Alcohol: an important cause of hypertension.

Alcohol: an important cause of hypertension Ten years ago who would have thought that one of the most important complications of drinking alcohol had still to be recognised?In 1977 Klatsky and colleagues from the Kaiser-Permanente Centre in San Francisco described an association between alcohol intake and blood pressure in some 84 000 people attending a health screening programme.'Three further papers that year supported the association,24 and Mathews suggested that alcohol might be responsible for almost a third of cases of so called essential hypertension.5I am not strictly accurate when I claim that this had not been described for Lian had noted in 1915 a higher prevalence of hypertension in heavy drinkers than in light drinkers or abstainers,' and there are passing references to alcohol and hypertension in the Framingham study7 and one report from India.8Yet the association did not impinge on medical consciousness, and standard textbooks on hypertension published up to the late 1970s omitted any reference to alcohol.By this time studies of alcohol dependent patients had shown that up to halfhad blood pressures ofover 140/90 mm Hg.9 Blood pressure returned to normal after detoxification in most and remained normal for as long as they stayed abstinent.'0In the past five years a flurry ofepidemiological, experimental, and laboratory studies has defined alcohol's contribution to hypertension and attempted to unravel the mechanisms.Cross sectional population studies include many demo- graphic and lifestyle variables that are known or potential risk factors for hypertension, and any inference that alcohol has a causal role can be made only when the effect of other variables has been controlled.In a geographically defined area of Western Australia a linear relation between daily alcohol intake and systolic (but not diastolic) blood pressure was confirmed and was independent of age, obesity, and cigarette smoking."A new analysis from the Kaiser- Permanente group has controlled for many confounding variables, including race, sex, age, cigarette smoking, use of coffee and tea, obesity, and several biochemical variables.'With all these taken into account in a multiple regression analysis, a progressive rise in both systolic and diastolic blood pressure was found with increasing daily alcohol consump- tion up to six to eight drinks daily among white subjects and in black men (but not women).The mean systolic pressure was 9-1 mm Hg higher in white men having six to eight