Relationships Between Current and Past Binge Drinking and Systolic Blood Pressure in Young Adults

Effects of at-risk alcohol use on nighttime blood pressure, urinary catecholamines, and sleep quality in midlife adults

BACKGROUND

The association between alcohol and hypertension has been predominantly based on office blood pressure (BP) measurements. However, little is known about the effect of alcohol use on nighttime BP and the underlying mechanisms. The purpose of this study was to investigate the effects of at-risk alcohol use on nighttime BP, urinary catecholamines, and sleep quality in midlife adults.

METHODS

A total of 32 midlife men and 30 postmenopausal women, free of major clinical diseases and nonsmokers (age: 58 ± 4; mean ± SD), were included. Among all participants, 22 were currently taking antihypertensive medications. At-risk drinkers were defined as those who had a dried blood spot phosphatidylethanol level ≥20 ng/mL. All participants completed 24-h ambulatory BP monitoring and urine collection to determine nighttime (or asleep) BP and nighttime urinary catecholamine levels. Sleep quality was determined by using the Pittsburgh Sleep Quality Index.

RESULTS

In midlife adults free of antihypertensive medications, at-risk drinkers had a higher nighttime systolic (118 ± 14 vs. 107 ± 14 mmHg, p = 0.02) and diastolic BP (70 ± 9 vs. 62 ± 9 mmHg, p = 0.003) than low-risk drinkers with no between-group differences in sleep quality component scores (p ≥ 0.14). In midlife adults taking antihypertensive medications, no difference in nighttime BP was found between at-risk drinkers and low-risk drinkers (p ≥ 0.68), with a higher score for the "use of sleeping medication" component in high-risk drinkers (p = 0.02). Regardless of antihypertensive medication use, no difference between at-risk drinkers and low-risk drinkers was found in nighttime urinary catecholamine levels (p ≥ 0.19).

CONCLUSIONS

Our findings suggest that in midlife adults free of antihypertensive medication use, at-risk alcohol use is associated with an increase in nighttime BP, and the increase in nighttime BP may be mediated by mechanisms other than increased catecholamines and poor sleep quality.

Drinking patterns among US men and women: Racial and ethnic differences from adolescence to early midlife

BACKGROUND

Drinking patterns among young adult men and women in the United States have been understudied, especially among racial and ethnic groups such as Asian Americans and Hispanics. Because alcohol-related racial and ethnic health disparities persist or increase in midlife, identifying peak ages of hazardous drinking could help to reduce disparities.

METHODS

We used the National Longitudinal Study of Adolescent to Adult Health to examine: (1) past 12-month heavy episodic drinking (HED) and total alcohol volume consumption among non-Hispanic White (NHW), Black, Hispanic, and Asian men and women from ages 12 through 41, and (2) age-varying associations of race and ethnicity with drinking. Hispanic and Asian ethnic groups were disaggregated by historical drinking patterns. Time-varying effect models accounted for major demographic confounders.

RESULTS

NHW men and women experienced elevated drinking rates in their early 20s, with a second elevation in their 30s. Black men and women did not have elevated drinking until their 30s. Among Hispanic men and women, peak drinking periods varied by gender and subgroup drinking pattern. Peak HED and total consumption emerged in the early 30s for Asian men, while peak HED occurred in the early 20s for Asian women. Drinking at certain ages for some racial and ethnic minoritized men and women did not differ from that in their NHW counterparts.

CONCLUSIONS

Age periods during which subgroups in the U.S. population experience elevated alcohol consumption vary by ethnicity and gender. Recognition of these group differences could enhance our understanding of intervention timing.

Alcohol use patterns and hypertension among adults in the United States: findings from the 2015-2016 NHANES data

OBJECTIVES

This study assessed the association between alcohol use patterns and the prevalence of hypertension.

STUDY DESIGN

Data on alcohol use patterns and hypertension among 5918 adults from the 2015-2016 National Health and Nutrition Examination Survey was used for this study.

METHODS

The association of alcohol use patterns; "ever-used alcohol", "binge drinking", "heavy drinking", and "everyday alcohol use" with hypertension were assessed using multivariable-adjusted logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) at a two-sided P < 0.05.

RESULTS

Overall, the mean age of respondents was 48.3 ± 18.5 years, 50.9% (n = 3034) were women, and 44.6% (n = 2132) were hypertensive. Also, 85.9% (n = 4177) had used alcohol in their lifetime, 51.9% (n = 1764) were heavy drinkers, 25.1% (n = 370) engaged in binge drinking, and 17.7% (n = 721) reported everyday alcohol use. Compared to those that have never used alcohol, the aOR (95%CI) of stage II hypertension was 1.570 (1.565, 1.575) for overall alcohol use, 1.370 (1.367, 1.373) for everyday alcohol use, 1.127 (1.125, 1.129) for heavy drinking, and 1.092 (1.087, 1.098) for binge drinking. Among current active smokers, the aOR (95%CI) of stage II hypertension was aggravated for everyday alcohol use; 2.583 (2.576, 2.590).

CONCLUSION

Alcohol use patterns were associated with a higher prevalence of hypertension, particularly among smokers. A population-based longitudinal study should clarify whether these alcohol use phenotypes are predictive of hypertension at the population level in the United States.

