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
BMC Medicine
Published in: BMC Medicine 1/2017

Open Access 01-12-2017 | Guideline

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Authors: Jürgen Rehm, Peter Anderson, Jose Angel Arbesu Prieto, Iain Armstrong, Henri-Jean Aubin, Michael Bachmann, Nuria Bastida Bastus, Carlos Brotons, Robyn Burton, Manuel Cardoso, Joan Colom, Daniel Duprez, Gerrit Gmel, Antoni Gual, Ludwig Kraus, Reinhold Kreutz, Helena Liira, Jakob Manthey, Lars Møller, Ľubomír Okruhlica, Michael Roerecke, Emanuele Scafato, Bernd Schulte, Lidia Segura-Garcia, Kevin David Shield, Cristina Sierra, Konstantin Vyshinskiy, Marcin Wojnar, José Zarco

Published in: BMC Medicine | Issue 1/2017

Login to get access

Abstract

Background

Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.

Methods

A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.

Results

Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.

Conclusions

The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
Appendix
Available only for authorised users
Literature
1.
World Health Organization. Global Action Plan for the Prevention and Control of NCDs 2013-2020. Geneva: WHO; 2013.
2.
Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA. 2003;289:2363–9.CrossRefPubMed
3.
World Health Organization. A global brief on hypertension. Geneva: WHO; 2013.
4.
Kontis V, Mathers CD, Rehm J, Stevens GA, Shield KD, Bonita R, et al. Contribution of six risk factors to achieving the “25 × 25” NCD mortality reduction target. Lancet. 2014;384:427–37.CrossRefPubMed
5.
Kontis V, Mathers CD, Bonita R, Stevens GA, Rehm J, Shield KD, et al. Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study. Lancet Glob Health. 2015;3:e746–57.CrossRefPubMed
6.
World Economic Forum & World Health Organization. From burden to “best buys”: Reducing the economic impact of non-communicable diseases in low- and middle-income countries. Davos: World Economic Forum; 2011.
7.
Chisholm D, Rehm J, van Ommeren M, Monteiro M. Reducing the global burden of hazardous alcohol use: a comparative cost-effectiveness analysis. J Stud Alcohol. 2004;65:782–93.CrossRefPubMed
8.
World Health Organization. Discussion Paper: Prevention and Control of NCDs: Priorities for Investment. Moscow: First Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Disease Control; 2011.
9.
10.
Collart F, de Timary P, Dom G, Dor BD, Duprez D, Lengelé JP, et al. Alcohol-induced hypertension: an important healthcare target in Belgium. Acta Clin Belg. 2015;70:389–95.CrossRefPubMed
11.
Aalto M, Jula A, Keinänen-Kiukaanniemi S, Liira H, Räsänen K, Rehm J, et al. Alkoholinkäytön suitsiminen vähentää kohonneen verenpaineen haittoja. Alkoholiseulonta, mini-interventiot ja riippuvuuden hoito voisivat merkittävästi vähentää kohonnutta verenpainetta sairastavien määrää. [Tackling alcohol consumption reduces high blood pressure damage. Alcohol Screening, brief-interventions and addiction treatment could significantly reduce elevated blood pressure in patients]. Suomen Lääkärilehti. 2017;35:2177–2179A.
12.
Rehm J, Gmel G, Kiefer F, Kreutz R, Kugler J, Müller-Walther M, et al. Verbessertes Hypertonie-Management durch Alkohol-Screening und Folgeinterventionen in der Hausarztpraxis. Deu Med Wochenschr. 2014;139:2457–62.CrossRef
13.
Gual A, Zarco J, Colom JF, Rehm J. Cribado precoz e intervención breve en el consumo perjudicial de alcohol para mejorar el tratamiento de la hipertensión arterial en atención primaria. Med Clin Barcelona. 2016;146:81–5.CrossRef
14.
15.
Stevens GA, Alkema L, Black RE, Boerma JT, Collins GS, Ezzati M, et al. Guidelines for accurate and transparent health estimates reporting: the GATHER statement. Lancet. 2016;388:e19–23.CrossRefPubMed
16.
Rehm J, Angel J, Prieto A, Beier M, Duhot D, Rossi A, et al. The role of alcohol in the management of hypertension in patients in European primary health care practices – a survey in the largest European Union countries. BMC Fam Prac. 2016;17:130.CrossRef
17.
18.
19.
