The Link Between Alcohol Consumption and Blood Pressure

A nearly linear relationship exists between usual alcohol intake (including limited amounts) and blood pressure (BP) with no evidence of a threshold for this association, according to findings published in Hypertension.

Investigators sought to determine the association between alcohol consumption (particularly at low levels) and BP. Mean differences over time of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were the primary outcomes.

The investigators conducted a systematic review and meta-analysis searching the Embase and PubMed databases for longitudinal studies reporting on the association between alcohol intake and BP levels in healthy adults, published in English or Italian before May 2023. They included 7 cohort or case-cohort studies (N=19,548; 65% men; median follow-up, 5.3 years [range, 4-12 years]). Among the included studies, 3 were conducted in the United States, 3 in Japan, and 1 in South Korea. Cross-sectional studies and those enrolling participants with existing cardiovascular disease, diabetes, or cirrhosis or primarily recruiting alcoholics or binge drinkers were excluded.

There was no suggestion of an exposure-effect threshold and over time a positive linear association was found to exist between baseline alcohol intake and changes in SBP and DBP.  Average SBP was 1.25 mm Hg higher for 12 grams daily (g/d) of alcohol consumption and 4.90 mm Hg higher for 48 g/d consumption compared with no consumption. The corresponding differences for DBP were 1.14 mm Hg for 12 g/d alcohol consumption and 3.10 mm Hg for 48 g/d consumption.

Stratified by highest vs lowest alcohol intake, SBP and DBP showed an increased mean difference (4.3 mm Hg [95% CI, -2.76 to 5.85; I²=67.11%]; and 2.42 mm Hg [95% CI, 1.13-3.71; I²=78.45%], respectively).

An almost linear relationship was found to exist between baseline alcohol intake and SBP changes in men and women, remaining consistent for DBP in men. DBP in women had an inverted U-shaped association with alcohol intake. SBP difference in men for an alcohol intake of 12 g/d vs no alcohol consumption was 1.33 mm Hg and 4.95 mm Hg for an intake of 48 g/d. Corresponding DBP difference in men was 1.20 mm Hg for 12 g/d alcohol consumption and 3.41 mm Hg for 48 g/d.

SBP difference in women for an alcohol intake of 12 g/d vs no consumption was 0.82 mm Hg and 3.31 mm Hg for an intake of 48 g/d. Corresponding DBP difference in women was 1.45 mm Hg for 12 g/d alcohol consumption and -1.27 mm Hg for 48 g/d.

Subgroup analysis showed that, other than DBP in North American patients, alcohol intake was positively associated with BP changes in Asian and North American patients. Among the 7 included studies, 2 were rated as low risk of bias, 4 as moderate risk, and 1 as high risk (according to the Risk of Bias in Nonrandomized Studies of Exposure assessment tool).

Study limitations include the small number of included studies, relatively high heterogeneity, exposure misclassification, and the nonexperimental design.

“Our results suggest the association between alcohol consumption and SBP is direct and linear with no evidence of a threshold for the association, while for DBP the association is modified by sex and geographic location,” the investigators wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.