Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Current Hypertension Reports
Published in: Current Hypertension Reports 3/2011

01-06-2011

Alcohol Consumption, Blood Pressure, and the Risk of Stroke

Authors: Matti Hillbom, Pertti Saloheimo, Seppo Juvela

Published in: Current Hypertension Reports | Issue 3/2011

Login to get access

Abstract

A synergistic effect of alcohol and hypertension has been suggested to increase the risk for stroke. However, the contribution of alcohol-induced hypertension to stroke morbidity and mortality may be greater than observed, because the effects of different drinking patterns have not been separately investigated. Alcohol-induced transient peaks in systolic blood pressure may predispose to stroke. Recent studies have measured time trends of blood pressure elevations in relation to alcohol consumption. They found a significant morning surge in blood pressure, which was related to alcohol intake in a dose-dependent manner and was independent of smoking. Men with a severe form of hypertension showed a 12-fold increased risk for cardiovascular disease mortality associated with heavy binge drinking. Binge drinking is a significant risk factor for stroke. Hypertensive patients should be warned about the risks of alcohol and urged to avoid binge drinking because of an increased risk for all subtypes of stroke.
Literature
1.
Lian C. L’alcoholisme, cause d’hypertension artérielle. Bull Acad Natl Méd Paris. 1915;74:525–8.
2.
Puddey IB, Zilkens RR, Beilin LJ. Alcohol, blood pressure and hypertension. In: Preedy VR and Watson RR, Comprehensive Handbook of Alcohol Related Pathology Volume 2. Elsevier 2005, 607–625.
3.
Mazzaglia G, Britton AR, Altmann DR, Chenet L. Exploring the relationship between alcohol consumption and non-fatal or fatal stroke: a systematic review. Addiction. 2001;96:1743–56.PubMedCrossRef
4.
• Patra J, Taylor B, Irving H, et al. Alcohol consumption and the risk of morbidity and mortality for different stroke types—a systematic review and meta-analysis. BMC Public Health. 2010;10:258. This is the first meta-analysis to explicitly separate morbidity and mortality of alcohol-attributable stroke. A linear relationship between consumption of alcohol and hemorrhagic stroke morbidity and mortality was observed in men, but the relationship was J-shaped in women. Risks for both hemorrhagic and ischemic stroke mortality were greater in women than in men at doses over 60 grams per day.PubMedCrossRef
5.
Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared. Stroke severity, mortality, and risk factors. Stroke. 2009;40:2068–72.PubMedCrossRef
6.
•• O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–23. In this study assessing PARs for all stroke, IS, and CH, self-reported history of hypertension was the strongest risk factor for stroke and it was stronger for CH than for IS. Risk for CH increased linearly with increasing alcohol intake. PAR for alcohol intake was greater for CH than for IS.PubMedCrossRef
7.
Klag MJ, He J, Whelton PK, et al. Alcohol use and blood pressure in a unacculturated society. Hypertension. 1993;22:365–70.PubMed
8.
• Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118:947–54. In this study, more than half of the ischemic strokes among US health professionals might have been prevented by healthy lifestyle, including not smoking, maintaining optimal body mass index, exercising daily, and consuming a healthy diet including a small amount of alcohol. Moderate alcohol intake did not reach significance as a protective factor against IS, whereas not smoking, optimal weight, and daily exercise did.PubMedCrossRef
9.
Berger K, Ajani UA, Kase CS, et al. Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians. N Engl J Med. 1999;341:1557–64.PubMedCrossRef
10.
Elkind SMV, Sciacca R, Boden-Albala B, et al. Moderate alcohol consumption reduces risk of ischemic stroke: the Northern Manhattan Study. Stroke. 2006;37:13–9.PubMedCrossRef
11.
Collins MA, Neafsey EJ, Mukamal KJ, et al. Alcohol in moderation, cardioprotection and neuroprotection: Epidemiological considerations and mechanistic studies. Alcohol Clin Exp Res. 2009;33:206–19.PubMedCrossRef
12.
Takashima Y, Miwa Y, Mori T, et al. Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study. Hypertens Res. 2010;3:748–52.CrossRef
13.
Marmot MG, Elliott P, Shipley MJ, et al. Alcohol and blood pressure: the INTERSALT study. BMJ. 1994;308:1263–7.PubMed
14.
