Alcohol intake and its relation to hypertension

U. Keil*, J. D. Swales, D. E. Grobbee

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

16 Citations (Scopus)

Abstract

A relationship between alcohol intake and blood pressure has been noted since 1915. A large number of cross-sectional studies, a smaller number of prospective cohort studies and a number of intervention studies have addressed the nature of this relationship in the last 25 years. Although a number of questions - such as the validity of measurement of alcohol intake, shape of the alcohol blood pressure relationship, threshold dose for hypertension, and plausible pathophysiologic mechanisms - have not yet been answered satisfactorily, it is clear that a causal association exists between chronic intake of ≥ 30 to 60 g of alcohol per day and blood pressure elevation in men and women. To call the alcohol blood pressure relationship causal is justified because chance, and to a large degree, bias and confounding have been ruled out as plausible explanations in most observational studies. More importantly, the intervention studies support the observational studies. This indicates that confounding factors are not responsible for the observed alcohol blood pressure relationship even where these have not been specifically controlled for in observational studies. The intervention studies show a remarkable consistency in demonstrating a potentially valuable fall in blood pressure when heavy drinkers abstain or restrict their alcohol intake. The fall in blood pressure induced in these studies is of a similar order of magnitude to that which would be predicted from the observational associations if these represented a causal effect. Taken in conjunction therefore the observational and intervention studies create a powerful case for alcohol as an important life-style factor in elevated blood pressure. From observational and intervention studies a rule of thumb can be derived: above 30 g of alcohol intake per day an increment of 10 g of alcohol per day increases systolic blood pressure on average by 1-2 mmHg and diastolic blood pressure by 1 mmHg. Focusing on the population attributable risk percent it has been calculated from several studies that about 7-11% of hypertension (≥ 160/95 mmHg) in men in the community are due to alcohol intake ≥ 40 g/day. In women this percentage is much smaller because of their much lower alcohol intake. The pressor effect of chronic ingestion of alcohol is still poorly understood. At present neural, humoral and direct vascular mechanisms are seen as possible mediators of the alcohol blood pressure association. The role of each of these mechanisms is still unclear. Today, alcohol intake of more than 30 to 60 g/day is seen as the second most important acquired determinant of hypertension, closely behind the risk factor overweight (obesity).

Original languageEnglish
Pages (from-to)189-200
Number of pages12
JournalCardiovascular Risk Factors
Volume3
Issue number4
Publication statusPublished - 1 Jan 1993

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