Even Moderate Drinking May Raise Hypertension Risk in Diabetes

Batya Swift Yasgur MA, LSW

September 22, 2020

New research suggests that even moderate alcohol consumption may raise hypertension risk in adults with type 2 diabetes (T2D).

Investigators analyzed data from over 10,000 adults participating in the ACCORD trial and found that moderate alcohol consumption raised the odds of elevated blood pressure (BP), stage I hypertension, and stage II hypertension by 79%, 66%, and 62%, respectively.

After accounting for covariates, the researchers found that heavy alcohol consumption was associated with an almost twofold risk of elevated BP, a 2.5-fold increase of stage I hypertension, and a threefold risk of stage II hypertension.

"Since moderate and heavy alcohol consumption are independently associated with higher odds of hypertension in patients with diabetes in this trial, we advise discussing the effects of moderate and heavy alcohol consumption on blood pressure in patients with diabetes, especially those who are having difficulty achieving adequate control of their hypertension," senior author Matthew J. Singleton, MD, chief electrophysiology fellow at Wake Forest School of Medicine, Winston-Salem, North Carolina, told theheart.org | Medscape Cardiology.

The new results from ACCORD were published online September 9 in the Journal of the American Heart Association.

Conflicting Findings

"Since patients with diabetes have particularly high cardiovascular risk, understanding the relationship between alcohol consumption and hypertension is very important in those with diabetes," Singleton said.

The link between heavy alcohol consumption and hypertension is well documented, the authors note. However, prior studies have shown conflicting findings on whether moderate alcohol consumption raises blood pressure in the general population and in those with diabetes, Singleton said.

Since the association was "debated" and its "consistency" unknown, "we decided to conduct the present study," he said.

The researchers drew on data of 10,200 participants in the ACCORD trial (mean age approximately 63 years), a previously reported randomized trial comparing interventions to reduce cardiovascular disease (CVD) in adults with T2D.

For this analysis, participants were divided into three groups: light (1-7 drinks/week); moderate (8-14 drinks/week); and heavy (≥15 drinks/week) users of alcohol, with a "drink" defined as a 12-ounce beer, 6 ounces of wine, or 1.5 ounces of liquor.

BPs were then categorized according to the American College of Cardiology/American Heart Association 2017 guidelines.

Dose-Risk Relationship

In a multivariable logistic regression model that accounted for age, sex, race, body mass index (BMI), prevalent CVD, smoking status, and number of years with T2D, no association was found between light alcohol consumption and elevated BP or any stage hypertension.

By contrast, moderate and heavy alcohol consumption were both associated with elevated blood pressure as well as stage 1 and stage 2 hypertension.

Table. Hypertension Risk by Alcohol Use

Alcohol Use Elevated BP OR (95% CI) Stage 1 Hypertension OR (95% CI) Stage 2 Hypertension OR (95% CI)
Moderate 1.79 (1.04 – 3.11) P = .03 1.66 (1.05 – 2.60) P =. 03 1.62 (1.03 – 2.54) P = .03
Heavy 1.91 (1.17 – 3.12) P = .01 2.49 (1.03 – 6.17) P =. 03 3.04 (1.28 – 7.22) P = .01

 

The authors caution that their study "should be interpreted in the context of its limitations." For example, residual confounding might be present, although they adjusted for covariates with either "known or suspected" relationships with hypertension. The findings also might have been affected by response and selection bias.

Nevertheless, they state, although "decades of literature and epidemiologic studies have suggested that light and moderate alcohol consumption may have beneficial effects on cardiovascular health, our work supports recent analyses suggesting that the consumption of >7 drinks per week may be associated with elevated BP, stage 1 and stage 2 hypertension in those with type 2 diabetes mellitus, and particularly those with elevated cardiovascular risk."

Additionally, they continue, the data "indicate a dose-risk relationship between alcohol consumption and the degree of hypertension."

Screen for Alcohol Use

Commenting on the study for theheart.org | Medscape Cardiology, Sara Tasnim, BPharm, MSc, Cochrane Hypertension Group, Toronto, Canada, noted that the data were collected only once from the eligible participants and do not "tell us how alcohol consumption affects diabetic patients over time."

Moreover, "although the findings from the study did not find any association between light alcohol consumption and hypertension, it does not mean that light alcohol consumption has any protective effect on cardiovascular functions, as so many observational studies suggest," said Tasnim, who was not involved with the study.

Also commenting on the findings for theheart.org | Medscape Cardiology, Parag Chevli, MBBS, assistant professor of internal medicine and co-chair of the research committee, Section on Hospital Medicine, Wake Forest University, Winston-Salem, North Carolina, said, "Despite its limitations, this is one of the very few studies which has examined the association of alcohol consumption and BP using the new 2017 ACC/AHA guidelines."

Moreover, "this is a unique cohort, as it includes patients with type 2 diabetes mellitus," said Chevli, who was not associated with the current research.

Chevli added that the study "emphasizes that every effort should be made at the clinical practice to screen for alcohol consumption during primary care visits, especially for patients with hypertension and diabetes."

No source of funding was listed. The study authors, Tasnim, and Chevli have disclosed no relevant financial relationships.

J Am Heart Assoc. Published online September 9, 2020. Full text

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