White SL, Polkinghorne KR, Cass A, et al. Alcohol consumption and 5-year onset of chronic kidney disease: the AusDiab study. Nephrol Dial Transplant. 2009;24:2464–72.PubMedCrossRef
15.
Ikeda A, Iso H, Yamagishi K, et al. Blood pressure and the risk of stroke, cardiovascular disease, and all-cause mortality among Japanese: the JPHC study. Am J Hypertens. 2009;22:237–8.CrossRef
16.
Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population. A systematic review. Stroke. 2003;34:2060–5.PubMedCrossRef
17.
Iso H, Kitamura A, Shimamoto T, et al. Alcohol intake and the risk of cardiovascular disease in middle-aged Japanese men. Stroke. 1995;26:767–73.PubMed
18.
Juvela S, Hillbom M, Palomäki H. Risk factors for spontaneous intracerebral hemorrhage. Stroke. 1995;26:1558–64.PubMed
19.
Diaz V, Cumsille MA, Bevilacqua JA. Alcohol and hemorrhagic stroke in Santiago. Chile. A case-control study. Neuroepidemiology. 2003;22:339–44.PubMedCrossRef
20.
Feldmann E, Broderick JP, Kernan WN, et al. Major risk factors for intracerebral hemorrhage in the young are modifiable. Stroke. 2005;36:1881–5.PubMedCrossRef
21.
Inagawa T. Risk factors for primary intracerebral hemorrhage in patients in Izumo City, Japan. Neurosurg Rev. 2007;30:225–34.PubMedCrossRef
22.
Tetri S, Huhtakangas J, Juvela S, et al. Better than expected survival after primary intracerebral hemorrhage in patients with untreated hypertension despite high admission blood pressures. Eur J Neurol. 2010;17:708–14.PubMedCrossRef
23.
Frey JL, Jahnke HK, Goslar PW. Study of the propensity for hemorrhage in Hispanic Americans with stroke. J Stroke Cerebrovasc Dis. 2008;17:58–63.PubMedCrossRef
24.
Hosomi N, Nava T, Ohkita H, et al. Predictors of intracerebral hemorrhage severity and its outcome in Japanese stroke patients. Cerebrovasc Dis. 2009;27:67–74.PubMedCrossRef
25.
Fujii Y, Takeuchi S, Tanaka R, et al. Liver dysfunction in spontaneous intracerebral hemorrhage. Neurosurgery. 1994;35:592–6.PubMedCrossRef
26.
Boudouresques G, Hauw J-J, Meininger V, et al. Hepatic cirrhosis and intracerebral hemorrhage: significance of the association in 53 pathological cases. Ann Neurol. 1980;8:204–5.PubMedCrossRef
27.
Ragni MV, Lewis JH, Spero JA, Hasiba U. Bleeding and coagulation abnormalities in alcoholic cirrhotic liver disease. Alcohol Clin Exp Res. 1982;6:267–74.PubMedCrossRef
28.
Peng GS, Yin SJ, Cheng CA. Increased risk of cerebral hemorrhage in Chinese male heavy drinkers with mild liver disorder. Cerebrovasc Dis. 2007;23:309–14.PubMedCrossRef
29.
Krishna V, Kim DH. Ethnic differences in risk factors for subarachnoid hemorrhage. J Neurosurg. 2007;107:522–9.PubMedCrossRef
30.
Feigin VL, Rinkel GJE, Lawes CMM, et al. Risk factors for subarachnoid hemorrhage. An updated systematic review of epidemiological studies. Stroke. 2005;36:2773–80.PubMedCrossRef
31.
Jiménez-Yepes CM. Londoño-Fernández. Risk of aneurismal subarachnoid hemorrhage. The role of confirmed hypertension. Stroke. 2008;39:1344–6.PubMedCrossRef
32.
van Munster CE, von und zu Fraunberg M, Rinkel GJE, et al. Differences in aneurysm and patient characteristics between cohorts of Finnish and Dutch patients with subarachnoid hemorrhage. Stroke. 2008;39:3166–71.PubMedCrossRef
33.
Qureshi AI, Sung GY, Suri MF, et al. Factors associated with aneurysm size in patients with subarachnoid hemorrhage: effect of smoking and aneurysm location. Neurosurgery. 2000;46:44–50.PubMedCrossRef
34.
Ellamushi HE, Grieve JP, Jäger HR, Kitchen ND. Risk factors for the formation of multiple aneurysms. J Neurosurg. 2001;94:728–32.PubMedCrossRef
35.
Wakabayashi I, Araki Y. Influences of gender and age on relationships between alcohol drinking and atherosclerotic risk factors. Alcohol Clin Exp Res. 2010;34(S1):S54–60.PubMedCrossRef
36.
Seppä K, Sillanaukee P. Binge drinking and ambulatory blood pressure. Hypertension. 1999;33:79–82.PubMed
37.
Yoshita K, Miura K, Morikawa Y, et al. Relationship of alcohol consumption to 7-year blood pressure change in Japanese men. J Hypertens. 2005;23:1485–90.PubMedCrossRef
38.
•• Nakashita M, Ohkubo T, Hara A, et al. Influence of alcohol intake on circadian blood pressure variation in Japanese men: The Ohasama Study. Am J Hypertens. 2009;22:1171–6. The authors measured ambulatory BPs, and 2-hour moving averages were used to compare BP variation during a 24-hour period among nondrinkers, light drinkers, and heavy drinkers. Heavy drinkers showed a rapid morning increase in BP.PubMedCrossRef
39.
