From the Guidelines
The treatment of hypertension in individuals with alcohol use disorder requires a dual approach addressing both conditions, with the most recent guidelines from 2020 recommending moderation of alcohol consumption as a key lifestyle modification 1. The first step in managing hypertension in individuals with alcohol use disorder is to reduce alcohol consumption, as even moderate reduction can lower blood pressure by 4-5 mmHg.
- Reducing alcohol intake to no more than 2 drinks per day for men and 1.5 drinks per day for women is recommended, as stated in the 2020 international society of hypertension global hypertension practice guidelines 1.
- For pharmacological management, thiazide diuretics, calcium channel blockers, or ACE inhibitors are often used, with beta-blockers generally avoided due to potential interactions with alcohol withdrawal symptoms.
- Clonidine, an alpha-2 agonist, can be beneficial in addressing both hypertension and withdrawal symptoms, and once-daily dosing regimens are preferred to improve medication adherence.
- Comprehensive treatment should include alcohol cessation support through counseling, support groups, and possibly medications like naltrexone or acamprosate to reduce cravings, as continued alcohol use can significantly reduce the effectiveness of antihypertensive medications and increase cardiovascular risk 1.
- Regular monitoring of liver function is also essential, especially with ACE inhibitors, due to the potential for hepatic impairment in individuals with alcohol use disorder.
- Lifestyle modifications, such as weight reduction, healthy diet, regular physical activity, and stress reduction, are also crucial in managing hypertension in this population, as recommended by the 2020 guidelines 1.
From the FDA Drug Label
Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. Many patients will require more than 1 drug to achieve blood pressure goals. Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake
The treatment for hypertension in individuals with alcohol use disorder may involve the use of antihypertensive drugs such as lisinopril.
- Key considerations for treatment include:
- Comprehensive cardiovascular risk management
- Lifestyle modifications (e.g., smoking cessation, exercise, limited sodium intake)
- Potential need for multiple drugs to achieve blood pressure goals
- Monitoring for interactions between alcohol and antihypertensive medications 2 However, the provided drug labels do not directly address the treatment of hypertension in individuals with alcohol use disorder.
From the Research
Treatment for Hypertension in Individuals with Alcohol Use Disorder
- The treatment for hypertension in individuals with alcohol use disorder involves lifestyle modifications, including reducing alcohol consumption 3, 4, 5.
- Reducing alcohol intake has been shown to lower blood pressure in both hypertensive and normotensive individuals 3, 5, 6.
- The Canadian low-risk drinking guidelines recommend limiting alcohol consumption to 2 or fewer standard drinks per day, with a maximum of 14 standard drinks per week for men and 9 standard drinks per week for women 3.
- Pharmacologic treatment for hypertension may be necessary, but it should be withheld until after 2 to 4 weeks of abstinence from alcohol 4.
- Angiotensin-converting enzyme inhibitors and calcium channel blockers may be the most appropriate pharmacologic treatment for hypertension in individuals with alcohol use disorder 4.
Lifestyle Modifications
- Reducing alcohol consumption is a key lifestyle modification for controlling hypertension in individuals with alcohol use disorder 3, 4, 5, 6.
- A reduction in alcohol intake of one drink per day can lower systolic and diastolic blood pressure by approximately 1 mm Hg 5.
- Cognitive-behavioral interventions can be effective in reducing alcohol intake, but their effect on blood pressure reduction is uncertain 7.
Pharmacologic Treatment
- Pharmacologic treatment for hypertension should be individualized and based on the patient's specific needs and medical history 4.
- Angiotensin-converting enzyme inhibitors and calcium channel blockers may be the most appropriate pharmacologic treatment for hypertension in individuals with alcohol use disorder 4.
- However, more research is needed to determine the most effective pharmacologic treatment for hypertension in individuals with alcohol use disorder 7.