Moderate Drinking Tied to Risk of Stage 1, 2 Hypertension

Marlene Busko

March 13, 2019

NEW ORLEANS — Studies have established that heavy drinkers are more likely to have hypertension compared with non-drinkers, and now new research confirms the link to high blood pressure and extends the finding to those consuming moderate amounts of alcohol.

In a snapshot of a national sample of adult Americans, researchers found that compared to abstainers, men and women who drank 7 to 13 alcoholic drinks a week (moderate drinkers) were 1.5 times as likely to have stage 1 hypertension and twice as likely to have stage 2 hypertension, based on criteria in the new 2017 ACC/AHA hypertension guidelines.

Heavy drinkers (14 or more drinks per week) had a similar, slightly higher risk of having stage 1 or stage 2 hypertension vs abstainers.

Lead author Amer I. Aladin, MD, a cardiology fellow at Wake Forest School of Medicine, Winston-Salem, North Carolina, presented these findings in a media briefing and will present the results at this weekend's American College of Cardiology (ACC) 2019 Annual Scientific Session.

"Moderate drinking in our study was associated with risk of hypertension, whereas in previous studies [it] showed moderate drinking was beneficial," Aladin told theheart.org | Medscape Cardiology in an email.

Dr Amer I. Aladin

The public health message is that people should ask their providers to check their blood pressure at each visit, especially if they are moderate or heavy drinkers, he said.

Invited to comment for Medscape Medical News, Michael Roerecke, PhD, a scientist at the Centre for Addiction and Mental Health (CAMH) and an assistant professor at the University of Toronto in Canada, similarly noted that "screening for both alcohol consumption and elevated blood pressure are not done regularly and should be conducted more often in clinical practice."

"Heavy drinkers should talk to their clinician about their risk and reduce drinking in consultations with their physician," he told theheart.org | Medscape Cardiology in an email.

Furthermore, although light drinking (1-6 drinks per week) was not associated with elevated blood pressure in this study, "binge drinking episodes (in the US defined as 4 or more drinks within a 2-hour period for women, and 5 or more drinks for men), may increase the risk for hypertension even when the average drinking over the week is low," he pointed out.

Alcohol has many effects on the body and mind, Roerecke noted. It is a known carcinogenic, hepatotoxin, and neurotoxin in humans. "Safe [consumption] may reduce the risk of myocardial infarction or type 2 diabetes; however, the risk for other diseases is elevated for any amount of drinking, which is the reason that no level of drinking is safe."

"In sum," he said, the current study supports the advice that "drinking less is better to avoid risk for many diseases."

Is Moderate Drinking Harmful or Beneficial?

The association between less than heavy drinking and the prevalence of hypertension, and the link with hypertension as defined by the new guidelines, is not clear, Aladin reported.

Roerecke noted that his group previously summarized the evidence for the association of drinking levels with risk for hypertension, based on the hypertension guidelines at the time (which defined hypertension as systolic blood pressure ≥140 and/or diastolic blood pressure ≥90 mm Hg), and showed that among men, the risk for hypertension was elevated for any amount of drinking; for women, there was no increased risk for 1 to 2 drinks/day, but an increased risk for consumption beyond this level.

Their team also showed that a reduction in drinking for people who consume more than 2 drinks per day resulted in a reduction in blood pressure, while there was no change in blood pressure for people who reduced drinking from 1 to 2 drinks to almost abstinence.

To examine the association of different levels of alcohol intake with the prevalence of hypertension categories defined by new guidelines, Aladin and colleagues identified 17,059 participants in the third National Health and Nutrition Examination Survey (NHANES III).

The participants had a mean age of 46; 40% were white, and 53% were women.

Based on replies to questionnaires, the participants were classified as being a never drinker (reference group), former drinker, light drinker (1 to 6 drinks/week), moderate drinker (7 to 13 drinks/week), or heavy drinker (14 or more drinks/week).

Based on at least three blood pressure measurements, they were also classified into four groups:

  • Normal blood pressure: less than 120/80 mm Hg

  • Elevated blood pressure (formerly pre-hypertension): systolic blood pressure 120 to 129 mm Hg and diastolic blood pressure < 80 mm Hg

  • Stage 1 hypertension: systolic blood pressure 130 to 139 mm Hg or diastolic blood pressure 80 to 89 mm Hg

  • Stage 2 hypertension: systolic blood pressure > 140 mm Hg and diastolic blood pressure > 90 mm Hg

Overall, the average blood pressure was about 109/67 mm Hg among never drinkers, 128/79 mm Hg among moderate drinkers and 153/82 mm Hg among heavy drinkers.

Compared with never drinkers, heavy drinkers were more likely to have elevated blood pressure (odds ratio [OR], 1.44; P = .002), in the model that was adjusted for age, sex, race, total annual income, ever smoker, physical activity, body mass index, diabetes, HDL cholesterol, and C-reactive protein.

Compared with the reference group, moderate drinkers were more likely to have stage 1 hypertension (OR, 1.53; P = .0001) or stage 2 hypertension (OR, 2.02; P < .0001)

And similarly, compared with the reference group, heavy drinkers had higher odds of having stage 1 hypertension (OR, 1.69; P < .0001) or stage 2 hypertension (OR, 2.41; P < .0001)

Aladin acknowledged that study limitations include that it is observational, and the researchers did not tease out separate findings for men and women, so more research is needed.

Similarly, Roerecke noted that "the current study used a cross-sectional study design, which cannot infer causality because both alcohol consumption and blood pressure were measured at the same time."

"We need more longitudinal studies," he said, "to examine the relationship between all levels of alcohol consumption and risk for hypertension as defined by the new guidelines."

The study authors and Roerecke have disclosed no relevant financial relationships.

American College of Cardiology (ACC) 2019 Annual Scientific Session: Poster to be presented March 17, 2019.

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