Daily Alcohol Consumption, Even in Low Amounts, Linked to Increased Risk of Hypertension

Marco Vinceti, MD, PhD
Credit: Children With Cancer UK

Routine alcohol consumption, even in small amounts, was linked to an increased risk of high blood pressure, according to a new study.

Despite some studies purporting a marginal benefit from consuming small amounts of alcohol, results of the current study, an analysis of 7 international studies of healthy adults with more than 19,000 participants, suggest daily alcohol consumption was linked to increases in systolic and diastolic blood pressure over time and these associations were present in both men and women.¹

“We found no beneficial effects in adults who drank a low level of alcohol compared to those who did not drink alcohol,” said senior investigator Marco Vinceti, MD, PhD, a professor of epidemiology and public health at the Medical School of the University of Modena and Reggio Emilia University in Italy and an adjunct professor in the department of epidemiology at Boston University’s School of Public Health.² “We were somewhat surprised to see that consuming an already-low level of alcohol was also linked to higher blood pressure changes over time compared to no consumption – although far less than the blood pressure increase seen in heavy drinkers.”

Despite being carcinogenic and increased consumption linked to increased risk of a slew of conditions, including multiple forms of cancer, consumption of alcohol remains commonplace in the US and abroad.³ It is so commonplace, multiple studies have come out in recent years purporting a potential benefit from low or moderate alcohol consumption, including one popular study drawing a link to improved heart health.⁴

In the current study, Vinceti, along with a team of investigators representing the University of Modena and Tulane University School of Public Health and Tropical Medicine, sought to assess how limited levels of alcohol consumption might influence risk of hypertension among healthy adults. To do so, investigators designed their study as a dose-response meta-analysis of nonexperimental cohort studies.¹

With this in mind, investigators searched the Pubmed and Embase databases for studies published in English or Italian before May 9, 2023, and reported on an association between usual alcohol intake and blood pressure levels. In order to be included, a study needed to be based on a cohort or case-cohort investigation, evaluated the relationship between alcohol consumption and change in blood pressure during follow-up, include healthy, adult participants, and report mean blood pressure and the corresponding 95% confidence intervals by baseline alcohol intake categories, or provided the data needed to calculate the corresponding variances.¹

The primary endpoints of interest for the study were the mean differences over time in systolic and diastolic blood pressure, which investigators plotted according to baseline alcohol intake using a dose-response relationship 1-stage meta-analytic methodology.¹

Overall, the investigators' search yielded 7256 records meeting inclusion criteria. After further screening and removal of duplicates, 219 full-text articles were identified for additional assessments of eligibility. Of these 219, 7 were included in the final analysis.¹

These 7 studies of interest were published from 1997-2021, were conducted in North America or Asia, and included 19,548 participants. Of the 19,548 included in the study, 65% were men. Investigators pointed out 3 studies included only men, 2 included both men and women, and 2 stratified the analysis by sex. The duration of these studies ranged from 4-12 years, with a median follow-up of 5.3 years.¹

Upon analysis, investigators observed a substantially linear positive association between baseline alcohol intake and changes over time in both systolic and diastolic blood pressure, without the presence of an exposure-effect threshold. Investigators pointed out the mean systolic blood pressure change was 1.25 mmHg with 12 grams of daily alcohol consumption and 4.90 mmHg with 48 grams of daily alcohol consumption relative to those with no consumption. Compared to those with no consumption, 12 grams per day of alcohol consumption was associated with an increase of 1.14 mmHg in diastolic blood pressure and consumption of 48 grams per day was associated with an increase of 3.10 mmHg.¹

In subgroups analyses, results indicated sex had an almost linear associaito0n between baseline alcohol intake and systolic blood pressure changes for both men and women. Additionally, investigators pointed out further analysis of this relationship suggested sex demonstrated an almost linear association between baseline alcohol intake and diastolic blood pressure in men but was associated with an inverted U-shaped association in women. Further subgroup analysis revealed alcohol consumption was positively associated with blood pressure changes in both Asian- and North American-based cohorts, with the exception of diastolic blood pressure among North Americans.¹

“Alcohol is certainly not the sole driver of increases in blood pressure; however, our findings confirm it contributes in a meaningful way. Limiting alcohol intake is advised, and avoiding it is even better,” Vinceti said.²

References:

1. _{^{Di Federico S, Filippini T, Whelton PK, et al. Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies [published online ahead of print, 2023 Jul 31]. Hypertension. 2023;10.1161/HYPERTENSIONAHA.123.21224. doi:10.1161/HYPERTENSIONAHA.123.21224}}
2. _{^{American Heart Association. Routinely drinking alcohol may raise blood pressure even in adults without hypertension. American Heart Association Newsroom. July 31, 2023. Accessed July 31, 2023. https://newsroom.heart.org/news/routinely-drinking-alcohol-may-raise-blood-pressure-even-in-adults-without-hypertension.}}
3. _{^{No level of alcohol consumption is safe for our health. World Health Organization. January 4, 2023. Accessed July 31, 2023. https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health.}}
4. _{^{Mezue K, Osborne MT, Abohashem S, et al. Reduced Stress-Related Neural Network Activity Mediates the Effect of Alcohol on Cardiovascular Risk. J Am Coll Cardiol. 2023;81(24):2315-2325. doi:10.1016/j.jacc.2023.04.015}}