Alcohol consumption and the risk of hypertension in women and men

Associations between age, cohort, and urbanization with SBP and DBP in China: a population-based study across 18 years

OBJECTIVE

Little is known about whether large-scale environmental changes, such as those seen with urbanization, are differentially associated with SBP versus DBP, and whether those changes vary by birth cohort.

METHODS

We used data from the China Health and Nutrition Survey, a population-based cohort study of Chinese adults (n = 18 754 aged 18-70 years), seen a maximum of seven times from 1991 to 2009. We used hierarchical multivariable linear models to simultaneously estimate SBP and DBP as correlated outcomes over time, accounting for their physiologic, time-varying correlation. Main exposure variables were urbanicity, age, and birth cohort. Over 18 years of modernization, median SBP and DBP increased by 10 and 7 mmHg, respectively.

RESULTS

Our hierarchical model results suggest greater temporal increases in SBP and particularly DBP at lower versus higher urbanicity. At the same chronological age, for a 10-year difference in birth cohort (i.e. born in 1980s versus 1970s), the adjusted mean DBP was approximately 3 mmHg higher for the later birth cohort (P < 0.001). Pulse pressure (calculated as model-predicted SBP minus DBP) was also higher at low versus high urbanicity.

CONCLUSIONS

These results suggest increased susceptibility of DBP (and thus peripheral vascular resistance) to environmental change, particularly in younger Chinese adults. Because DBP more strongly predicts cardiovascular disease risk in younger adulthood, hypertension-related health burden in China may increase over time.

Prevalência de hipertensão arterial sistêmica e fatores associados em homens e mulheres residentes em municípios da Amazônia Legal

RESUMO: Introdução: A hipertensão arterial sistêmica é um importante problema de saúde pública devido à sua alta prevalência, baixas taxas de controle e causa de morbidade e mortalidade cardiovascular. Objetivo: Analisar a prevalência de hipertensão arterial sistêmica e fatores associados em homens e mulheres residentes em municípios da Amazônia Legal. Métodos: No estudo transversal de base populacional conduzido com 1.296 adultos de ambos os sexos foram coletados dados sociodemográficos, estilo de vida, antropométricos e pressão arterial, sendo considerados hipertensos os que apresentaram pressão arterial ≥ 140/90 mmHg e/ou os que referiram uso de drogas anti-hipertensivas. As análises estatísticas foram feitas no módulo survey do programa Stata versão 11.0. Resultados: A prevalência da hipertensão arterial sistêmica foi de 22,3%. Após ajustes, as variáveis que se associaram à hipertensão nos homens foram a idade de 30 a 39 anos (RP ajustada = 2,69; IC95% 1,49 - 4,86), 40 a 49 anos (RP ajustada = 3,28; IC95% 1,82 - 5,93) e 50 a 59 anos (RP ajustada = 4,80; IC95% 2,63 - 8,76), sobrepeso (RP ajustada = 1,97; IC95% 1,39 - 2,78), obesidade (RP ajustada = 3,32; IC95% 2,32 - 4,75) e ser natural da região Norte ou Nordeste (RP ajustada = 0,31; IC95% 0,18 - 0,59). Entre as mulheres, associaram à hipertensão a idade de 40 a 49 anos (RP ajustada = 3,41; IC95% 1,91 - 6,07) e 50 a 59 anos (RP ajustada = 7,29; IC95% 4,07 - 13,07); o consumo de vinho (RP ajustada = 0,31; IC95% 0,10 - 0,97) e obesidade (RP ajustada = 2,39; IC95% 1,65 - 3,45). Conclusão: A hipertensão arterial associou-se independentemente com a idade, estado nutricional e naturalidade nos homens. E nas mulheres com a idade, estado nutricional e tipo de bebida alcoólica.

Relationships Between Current and Past Binge Drinking and Systolic Blood Pressure in Young Adults

PURPOSE

Heavy episodic (i.e., "binge") drinking (i.e., ≥five drinks/occasion) is highly prevalent among young adults; those who binge do so four times per month on average, consuming nine drinks on average on each occasion. Although it is well established that chronic heavy drinking (≥two alcoholic beverages per day) increases the risk of hypertension, the relationship between binge drinking and blood pressure is not well described. Our aim was to describe the relationship between frequency of binge drinking, both current (at age 24 years) and past (at age 20 years), and systolic blood pressure (SBP) at age 24 years.

METHODS

Participants (n = 756) from the longitudinal Nicotine Dependence in Teens study reported alcohol consumption at ages 20 and 24 years and had SBP measured at age 24 years. We examined the association between binge drinking and SBP using multiple linear regression, controlling for sex, race/ethnicity, education, monthly drinking in high school, cigarette smoking, and body mass index.

RESULTS

Compared to nonbinge drinkers, SBP at age 24 years was 2.61 [.41, 4.82] mm Hg higher among current monthly bingers and 4.03 [1.35, 6.70] mm Hg higher among current weekly bingers. SBP at age 24 years was 2.90 [.54, 5.25] mm Hg higher among monthly bingers at age 20 years and 3.64 [.93, 6.35] mm Hg higher among weekly bingers at age 20 years, compared to nonbinge drinkers.

CONCLUSIONS

Frequent binge drinking at ages 20 and 24 years is associated with higher SBP at age 24 years and may be implicated in the development of hypertension.

Predicting all-cause mortality from basic physiology in the Framingham Heart Study

Using longitudinal data from a cohort of 1349 participants in the Framingham Heart Study, we show that as early as 28-38 years of age, almost 10% of variation in future lifespan can be predicted from simple clinical parameters. Specifically, we found diastolic and systolic blood pressure, blood glucose, weight, and body mass index (BMI) to be relevant to lifespan. These and similar parameters have been well-characterized as risk factors in the relatively narrow context of cardiovascular disease and mortality in middle to old age. In contrast, we demonstrate here that such measures can be used to predict all-cause mortality from mid-adulthood onward. Further, we find that different clinical measurements are predictive of lifespan in different age regimes. Specifically, blood pressure and BMI are predictive of all-cause mortality from ages 35 to 60, while blood glucose is predictive from ages 57 to 73. Moreover, we find that several of these parameters are best considered as measures of a rate of 'damage accrual', such that total historical exposure, rather than current measurement values, is the most relevant risk factor (as with pack-years of cigarette smoking). In short, we show that simple physiological measurements have broader lifespan-predictive value than indicated by previous work and that incorporating information from multiple time points can significantly increase that predictive capacity. In general, our results apply equally to both men and women, although some differences exist.

Job Burnout, Work Engagement and Self-reported Treatment for Health Conditions in South Africa

The purpose of the study being reported here was to investigate the relationship of job burnout and work engagement with self-reported received treatment for health conditions (cardiovascular condition, high cholesterol, depression, diabetes, hypertension and irritable bowel syndrome), while controlling for age, gender, smoking and alcohol use. The sample comprised 7895 employees from a broad range of economic sectors in the South African working population. A cross-sectional survey design was used for the study. Structural equation modelling methods were implemented with a weighted least squares approach. The results showed that job burnout had a positive relationship with self-reported received treatment for depression, diabetes, hypertension and irritable bowel syndrome. Work engagement did not have any significant negative or positive relationships with the treatment for these health conditions. The results of this study make stakeholders aware of the relationship between job burnout, work engagement and self-reported treatment for health conditions. Evidence for increased reporting of treatment for ill-health conditions due to burnout was found. Therefore, attempts should be made to manage job burnout to prevent ill-health outcomes.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations

AIMS

To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences.