•• Ohira T, Tanigawa T, Tabata M, et al. Effects of habitual alcohol intake on ambulatory blood pressure, heart rate, and its variability among Japanese men. Hypertension. 2009;53:13–9. In this cross-sectional study, even light drinkers of alcohol showed significantly higher BPs than nondrinkers. Time trends of systolic BP levels showed excess elevation of systolic BP in the morning in alcohol users in a dose-dependent manner across alcohol drinking categories.PubMedCrossRef
40.
Metoki H, Ohkubo T, Kikuya M, et al. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension. 2006;47:149–54.PubMedCrossRef
41.
Estruch R, Coca A, Rodicio JL. High blood pressure, alcohol, and cardiovascular risk. J Hypertens. 2005;23:226–9.PubMedCrossRef
42.
• Stewart SH, Oroszi G, Randall PK, Anton RF. COMT genotype influences the effect of alcohol on blood pressure: results from the COMBINE study. Am J Hypertens. 2009;22:87–91. Findings suggest that alcohol-induced BP elevation may be related to the effects of catecholamines and their genetically determined inactivation.PubMedCrossRef
43.
Li S-J, Hu W-L, Liu D-T. MTAP gene is associated with ischemic stroke in Chinese Hans. J Neurol Sci. 2009;284:103–7.PubMedCrossRef
44.
• Mostofsky E, Burger MR, Schlaug G, et al. Alcohol and acute ischemic stroke onset. The Stroke Onset Study. Stroke. 2010;41:1845–9. The relative risk of IS in the hour after consuming even a small amount of alcohol was 2.3 (95% CI, 1.4–4.0) compared with the risk during periods of no alcohol consumption. The risk remained after adjusting for age, sex, smoking status, etiology of stroke, and other potential stroke triggers. Alcohol consumption within 1 h of stroke onset was reported by 14 of 390 subjects.PubMedCrossRef
45.
Rantakömi SH, Laukkanen JA, Kurl S, Kauhanen J. Binge drinking and the progression of atherosclerosis in middle-aged men: an 11-year follow-up. Atherosclerosis. 2009;205:266–71.PubMedCrossRef
46.
Nakaguchi H, Teraoka A. Relationship between the occurrence of spontaneous intracerebral hemorrhage and holidays and traditionally unlucky days in Fukuyama city, Hiroshima prefecture, Japan. J Stroke Cerebrovasc Dis. 2007;16:194–8.PubMedCrossRef
47.
• Sundell L, Salomaa V, Vartiainen E, et al. Increased stroke risk is related to a binge drinking habit. Stroke. 2008;39:3179–84. The authors found that binge drinking was an independent risk factor for IS after adjusting for average alcohol consumption and other potential confounders. They found no association between average alcohol consumption and any type of stroke. This is not surprising, as binge drinking is the prevailing pattern of drinking in Finland. Similar findings may not be found in countries where the pattern is regular moderate drinking with meals.PubMedCrossRef
48.
• Sull JW, Yi SW, Nam CM, Ohrr H. Binge drinking and mortality from all causes and cerebrovascular diseases in Korean men and women. A Kangwha Cohort Study. Stroke. 2009;40:2953–8. In a cohort of 6,291 subjects followed for 20.8 years, frequent binge drinking showed a harmful effect on total stroke and hemorrhagic stroke in men.PubMedCrossRef
49.
•• Sull JW, Yi SW, Nam CM, et al. Binge drinking and hypertension on cardiovascular disease mortality in Korean men and women. A Kangwha Cohort Study. Stroke. 2010;41:2157–62. In the same cohort as in ref. [48•], binge drinkers and heavy binge drinkers with Grade 3 hypertension revealed 4.4-fold and 12.7-fold increased risk of cardiovascular mortality even after adjusting for total alcohol consumption.PubMedCrossRef
50.
Leon DA, Chenet L, Shkolnikov VM, et al. Huge variation in Russian mortality rates 1984–94: artifact, alcohol, or what? Lancet. 1997;350:383–8.PubMedCrossRef
Metadata
Title
Alcohol Consumption, Blood Pressure, and the Risk of Stroke
Authors
Matti Hillbom
Pertti Saloheimo
Seppo Juvela
Publication date
01-06-2011
Publisher
Current Science Inc.
Published in
Current Hypertension Reports / Issue 3/2011
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-011-0194-y

Other articles of this Issue 3/2011

Current Hypertension Reports 3/2011 Go to the issue

ReviewPaper

Vitamin D Therapy and Cardiovascular Health

ReviewPaper

Stress and Its Role in Sympathetic Nervous System Activation in Hypertension and the Metabolic Syndrome

ReviewPaper

Home Blood Pressure Monitoring: How Good a Predictor of Long-Term Risk?

ReviewPaper

Sympathetic Neural Mechanisms in Human Blood Pressure Regulation

ReviewPaper

Vascular Mechanisms in the Pathogenesis of Stroke

Clinical Trial Report

Renal Nerve Ablation for Resistant Hypertension
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits