Effects of alcohol use and other aspects of lifestyle on blood pressure levels and prevalence of hypertension in a working population

Alcohol consumption and cardiovascular risk factors

This chapter reviews epidemiologic evidence relating alcohol consumption to the cardiovascular risk factors of high-density lipoprotein (HDL)-cholesterol and blood pressure. Alcohol consumption shows a linear dose-response relationship with HDL-cholesterol that is independent of other known determinants of HDL-cholesterol. The effect of alcohol on HDL-cholesterol appears to be reversible. The relationship of alcohol consumption to HDL-cholesterol subfractions and to the HDL apoproteins is not clear. Alcohol consumption also shows a linear dose-response relationship with blood pressure. Although the association is consistent, the estimated effect of alcohol consumption on blood pressure is small. This effect of alcohol may also be reversible. No biological mechanisms have been established for these associations. Some of the effect of alcohol on the risk of coronary heart disease may be explained by the effects of alcohol on these risk factors. It remains to be determined if alcohol also exerts an effect that is independent of these risk factors.

Alcohol consumption and blood pressure: analysis of data from the Canada Health Survey

Recent epidemiologic studies report a significant association between alcohol consumption and elevations in both systolic (SBP) and diastolic (DBP) blood pressures. To test this hypothesis, we conducted a multivariate analysis of physical examination and other data on 721 men and 697 women aged 20 or more collected during the Canada Health Survey in 1978-1979. SBP and DBP were considered as separate dependent variables in multiple regression models with the following independent variables: age, alcohol consumption (measured as a 7-day recall history and as an average frequency of consumption), serum cholesterol, plasma glucose, physical activity, Quetelet index, parental history of hypertension, cigarette consumption, income, education, and exogenous hormonal use in women. In both weighted and unweighted multiple regression analyses, we could not demonstrate for either sex, a significant association between alcohol consumption (as recorded and following quadratic and logarithmic transformations) and either SBP or DBP. For both sexes, only age and Quetelet index were highly significantly (P less than 0.0001) and consistently associated with both SBP and DBP. No other independent variables were consistently associated, for either sex, with SBP and DBP. Further, the dose-response patterns noted by other investigators suggesting either a positive and linear relationship or a curvilinear relationship were not found in either our univariate or multivariate analyses. Rather, the alcohol-blood pressure curves showed no consistent patterns of any kind in either sex. These findings do not support recent claims that alcohol consumption is a determinant of elevations in either SBP or DBP.

Alcohol and hypertension

The nature of the association between alcohol consumption and blood pressure has been studied in 491 working men in Western Australia. The effect of alcohol on systolic blood pressure was seen to be independent of obesity, age, cigarette smoking, coffee or tea consumption, educational attainment or personality type. Ex-heavy drinkers had similar blood pressures to teetotallers. Men drinking the equivalent of three or more glasses of beer a day had a 10.4% prevalence of hypertension compared with 2.6% in teetotallers while the most introverted tertile of non-smoking drinkers had a 22% prevalence of hypertension. Possible mechanisms by which repeated alcohol ingestion might lead to hypertension are discussed in the light of hemodynamic and biochemical studies in pairs of drinkers and teetotallers.

Haemodynamic and neuroendocrine consequences of stopping smoking--a controlled study

The haemodynamic and neuroendocrine consequences of stopping smoking for a 6 week period were studied in thirty-three smokers and their matched controls. Complete smoking cessation was associated with a significant fall in adrenaline and cortisol levels, consistent with the withdrawal of a nicotine stimulus to adrenomedullary and cortical activity. Supine systolic and diastolic blood pressure did not change significantly. However, the response to a cold pressor stimulus was altered with a delay in return of systolic blood pressure to basal values. This study has been unable to confirm findings from epidemiological studies of lower blood pressure in smokers. However, the possibility is raised that this phenomenon may be due to modification by smoking of the normal physiological response to stressful stimuli.

Occupation and blood pressure

Australian-born men in low-status occupations have, on average, higher blood pressures than those classified as professional or technical workers, according to the results of a national survey carried out by the National Heart Foundation and the Commonwealth Department of Health, Australia, in 1980. The expected correlations between age, alcohol consumption, body mass, and blood pressure were found. The association between occupation and blood pressure persisted after statistical adjustments for differences in age, obesity, and self-reported alcohol consumption. Though small, the differences in group averages are statistically significant, and suggest the potential for differences of cardiovascular morbidity for workers in different occupations. These findings are consistent with similar gradients in occupational mortality reported in Australia and elsewhere. It is likely that these effects are related to work, both through neuroendocrine stress mechanisms associated with certain job characteristics and through job-determined adverse health-related behaviour. The public health and preventive significance of such associations is stressed.

Alcohol intake and hypertension among urban and rural Japanese populations

A significant positive relationship was found between alcohol intake and blood pressure for men 40-69 years old living in urban Osaka (492 men) and in rural Akita (395 men), Japan, surveyed from 1975 to 1977. Both mean blood pressure and the prevalence of hypertension were related to alcohol intake in a graded fashion. Stepwise multiple regression also showed that both systolic and diastolic pressure were associated with alcohol intake independent of ponderosity index, serum cholesterol, triglycerides, hemoglobin, uric acid, smoking, and age. This cross-sectional study indicates a continuous--and not a threshold--relationship between alcohol and blood pressure, with the effect of even moderate consumption, e.g. 28-55 g per day (equivalent to about 2-4 U.S. drinks per day).

The effects of alcohol on blood pressure and electrolytes

The interaction between alcohol abuse, changes in blood pressure, and electrolyte abnormalities is complex. Some effects of alcohol are seen only with acute ingestion, some during withdrawal, and some only in chronic drinkers. Careful attention to the interactions between the metabolism of various electrolytes can prevent unnecessary morbidity and mortality in alcoholic patients.

Pressor effect of moderate alcohol consumption in man: a proposed mechanism

Ingestion of alcohol was associated with a highly significant increase in systolic blood pressure and heart rate which occurred before the blood alcohol reached its peak concentration of 16.9 (s.e.m. = 1.1) mol/1. Drinking non-alcoholic cold liquids caused a marked but transient fall in adrenaline and a rise in noradrenaline concentration. Alcohol prevented this fall in adrenaline and led to a sustained increase in noradrenaline concentration. These changes may be implicated in the elevation of blood pressure associated with alcohol consumption.