METHODS

MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence.

RESULTS

Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women.

CONCLUSIONS

Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

Association Between High-Sensitivity C-Reactive Protein and Total Stroke by Hypertensive Status Among Men

BACKGROUND

High-sensitivity C-reactive protein (hsCRP), a marker of systemic inflammation, may promote atherosclerosis, particularly among adults with elevated blood pressure; however, data are sparse. We examined the association between hsCRP concentrations and risk of total stroke by hypertension status (normotension, prehypertension, and hypertension) among men in the Physicians' Health Study (PHS).

METHODS AND RESULTS

Blood samples were collected (1996-1997) and assayed for hsCRP among 10 456 initially healthy men from PHS I and PHS II and followed from 1997 to 2012. Self-reported hypertension status, cardiovascular risk factors, lifestyle, and alcohol consumption were obtained from the baseline questionnaire prior to randomization in PHS II. Strokes were updated approximately annually and confirmed by medical records according to the National Survey of Stroke criteria. Multivariable Cox models were used. We observed 395 incident total strokes over 115 791 person-years. In analyses adjusted for potential confounders and stroke risk factors, clinically elevated hsCRP (>3 mg/L) was associated with a 40% significantly greater hazard of total stroke compared with hsCRP <1 mg/L (hazard ratio 1.40, 95% CI 1.06 to 1.87; Ptrend=0.01). Additional adjustment for blood pressure and biomarkers associated with cardiovascular risk marginally attenuated the estimates. Results were similar by hypertension status, although not statistically significant among normotensive and prehypertensive participants due to limited events.

CONCLUSIONS

Elevated hsCRP levels were associated with a greater risk of total stroke, even after adjustment for potential confounders and cardiovascular risk factors. Risk of total stroke was significantly higher among hypertensive men with elevated hsCRP compared with normotensive men with low hsCRP.

Primary Care Management of Alcohol Misuse

More than one in four American adults consume alcohol in quantities exceeding recommended limits. One in 12 have an alcohol use disorder marked by harmful consequences. Both types of alcohol misuse contribute to acute injury and chronic disease, making alcohol the third largest cause of preventable death in the United States. Alcohol misuse alters the management of common conditions from insomnia to anemia. Primary care providers should screen adult patients to identify the full spectrum of alcohol misuse. A range of effective treatments are available - from brief counselling interventions and mutual help groups to medications and behavioral therapies.

Alcohol Consumption in Vietnam, and the Use of 'Standard Drinks' to Measure Alcohol Intake

AIMS

To provide nationally representative data on alcohol consumption in Vietnam and to assess whether reported numbers of 'standard drinks' consumed have evidence of validity (particularly in rural areas where home-made alcohol is consumed from cups of varying size).

METHODS

A nationally representative population-based survey of 14,706 participants (46.5% males, response proportion 64.1%) aged 25-64 years in Vietnam. Measurements were made in accordance with WHO STEPS protocols. Data were analysed using complex survey methods.

RESULTS

Among men, 80% reported drinking alcohol during the last year, and 40% were hazardous/harmful drinkers. Approximately 60% of men and <5% of women had consumed alcohol during the last week, with one-in-four of the men reporting having consumed at least five standard drinks on at least one occasion. Numbers of standard drinks reported by men were associated with blood pressure/hypertension, particularly in rural areas (P < 0.001 for trend). Most of the calibration and discrimination possible from self-reported information on alcohol consumption was provided by binary responses to questions on whether or not alcohol had been consumed during the reference period.

CONCLUSION

Alcohol use and harmful consumption were common among Vietnamese men but less pronounced than in Western nations. Self-reports of quantity of alcohol consumed in terms of standard drinks had predictive validity for blood pressure and hypertension even in rural areas. However, using detailed measures of consumption resulted in only minor improvements in prediction compared to simple measures.

Association of alcohol consumption and components of metabolic syndrome among people in rural China

Background

Accumulative evidence in the literature suggests alcohol consumption is a protective factor of the metabolic syndrome (MS). However, few studies investigated the relationship between alcohol consumption and components of MS. We examined association of several types of alcoholic beverage with components of MS among people in rural China.

Methods

In the Nantong Metabolic Syndrome Study (NMSS), a cross-sectional study, a total of 20,502 participants, including 13,505 women and 6,997 men aged 18–74 years, were recruited between 2007 and 2008 in Nantong, China. Socio-economic status, dietary intake, physical exercise, alcoholic beverage consumption, and smoking status information were obtained, and triglycerides (TG), high-density lipoprtein cholesterol (HDL-c), blood pressure (BP) and blood glucose level were examined for all participants. Logistic regression model and the restricted cubic spline approach were used to analyze the associations between alcoholic beverage consumption and MS components.

Results

The MS prevalence was 21.1% in the whole population, which was significantly low among drinkers (20.6%), compared with non-drinkers (23.6%) in women, and was comparable in men (16.4% versus 17.1%). High HDL-c level was observed among drinkers, compared with non-drinkers in both men and women. Low TG level and Systolic BP (SBP) were found only among rice wine drinkers in women, and high waist circumference, high TG and BP were found among beer and liquor drinkers in men. Furthermore, we found that the highest quartile of rice wine drink in women may decrease 24% risk of high TG, 30% risk of low HDL-c and 43% risk of high glucose among MS components cases respectively, compared with non-drinkers (p for trend <0.01 for those three components). While compared non-drinkers among men, the highest quartile of liquor drink may increase 32% risk of high SBP, 55% risk of high Diastolic BP (DBP) and 34% risk of abdominal obesity among MS components cases respectively, but decrease 45% risk of low HDL-c (p for trend <0.05 for those four components).

Conclusion

Our data suggested that all alcoholic beverages increased HDL-c level. Rice wine decreased both TG level and blood glucose in women only and it could be one of healthy alcoholic beverages in MS prevention in Chinese women. While excessive liquor consumption increased BP and waist circumference level and it may lead to hypertension and central obesity in Chinese men.

Serum bilirubin and the risk of hypertension

BACKGROUND

Experimental studies suggest oxidative stress could lead to the development of hypertension. Serum bilirubin is a major contributor to the antioxidant capacity in blood plasma and has been identified as an independent cardiovascular risk factor in cohort studies. However, data on the relationship between bilirubin and blood pressure are scarce and inconclusive.