Prevalence and risk factors of prehypertension/hypertension among freshman students from the Vietnam National University: a cross-sectional study

BACKGROUND

Prehypertension (PHT) and hypertension (HTN) in young adults are essential risk factors for other cardiovascular diseases (CVD) in later years of life. However, there is a lack of knowledge about the burden and risk factors of PHT/HTN for Vietnamese youth. The aim of this study was to investigate the prevalence of PHT/HTN and risk factors among university students in Hanoi, Vietnam.

METHODS

This study was designed as a cross-sectional investigation with 840 students (394 males and 446 females) randomly sampled from freshmen of Vietnam National University, Hanoi (VNU). Socio-demographic, anthropometric, and lifestyle data were collected using questionnaire forms and physical measurements. HTN was defined as blood pressure (BP) ≥ 140/90 mmHg and/or current treatment with antihypertensive medications. PHT was defined as a systolic BP from 120 to 139 mmHg and/or a diastolic BP from 80 to 89 mmHg. Body mass index (BMI) was classified according to the WHO diagnostic criteria for Asian adults: normal weight (BMI 18.5-22.9 kg/m2), underweight (BMI < 18.5 kg/m2), overweight (BMI 23-24.9 kg/m2), and obese (BMI ≥ 25 kg/m2). Bivariable and multivariable log-binomial regression analyses were conducted to explore the association of PHT/HTN with different risk factors.

RESULTS

The overall prevalence of prehypertension and hypertension was 33.5% [95% CI: 30.3-36.8%] (54.1% in men and 15.3% in women) and 1.4% [95% CI: 0.7-2.5%] (2.5% in men and 0.5% in women), respectively. Regarding CVD major risk factors, 119 (14.2%) were identified as overweight/obese, 461 (54.9%) were physical inactivity, 29.4% of men and 8.1% of women reported consuming alcohol. The multivariable analysis indicated the male sex (adjusted prevalence ratio [aPR] = 3.07; 95% CI: 2.32-4.06), alcohol consumption (aPR = 1.28; 95% CI: 1.03-1.59) and obesity (aPR = 1.35; 95% CI: 1.08-1.68) as the independent risk factors for PHT/HTN.

CONCLUSIONS

The results revealed the high burden of prehypertension and hypertension among university freshmen in VNU. Male sex, alcohol consumption, and obesity were identified as important risk factors for PHT/HTN. Our study suggests an early screening program for PHT/HTN and campaigns to promote a healthy lifestyle for young adults in Vietnam.

Mediterranean Alcohol-Drinking Pattern and Arterial Hypertension in the "Seguimiento Universidad de Navarra" (SUN) Prospective Cohort Study

Alcohol drinking patterns may determine the risk of hypertension and may also modify the detrimental effect of high alcohol intake. We prospectively evaluated the effect of the Mediterranean alcohol-drinking pattern and its interaction with the amount of alcohol consumed on the incidence of arterial hypertension. In the “Seguimiento Universidad de Navarra” (SUN) cohort, we followed-up 13,805 participants, all of them initially free of hypertension, during a maximum period of 16 years. Information about diet, chronic diseases, lifestyle and newly diagnosed hypertension was collected using validated questionnaires. We used a 7-item score (0 to 9 points) that jointly considered moderate alcohol consumption, distributed over the week, with meals, and a preference for red wine and avoidance of binge-drinking. During 142,404 person-years of follow-up, 1443 incident cases of hypertension were identified. Low adherence (score < 2) to the Mediterranean alcohol-drinking pattern was significantly associated with a higher incidence of hypertension (multivariable-adjusted hazard ratio 1.81, 95% confidence interval 1.09−2.99) as compared to the high-adherence (score > 7) category. Among alcohol consumers, a high adherence to the MADP is associated with a lower incidence of hypertension. Compared with abstinence, a high adherence did not seem to differ regarding its effect on hypertension risk.

Alcohol Use and Blood Pressure Among Adults with Hypertension: the Mediating Roles of Health Behaviors

BACKGROUND

Alcohol use is associated with increased blood pressure among adults with hypertension, but it is unknown whether some of the observed relationship is explained by mediating behaviors related to alcohol use.

OBJECTIVE

We assess the potential indirect role of smoking, physical inactivity, unhealthy diet, and poor medication adherence on the association between alcohol use and blood pressure among Black and White men and women with hypertension.

DESIGN

Adjusted repeated-measures analyses using generalized estimating equations and mediation analyses using inverse odds ratio weighting.

PARTICIPANTS

1835 participants with hypertension based on ACC/AHA 2017 guidelines in three most recent follow-up exams of the longitudinal Coronary Artery Risk Development in Young Adults cohort study (2005-2016).

MAIN MEASURES

Alcohol use was assessed using both self-reported average ethanol intake (drinks/day) and engagement in heavy episodic drinking (HED) in the past 30 days. Systolic and diastolic blood pressure (SBP, DBP) were measured by trained technicians (mmHg). Smoking, physical inactivity, and diet were self-reported and categorized according to American Heart Association criteria, and medication adherence was assessed using self-reported typical adherence to antihypertensive medications.

