From the Guidelines
Excess alcohol consumption causes hypertension through multiple mechanisms affecting the cardiovascular system, and limiting daily intake to no more than 2 drinks for men and 1 drink for women is essential to prevent or manage hypertension. Regular heavy drinking increases blood pressure by activating the sympathetic nervous system, which constricts blood vessels and increases heart rate, as reported in studies such as 1. Alcohol also disrupts the renin-angiotensin-aldosterone system, leading to sodium and water retention that increases blood volume and pressure.
Some key mechanisms by which excess alcohol consumption leads to hypertension include:
- Activation of the sympathetic nervous system, leading to vasoconstriction and increased heart rate
- Disruption of the renin-angiotensin-aldosterone system, resulting in sodium and water retention
- Damage to the endothelium, reducing nitric oxide production and impairing vasodilation
- Inflammation and oxidative stress, contributing to blood vessel damage and arterial stiffness
- Contribution to weight gain due to high calorie content, another risk factor for hypertension
According to recent guidelines, such as those outlined in 1 and 1, moderation of alcohol intake is crucial for improving hypertension control. Reducing alcohol intake to moderate levels or abstaining completely can significantly lower blood pressure, often within 2-4 weeks, and lifestyle changes including alcohol reduction remain essential for long-term blood pressure control. Blood pressure medications may be needed initially, but limiting daily alcohol intake is a critical component of hypertension management.
From the Research
Mechanisms of Excess Alcohol Consumption and Hypertension
- Excess alcohol consumption has been associated with an increased risk of hypertension, with three or more alcoholic drinks daily showing a relationship with hypertension 2, 3.
- The mechanisms through which alcohol raises blood pressure are not fully understood, but possible mechanisms include:
- Imbalance of the central nervous system
- Impairment of the baroreceptors
- Enhanced sympathetic activity
- Stimulation of the renin-angiotensin-aldosterone system
- Increased cortisol levels
- Increased vascular reactivity due to increased intracellular calcium levels
- Stimulation of the endothelium to release vasoconstrictors
- Loss of relaxation due to inflammation and oxidative injury of the endothelium leading to inhibition of endothelium-dependent nitric oxide production 4, 5.
Effects of Reducing Alcohol Intake on Blood Pressure
- Reduction in alcohol intake is associated with a significant dose-dependent lowering of mean systolic and diastolic blood pressure, with each drink per day reduction in intake lowering blood pressure by approximately 1 mm Hg 2, 3.
- Reducing alcohol intake to an average maximum of one drink per day in women and two drinks per day in men is a reasonable goal for persons with hypertension who drink excessively, if drinking is not otherwise contraindicated 2.
Prevention and Treatment of Alcohol-Induced Hypertension
- Physical conditioning/exercise training is one of the most important strategies to prevent/treat chronic alcohol-induced hypertension on a physiological basis 4.
- Pharmacologic treatment, including angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARBs), which have antioxidant activity, and calcium channel blockers, may be effective in preventing/treating alcohol-induced hypertension 4, 5, 6.