METHODS

We analysed data from the National Health and Nutrition Examination Surveys (NHANES) 1999-2012 (N=31069). Fifty multiple imputed data sets were generated and analysed to avoid selection/confounding bias due to excluding individuals/variables with missing values. A minimal sufficient adjustment set of variables (MSAS) needed to estimate the unconfounded effect of bilirubin on blood pressure and hypertension (systolic/diastolic blood pressure ≥ 140/90 mmHg or using antihypertensive medication) was identified using the back-door criterion and included in all regression models.

RESULTS

After adjustment for the MSAS variables, systolic blood pressure decreased progressively up to -2.5 mmHg (p<0.001) and the prevalence of hypertension was up to 25% lower (P<0.001) in those with bilirubin ≥ 1.0 mg/dl-the highest two deciles-compared with those with 0.1-0.4 mg/dl-the lowest decile. Sensitivity analyses showed these results were unlikely to be explained by residual confounding or selection bias.

CONCLUSIONS

High serum bilirubin may decrease the risk of hypertension by inactivating and inhibiting the synthesis of reactive oxygen species in vascular cells. Strategies to boost the bioavailability of circulating and tissue bilirubin or to mimic bilirubin's antioxidant properties could have a significant impact on prevention and control of hypertension as well as coronary heart disease.

National prevalence and associated risk factors of hypertension and prehypertension among Vietnamese adults

BACKGROUND

Hypertension has recently been identified as the leading risk factor for global mortality. This study aims to present the national prevalence of hypertension and prehypertension and, their determinants in Vietnamese adults.

METHODS

Nationally representative data were obtained from the National Adult Overweight Survey 2005. This one visit survey included 17,199 subjects aged 25-64 years, with a mean body mass index (BMI) of 20.7 kg/m(2).

RESULTS

The overall census-weighted JNC7 (the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) defined prevalence of hypertension was 20.7% (95% confidence interval (CI) = 19.4-22.1); the prevalence of prehypertension was 41.8% (95% CI = 40.4-43.1). Hypertension and prehypertension were more prevalent in men. Higher age, overweight, alcohol use (among men), and living in rural areas (among women) were independently associated with a higher prevalence of hypertension, whereas higher physical activity and education level were inversely associated. Age, BMI, and living in rural areas were independently associated with an increased prevalence of prehypertension. Among the hypertensives, 25.9% were aware of their hypertension, 12.2% were being treated, and 2.8% had their blood pressure under control; among the treated hypertensives, 32.4% had their blood pressure controlled.

CONCLUSIONS

Hypertension and prehypertension are prevalent in Vietnam, but awareness, treatment, and control are low. The findings suggest that lifestyle modifications, including the prevention of overweight, the promotion of physical activity particularly in urban areas, and the reduction of high alcohol consumption, may help to prevent hypertension in Vietnam. Furthermore, increased efforts regarding education, detection, and treatment could be important in management of hypertension and cardiovascular disease risk prevention.

The medieval origins of the concept of hypertension

Despite the well-known history of hypertension research in the modern era, like many other cardiovascular concepts, main points in the medieval concept of this disease and its early management methods remain obscure. This article attempts to make a brief review on the medieval origin of the concept of this disease from the Hidayat of Al-Akhawayni (?-983 AD). This article has reviewed the chapter of “Fi al-Imtela” (About the Fullness) from the Hidβyat al-Muta’allimin fi al-Tibb (The Students' Handbook of Medicine) of Al-Akhawayni.

The definition, symptoms and treatments presented for the Imtela are compared with the current knowledge on hypertension. Akhawayni believed that Imtela could result from the excessive amount of blood within the blood vessels. It can manifest with symptoms including the presence of a pulsus magnus, sleepiness, weakness, dyspnea, facial blushing, engorgement of the vessels, thick urine, vascular rupture, and hemorrhagic stroke. He also suggested some ways to manage al-Imtela'. These include recommendations of changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar). Al-Akhawayni's description of “Imtela,” despite of its numerous differences with current knowledge of hypertension, can be considered as medieval origin of the concept of hypertension.

Self-reported alcohol intake is a better estimate of 5-year change in blood pressure than biochemical markers in low resource settings: the PURE study

BACKGROUND

Despite criticism of self-reported alcohol intake, it is a valuable tool to screen for alcohol abuse as a risk factor for cardiovascular disease. We aimed to compare various self-reported estimates of alcohol use with γ-glutamyltransferase (GGT) and percentage carbohydrate deficient transferrin (%CDT) considering their relationship with blood pressure changes (%BP) over a 5-year period in black South Africans.

METHOD

We recruited 1994 participants and collected 5-year followed up data (N = 1246). Participants completed questionnaires on alcohol intake indicating their former and current alcohol use ('yes' response and 'no' if alcohol was never used). We assessed alcohol intake (in g) using a quantified food frequency questionnaire. We collected blood samples and measured GGT and %CDT. Brachial BP (bBP) was measured at baseline and follow-up and central BP (cBP) at follow-up only.

RESULTS

Self-reported alcohol intake was significantly associated with the 5-year change in bBP before and after adjusting for confounders (%bSBP: R(2) = 0.263, β = 0.06, P = 0.023; %bDBP: R(2) = 0.326, β = 0.08 P = 0.005), as well as cSBP (R (2)= 0.286, β = 0.09, P = 0.010) and central pulse pressure (R(2) = 0.254, β = 0.06, P = 0.020). GGT and %CDT correlated well with self-reported alcohol intake (r = 0.44; P = 0.001; r = 0.34 P = 0.001), but did not associate significantly with %bBP or cBP at follow-up.

CONCLUSION

Self-reported alcohol use was strongly associated with a 5-year increase in BP in Africans with a low socio-economic status. This was not found for biochemical measures, GGT and %CDT. Self-reported alcohol intake could be an important measure to implement in primary healthcare settings in middle to low income countries, where honest reporting is expected.

Development of a risk prediction model for incident hypertension in a working-age Japanese male population

The aim of this study was to develop a risk prediction model for incident hypertension in a Japanese male population. Study participants included 15,025 nonhypertensive Japanese male workers (mean age, 38.8±8.9 years) who underwent an annual medical checkup at a company. The participants were followed-up for a median of 4.0 years to determine new-onset hypertension, defined as a systolic blood pressure (BP) ⩾140 mm Hg, a diastolic BP ⩾90 mm Hg, or the initiation of antihypertensive medication. Participants were divided into the following two cohorts for subsequent analyses: the derivation cohort (n=12,020, 80% of the study population) and the validation cohort (n=3005, the remaining 20% of the study population). In the derivation cohort, a multivariate Cox proportional hazards model demonstrated that age, body mass index, systolic and diastolic BP, current smoking status, excessive alcohol intake and parental history of hypertension were independent predictors of incident hypertension. Using these variables, a risk prediction model was constructed to estimate the 4-year risk of incident hypertension. In the validation cohort, the risk prediction model demonstrated high discrimination ability and acceptable calibration, with a C-statistic of 0.861 (95% confidence interval 0.844, 0.877) and a modified Hosmer-Lemeshow χ2 statistic of 15.2 (P=0.085). A risk score sheet was constructed to enable the simple calculation of the approximate 4-year probability of incident hypertension. In conclusion, a practical risk prediction model for incident hypertension was successfully developed in a working-age Japanese male population.

Physical, behavioural and genetic predictors of adult hypertension: the findings of the Kaunas Cardiovascular Risk Cohort study

Background

The roots of adult hypertension go back to childhood. This study aimed to examine the independent effects of physical, behavioural and genetic factors identified in childhood and mid-adulthood for prediction of adult hypertension.

Methods

The study subjects were participants of the Kaunas Cardiovascular Risk Cohort study started in 1977 (n = 1082, age 12–13 years). In 2012, a total of 507 individuals (63.9% of eligible sample) participated in the 35-year follow-up survey. Health examination involved measurements of blood pressure (BP), anthropometric parameters, and interview about health behaviours. Subjects were genotyped for AGT (M235T), ACE (I/D, rs4340), ADM (rs7129220), and CACNB2 (rs12258967) genes polymorphisms. A genetic risk score was calculated as the sum of the number of risk alleles at each of four single nucleotide polymorphisms.

Results

AGT TT genotype male carriers had the highest mean values of systolic BP in childhood. In females, ADM genotype AA was associated with the highest values of systolic and diastolic BP, while CACNB2 genotype CC carriers had the highest values of diastolic BP in childhood. Systolic and diastolic BP in childhood, gain in BMI from childhood to adulthood, and risky alcohol consumption predicted hypertension in middle-aged men. In women, genetic risk score together with diastolic BP in childhood and gain in BMI were significant predictors of adult hypertension. The comparison of four nested logistic regression models showed that the prediction of hypertension improved significantly after the addition of BMI gain. Genetic risk score had a relatively weak effect on the improvement of the model performance in women.

Conclusions

BP in childhood and the gain in BMI from childhood to adulthood were significant predictors of adult hypertension in both genders. Genetic risk score in women and risky alcohol consumption in men were independently related with the risk of adult hypertension.

Relationship Between Alcohol Consumption and Serum Lipid Profiles Among Middle-Aged Population in China: A Multiple-Center Cardiovascular Epidemiological Study

We assessed the relationship between alcohol consumption and serum lipids in a middle-aged Chinese population. The overall prevalence of drinking among 10 154 participants was 34.07% in males and 3.61% in females. Heavy alcohol drinkers (≥ 30 g/d) tended to be older, smokers, hypertensive, do heavy physical activity, and have a lower body mass index. Levels of high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) A1, low-density lipoprotein cholesterol-HDL-C ratio, and apo B-apo A1 ratio rose with increase in alcohol intake in males. An increase of 0.27 mmol/L in triglycerides and a decrease of 2.10 mg/dL in lipoprotein(a), Lp(a), were observed in male alcohol drinkers who consumed ≥30 g alcohol/d compared with abstainers after controlling for all confounders. Levels of total cholesterol, HDL-C, and apo A1 increased with increase in alcohol intake in both genders and Lp(a) decreased with the increase in alcohol intake in males.

Dietary approaches to prevent hypertension

Elevated blood pressure arises from a combination of environmental and genetic factors and the interactions of these factors. A substantial body of evidence from animal studies, epidemiologic studies, meta-analyses, and randomized controlled trials has demonstrated that certain dietary patterns and individual dietary elements play a prominent role in the development of hypertension. Changes in diet can lower blood pressure, prevent the development of hypertension, and reduce the risk of hypertension-related complications. Dietary strategies for the prevention of hypertension include reducing sodium intake, limiting alcohol consumption, increasing potassium intake, and adopting an overall dietary pattern such as the DASH (Dietary Approaches to Stop Hypertension) diet or a Mediterranean diet. In order to reduce the burden of blood pressure-related complications, efforts that focus on environmental and individual behavioral changes that encourage and promote healthier food choices are warranted.

Long-term alcohol consumption is an independent risk factor of hypertension development in northern China: evidence from Kailuan study

OBJECTIVE

The purpose of the present study was to determine the impact of alcohol consumption on the incidence of hypertension.

METHODS

A total of 32,389 male coal mine workers from Kailuan Coal Group in northern China (Kailuan study), free of hypertension, myocardial infarction, stroke, transient ischemia attack and cancer, were followed up every 2 years for 4 years. The average alcohol intake during the past year was reported as baseline.

RESULTS

During 4 years of follow-up, 9151 out of 32,389 workers developed hypertension categorically. At the end of the follow-up, the cumulative incidence of hypertension in relation to daily alcoholic intake of none, 1-24, 25-49, 50-99, 100-149 and at least 150 g was 25.03, 28.82, 30.10, 37.07, 40.14 and 42.49%, respectively. After adjusting for age, we found that the relative risk of hypertension in those who were never exposed to alcohol was the lowest, with the group 25-49 g/day being the next. This trend was unchanged after adjustment for age, exercise, smoking status, job type and salt intake. After further adjustment for BMI, history of high cholesterol and diabetes mellitus, a positive, linear association between alcohol consumption and the risk of hypertension was found. Models stratified by baseline SBP (<120 and 120-139 mmHg) or DBP (<80 and 80-89 mmHg) did not alter the trend.

CONCLUSION

The Kailuan study demonstrates that long-term alcohol intake is an independent risk factor of incident hypertension in a large cohort of coal mine workers. Even light-to-moderate alcohol consumption increases the risk of incident hypertension.

Intervention to reduce excessive alcohol consumption and improve comorbidity outcomes in hypertensive or depressed primary care patients: two parallel cluster randomized feasibility trials

BACKGROUND

Many primary care patients with raised blood pressure or depression drink potentially hazardous levels of alcohol. Brief interventions (BI) to reduce alcohol consumption may improve comorbid conditions and reduce the risk of future alcohol problems. However, research has not established their effectiveness in this patient population. This study aimed to establish the feasibility of definitive trials of BI to reduce excessive drinking in primary care patients with hypertension or mild to moderate depression.

METHODS

Thirteen general practices in North East England were randomized to the intervention or control arm of one of two parallel pilot trials. Adult patients drinking excessively and diagnosed with hypertension or mild-to-moderate depression received the Alcohol Use Disorders Identification Test (AUDIT) by postal survey. Consenting respondents scoring more than 7 on AUDIT (score range 0 to 40) received brief alcohol consumption advice plus an information leaflet (intervention) or an information leaflet alone (control) with follow-up at six months. Measurements included the numbers of patients eligible, recruited, and retained, and the AUDIT score and systolic/diastolic blood pressure of each patient or the nine-item Patient Health Questionnaire (PHQ-9) score. Acceptability was assessed via practitioner feedback and patient willingness to be screened, recruited, and retained at follow-up.

RESULTS

In the hypertension trial, 1709 of 33,813 adult patients (5.1%) were eligible and were surveyed. Among the eligible patients, 468 (27.4%) returned questionnaires; 166 (9.6% of those surveyed) screened positively on AUDIT and 83 (4.8% of those surveyed) were recruited (50.0% of positive screens). Sixty-seven cases (80.7% of recruited patients) completed follow-up at six months. In the depression trial, 1,044 of 73,146 adult patients (1.4%) were eligible and surveyed. Among these eligible patients, 215 (20.6%) responded; 104 (10.0% of those surveyed) screened positively on AUDIT and 29 (2.8% of those surveyed) were recruited (27.9% of positive screens). Nineteen cases (65.5% of recruited patients) completed follow-up at six months.