KEY RESULTS

At baseline (2005-2006), 57.9% of participants were Black and 51.4% were women. Mean age (standard deviation) was 45.5 (3.6) years, mean SBP was 128.7 (15.5) mmHg, and mean DBP was 83.2 (10.1) mmHg. Each additional drink per day was significantly associated with higher SBP (β = 0.713 mmHg, 95% confidence interval (CI): 0.398, 1.028) and DBP (β = 0.398 mmHg, 95% CI: 0.160, 0.555), but there was no evidence of mediation by any of the behaviors. HED was not associated with blood pressure independent of average consumption.

CONCLUSIONS

These findings support the direct nature of the association of alcohol use with blood pressure and the utility of advising patients with hypertension to limit consumption in addition to other behavioral and pharmacological interventions.

The effect of acute alcohol ingestion on systemic hemodynamics and sleep architecture in young, healthy men

Objective Heightened nocturnal blood pressure (BP) may be attributed to the disruption of sleep, a condition worsened by alcohol ingestion. This study investigated the effects of acute alcohol ingestion on hemodynamics and sleep architecture in a young, healthy cohort of male. METHODS: Subjects (n = 17) underwent acute alcohol ingestion reaching a breath alcohol content of 0.08. Each subject endured a battery of hemodynamic tests and had their sleep architecture and nocturnal blood pressure monitored pre- and post-ingestion. Results: Systolic blood pressure (SBP) increased both 30 minutes and 12 hours after alcohol. Ambulatory nocturnal SBP significantly increased after alcohol compared to baseline measures. Minutes of total, rapid eye movement, and light sleep all increased after alcohol ingestion, while a decrease was observed for sleep latency. Conclusions: An acute bout of heavy alcohol consumption may attenuate nocturnal BP dipping that, in turn, may hasten the progression of hypertension-related cardiovascular disease.

The effects of repeated binge drinking on arterial stiffness and urinary norepinephrine levels in young adults

OBJECTIVES

The aim of this study was to investigate the effect of repeated binge drinking and moderate alcohol consumption in young adults on arterial stiffness and sympathetic activity.

METHODS

We enrolled 49 healthy young adults, free of cardiovascular diseases (25 men; age: 23.5 ± 0.4 years; BMI: 23.4 ± 0.4 kg/m; mean ± S.E). Individuals included were those with a history of repeated binge drinking (>2 years duration; n = 20), drank at moderate levels (MODs, >5 years duration; n = 16) and abstained from alcohol (last 2-3 years; n = 13). Arterial stiffness was assessed using carotid to femoral pulse wave velocity (cfPWV) and sympathetic activity was assessed using 24-h urinary norepinephrine levels. Also measured was aortic SBP and augmentation index (AIx), a measure of wave reflection.

RESULTS

Binge drinkers and MODs had higher cfPWV than alcohol abstainers (0.6 and 0.5 m/s, respectively; P ≤ 0.04). In addition, binge drinkers had higher urinary norepinephrine levels than MODs and alcohol abstainers (P < 0.05). Higher cfPWV were correlated with higher norepinephrine levels (r = 0.35. P = 0.02). Aortic SBP (P = 0.2) and AIx (P = 0.96) were similar among binge drinkers, MODs and alcohol abstainers.

CONCLUSION

Our findings suggest that repeated exposure to alcohol, regardless of drinking pattern, may increase aortic arterial stiffness in healthy young adults. In addition, sympathetic activation, reflected by increased 24-h urinary norepinephrine levels, may contribute to alcohol-induced arterial stiffening in young adults.

Discrete time measures versus trajectories of drinking frequency across adolescence as predictors of binge drinking in young adulthood: a longitudinal investigation

OBJECTIVES

We compared discrete time measures with trajectories of adolescent drinking frequency as predictors of sustained binge drinking in young adulthood.

DESIGN

Prospective longitudinal study.

SETTING

10 high schools in Montréal, Canada.

PARTICIPANTS

1293 high-school students followed from mean (SD) age 12 (0.6) to 24 (0.7) years.

PRIMARY OUTCOME MEASURES

Patterns of drinking frequency (self-reports every 3 months from ages 12 to 17) identified using group-based trajectory modelling. Sustained binge drinking was defined as binging monthly or more often at both ages 20 and 24.

ANALYSES

Using logistic regression, sustained binge drinking was regressed on trajectory group membership and on four discrete time measures (frequency of drinking at age 12; frequency of drinking at age 17; age at drinking onset; age at onset of drinking monthly or more often).

RESULTS

We identified seven drinking trajectories: late triers (15.2%), decreasers (9.5%), late escalators (10.4%), early slow escalators (16.5%), steady drinkers (14.4%), early rapid escalators (15.8%) and early frequent drinkers (18.2%). Sustained binge drinking was reported by 260 of 787 participants (33.0%) with complete data at both ages 20 and 24. Decreasers did not differ from late triers; all other patterns were associated with higher odds of sustained binge drinking (adjusted ORs: AORs=1.4-17.0). All discrete time measures were associated with sustained binge drinking, notably frequency at age 12 (a bit to try and drinking monthly: (AORs=2.6 (1.7; 3.9) and 2.8 (1.3; 6.1), respectively), age of drinking onset <13 years (AOR=7.6 (3.0; 24.1)), and any age of onset of drinking monthly or more often (AORs=5.1-8.2).