National Institute for Health and Clinical Excellence. The Guidelines Manual. London: National Clinical Guideline Centre; 2012.
20.
Taylor B, Irving HM, Baliunas D, Roerecke M, Patra J, Mohapatra S, et al. Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis. Addiction. 2009;104:1981–90.CrossRefPubMed
21.
Briasoulis A, Agarwal V, Messerli FH. Alcohol consumption and the risk of hypertension in men and women: a systematic review and meta-analysis. J Clin Hypertens. 2012;14:792–8.CrossRef
22.
O’Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ. Alcohol and cardiovascular health: the dose makes the poison…or the remedy. Mayo Clin Proc. 2014;89:382–93.CrossRefPubMed
23.
Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol. 2006;33:847–52.CrossRefPubMed
24.
Klatsky AL, Gunderson E. Alcohol and hypertension. In: Mohler ER, Townsend RR, editors. Advanced Therapy in Hypertension and Vascular Disease. Hamilton: BC Decker Inc.; 2006. p. 108–17.
25.
Sesso HD, Cook NR, Buring JE, Manson JE, Gaziano JM. Alcohol consumption and the risk of hypertension in women and men. Hypertension. 2008;51:1080–7.CrossRefPubMed
26.
Klatsky AL, Gundersen E, Kipp H, Udaltsova N, Friedman GD. Higher prevalence of systemic HTN among moderate alcohol drinkers: exploring the role of under-reporting. J Stud Alcohol. 2006;67:421–8.CrossRefPubMed
27.
28.
Rehm J, Allamani A, Elekes Z, Jakubczyk A, Landsmane I, Manthey J, et al. General practitioners recognizing alcohol dependence: a large cross-sectional study in six European countries. Ann Fam Med. 2015;13:28–32.PubMedCentralCrossRefPubMed
29.
Rehm J, Gmel SG, Gmel GE, Hasan OSM, Imtiaz S, Popova S, et al. The relationship between different dimensions of alcohol use and the burden of disease - an update. Addiction. 2017;112(6):968–1001.PubMedCentralCrossRefPubMed
30.
31.
Rehm J, Baliunas D, Borges GL, Graham K, Irving HM, Kehoe T, et al. The relation between different dimensions of alcohol consumption and burden of disease - An overview. Addiction. 2010;105:817–43.PubMedCentralCrossRefPubMed
32.
Xin X, He J, Frontini MG, Ogden LG, Motsamai OJ, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2001;38:1112–7.CrossRefPubMed
33.
Stewart SH, Latham PK, Miller PM, Randall P, Anton RF. Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study. Addiction. 2008;103:1622–8.PubMedCentralCrossRefPubMed
34.
Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis of trial data. Lancet Public Health. 2016;2:e108–20.CrossRef
35.
36.
Patel HC, Hayward C, Ozdemir BA, Rosen SD, Krum H, Lyon AR, et al. Magnitude of blood pressure reduction in the placebo arms of modern hypertension trials: implications for trials of renal denervation. Hypertension. 2015;65:401–6.CrossRefPubMed
37.
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.CrossRefPubMed
38.
Campbell NR, Ashley MJ, Carruthers SG, Lacourcière Y, McKay DW. Lifestyle modifications to prevent and control hypertension. 3. Recommendations on alcohol consumption. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. Can Med Assoc J. 1999;160:S13–20.
39.
National Clinical Guideline Centre. Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34. London: Royal College of Physicians (UK) - National Clinical Guideline Centre; 2011.
40.
Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens. 2014;32:3–15.CrossRefPubMed
41.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.CrossRefPubMed
42.
Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Houston Miller N, Hubbard VS, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2960–84.CrossRefPubMed
43.
Rehm J, Marmet S, Anderson P, Gual A, Kraus L, Nutt DJ, et al. Defining substance use disorders: do we really need more than heavy use? Alcohol Alcohol. 2013;48:633–40.CrossRefPubMed
44.
Li TK. Quantifying the risk for alcohol-use and alcohol-attributable health disorders: present findings and future research needs. J Gastroenterol Hepatol. 2008;23:S2–8.CrossRefPubMed
45.
Klatsky AL, Koplik S, Gunderson E, Kipp H, Friedman GD. Sequelae of systemic hypertension in alcohol abstainers, light drinkers, and heavy drinkers. Am J Cardiol. 2006;98:1063–8.CrossRefPubMed
