as Mendelian randomization studies, 8 have presented better evidence regarding the relationship between alcohol consumption and cardiovascular outcomes.…”

Alcohol: taking a population perspective

“…The relationship between increasing average daily alcohol consumption and the incidence of cirrhosis and pancreatitis and subsequent mortality from these diseases is exponential 19,20 . The rise in cirrhosis mortality has been so striking in the UK over the past 20 years that it is likely that the effects of alcohol and have been shown to negate any protective effect from low-level drinking on coronary heart disease 32 , and an RCT published in 2015 reported that regular low levels of alcohol consumption increases the risk of hypertension among women 33 . In addition, Mendelian randomization studies that more closely replicate RCTs than traditional observational studies have called into question the veracity of the apparent protective effects of alcohol against cardiovascular disease, as well as several key hypothesized causal mechanisms 34,35 .…”