CONCLUSION

Youth at risk of sustained binge drinking as young adults can be identified with indicators of early drinking as early as 7th grade (aged 12-13 years). Identification of easy-to-obtain indicators can facilitate screening and intervention efforts.

Alcohol intake reduction for controlling hypertension

BACKGROUND

High blood pressure constitutes one of the leading causes of mortality and morbidity all over the world. At the same time, heavy drinking increases the risk for developing cardiovascular diseases, including cardiomyopathy, hypertension, atrial arrhythmias, or stroke. Several studies have already assessed specifically the relationship between alcohol intake and hypertension. However, the potential effect on blood pressure of alcohol intake reduction interventions is largely unknown.

OBJECTIVES

To assess the effect of any intervention to reduce alcohol intake in terms of blood pressure decrease in hypertensive people with alcohol consumption compared to a control intervention or no intervention at all. To determine additional effects related to mortality, major cardiovascular events, serious adverse events, or quality of life.

SEARCH METHODS

The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to June 2020: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 5, 2020), MEDLINE Ovid (from 1946), MEDLINE Ovid Epub Ahead of Print, and MEDLINE Ovid In-Process, Embase Ovid (from 1974), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. Trial authors were contacted when needed and no language restrictions were applied.

SELECTION CRITERIA

We included randomised controlled trials with minimum 12 weeks duration and including 50 or more subjects per group with quantitative measurement of alcohol consumption and/or biological measurement of the outcomes of interest. Participants were adults (16 years of age or older) with systolic blood pressure (SBP) greater than 140 mmHg and diastolic blood pressure (DBP) greater than 90 mmHg, and SBP ≥ 130 or DBP ≥ 80 mmHg in participants with diabetes. We included any intervention implemented to reduce their alcohol intake.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed search results and extracted data using standard methodological procedures adopted by Cochrane.

MAIN RESULTS

A total of 1210 studies were screened. We included one randomised controlled trial involving a total of 269 participants with a two-year follow-up. Individual patient data for all participants were provided and used in this review. No differences were found between the cognitive-behavioural intervention group and the control group for overall mortality (RR 0.72, 95% CI 0.16 to 3.17; low-certainty evidence), cardiovascular mortality (not estimable) and cardiovascular events (RR 0.80, 95% CI 0.36 to 1.79; very low-certainty evidence). There was no statistical difference in systolic blood pressure (SBP) reduction (Mean Difference (MD) -0.92 mmHg, 95% confidence interval (CI) -5.66 to 3.82 mmHg; very low-certainty evidence) or diastolic blood pressure (DBP) decrease (MD 0.98 mmHg, 95% CI -1.69 to 3.65 mmHg; low-certainty evidence) between the cognitive-behavioural intervention group and the control group. We also did not find any differences in the proportion of subjects with SBP < 140 mmHg and DBP < 90 mmHg (Risk Ratio (RR) 1.21, 95% CI 0.88 to 1.65; very low-certainty evidence). Concerning secondary outcomes, the alcohol intake was significantly reduced in the cognitive-behavioural intervention compared with the control group (MD 191.33 g, 95% CI 85.36 to 297.30 g). We found no differences between the active and control intervention in the proportion of subjects with lower-risk alcohol intake versus higher-risk and extreme drinkers at the end of the study (RR 1.04, 95% CI 0.68 to 1.60). There were no estimable results for the quality of life outcome.

AUTHORS' CONCLUSIONS

An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question.

Binge drinking, HIV/HPV co-infection risk, and HIV testing: Factors associated with HPV vaccination among young adults in the United States

Human papillomavirus (HPV) is a common sexually transmitted infection. Binge drinkers often engage in HIV/HPV co-infection high-risk behaviors. We examined the association between binge drinking, HIV/HPV co-infection risk, HIV testing and HPV vaccination among young adults. Data from the 2017 Behavioral Risk Factor Surveillance System survey were examined. Participants (N = 430/450,016; 0.11%) were HPV vaccine-eligible young adults ages 18-26 years. Multivariable logistic regression examined the association between binge drinking in the past 30 days, HIV/HPV co-infection high-risk risk behaviors, HIV testing, and HPV vaccination (initiated/completed, unvaccinated) among young adults. Respondents were primarily cisgender (99.8%), non-Hispanic White (41.4%), employed (46.2%) or student (35.4%), and insured (68.2%). Most did not binge drink (55.2%). The majority did not engage in HIV/HPV co-infection high-risk risk behaviors (78.2%). More than one-half had never been tested for HIV (59%) nor vaccinated against HPV (60.6%). Although binge drinkers (44.8%) were significantly more likely to engage in HIV/HPV co-infection high-risk behaviors (OR = 2.1; 95% CI: 1.0-4.5), binge drinking was not positively associated with HIV testing (OR = 0.98; 95% CI: 0.63-1.53). After adjusting for demographics and HIV/HPV co-infection high-risk behaviors, one (aOR = 2.71; 95% CI: 1.11-6.65) and two episodes (aOR = 3.05; 95% CI: 1.26-7.41) of binge drinking in the past 30 days were significantly associated with HPV vaccination uptake. Positive associations between HPV vaccination and participants having an HIV test in 2017 (aOR = 3.86; 95% CI: 1.42-10.55) and before 2017 (aOR = 2.62; 95% CI: 1.23-5.56) were also statistically significant. Because young adult binge drinkers are more likely to engage in HIV/HPV co-infection high-risk behaviors, promoting HPV vaccination and HIV testing are important public health objectives.