CONCLUSIONS

Recruitment and retention rates were higher in the hypertension trial than in the depression trial. A full brief intervention trial appears feasible for primary care patients with hypertension who drink excessively. High AUDIT scores in the depression trial suggest the importance of alcohol intervention in this group. However, future work may require alternative screening and measurement procedures.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN89156543; registered 21 October 2013.

Metabolomic patterns and alcohol consumption in African Americans in the Atherosclerosis Risk in Communities Study

BACKGROUND

Effects of alcohol consumption on health and disease are complex and involve a number of cellular and metabolic processes.

OBJECTIVE

We examined the association between alcohol consumption habits and metabolomic profiles.

DESIGN

We conducted a cross-sectional study to explore the association of alcohol consumption habits measured by using a questionnaire with serum metabolites measured by using untargeted mass spectrometry in 1977 African Americans from the Jackson field center in the Atherosclerosis Risk in Communities Study. The whole sample was split into a discovery set (n = 1500) and a replication set (n = 477). Alcohol consumption habits were treated as an ordinal variable, with nondrinkers as the reference group and quartiles of current drinkers as ordinal groups with higher values. For each metabolite, a linear regression was conducted to estimate its relation with alcohol consumption habits separately in both sets. A modified Bonferroni procedure was used in the discovery set to adjust the significance threshold (P < 1.9 × 10⁻⁴).

RESULTS

In 356 named metabolites, 39 metabolites were significantly associated with alcohol consumption habits in both discovery and replication sets. In general, alcohol consumption was associated with higher levels of most metabolites such as those in amino acid and lipid pathways and with lower levels of γ-glutamyl dipeptides. Three pathways, 2-hydroxybutyrate-related metabolites, γ-glutamyl dipeptides, and lysophosphatidylcholines, which are considered to be involved in inflammation and oxidation, were associated with incident cardiovascular diseases.

CONCLUSIONS

To our knowledge, this is the largest metabolomic study thus far conducted in nonwhites. Metabolomic biomarkers of alcohol consumption were identified and replicated. The results lend new insight into potential mediating effects between alcohol consumption and future health and disease.

Alcohol-induced hypertension: Mechanism and prevention

Epidemiological, preclinical and clinical studies established the association between high alcohol consumption and hypertension. However the mechanism through which alcohol raises blood pressure remains elusive. Several possible mechanisms have been proposed such as an imbalance of the central nervous system, impairment of the baroreceptors, enhanced sympathetic activity, stimulation of the renin-angiotensin-aldosterone system, increased cortisol levels, increased vascular reactivity due to increase in intracellular calcium levels, stimulation of the endothelium to release vasoconstrictors and loss of relaxation due to inflammation and oxidative injury of the endothelium leading to inhibition of endothelium-dependent nitric oxide production. Loss of relaxation due to inflammation and oxidative injury of the endothelium by angiotensin II leading to inhibition of endothelium-dependent nitric oxide production is the major contributors of the alcohol-induced hypertension. For the prevention of alcohol-induced hypertension is to reduce the amount of alcohol intake. Physical conditioning/exercise training is one of the most important strategies to prevent/treat chronic alcohol-induced hypertension on physiological basis. The efficacious pharmacologic treatment includes the angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 receptor blockers (ARBs) which have antioxidant activity and calcium channel blockers. The most effective prevention and treatment of alcohol-induced hypertension is physical exercise and the use of ACE inhibitors or ARBs in the clinic

Alcohol consumption and ambulatory blood pressure: a community-based study in an elderly cohort

BACKGROUND

Although heavy alcohol consumption is associated with hypertension, the impact of lighter consumption on blood pressure (BP) is controversial. The protective effect of light alcohol consumption on cardiovascular disease described in previous studies could be, in part, mediated by effects of alcohol on BP. However, only a few studies investigating the association between alcohol and BP included elderly subjects, despite their higher risk of hypertension sequelae. Accordingly, we evaluated the relationship between alcohol consumption and 24-hour ambulatory BP in a community-based elderly cohort.

METHODS

Among the participants in the Cardiac Abnormalities and Brain Lesion study, 553 subjects (mean age = 70.6 ± 9.6 years) who underwent 24-hour ambulatory BP monitoring were examined. Alcohol consumption was categorized as (i) none (reference; <1 drink/month); (ii) very light consumption (1 drink/month to 1 drink/week); (iii) light consumption (2 drinks/week to 1 drink/day); (iv) moderate-to-heavy consumption (>1 drink/day). Former drinkers were excluded.

RESULTS

After adjustment for relevant covariables, mean values of daytime diastolic BP (DBP), nighttime DBP, and 24-hour DBP were significantly higher in moderate-to-heavy drinkers than in the reference group, whereas systolic BP parameters were not significantly different across consumption groups. Daytime systolic BP and DBP variability (SD of the measurements) were significantly lower in very light drinkers than in the reference group, independent of potential confounders.

CONCLUSIONS

Moderate-to-heavy alcohol consumption was associated with higher DBP values. Very light alcohol consumption was associated with reduced daytime BP variability. The latter association may contribute to the known beneficial cardiovascular effects of light alcohol consumption.

Dietary pattern and hypertension in Korean adults

OBJECTIVE

To assess the dietary pattern associated with hypertension and pre-hypertension among Korean male and female adults.

DESIGN

Cross-sectional study from a representative sample of the Korean population.

SETTING

The Korea National Health and Nutrition Examination Survey IV, which was conducted in 2007 and 2008.

SUBJECTS

Males and females (n 5308) over the age of 20 years.

RESULTS

Scores for three major dietary patterns ('whole food', 'Western' and 'drinking') were generated using a factor analysis of thirty predefined food groups based on the food items consumed. We used polytomous logistic regression analyses to obtain odds ratios and 95% confidence intervals for pre-hypertension and hypertension. Participants with a high drinking pattern score (moderate to high alcohol intake, salted fermented seafood intake) had a significantly higher prevalence of pre-hypertension or hypertension than those with a lower drinking pattern score; odds for the top quintile v. the bottom quintile were OR = 1·56 (95% CI 1·23, 1·99; P trend = 0·001) for pre-hypertension and OR = 3·05 (95% CI 2·12, 4·40; P trend < 0·001) for hypertension. The whole food pattern was not associated with either pre-hypertension or hypertension, while the Western pattern was associated with the prevalence of hypertension only among men.

CONCLUSIONS

Our finding warrants further prospective studies to examine whether alcohol drinking and salty food consumption increase the risk of developing hypertension in Koreans.