46.
Miller PM, Anton RF, Egan BM, Basile J, Nguyen SA. Excessive alcohol consumption and hypertension: clinical implications of current research. J Clin Hypertens. 2005;7:346–53.CrossRef
47.
Manthey J, Gual A, Jakubczyk A, Pieper L, Probst C, Struzzo P, et al. Alcohol use disorders in Europe: a comparison of general population and primary health care prevalence rates. J Subst Use. 2016;21:478–84.CrossRef
48.
Rehm J, Allamani A, Elekes Z, Jakubczyk A, Manthey J, Probst P, et al. Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care. BMC Fam Prac. 2015;16:90.CrossRef
49.
Rehm J, Manthey J, Struzzo P, Gual A, Wojnar M. Who receives treatment for alcohol use disorders in the European Union? A cross-sectional representative study in primary and specialized health care. Euro Psych. 2015;30:885–93.CrossRef
50.
Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007;18:CD004148.
51.
Miller WR, Wilbourne PL. Mesa Grande: a methodological analysis of clinical trials of treatments for alcohol use disorders. Addiction. 2002;97:265–77.CrossRefPubMed
52.
Martin G, Rehm J. The effectiveness of psychosocial modalities in the treatment of alcohol problems in adults: a review of the evidence. Can J Psychiatry. 2012;57:350–8.CrossRefPubMed
53.
Mann K, Bladström A, Torup L, Gual A, Van den Brink W. Extending the treatment options in alcohol dependence: a randomized controlled study of as-needed nalmefene. Biol Psychiat. 2013;73:706–13.CrossRefPubMed
54.
Gual A, He Y, Torup L, Van Den Brink W, Mann K, ESENSE 2 Study Group. A randomised, double-blind, placebo-controlled, efficacy study of nalmefene, as-needed use, in patients with alcohol dependence. Eur Neuropsychopharmacol. 2013;23:1432–42.CrossRefPubMed
55.
van den Brink W, Sørensen P, Torup L, Mann K, Gual A, SENSE Study Group. Long-term efficacy, tolerability and safety of nalmefene as-needed in patients with alcohol dependence: A 1-year, randomised controlled study. J Psychopharmacol. 2014;28:733–44.CrossRefPubMed
56.
Kraus L, Schulte B, Manthey J, Rehm J. Alcohol screening and alcohol interventions among patients with hypertension in primary health care: An empirical survey of German general practitioners. Addict Res Theory. 2017;25(4):285–92.CrossRef
57.
Anderson P, Bendtsen P, Spak F, Reynolds J, Drummond C, Segura L, et al. Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the Optimizing Delivery of Health Care Intervention (ODHIN) five-country cluster randomized factorial trial. Addiction. 2016;111:1935–45.CrossRefPubMed
58.
Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health. 2011;33:412–21.CrossRef
59.
Anderson P, Wojnar M, Jakubczyk A, Gual A, Segura L, Sovinova H, et al. Managing alcohol problems in general practice in Europe: results from the European ODHIN survey of general practitioners. Alcohol Alcohol. 2014;49:531–9.CrossRefPubMed
60.
61.
Joint National Committee on Detection Evaluation and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNC V). Arch Intern Med. 1993;153:154–83.CrossRef
62.
Ezzati M, Lopez A, Rodgers A, Murray CJL. Comparative quantification of health risks. Global and regional burden of disease attributable to selected major risk factors. Geneva: WHO; 2004.
63.
64.
O’Donnell A, Anderson P, Newbury-Birch D, Schulte B, Schmidt C, Reimer J, et al. The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol. 2014;49:66–78.CrossRefPubMed
65.
Rehm J, Patra J, Popova L. Alcohol drinking cessation and its effect on oesophageal and head and neck cancers: a pooled analysis. Int J Cancer. 2007;121:1132–7.CrossRefPubMed
66.
Holmes J, Meier PS, Booth A, Guo Y, Brennan A. The temporal relationship between per capita alcohol consumption and harm: a systematic review of time lag specifications in aggregate time series analyses. Drug Alcohol Depend. 2012;123:7–14.CrossRefPubMed
67.
Zatonski W, Sulkowska U, Manczuk M, Rehm J, Lowenfels AB, La Vecchia C. Liver cirrhosis mortality in Europe, with special attention to central and eastern Europe. Eur Addict Res. 2010;16:193–201.CrossRefPubMed