Tetrahydrobiopterin Restores Microvascular Dysfunction in Young Adult Binge Drinkers

BACKGROUND

Repeated binge drinking is associated with reduced microvascular function. However, microvascular responses to pathophysiological stimulus such as high pressure as well as potential mechanisms that underlie binge-induced microvascular dysfunction are unknown. Therefore, using an ex vivo experimental model, we examined microvascular responses following a brief period of high intraluminal pressure in isolated arterioles from young adults who have a history of repeated binge drinking. In addition, we examined whether the application of the endothelial nitric oxide synthase cofactor, tetrahydrobiopterin, would restore microvascular function in response to flow and high intraluminal pressure in young adult binge drinkers.

METHODS

Isolated subcutaneous adipose arterioles were obtained from young adult binge drinkers (BD; n = 14), moderate drinkers (MODs; n = 10), and alcohol abstainers (ABs; n = 12; mean age: 23.7 ± 0.5 years; and body mass index: 23.4 ± 0.4 kg/m2 ). Arteriolar flow-induced dilation (FID, pressure gradient: ∆10 to 100 cm H2 O) was measured before and after acute high intraluminal pressure with and without tetrahydrobiopterin.

RESULTS

Before high pressure, FID at Δ60 and Δ100 cm H2 O pressure gradient in BDs was 14% lower and 18% lower, respectively, than ABs (p < 0.05), while MODs and ABs had similar FID across all pressure gradients (p ≥ 0.2). After high pressure, FID in BDs was further reduced by 10% (p < 0.0005) and this impairment was ameliorated by the treatment of tetrahydrobiopterin (4 to 26% higher, p < 0.005). In contrast, FID after high pressure did not change in MODs and ABs (p ≥ 0.5).

CONCLUSIONS

Microvascular dysfunction in young adult binge drinkers may be exacerbated with acute pathophysiological stimulus. These binge-induced dysfunctions may be reversed by tetrahydrobiopterin, which suggests a role of oxidative stress and/or uncoupled endothelial nitric oxide synthase in binge drinking.

Food Products That May Cause an Increase in Blood Pressure

PURPOSE OF REVIEW

To review latest reports of the food products which might increase blood pressure and therefore might participate in the pathogenesis of hypertension.

RECENT FINDINGS

Results of clinical study suggest that consumption of high-sodium food leads to transient increase in plasma sodium concentration. This is accompanied by blood pressure increase. Results of both clinical and experimental studies suggest direct vasculotoxic effects of sodium. Increased plasma sodium concentration could mediate its effects on blood pressure by changes in endothelial cell stiffness and glycocalyx integrity. Energy drinks are non-alcoholic beverages with increasing popularity. Clinical, interventional, randomized, placebo controlled, and cross-sectional studies showed that energy drinks may increase arterial blood pressure. Blood pressure increase after exposure for the energy drinks is mainly related to the caffeine content in these drinks. Many case reports were published concerning the clinically significant increase in blood pressure caused by the consumption of liquorice root or food products containing liquorice, such as candies, tea, Pontefract cookies, and chewing gum. Liquorice contains a precursor of glycyrrhetic acid. Glycyrrhetic acid reduces the activity of the 11β-hydroxysteroid dehydrogenase type 2 (11ß-HSD2) isoenzyme, which leads to activation of the mineralocorticoid receptor by cortisol in the distal convoluted tubule resulting in hypertension, hypokalemia, and metabolic alkalosis. The relationship between chronic alcohol intake and blood pressure is well established on the basis of a diverse body of evidence including animal experiments, epidemiological studies, mendelian randomization studies, and interventional studies. Results of recent studies suggested that binge drinking (i.e., episodic consumption of a very high amount of alcohol beverages) has pronounced hypertensinogenic effects. Recently, it was documented that also low doses of alcohol may increase the risk of cardiovascular complications. Therefore, the amount of alcohol consumption that is safe is zero. High-salt food products, energy drinks, food products containing liquorice, and alcoholic beverages have hypertensinogenic properties. Patients with hypertension and other cardiovascular diseases should avoid even accidental consumption of these food products.

Alcohol consumption patterns in young adults with type 1 diabetes: The SEARCH for diabetes in youth study

AIMS

The objective of this study is to describe alcohol consumption behaviors of young adults with T1D and to examine associations between alcohol consumption and diabetes-related clinical markers.

METHODS

Data from 602 SEARCH for Diabetes in Youth Study participants age ≥ 18 yrs. with T1D were collected from 12/2011 to 6/2015 (50% female, mean age 21.3(SD 2.4), 22% race/ethnic minority). Participants were characterized as alcohol non-drinkers (n = 269), drinkers but non-binge drinkers (n = 167), or binge drinkers (n = 166) based on reported consumption in the past 30 days. Analyses were conducted using one-way ANOVAs, chi-square tests, and logistic regression modeling to examine associations between drinking and clinical markers.

RESULTS

Fifty-five percent of participants reported alcohol consumption; 27.6% of participants reported binge drinking. After adjusting for demographic characteristics, neither binge drinking nor non-binge drinking were associated with HbA1c or severe hypoglycemic events relative to non-drinkers. Binge drinking was associated with higher HDL (p = 0.008), lower systolic blood pressure (p = 0.011), and a lower waist:height ratio compared to non-drinkers (p = 0.013).

CONCLUSIONS

Young adults with T1D in the SEARCH cohort reported similar alcohol use but higher rates of binge drinking compared to the general United States population and previously reported rates in adults with T1D.

Factors Associated With Blood Pressure Classification in Korean University Students: A Descriptive Survey

BACKGROUND

The prevalence of hypertension in young adults has increased. Hypertension is known to be a leading contributor to many diseases.

PURPOSE

The study aimed to identify factors influencing blood pressure (BP) classification in university students and to establish a basis for the prevention and management of hypertension in young adults.

METHODS

Four hundred three university students in South Korea were analyzed to determine the factors that influence BP classification. Data were analyzed using the chi-square test, analysis of variance, and multinomial logistic regression.

RESULTS

The reference group for the logistic regression analysis included students with normal BP. The odds of being male and of having an overweight or obese body mass index were significantly higher in the prehypertension group than in the normal BP group. The odds of regular (≥ 6 months) exercise habits, having subcutaneous and borderline visceral fat types, and social support were significantly lower in the prehypertension group than in the normal BP group. The odds of being male, being overweight or obese, and having more exercise barriers were significantly higher in the hypertension group than in the normal BP group. The odds of having a high or low economic status were higher and lower in the hypertension group, respectively. Finally, the odds of having subcutaneous or borderline visceral fat types and a vigorous physical activity level were significantly lower in the hypertension group than in the normal BP group.

CONCLUSIONS

Interventions that address the factors related to BP in young adults are necessary to prevent the occurrence and progression of hypertension in young adults.

Cardiovascular effects of alcohol: A double-edged sword / how to remain at the nadir point of the J-Curve?

BACKGROUND

In addition to its established harmful effects on the liver and other organs, heavy alcohol use confers deleterious effects on the cardiovascular (CV) system, as well. However, data have emerged that light/moderate alcohol consumption (1 drink/day for women and 1-2 drinks/day for men) may be protective against CV disease.

OBJECTIVE/METHODS

English articles regarding the CV effects of alcohol/ethanol were reviewed by search in Medline, Scopus, and Google Scholar.

RESULTS

A J-shaped curve has been proposed to illustrate a differential effect of alcohol on the CV system with the lowest point on the curve (light/moderate drinking) corresponding to optimal exposure to alcohol, which may confer cardioprotection, the rather neutral effect of non-drinking, and the highest risk of heavy and/or binge drinking reflecting the consequence of harmful exposure. However, staying at the nadir of this J-shaped curve appears difficult. Furthermore, concern and distrust have also been raised about the quality of evidence for such "cardioprotection", emphasizing the need for further randomized controlled trials. Another concern relates to the risk of moderate drinking leading to problem drinking, since alcohol is the most common addictive substance.

CONCLUSION

Optimal exposure to alcohol (light/moderate use) means that one needs to stay at the nadir of the J-shaped curve for alcohol use to avail oneself of possible cardioprotection, and this may not be an easy thing to accomplish and/or adhere to, especially if one "likes" alcohol drinking. However, the evidence of "cardioprotection" conferred by alcohol has also been refuted, due to lack of randomized controlled trials.

Association of binge drinking in adolescence and early adulthood with high blood pressure: findings from the National Longitudinal Study of Adolescent to Adult Health (1994–2008)

Background

An investigation of the risk of high blood pressure (HBP) associated with heavy alcohol consumption in adolescence and early adulthood is lacking. Therefore, we aimed to investigate the association between binge drinking from adolescence to early adulthood and the risk of HBP in early adulthood.

Methods

We applied logistic regression to publicly available, population-representative data from waves I (1994–1995; ages 12–18) and IV (2007–2008; ages 24–32) of the National Longitudinal Study of Adolescent to Adult Health (n=5114) to determine whether past 12-month binge drinking in adolescence (wave I) and early adulthood (wave IV) was associated with HBP in early adulthood after adjusting for covariates, including smoking and body mass index. HBP was defined according to both the former and new classifications.

Results

HBP was significantly, positively associated with infrequent binge drinking (less than once a week) in adolescence based on the new classification (overall: OR 1.23, 95% CI 1.02 to 1.49; male: OR 1.35, 95% CI 1.00 to 1.81) and frequent binge drinking (heavy consumption) in adolescence based on the former classification (overall: OR= 1.64, 95% CI 1.22 to 2.22; male: OR= 1.79, 95% CI 1.23 to 2.60). The risk of HBP was high when participants engaged in frequent binge drinking in both adolescence and early adulthood, especially based on the former classification (overall: OR 2.43, 95% CI 1.13 to 5.20; female: OR 5.81, 95% CI 2.26 to 14.93).

