Alcohol, hypertension and cardiovascular disease--implications for management

Regular alcohol consumption raises blood pressure and in drinking populations contributes significantly to the prevalence of hypertension. The effect of alcohol is additive to that of obesity. Reduction in alcohol intake leads to a lowering of blood pressure over 1-4 weeks. Acute alcohol ingestion in the evening may lower blood pressures overnight. Heavy weekend drinking may lead to a pressor effect for the succeeding 3 to 4 days. Certain personality types or heavy job strain increase susceptibility to pressor effects of alcohol. Alcohol consumption in the range of 1-3 standard drinks a day appears to have a protective effect against coronary disease and ischaemic stroke, which may be greater in those with a higher risk of vascular disease. At higher levels of consumption the risks of haemorrhagic stroke, cardiomyopathy and hypertension deaths predominate. Moderation of alcohol consumption to no more than two standard drinks a day can be an effective means of improving blood pressure control reducing drug requirements in treated hypertensives, and avoiding drugs in mild hypertensives. Moderating alcohol and reducing excess weight have additive effects in reducing overall cardiovascular risk.