68.
Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Smith N, et al. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. In: Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the US Preventive Services Task Force. Rockville: Agency for Healthcare Research and Quality; 2014.
69.
U.S. Preventive Services Task Force. Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2007;147:783–6.CrossRef
70.
Sheridan S, Pignone M, Donahue K. Screening for high blood pressure: a review of the evidence for the U.S. Preventive Services Task Force. Am J Prev Med. 2003;25:151–8.CrossRefPubMed
71.
Kaczorowski J, Chambers LW, Dolovich L, Paterson JM, Karwalajtys T, Gierman T, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ. 2011;342:d442.PubMedCentralCrossRefPubMed
72.
Hodgkinson J, Mant J, Martin U, Guo B, Hobbs FD, Deeks JJ, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ. 2011;342:d3621.PubMedCentralCrossRefPubMed
73.
National Institute for Health and Clinical Excellence. Alcohol use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. London: NICE; 2011.
74.
75.
Spithoff S, Kahan M. Primary care management of alcohol use disorder and at-risk drinking: Part 2: counsel, prescribe, connect. Can Fam Physician. 2015;61:515–21.PubMedCentralPubMed
76.
Rehm J, Anderson P, Manthey J, Shield KD, Struzzo P, Wojnar M, et al. Alcohol use disorders in primary health care – what do we know and where do we go? Alcohol Alcohol. 2015;51:422–7.CrossRefPubMed
77.
Rösner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev. 2010;12:CD001867.
78.
Lee J, Kresina TF, Campopiano M, Lubran R, Clark HW. Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. Biomed Res Int. 2015;2015:137020.PubMedCentralPubMed
79.
Baros AM, Wright TM, Latham PK, Miller PM, Anton RF. Alcohol consumption, %CDT, GGT and blood pressure change during alcohol treatment. Alcohol Alcohol. 2008;43:192–7.CrossRefPubMed
80.
Aguilera MT, De la Sierra A, Coca A. Effect of alcohol abstinence on blood pressure. Hypertension. 1999;33:653–7.CrossRefPubMed
81.
Wallace P, Cutler S, Haines A. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ. 1988;297:663–8.PubMedCentralCrossRefPubMed
82.
Rehm J, Anderson P, Gual A, Kraus L, Marmet S, Room R, et al. The tangible common denominator of substance use disorders: a reply to commentaries to Rehm et al. (2013). Alcohol Alcohol. 2014;49:118–22.CrossRefPubMed
83.
European Medicines Agency. Guideline on the Development of Medicinal Products for the Treatment of Alcohol Dependence. London: European Medicines Agency; 2010.
84.
Sarafidis PA, Georgianos P, Bakris GL. Resistant hypertension--its identification and epidemiology. Nat Rev Nephrol. 2013;9:51–8.CrossRefPubMed
85.
Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation. 2008;117:e510–26.CrossRefPubMed
86.
Denolle T, Chamontin B, Doll G, Fauvel JP, Girerd X, Herpin D, et al. Management of resistant hypertension. Expert consensus statement from the French Society of Hypertension, an affiliate of the French Society of Cardiology. Presse Med. 2014;43:1325–31.CrossRefPubMed
87.
Organisation for Economic Co-operation and Development. Tackling Harmful Alcohol Use: Economics and Public Health Policy. Paris: Organisation for Economic Co-operation and Development; 2015.
88.
Angus C, Latimer N, Preston L, Li J, Purshouse R. What are the implications for policy makers? A systematic review of the cost-effectiveness of screening and brief interventions for alcohol misuse in primary care. Front Psychiatry. 2014;5:114.PubMedCentralCrossRefPubMed
89.
Angus C, Thomas C, Anderson P, Meier PS, Brennan A. Estimating the cost-effectiveness of brief interventions for heavy drinking in primary health care across Europe. Eur J Public Health. 2017;27(2):345–51.PubMed
90.
Shield KD, Rylett M, Rehm J. ublic health successes and missed opportunities, Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990-2014. Copenhagen: WHO European Region; 2016.
91.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. 3rd ed. New York: Oxford University Press; 2005.