Conclusion

Binge drinking in adolescence may increase risk of HBP in early adulthood. This association is independent of other important risk factors for HPB, such as smoking and obesity.

Features of and preventive measures against hypertension in the young

The Japanese hypertension guidelines report that essential hypertension is detected in 1–3% of upper elementary and high school students during blood pressure (BP) screenings. Hypertension in these age groups is an emerging public health concern mainly attributed to the rising rate of pediatric obesity. Considering the existence of BP tracking phenomenon, early preventive education and instruction are necessary, especially for male students with moderately elevated BP showing a tendency toward obesity, despite the low prevalence of hypertension in high school students. Students with a positive family history of hypertension and those born with low birth weight need the same measures. Lifestyle habits, such as increased alcohol intake, dramatically change once students begin university; thus, early education and instruction regarding the factors influencing BP are necessary. In particular, for male students with higher BP during high school, caution regarding increased body weight is required irrespective of their level of obesity. Young adults aged <40 years should be educated about the association between body weight and hypertension. Particular caution surrounding lifestyle habits, including drinking and smoking, is warranted in male hypertensive subjects because hypertension at a young age is strongly associated with obesity. BP monitoring and the management of obesity should be considered efficient approaches to the detection and treatment of hypertension. For the lifetime prevention of hypertension, it is essential to be aware of one’s health status and learn about healthy lifestyles beginning in childhood. BP measurement may be an appropriate means to achieve this goal.

Relationship between cardiovascular risk factors and binge drinking among college students in South Korea

This study determined cardiovascular risk among Korean college students with a history of binge drinking. Variables included alcohol consumption, cardiovascular risk factors (increased blood pressure, body mass index, lipid values) and markers (high-sensitivity C-reactive protein, fibrinogen), and 10-year Framingham risk scores. Korean college student binge drinkers had higher triglyceride levels and higher ratios of triglyceride to high-density lipoprotein cholesterol than did abstainers. Average number of drinks on one occasion was correlated with higher body mass index, triglyceride level, ratio of triglyceride to high-density lipoprotein cholesterol, and 10-year Framingham risk score. The findings indicate that binge drinking may be associated with premature cardiovascular disease risk.

Effects of Repeated Binge Drinking on Blood Pressure Levels and Other Cardiovascular Health Metrics in Young Adults: National Health and Nutrition Examination Survey, 2011-2014

BACKGROUND

Binge drinking prevalence rates are highest in young adults; however, little is known about the effects of binge drinking on blood pressure (BP) and other cardiovascular health metrics in individuals between 18 and 45 years of age. The aim of this study was to determine the effects of regular binge drinking on BP, lipid and glucose levels and to determine if there were differences in these associations between men and women.

METHODS AND RESULTS

We analyzed data from NHANES (the US National Health and Nutrition Examination Survey) for men and women 18 to 45 years old who were non-binge drinkers, binge drank 1 to 12 times, or binge drank >12 times in the past year. After controlling for diet and physical activity, both categories of men binge drinkers compared with non-binge drinkers had higher systolic BP (121.8 and 119.0 mm Hg versus 117.5 mm Hg) and total cholesterol (215.5 and 217.9 mg/dL versus 207.8 mg/dL) values. There were no effects of binge drinking on systolic BP or total cholesterol in women. Binge drinking in men and women was associated with higher high-density lipoprotein-cholesterol values. The effects of binge drinking on glucose parameters in men and women were variable.

CONCLUSIONS

Compared with young adult women, repeated binge drinking in men was associated with an elevated systolic BP, and greater frequency of binge drinking in men was associated with a more unfavorable lipid profile. In young adults with elevated systolic BP, practitioners should consider the possible role of binge drinking and address the importance of reducing alcohol intake as an important cardiovascular risk reduction strategy.

QTc prolongation, increased NT-proBNP and pre-clinical myocardial wall remodeling in excessive alcohol consumers: The SABPA study

Alcohol contributes greatly to vascular and structural modifications. Due to differences in the metabolism and tolerance of alcohol between ethnic groups, the manner of these modifications may differ. We investigated the association between alcohol consumption - measured via ethnic-specific gamma glutamyl transferase (γ-GT) cut-points - and markers of cardiac perfusion, electrical activity, and pre-clinical structural alterations. A South African target population study was performed in a bi-ethnic cohort (n = 405). Alcohol consumption was determined according to previously defined ethnic-specific γ-GT cut-points, where γ-GT ≥ 19.5 U/L and γ-GT ≥ 55 U/L indicated excessive alcohol consumption in Caucasians and Africans, respectively. Ambulatory 24-h blood pressure and electrocardiograms (ECG), 10-lead ECG left ventricular hypertrophy (LVH), ischemic events, N-terminal pro-brain natriuretic peptide (NT-proBNP), and QTc prolongation were assessed. Fasting blood samples were obtained. A poorer cardio-metabolic profile and mean 24-h hypertensive and ECG-LVH values were evident in high γ-GT groups of both ethnicities, when compared to their low counterparts. The African high γ-GT group reported a higher intake of alcohol and presented significant increases in NT-proBNP (p < 0.001), QTc prolongation (p = 0.008), and ischemic events (p = 0.013). Regression analyses revealed associations between ECG-LVH and NT-proBNP, QTc prolongation, ischemic events, and SBP, in the African high γ-GT group exclusively. High alcohol consumers presented delayed electrical conduction in the heart accompanied by ECG-LVH, ischemic events, and increased vaso-responsiveness, predominantly in Africans. Ultimately, increased left ventricular distension on a pre-clinical level may elevate the risk for future cardiovascular events in this population.