Alcohol and cardiovascular health: the dose makes the poison…or the remedy

Habitual light to moderate alcohol intake (up to 1 drink per day for women and 1 or 2 drinks per day for men) is associated with decreased risks for total mortality, coronary artery disease, diabetes mellitus, congestive heart failure, and stroke. However, higher levels of alcohol consumption are associated with increased cardiovascular risk. Indeed, behind only smoking and obesity, excessive alcohol consumption is the third leading cause of premature death in the United States. Heavy alcohol use (1) is one of the most common causes of reversible hypertension, (2) accounts for about one-third of all cases of nonischemic dilated cardiomyopathy, (3) is a frequent cause of atrial fibrillation, and (4) markedly increases risks of stroke-both ischemic and hemorrhagic. The risk-to-benefit ratio of drinking appears higher in younger individuals, who also have higher rates of excessive or binge drinking and more frequently have adverse consequences of acute intoxication (for example, accidents, violence, and social strife). In fact, among males aged 15 to 59 years, alcohol abuse is the leading risk factor for premature death. Of the various drinking patterns, daily low- to moderate-dose alcohol intake, ideally red wine before or during the evening meal, is associated with the strongest reduction in adverse cardiovascular outcomes. Health care professionals should not recommend alcohol to nondrinkers because of the paucity of randomized outcome data and the potential for problem drinking even among individuals at apparently low risk. The findings in this review were based on a literature search of PubMed for the 15-year period 1997 through 2012 using the search terms alcohol, ethanol, cardiovascular disease, coronary artery disease, heart failure, hypertension, stroke, and mortality. Studies were considered if they were deemed to be of high quality, objective, and methodologically sound.

Contribution of alcohol to hypertension mortality in Russia

Background. Hypertension (HTN) is reported to be the leading contributor to premature death globally. Considerable research evidence suggests that excessive alcohol intake (binge drinking) is an independent risk factor for HTN. It was repeatedly emphasized that binge drinking is a major contributor to a high cardiovascular mortality rate in Russia. Objective. The aim of this study was to examine the aggregate-level relation between alcohol consumption and HTN mortality rates in Russia. Method. Age-standardized sex-specific male and female HTN mortality data for the period 1980–2005 and data on overall alcohol consumption were analyzed by means of ARIMA (autoregressive integrated moving average) time-series analysis. The level of alcohol consumption per capita has been estimated using the indirect method based on alcohol psychoses incidence rate and employing ARIMA time-series analysis. Results. Alcohol consumption was significantly associated with both male and female HTN mortality rates: a 1-liter increase in overall alcohol consumption would result in a 6.3% increase in the male HTN mortality rate and in a 4.9% increase in female HTN mortality rate. The results of the analysis suggest that 57.5% of all male HTN deaths and 48.6% of all female HTN deaths in Russia could be attributed to alcohol. Conclusions. The outcomes of this study provide support for the hypothesis that alcohol is an important contributor to the high HTN mortality rate in the Russian Federation. The findings from the present study have important implications with to regards HTN mortality prevention, indicating that a restrictive alcohol policy can be considered as an effective measure of prevention in countries with a higher rate of alcohol consumption.

Efficiency of brief interventions on alcohol-related risks in occupational medicine

AIM

To evaluate the effectiveness of brief interventions (BIs) in reducing alcohol use among hazardous drinkers consulting their occupational doctors.

MATERIALS AND METHODS

DESIGN

Randomized controlled trial with 12-month follow-up, conducted between November 2004 and September 2006.

SETTING

Fifteen French regional occupational medicine centers with 147 doctors and 157 assistants who were trained in BI and screening with the AUDIT questionnaire.

PARTICIPANTS

We invited 33,488 individuals to fill out AUDIT. These patients were eligible if their scores were 6-12 for women and 7-12 for men, indicating hazardous drinking without dependence (found in 7.1% of respondents).

INTERVENTION

After randomization, BIs (informative advice using motivational approach, with 10-minute average duration) were performed by the occupational doctors. The control group received information booklets from the doctors' assistants.

MEASUREMENTS

Situations were evaluated 12 months after inclusion.

OUTCOME MEASURES

AUDIT scores, self-reported alcohol consumption (SRAC) and biological assays. The main criteria were the differences observed between groups for SRAC, the AUDIT score at follow-up, and any reduction in score between inclusion and final assessment. Success of intervention, which was defined as an AUDIT score below the hazardous drinking threshold at follow-up, was considered to analyze the variables associated with the efficiency of intervention.

RESULTS

The analyzed sample included 787 persons, among whom 435 were met again 12 months later. In the BI group, we found a lower AUDIT score (p = 0.01), a higher reduction in reported consumptions (-60 g/week versus -44 g/week, p = 0.04) and in AUDIT scores (p = 0.009). In the control group, 44.8% reduced their AUDIT scores below hazardous drinking thresholds, as compared to 51.6% in the BI group (p = 0.15). Success was associated with a significant reduction in biological and clinical indices.

CONCLUSIONS

Though the high attrition rate led to careful conclusions, BIs seem to be efficient in occupational medicine, in comparison with written information, which also seems to influence drinking behavior.

Hypertension and associated factors in older adults in South Africa

BACKGROUND

Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Little attention has been focused on hypertension and associated factors among older adults in Africa. Therefore, this study aimed to investigate the prevalence and associated factors of hypertension in a national sample of older South Africans who participated in the Study of Global Ageing and Adults' Health (SAGE) in 2008.

METHODS

In 2008 we conducted a national, population-based, cross-sectional study of a sample of 3 840 subjects aged 50 years or older in South Africa. The questionnaire included socio-demographic characteristics, health variables, and anthropometric and blood pressure measurements.

RESULTS

The prevalence of hypertension in the sample population was 77.3% (male 74.4%, female 79.6%). The rates of awareness, treatment and control among the hypertensive participants were 38.1, 32.7 and 17.1%, respectively. The results of multivariate logistic regression analysis revealed that the prevalence of hypertension was associated with being in the Coloured population group, having had a stroke, being overweight or obese and having had five or more out-patients care visits in the past 12 months. Hypertension was inversely associated with current alcohol use.

CONCLUSION

This study revealed high rates of hypertension among older adults (50 years and more) in South Africa, which puts them at risk for cardiovascular disease. The percentages of hypertensive subjects who were aware, treated and controlled were very low. These data underscore the urgent need to strengthen the public health education and blood pressure-monitoring systems to better manage hypertension among older adults in South Africa.

Appropriate body mass index and waist circumference cutoff for overweight and central obesity among adults in Cambodia

BACKGROUND

Body mass index (BMI) and waist circumference (WC) are used in risk assessment for the development of non-communicable diseases (NCDs) worldwide. Within a Cambodian population, this study aimed to identify an appropriate BMI and WC cutoff to capture those individuals that are overweight and have an elevated risk of vascular disease.