92.
Banegas JR, Graciani A, de la Cruz-Troca JJ, León-Muñoz LM, Guallar-Castillón P, Coca A, et al. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study. Hypertension. 2012;60:898–905.CrossRefPubMed
93.
Godet-Thobie H, Vernay M, Noukpoape A, Salanave B, Malon A, Castebon K, et al. Niveau tensionnel moyen et prévalence de l’hypertension artérielle chez les adultes de 18 à 74 ans, ENNS 2006-2007. BEH Thématique. 2008;49-50:478–83.
94.
Neuhauser H, Thamm M, Ellert U. Blutdruck in Deutschland 2008-2011. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl. 2013;56:795–801.CrossRef
95.
O’Brien E, Petrie J, Littler WA, de Swiet M, Padfield PL, Altman D, et al. The British Hypertension Society Protocol for the evaluation of blood pressure measuring devices. J Hypertens. 1993;11:S43–63.
96.
97.
Bianchini E, Brignoli O, Cricelli C, Cricelli I, Giustini S, Medea G, et al. Health Search - Instituto di Ricerca Della SIMG. Firenze: Società Italiana di Medicina Generale e delle Cure Primarie; 2014.
98.
Ferrario M, Chiodini P, Chambless LE, Cesana G, Vanuzzo D, Panico S, et al. Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE Cohort Study prediction equation. Int J Epidemiol. 2005;34:413–21.CrossRefPubMed
99.
Llisterri JL, Rodriguez-Roca GC, Escobar C, Alonso-Moreno FJ, Prieto MA, Barrios V, et al. Treatment and blood pressure control in Spain during 2002-2010. J Hypertens. 2012;30:2425–31.CrossRefPubMed
100.
Catalá-López F, Ridao M, Sanfélix-Gimeno G, Peiró S. Trends of uncontrolled blood pressure in Spain: an updated meta-regression analysis. J Hypertens. 2013;31:630–1.CrossRefPubMed
101.
Joffres M, Falaschetti E, Gillespie C, Robitaille C, Loustalot F, Poulter N, et al. Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study. BMJ Open. 2013;3:e003423.PubMedCentralCrossRefPubMed
102.
103.
Pater C. The Blood Pressure “Uncertainty Range” - a pragmatic approach to overcome current diagnostic uncertainties (II). Curr Control Trials Cardiovasc Med. 2005;6:5.PubMedCentralCrossRefPubMed
104.
Laatikainen T, Jula A, Kastarinen M, Salomaa V, Borodulin K, Harald K, et al. Verenpainetasot ja hoitotasapaino FINRISKI-tutkimusaluiella 1982-2012 [Blood pressure levels and therapeutic balance in FINRISK study areas in 1982-2012]. Suomen Laakarilehti. 2013;68:1803–9.
105.
Koskinen S, Lundqvist A, Ristiluoma N. Terveys, toimintakysky ja hyvinvointi Suomessa 2011. Tampere: Juvenes Print - Suomen Yliopistopaino Oy; 2012.
106.
107.
Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ. 1994;72(3):429–45.PubMedCentralPubMed
108.
109.
Rehm J, Gmel G, Sierra C, Gual A. Reduction of mortality following better detection of hypertension and alcohol problems in primary health care in Spain. Adicciones. 2016. Ahead of print.
Metadata
Title
Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union
Authors
Jürgen Rehm
Peter Anderson
Jose Angel Arbesu Prieto
Iain Armstrong
Henri-Jean Aubin
Michael Bachmann
Nuria Bastida Bastus
Carlos Brotons
Robyn Burton
Manuel Cardoso
Joan Colom
Daniel Duprez
Gerrit Gmel
Antoni Gual
Ludwig Kraus
Reinhold Kreutz
Helena Liira
Jakob Manthey
Lars Møller
Ľubomír Okruhlica
Michael Roerecke
Emanuele Scafato
Bernd Schulte
Lidia Segura-Garcia
Kevin David Shield
Cristina Sierra
Konstantin Vyshinskiy
Marcin Wojnar
José Zarco
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2017
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-017-0934-1

Other articles of this Issue 1/2017

BMC Medicine 1/2017 Go to the issue

Commentary

Observational studies: goldmines of information on rare diseases

Opinion

The new field of ‘precision psychiatry’

Commentary

Food for thought: why does the medical community struggle with research about nutritional therapy in the acute care setting?

Minireview

Non-alcoholic fatty liver disease

Review

The renin–angiotensin system: a possible new target for depression

Research article

Pre-diagnostic metabolite concentrations and prostate cancer risk in 1077 cases and 1077 matched controls in the European Prospective Investigation into Cancer and Nutrition