From the Guidelines
Alcohol consumption is a significant risk factor for hypertension, and limiting it to no more than 2 standard drinks for men and 1.5 for women per day is crucial to prevent alcohol-induced hypertension. According to the 2020 international society of hypertension global hypertension practice guidelines 1, there is a positive linear association between alcohol consumption, blood pressure, the prevalence of hypertension, and cardiovascular disease (CVD) risk. The guidelines recommend moderation of alcohol consumption, with a daily limit of 2 standard drinks for men and 1.5 for women (10 g alcohol/standard drink).
The mechanisms by which alcohol causes hypertension are multifaceted. Regular consumption of alcohol, especially in excessive amounts, directly raises blood pressure by:
- Affecting the nervous system, causing blood vessels to constrict and heart rate to increase
- Reducing the body's production of nitric oxide, a substance that helps blood vessels relax and dilate
- Interfering with the renin-angiotensin-aldosterone system, leading to fluid retention and increased blood volume
- Damaging the walls of blood vessels, making them less elastic and more resistant to blood flow
- Contributing to weight gain, which is an independent risk factor for hypertension
The 2013 ESH/ESC guidelines for the management of arterial hypertension 2 also support the recommendation to limit alcohol consumption, advising hypertensive men to limit their consumption to no more than 20–30 g, and hypertensive women to no more than 10–20 g, of ethanol per day.
Key points to consider:
- Limit alcohol consumption to no more than 2 standard drinks for men and 1.5 for women per day
- Avoid binge drinking
- Be aware of the calorie content of alcohol and its potential contribution to weight gain
- Consider the individual's overall cardiovascular risk profile when assessing the risks and benefits of alcohol consumption.
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 3, 4, 5 + Impairment of the baroreceptors 3, 4 + Enhanced sympathetic activity 3, 4, 5, 6 + Stimulation of the renin-angiotensin-aldosterone system 3, 4, 5 + Increased cortisol levels 3, 4 + Increased vascular reactivity due to increased intracellular calcium levels 3, 4, 5 + Stimulation of the endothelium to release vasoconstrictors 3, 4 + Loss of relaxation due to inflammation and oxidative injury of the endothelium leading to inhibition of endothelium-dependent nitric oxide production 3, 5
Effects of Alcohol Consumption on Blood Pressure
- Chronic consumption of alcoholic beverages is associated with a high incidence of hypertension in men and women 6
- The risk of hypertension begins at moderate alcohol consumption in women 6
- The risks of alcohol consumption are higher in Blacks than in Asians or Caucasians 6
- Short-term trials have shown that alcohol withdrawal promotes blood pressure reduction 6
Prevention and Treatment of Alcohol-Induced Hypertension
- Reduction of alcohol intake is the first step in controlling hypertension 3, 4, 7
- Physical conditioning/exercise training is an important strategy to prevent/treat chronic alcohol-induced hypertension 3
- Pharmacologic treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARBs) may be effective 3, 4
- Calcium channel blockers may also be used to treat alcohol-induced hypertension 3, 4