MicroRNA-21 Contributes to Reduced Microvascular Function in Binge Drinking Young Adults

BACKGROUND

Binge drinking is associated with increased risk for cardiovascular (CV) disease. MicroRNA-21 (miR21) is up-regulated in the setting of excessive alcohol consumption and CV disease. Therefore, the goal of this study was to examine the vasodilatory responses to flow and acetylcholine (ACh) in the absence and presence of an anti-miR21 inhibitor in the microcirculation of young adult repeated binge drinkers (BDs).

METHODS

Gluteal subcutaneous adipose tissue biopsies were obtained from young adults (18 to 30 years, n = 35 vessels from BDs and n = 28 vessels from abstainers). Resistance arteries (RAs) were isolated, incubated with anti-miR21 or a negative control (NC) to miR21 (12 hours; 50 nM), and lumen diameters measured with video microscopy. miR21 of adipose tissues was determined by quantitative polymerase chain reaction.

RESULTS

Flow-induced dilation and ACh-induced dilation (AChID) were reduced in BDs as compared to abstainers. The miR21 inhibitor but not the NC abrogated these effects in BDs, but did not affect vasodilation in abstainers. Nitric oxide synthase inhibition with L-NAME reduced vasodilation in abstainers but not in BDs. In BDs, vasodilation was reduced by L-NAME in the presence of anti-miR21 but not the NC. Scavenging the reactive oxygen species, hydrogen peroxide with polyethylene glycol catalase reduced dilation in BDs but did not affect the restored dilation by the miR21 inhibitor. Maximum dilation to papaverine (endothelium independent) was similar between groups and unaffected by pharmacological inhibition. Finally, vascular endogenous miR21 was increased in BDs compared to abstainers.

CONCLUSIONS

Endogenous miR21 is increased in RAs of young BDs, leading to reduced flow and AChID in the microcirculation.

Cardiovascular Consequences of Binge Drinking: An Integrative Review with Implications for Advocacy, Policy, and Research

Worldwide, binge drinking is a major public health problem. The popularized health risks associated with binge drinking include physical injury and motor vehicle crashes; less attention has been given to the negative effects on the cardiovascular (CV) system. The primary aims of this review were to provide a summary of the adverse effects of binge drinking on the risk and development of CV disease and to review potential pathophysiologic mechanisms. Using specific inclusion criteria, an integrative review was conducted that included data from human experimental, prospective cross-sectional, and cohort epidemiological studies that examined the association between binge drinking and CV conditions such as hypertension (HTN), myocardial infarction (MI), stroke, and arrhythmias. Studies were identified that examined the relationship between binge drinking and CV outcomes. Collectively, findings support that binge drinking is associated with a higher risk of pre-HTN, HTN, MI, and stroke in middle-aged and older adults. Binge drinking may also have adverse CV effects in young adults (aged 18 to 30). Mechanisms remain incompletely understood; however, available evidence suggests that binge drinking may induce oxidative stress and vascular injury and be proatherogenic. Public health messages regarding binge drinking need to include the effects of binge drinking on the CV system.

Sex-specific trajectories of systolic and diastolic blood pressure in youth

BACKGROUND AND OBJECTIVE

High blood pressure early in life is associated with cardiovascular disease morbidity and mortality in adulthood. The objective was to identify sex-specific trajectories of SBP and DBP from early adolescence to early adulthood and to assess the impact of modifiable factors on the trajectories, including BMI, smoking, alcohol use, physical activity, and screen-time.

METHODS

Data were drawn from four waves of a prospective investigation of 1294 youth aged 12-13 years at inception and followed until age 24 years. Group-based trajectory models were used to identify trajectories and assess the impact of modifiable factors in 403 men and 432 women.

RESULTS

Three SBP trajectories were identified in men [corresponding to low (43.2%), medium (45.2%), and high SBP (11.7%)] and women [corresponding to low (48.1%), medium (44.7%), and high SBP (7.2%)]. Similar results were observed for DBP in both sexes. BMI and smoking were associated with higher SBP and DBP values in most trajectory groups, whereas screen-time in both sexes and physical activity in women were associated with high SBP trajectories only.

CONCLUSION

There is heterogeneity in the sex-specific natural course of SBP and DBP in youth and in the magnitude of the effect of modifiable factors on SBP and DBP across trajectories. Distinguishing trajectories allows identification of subgroups at risk of hypertension and cardiovascular disease later in life and in addition can inform the design of targeted interventions to attenuate high SBP and DBP trajectories over time and maintain normal trajectories.