Alcoholic drinks, regardless of type, raise BP level

Alcohol consumption contributes to a substantial increase in both systolic (SBP) and diastolic (DBP) blood pressure (BP), regardless of the type of alcoholic drink, reports a study. 

“Alcohol intake is associated with highly significant increased SBP and DBP,” the investigators said. “The effect is similar for red wine, white wine, beer, and spirits.”

A total of 104,467 adults aged 20−100 years were included in the analysis of the Danish general population. A questionnaire was used to evaluate alcohol use and the type of alcoholic drink, while an automated BP manometer was utilized to measure BP.

The investigators explored the relationship between the number of drinks per week and BP using multivariable linear regression models, stratified by sex and adjusted for relevant confounders. They also analysed each alcohol type (ie, red wine, white wine, beer, and spirits and dessert wine) in similar models, with adjustments for other alcohol types.

Most of the participants (n=76,943, 73.7 percent) consumed more than one type of alcoholic beverage. On the other hand, 12,093 (12.6 percent) drank red wine only, 4,288 (4.5 percent) beer only, 1,815 (1.9 percent) white wine only, and 926 (1.0 percent) spirits and dessert wine only. [Am J Med 2024;137:857-864.e4]

A dose-response relationship was noted between total drinks per week and SBP and DBP (p<0.001). The crude difference between high (>35 drinks per week) and low (1 to 2 drinks per week) alcohol intake was 11 mm Hg SBP and 7 mm Hg DBP. Overall, SBP rose by 0.15−0.17 mm Hg and DBP by 0.08−0.15 mm Hg per weekly drink.

After adjusting for age and sex, the increased BP associated with alcohol intake was slightly higher among women and among those aged <60 years.

Biological mechanism

“Acute intake of alcohol induces vasodilatation while also increasing adrenergic activation, resulting in increased heart rate, and slightly decreasing BP,” the investigators said. “The effects seem to disappear in about 12 hours.” [Cochrane Database Syst Rev 2020;7:CD012787]

The current study showed a dose-dependent effect on BP, with higher daily alcohol consumption contributing to BP elevations. These increases in BP were almost nonexistent or modest for people with ≤1 drink per day but rose linearly for those having >1 drink per day.

"The major contributor to the alcohol hypertensive effect might have been loss of relaxation due to inflammation, and oxidative injury to the endothelium by angiotensin II leading to inhibition of endothelium-dependent nitric oxide production,” the investigators said.” [World J Cardiol 2014;6:245-252]

“Withdrawal symptoms might have also played a role,” they added. [Clin Exp Pharmacol Physiol 1995;22:185-188]

Additionally, beer appears to stimulate some effect on vascular tone, whereas the effects of flavonoids found in red wine remain in question. [Lancet 2018;392:1015-1035; Molecules 2017;22:292]

"We are not aware of studies of specific effects of white wine,” the investigators said. “Because the effects on BP are similar across the various types of alcohol, it is likely that the ethanol itself is the culprit.”