What is the clinical evidence from this study?

Study design: Review. Population: Hypertension. Intervention: Alcohol.

August 27, 2020Open Access

Hypertension and Alcohol: A Mechanistic Approach

Key Result

Heavy alcohol use is almost invariably associated with an increased risk of developing primary hypertension regardless of age or gender, while the effects of low or moderate use remain unclear.

Structured PICO

Does alcohol consumption increase the risk of developing primary or secondary hypertension?

Population

Individuals assessed for the relationship between alcohol use and hypertension development

Intervention

Alcohol consumption (heavy, moderate, or low)

Comparator

Abstinence or different levels of alcohol consumption

Outcome

Development of primary or secondary hypertension

Heavy alcohol use is consistently associated with an increased risk of primary hypertension, whereas the effects of low to moderate consumption remain unclear and require further investigation.

Limitations

No quality assessment of individual studies used for this review was performed
Findings in some of the studies may not be applicable to the general population
The evidence in many of the studies is weak and the conclusions were often based on animal models
Performing randomized controlled trials would be unethical

Abstract

Hypertension is a global public health challenge and a major cause of morbidity and mortality. Alcohol is one of the most frequently abused substances around the world. The financial implications of treating hypertension are also significant. Developing successful strategies to prevent hypertension may be as important, if not more important, than managing the disease once it arises. In this review we assess the relationship between alcohol use and hypertension development. We have searched the available literature using the PubMed database and identified studies that discussed the relationship between alcohol use and either primary or any of the common causes of secondary hypertension. We found that heavy alcohol use was almost invariably associated with increased risk of developing primary hypertension, regardless of the age or gender of the participants. The relationship between low or moderate alcohol use and hypertension is less clear and some evidence even points towards possible protective effects. The pathophysiology behind the association is incompletely understood and a number of mechanisms have been proposed. Heavy alcohol use also increases the risk of insulin resistance and obstructive sleep apnea, known causes of secondary hypertension. It has also been linked to a state of hypercortisolism, sometimes called pseudo-Cushing state. Moderate alcohol consumption may be protective against diabetes and hyperthyroidism associated with Graves' disease. Overall, public health efforts should address the issue of heavy alcohol use. There does not appear to be enough evidence to recommend abstinence to those consuming low amounts of alcohol with the aim of protecting against hypertension. We believe that the current understanding of the issue is insufficient and that more both basic science and clinical research needs to be done.

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