METHODOLOGY/PRINCIPAL FINDINGS

We used nationally representative cross-sectional data from the STEP survey conducted by the Department of Preventive Medicine, Ministry of Health, Cambodia in 2010. In total, 5,015 subjects between age 25 and 64 years were included in the analyses. Chi-square, Fisher's Exact test and Student t-test, and multiple logistic regression were performed. Of total, 35.6% (n = 1,786) were men, and 64.4% (n = 3,229) were women. Mean age was 43.0 years (SD = 11.2 years) and 43.6 years (SD = 10.9 years) for men and women, respectively. Significant association of subjects with hypertension and hypercholesterolemia was found in those with BMI ≥ 23.0 kg/m(2) and with WC >80.0 cm in both sexes. The Area Under the Curve (AUC) from Receiver Operating Characteristic curves was significantly greater in both sexes (all p-values <0.001) when BMI of 23.0 kg/m(2) was used as the cutoff point for overweight compared to that using WHO BMI classification for overweight (BMI ≥ 25.0 kg/m(2)) for detecting the three cardiovascular risk factors. Similarly, AUC was also significantly higher in men (p-value <0.001) when using WC of 80.0 cm as the cutoff point for central obesity compared to that recommended by WHO (WC ≥ 94.0 cm in men).

CONCLUSION

Lower cutoffs for BMI and WC should be used to identify of risks of hypertension, diabetes, and hypercholesterolemia for Cambodian aged between 25 and 64 years.

Association of alcohol consumption with incident hypertension among middle-aged and older Japanese population: the Ibarakai Prefectural Health Study (IPHS)

The objective of this study was to examine the effect of age on the relationship between alcohol consumption and incident hypertension in a general Japanese population. A cohort of Japanese men (n=37 310) and women (n=78 426) aged 40 to 79 years who underwent community-based health checkups from 1993 to 2004 and were free of hypertension were followed up with annual examinations, including the measurement of blood pressure, until the end of 2010. Incident hypertension was defined as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or the initiation of treatment for hypertension. Hazard ratios for incident hypertension according to alcohol consumption were estimated using a Cox proportional hazards model adjusted for possible confounding variables. A total of 45 428 participants (39.3%) developed hypertension (16 155 men and 29 273 women) for a mean follow-up time of 3.9 (1-18) years. Significant associations between alcohol consumption and incident hypertension were found in both sexes and age groups (P for trend was <0.001 for men aged 40-59 years and aged 60-79 years; 0.004 for women aged 40-59 years and 0.026 for women aged 60-79 years). No significant interaction with age on the association of alcohol consumption with incident hypertension was found in either sex (P for interaction, >0.05). Our results suggest that alcohol consumption is a similar risk factor for incident hypertension in both the middle-aged and the older populations.

Binge drinking and blood pressure: cross-sectional results of the HAPIEE study

OBJECTIVES

To investigate whether binge drinking pattern influences blood pressure independently from drinking volume or whether it modifies the effect of volume of drinking.

METHODS

We used cross-sectional data from population samples of 7559 men and 7471 women aged 45-69 years in 2002-05, not on antihypertensive medication, from Russia, Poland and Czech Republic. Annual alcohol intake, drinking frequency and binge drinking (≥ 100 g in men and ≥ 60 g in women in one session at least once a month) were estimated from graduated frequency questionnaire. Blood pressure was analysed as continuous variables (systolic and diastolic pressure) and a binary outcome (≥ 140/90 mm Hg).

RESULTS

In men, annual alcohol intake and drinking frequency were strongly associated with blood pressure. The odds ratio of high blood pressure for binge drinking in men was 1.62 (95% CI 1.45-1.82) after controlling for age, country, body mass index, education and smoking; additional adjustment for annual alcohol intake reduced it to 1.20 (1.03-1.39). In women, the fully adjusted odds ratio of high blood pressure for binge drinking was 1.31 (1.05-1.63). Binge drinking did not modify the effect of annual alcohol intake. Consuming alcohol as wine, beer or spirits had similar effects.

CONCLUSIONS

The results suggest that the independent long-term effect of binge drinking was modest, that binge drinking did not modify the effect of alcohol intake, and that different alcoholic beverages had similar effects on blood pressure.

Moderate alcohol use and health: a consensus document

AIMS

The aim of this consensus paper is to review the available evidence on the association between moderate alcohol use, health and disease and to provide a working document to the scientific and health professional communities.

DATA SYNTHESIS

In healthy adults and in the elderly, spontaneous consumption of alcoholic beverages within 30 g ethanol/d for men and 15 g/d for women is to be considered acceptable and do not deserve intervention by the primary care physician or the health professional in charge. Patients with increased risk for specific diseases, for example, women with familiar history of breast cancer, or subjects with familiar history of early cardiovascular disease, or cardiovascular patients should discuss with their physician their drinking habits. No abstainer should be advised to drink for health reasons. Alcohol use must be discouraged in specific physiological or personal situations or in selected age classes (children and adolescents, pregnant and lactating women and recovering alcoholics). Moreover, the possible interactions between alcohol and acute or chronic drug use must be discussed with the primary care physician.

CONCLUSIONS

The choice to consume alcohol should be based on individual considerations, taking into account the influence on health and diet, the risk of alcoholism and abuse, the effect on behaviour and other factors that may vary with age and lifestyle. Moderation in drinking and development of an associated lifestyle culture should be fostered.

Prevalence rates of self-care behaviors and related factors in a rural hypertension population: a questionnaire survey

The objective of this study was to investigate the self-care behaviors among hypertensive patients in primary care. A cross-sectional survey, with 318 hypertensive patients, was conducted in a rural area in Beijing, China, in 2012. Participants were mainly recruited from a community health clinic and completed questionnaires assessing their self-care behaviors, including data on adherence to a prescribed medication regimen, low-salt diet intake, smoking habits, alcohol consumption, blood pressure monitoring, and physical exercise. The logistic regression model was used for the analysis of any association between self-care behaviors and age, gender, duration of hypertension, self-rated health, marital status, education level, diabetes status, or body mass index. Subjects that adhered to their medication schedule were more likely to have hypertension for a long duration (OR, 3.44; 95% CI 1.99–5.97). Older participants (OR, 1.80; 95% CI 1.08–2.99) were more likely to monitor their blood pressure. Subjects who did not partake in physical exercise were more likely to be men, although the difference between genders was not significant (OR, 0.60; 95% CI 0.36–1.01). Patients with shorter history of hypertension, younger and being males have lower self-care behaviors. Primary care providers and public health practitioner should pay more attention to patients recently diagnosed with hypertension as well as younger male patients.

