Understanding the impact of alcohol on blood pressure and hypertension: From moderate to excessive drinking

Observational studies report a strong positive linear association between alcohol consumption and blood pressure but also suggested a lower cardiovascular risk with light drinking compared with abstainers. However, this potential cardioprotective effect of low-to-moderate alcohol intake seems attributable to a healthier life style in these individuals. Hence, more recent epidemiological and genetic Mendelian randomization studies indicated a continuous nonlinear positive relationship between alcohol intake and blood pressure (BP). The risk for hypertension increases in both men and women, if daily alcohol intake is at least one to two drinks (about 10-20 g alcohol) per day. Alcohol reduction close to abstinence is associated with a 3.3 and 2.0 mm Hg reduction in systolic BP and diastolic BP. A dose-dependent relationship between alcohol intake and BP was observed particularly in heavy drinkers consuming at least 6 drinks/day. In this group, more profound BP reductions can be expected by reducing alcohol intake. Additionally, both trial data and observational literature support the hypertensiogenic effect of binge drinking, which together with uncontrolled hypertension, is the most important risk factor for intracranial hemorrhage. Consequently, excessive (binge) drinking should be avoided, and patients with high risk for intracranial bleedings should be advised accordingly. Recommendations in different guidelines vary regarding the upper limits and definition of drinks, and recommendations for sex-specific upper limits for alcohol intake appear questionable. Moderation in alcohol intake and implementation of alcohol-free days during the week in both men and women who consume drinks that contain alcohol are recommended to improve BP control and overall health.