Alcohol, blood pressure, and hypertension

CONTENTS

Alcohol intake and blood pressure

Many studies have shown a direct, dose-dependent relationship between alcohol intake and blood pressure, particularly for intake above two drinks per day.
This relationship is independent of:

  • age;
  • salt intake;
  • obesity;
  • finally, it persists regardless of beverage type.

Furthermore, heavy consumption of alcoholic beverages for long periods of time is one of the factors predisposing to hypertension: from 5 to 7% of hypertension cases is due to an excessive alcohol consumption.
A meta-analysis of 15 randomized controlled trials has shown that decreasing alcoholic beverage intake intake has therapeutic benefit to hypertensive and normotensive with similar systolic and diastolic blood pressure reductions (in hypertensive reduction occurs within weeks).

Alcohol intake and prevention of hypertension

AlcoholGuidelines on the primary prevention of hypertension recommend that alcohol (ethanol) consumption in most men, in absence of other contra, should be less than 28 g/day, the limit in which it may reduce coronary heart disease risk.
The consumption limited to these quantities must be obtained by intake of drinks with low ethanol content, preferably at meals (drinking even lightly to moderately outside of meals increases the probability to have hypertension). This means no more than 680 ml or 24 oz of regular beer or 280 ml or 10 oz of wine (12% ethanol), especially in hypertension; for women and thinner subjects consumption should be halved1.
To avoid intake of drinks with high ethanol content even though the total ethanol content not exceeding 28 g/day.

Relationship between ethanol intake and blood pressure

Anyway, uncertainty remains regarding benefits or risks attributable to light-to-moderate alcoholic beverage intake on the risk of hypertension.
In a study published on April 2008, the authors examined the association between ethanol intake and the risk of developing hypertension in 28848 women from “The Women’s Health Study” and 13455 men from the “Physicians’ Health Study”, (the follow-up lasted respectively for 10.9 and 21.8 years). The study confirms that heavy ethanol intake (exceeding 2 drinks/day) increases hypertension risk in both men and women but, surprisingly, found that the association between light-to-moderate alcohol intake (up to 2 drinks/day) and the risk of developing hypertension is different in women and men. Women have a potential reduced risk of hypertension from a light-to-moderate ethanol consumption with a J-shaped association2; men have no benefits of light-to-moderate ethanol consumption but an increased risk of hypertension.
However, guidelines for the primary prevention of hypertension limit alcohol consumption to less 2 drinks/day in men and less 1 drink/day in thinner subjects and women.

1. A standard drink contains approximately 14 g of ethanol i.e. a 340 ml or 12 oz of regular beer, 140 ml or 5 oz wine (12% alcohol), or 42 ml or 1,5 oz of distilled spirits (inadvisable).

2. Many studies have shown a J-shaped relationship between ethanol intake and blood pressure. Light drinker (no more than 28 g of ethanol/day) have lower blood pressure than teetotalers; instead, who consumes more than 28 g ethanol/day have higher blood pressure than non drinker. So alcohol is a vasodilator at low doses but a vasoconstrictor at higher doses.

References

Pickering T.G. New guidelines on diet and blood pressure. Hypertension 2006;47:135-6. doi:10.1161/01.HYP.0000202417.57909.26

Sesso H.D., Cook N.R., Buring J.E., Manson J.E. and Gaziano J.M. Alcohol consumption and the risk of hypertension in women and men. Hypertension 2008;51:1080-87. doi:10.1161/HYPERTENSIONAHA.107.104968

Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER Clinical Trial. JAMA 2003;289:2083-2093. doi:10.1001/jama.289.16.2083

World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. Guidelines and recommendations. J Hyperten 2003;21:1983-92.


Overweight, physical activity, blood pressure, and hypertension

Overweight, obesity and blood pressure

Body weight is a determinant of blood pressure at all age; in fact:

  • it has been estimated that the risk of developing elevated blood pressure is two to six time higher in overweight than in normal-weight individuals;
  • there is a linear correlation between blood pressure and body weight or body mass index (BMI) (a BMI greater than 27, i.e. overweight or obesity, is correlated with increased blood pressure): even when dietary sodium intake is held constant, the correlation between change in weight and change in blood pressure is linear;
  • 60% of hypertensives are more than 20% overweight;
  • centripetal distribution of body fat (waist circumference greater than 34 inches in women and 39 inches in man), also associated with insulin resistance, is more important determinant of blood pressure elevation than that peripherally located in both man and women;
  • it has been shown that weight loss, both in hypertensive and normotensive individual, can reduce blood pressure and reductions occur before, and without, attainment of a desirable body weight.

In view of the difficulties of sustaining weight loss, efforts to prevent weight gain among those who have normal body weight are critically important.

How to calculate BMI

BMI is total body weight, expressed in kilograms [kg] or pounds [lb], divided by the height squared, expressed in meters or inches (in.).
It can be calculated using the following equations:

BMI = weight [kg]/height2 [m] or
BMI = (weight [lb.]/heigth2 [in.]) x 705

BMI is a good indication of body fat because most of the weight differential among adults is due to body fat; its major flaw is that some muscular individuals may be classified as obese even if they are not.
A healthy BMI is between 18 to 24,9.
Overweight is considered to be between 25 to 29,9.
Obesity is categorized by BMI according to three grades:

  • 30 to 34,9 I grade obesity;
  • 35 to 40 II grade obesity:
  • 40 and above III grade obesity.

Physical activity, and blood pressure

overweightMaintaining a high level of physical activity is a critical factor in sustaining weight loss.
In addition to the effect on body weight, activity and exercise in itself reduce the rise in blood pressure.
Physical activity produces a fall in systolic blood pressure and diastolic blood pressure; so, increasing physical activity of low to moderate intensity to 30 to 45 minutes 3-4 days/week up to 1 hour nearly every day, as recommended by World Health Organization, is important for the primary prevention of hypertension.
Less active persons are 30% to 50% more likely to develop hypertension than active ones.
Remember: a rolling stone gathers no moss!

References

Mahan LK, Escott-Stump S.: “Krause’s foods, nutrition, and diet therapy” 10th ed. 2000

Shils M.E., Olson J.A., Shike M., Ross A.C. “Modern nutrition in health and disease” 9th ed., by Lippincott, Williams & Wilkins, 1999

Writing Group of the PREMIER Collaborative Research Group. Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER Clinical Trial. JAMA 2003;289:2083-2093. doi:10.1001/jama.289.16.2083

World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. Guidelines and recommendations. J Hyperten 2003;21:1983-92.