From the Guidelines
Alcohol consumption is a significant risk factor for hypertension, and limiting daily intake to no more than 2 standard drinks for men and 1.5 for women is recommended to reduce this risk. According to the 2020 International Society of Hypertension Global Hypertension Practice Guidelines 1, there is a positive linear association between alcohol consumption, blood pressure, and cardiovascular disease risk. The guidelines recommend moderation of alcohol consumption to reduce the risk of hypertension.
The relationship between alcohol and blood pressure is dose-dependent, with higher consumption leading to increased blood pressure 1. Alcohol increases the production of cortisol and other stress hormones that constrict blood vessels, activates the sympathetic nervous system, and interferes with calcium levels in blood vessel walls, making them less able to relax and dilate properly. Long-term drinking can also damage the lining of blood vessels, reducing their elasticity and making them stiffer, which increases resistance to blood flow.
Some key points to consider when advising patients on alcohol consumption and hypertension include:
- Limiting daily alcohol intake to no more than 2 standard drinks for men and 1.5 for women
- Avoiding binge drinking
- Being aware of the potential for alcohol to interact with other lifestyle factors, such as diet and physical activity, to increase blood pressure
- Considering complete abstinence for patients with existing hypertension
Overall, the evidence suggests that moderating alcohol consumption is an important lifestyle modification for reducing the risk of hypertension and improving overall cardiovascular health 1.
From the Research
Mechanisms of Alcohol-Induced Hypertension
- Several possible mechanisms have been proposed to explain how alcohol raises blood pressure, including:
- Imbalance of the central nervous system 2, 3
- Impairment of the baroreceptors 2, 3
- Enhanced sympathetic activity 2, 3
- Stimulation of the renin-angiotensin-aldosterone system 2, 3
- Increased cortisol levels 2, 3
- Increased vascular reactivity due to increased intracellular calcium levels 2, 3
- Stimulation of the endothelium to release vasoconstrictors 2, 3
- Loss of relaxation due to inflammation and oxidative injury of the endothelium leading to inhibition of endothelium-dependent nitric oxide production 2, 3
Effects of Alcohol on Blood Pressure
- Heavy alcohol consumption (three or more standard drinks per day) is associated with and predictive of hypertension 4, 5
- Reduction in alcohol consumption is associated with a significant dose-dependent lowering of mean systolic and diastolic blood pressure 4, 5
- High-dose alcohol has a biphasic effect on blood pressure, decreasing it up to 12 hours after consumption and increasing it more than 13 hours after consumption 6
- High-dose alcohol increases heart rate at all times up to 24 hours 6
Prevention and Treatment of Alcohol-Induced Hypertension
- Reduction of alcohol intake is a key strategy for preventing and treating alcohol-induced hypertension 4, 2, 3, 5
- Physical conditioning/exercise training is also an important strategy for preventing and treating chronic alcohol-induced hypertension 2
- Pharmacologic treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARBs) may be effective in treating alcohol-induced hypertension 2, 3