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Alcohol and blood pressure: the INTERSALT study

Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6EA Environmental Epidemiology Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT Department of Preventive Medicine, Northwestern University Medical School, Chicago, IL 60611, USA Department of Health Science, Shiga University of Medical Science, Otsu, Japan Department of Medicine, Dudley Road Hospital, Birmingham B18 7QH Department of Epidemiology, St Raphael University Hospital, B-3000 Leuven, Belgium Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine, London WC1E 7HT Correspondence to: Professor Marmot.

Abstract

Objectives : To assess the relation between alcohol intake and blood pressure in men and women and in men at younger and older ages; to examine the influence of amount and pattern of alcohol consumption, as well as of acute effects, taking into account body mass index, smoking, and urinary sodium and potassium excretion. Design - Subjects reported alcohol consumption20for each of seven days before standardised blood pressure measurement, and whether they had consumed any alcohol in the 24 hours before measurement.
Setting : 50 centres worldwide.
Subjects : 4844 men and 4837 women aged 20-59.
Main outcome measures : Effect of alcohol on blood pressure estimated by taking a weighted average of regression coefficients from centres. Acute effect assessed by examining mean differences in blood pressure of non- drinkers and of heavy drinkers who had and had not consumed alcohol in the 24 hours before measurement. Effect of pattern of consumption assessed by examining mean differences in blood pressure of non-drinkers compared with drinkers (i) whose intake was concentrated in fewer days or who were drinking more frequently, and (ii) whose alcohol intake varied little over the seven days or varied more substantially, as indicated by the standard deviation of daily consumption.
Results : Of the 48 centres in which some people reported consuming at least 300 ml/week of alcohol, 35 had positive regression coefficients linking heavy alcohol consumption to blood pressure. Overall, alcohol consumption was associated with blood pressure, significantly at the highest intake. After account was taken of key confounders, men who drank 300-499 ml alcohol/week had systolic/diastolic blood pressure on average 2.7/1.6 mm Hg higher than non-drinkers, and men who drank >=500 ml alcohol/week had pressures of 4.6/3.0 mm Hg higher. For women, heavy drinkers (>=300 ml/week) had blood pressures higher by 3.9/3.1 mm Hg than non-drinkers. Heavy drinking and blood pressure were strongly associated in both sexes, and in men at both younger (20-39 years) and older (40-59 years) ages. In men who were heavy drinkers, episodic drinkers (those with great variation in daily alcohol consumption) had greater differences in blood pressure compared with non-drinkers than did regular drinkers of relatively constant amounts.
Conclusion : The significant relation of heavy drinking (3-4 or more drinks/day) to blood pressure, observed in both men and women, and in younger and older men, was independent of and added to the effect on blood pressure of body mass index and urinary excretion of sodium and potassium. The findings indicate the usefulness of targeting those at higher risk as well as the general population to reduce the adverse effects of alcohol on blood pressure.

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