Moderate and heavy alcohol consumption associated with hypertension

Association of Alcohol Intake With Hypertension in Type 2 Diabetes Mellitus:The ACCORD Trial

Literature - Mayl JJ, German CA, Bertoni AG et al., - J Am Heart Assoc. 2020;. DOI: 10.1161/JAHA.120.017334

Introduction and methods

It has been known for years that high alcohol intake is associated with hypertension. Light and moderate consumption of alcohol, however, does not show an association with hypertension and even has been associated with improved CV outcomes when compared with abstainers [1-4]. CV benefit by light and moderate alcohol intake may be mediated via decreased atherosclerosis, blood clotting and platelet aggregation and therefore some have recommended light to moderate alcohol consumption as beneficial and cardioprotective [5,6]. Other studies, more recent ones, identified a linear relationship identified for the amount of alcohol consumption and the degree of hypertension [7,8].

In this study the association of alcohol consumption and hypertension was examined in participants of the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes, [9]). In the ACCORD trial, 10251 type 2 diabetes patients were enrolled, who either had high risk of CVD or established CVD. This analysis included those who had baseline self-reported alcohol consumption and baseline blood pressure measurements, leaving 102000 participants. Light, moderate, and heavy alcohol consumption were defined as 1 to 7 drinks/week, 8 to 14 drinks/ week, and ≥15 drinks/week, respectively. A drink was defined as a 12-ounce beer, 6 ounces of wine, or 1.5 ounces of liquor. Blood pressure was categorized according to the ACC/AHA 2017 guidelines.

Main results

  • The distribution of alcohol intake in this cohort was as follows: none n=7767, light n=2124, moderate n=232, heavy n=77.
  • Light alcohol consumption was not associated with elevated blood pressure (OR 1.11, 95%CI: 0.93-1.13, P=0.25) (those who had no alcohol intake were the referent group). Moderate and heavy alcohol consumption were associated with elevated blood pressure (OR 1.79, 95%CI: 1.04-3.11, P=0.03 and OR 1.91, 95%CI: 1.17-3.12, P=0.01).
  • There was no association with light alcohol consumption and stage 1 hypertension (OR 1.11, 95%CI: 0.85-1.45, P=0.45). Moderate and heavy alcohol consumption were associated with stage 1 hypertension (OR 1.66, 95%CI; 1.05-2.60, P=0.03, and OR 2.49, 95%CI: 1.03-6.17, P=0.03).
  • Light alcohol consumption was not associated with stage 2 hypertension (OR 1.02, 95%CI:0.88-1.19, P=0.76). Moderate and heavy alcohol consumption were associated with stage 2 hypertension (OR 1.62, 95%CI; 1.03-2.54, P-0.03 and OR 3.04, 95%CI: 1.28-7.22, P=0.01).

Conclusion

In this cohort of T2DM patients with high CV risk, who participated in the ACCORD trial, moderate (>7 drinks per week) and heavy alcohol consumption was associated with elevated blood pressure, stage 1 and stage 2 hypertension.

References

1. Klatsky AL, Armstrong MA, Friedman GD. Relations of alcoholic beverage use to subsequent coronary artery disease hospitalization. Am J Cardiol. 1986;58:710–714.

2. Klatsky AL, Armstrong MA, Friedman GD. Risk of cardiovascular mortality in alcohol drinkers, ex-drinkers and nondrinkers. Am J Cardiol. 1990;66:1237–1242.

3. Fuchs CS, Stampfer MJ, Colditz GA, Giovannucci EL, Manson JE, Kawachi I, Hunter DJ, Hankinson SE, Hennekens CH, Rosner B, et al. Alcohol consumption and mortality among women. N Engl J Med. 1995;332:1245–1250.

4. Rimm EB, Giovannucci EL, Willett WC, Colditz GA, Ascherio A, Rosner B, Stampfer MJ. Prospective study of alcohol consumption and risk ofcoronary disease in men. Lancet. 1991;338:464–468.

5. Rimm EB, Klatsky A, Grobbee D, Stampfer MJ. Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine, or spirits. BMJ. 1996;312:731–736.

6. Xi B, Veeranki SP, Zhao M, Ma C, Yan Y, Mi J. Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortalityin U.S. adults. J Am Coll Cardiol. 2017;70:913–922.

7. Taylor B, Irving HM, Baliunas D, Roerecke M, Patra J, Mohapatra S, Rehm J. Alcohol and hypertension: gender differences in dose–response relationships determined through systematic review and meta-analysis. Addiction. 2009;104:1981–1990.

8. Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health. 2017;2:e108–e120.

9. Chew EY, Ambrosius WT, Howard LT, Greven CM, Johnson S, Danis RP, Davis MD, Genuth S, Domanski M. Rationale, design, and methods of the action to control cardiovascular risk in diabetes eye study (ACCORD-EYE). Am J Cardiol. 2007;99:S103–S111.

Find this article online at J Am Heart

Facebook Comments

Register

We’re glad to see you’re enjoying PACE-CME…
but how about a more personalized experience?

Register for free