Deletion of angiotensin II type 1 receptor gene or scavenge of superoxide prevents chronic alcohol-induced aortic damage and remodelling

To investigate whether chronic alcohol consumption induces vascular injury via angiotensin II (Ang II) type 1 (AT1) receptor-dependent superoxide generation, male transgenic mice with knockout of AT1 gene (AT1-KO) and age-matched wild-type (WT) C57BL/6 mice were pair-fed a modified Lieber-DeCarli alcohol or isocaloric maltose dextrin control liquid diet for 2 months. Ethanol content (%, W/V) in the diet was 4.8 (34% of total calories) at initiation, and gradually increased up to 5.4 (38% of total calories). For some WT mice with and without alcohol treatment, superoxide dismutase mimetic (MnTMPyP) was given simultaneously by intraperitoneal injection at 5 mg/kg body weight daily for 2 months. At the end of studies, aortas were harvested for histopathological and immunohistochemical examination. Significant increases in the wall thickness and structural disarrangement of aorta were found in alcohol group, along with significant increases in aortic oxidative and/or nitrosative damage, expressions of NADPH oxidases (NOXs), inflammatory response, cell death and proliferation, and remodelling (fibrosis). However, these pathological changes were completely attenuated in alcohol-treated AT1-KO mice or in alcohol-treated WT mice that were also simultaneously treated with MnTMPyP for 2 months. These results suggest that chronic alcohol consumption may activate NOX via Ang II/AT1 receptor, to generate superoxide and associated peroxynitrite that in turn causes aortic nitrosative damage, inflammation, cell death and proliferation, and remodelling. Therefore, blocking Ang II/AT1 system or scavenging superoxide may become a potential preventive and/therapeutic approach to alcoholic vascular damage.

Drinking pattern and blood pressure among non-hypertensive current drinkers: findings from 1999-2004 National Health and Nutrition Examination Survey

CONTEXT AND OBJECTIVE

Epidemiological studies show the apparent link between excessive alcohol consumption and hypertension. However, the association between alcohol intake and blood pressure among non-hypertensive individuals is scarcely examined.

METHODS

This analysis included participants in the 1999-2004 National Health and Nutrition Examination Survey who were aged 20 to 84 years without a diagnosis of cardiovascular disease, hypertension or pregnancy, whose systolic/diastolic blood pressure (SBP/DBP) was lower than 140/90 mmHg, who were not on antihypertensive medication, and who consumed 12 drinks or more during the past 12 months (N = 3957). Average drinking volume (average alcohol intake per day), usual drinking quantity (drinks per day when drinking) and frequency of binge drinking were used to predict SBP/DBP. Covariates included age, gender, race/ethnicity, education level, smoking status, average physical activity level, and daily hours spent on TV/ video/computer.

RESULTS

Drinking volume was directly associated with higher SBP in a linear dependent manner (an increment of 10 g of alcohol per day increased average SBP by 1 mmHg among both men and women). Drinking above the US Dietary Guidelines (men more than two drinks and women more than one drink per drinking day) was associated with higher SBP. Binge drinking was associated with both higher SBP and higher DBP. Average intake greater than two drinks per day was particularly associated with higher DBP among women (P = 0.0003).

CONCLUSION

This analysis from a population-based survey indicates a direct association between higher alcohol consumption and a higher prevalence of prehypertension among non-hypertensive drinkers.

Prospective study of alcohol consumption and the incidence of the metabolic syndrome in US men

Few studies have evaluated the effects of alcohol consumption on the incidence of the metabolic syndrome (MetS). Therefore, the objective of the present study was to examine the association between alcohol consumption and incident MetS in a population of US men. This is a prospective study of 7483 Caucasian men, who were free of the MetS and CVD at baseline. Information was collected on alcohol consumption, health status and fitness level at an initial clinical examination. Additional health information and determination of incident cases of the MetS were obtained at follow-up clinical examinations between 1979 and 2005. Compared with non-drinkers, the multivariate hazard ratios of the MetS for light (1–3 drinks/week), moderate (4–7 drinks/week), moderate–heavy (8–13 drinks/week) and heavy ( ≥ 14 drinks/week) drinkers were 0·81 (95 % CI 0·68, 0·95), 0·68 (95 % CI 0·57, 0·80), 0·70 (95 % CI 0·59, 0·83) and 0·78 (95 % CI 0·66, 0·91), respectively. This association was seen across age groups, in men with one or more pre-existing MetS risk factors, and those with BMI ≥ 25 kg/m2, and in all alcohol beverage types at most levels of alcohol consumption. An inverse dose–response association between alcohol consumption and low HDL concentrations was observed, while significant associations were observed between high fasting glucose concentrations and moderate, moderate–heavy and heavy levels of alcohol consumption. Alcohol consumption was not significantly associated with central obesity, hypertriacylglycerolaemia or hypertension. All levels of alcohol consumption provided significant inverse associations with incidence of the MetS. In particular, this effect was observed in overweight and/or obese individuals, in those who had pre-existing risk factors for the MetS, and extended across all types of alcoholic beverages consumed.

Interactive effects of ApoE polymorphism, alcohol and smoking on age-related trends of blood pressure levels in elderly men: the Bambuì Cohort Study of Ageing (1997-2008)

Data from a population-based prospective study were used to examine longitudinal changes in blood pressure (BP) and seek interactions between apolipoprotein E (ApoE) genotypes, smoking and alcohol in a cohort of 557 elderly Brazilian men. Repeated BP measurements were obtained in four waves, and multi-level random-effects pattern-mixture models were used to evaluate age-related BP trajectories while accounting for non-ignorable dropouts/deaths and handling heterogeneities as random parameter variations. Alcohol was associated with high systolic BP in ε2 carriers and those with the ε3/3 genotype, but not in ε4 carriers. This was dependent on age and smoking habits: at the age of 60, expected systolic BP in alcohol drinking ε2 carriers was 16.5 mm Hg higher than in the reference group of non-smokers/non-drinkers if they were not smokers (P=0.049), and 28.6 mm Hg higher if they were also smokers (P=0.004). The youngest smoking/non-drinking ε2 carriers had lower systolic BP, but it increased rapidly and led to higher expected levels among older carriers. Alcohol consumption, alone or together with smoking, interacts with the effects of ApoE genotype on systolic BP, probably nullifying the more favourable lipid profile of ε2 carriers. The interactions of gene-modifiable risk factors have major public health implications.

Blood pressure tracking over the adult life course: patterns and correlates in the Framingham heart study

The extent to which select vascular risk factors differentially influence blood pressure (BP) is incompletely understood. Thus, we used multilevel modeling to analyze serial BP measurements using 21 732 person-observations obtained on Framingham Heart Study participants (mean age, 38 years, 52% women; 4993 unique individuals) over a 28-year period. We related longitudinal tracking of each BP measure (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure) to age, sex, body mass index, smoking, diabetes mellitus, total/high-density lipoprotein cholesterol ratio, and heart rate. In multivariable-adjusted analyses, we observed that older age, male sex, greater body mass index, and higher heart rate were positively associated with increase in all BP measures (P<0.0001). Notably, higher total/high-density lipoprotein cholesterol ratio was associated with greater mean arterial pressure (P<0.01). Conversely, diabetes mellitus and smoking were associated with higher pulse pressure (P<0.01). We also observed effect modification by sex: the increase in pulse pressure with age and body mass index was more pronounced in women compared with men (P<0.0001). All BP measures tracked at higher levels in both men and women with multiple vascular risk factors. Taken together, our longitudinal observations in a large community-based sample demonstrate a greater pulsatile load in women than in men with increasing age. We also observed a differential impact of select vascular risk factors on the individual components of BP, underscoring distinct regulation of these measures over the life course.

Interaction of current alcohol consumption and abdominal obesity on hypertension risk

The high prevalence of alcohol consumption and abdominal obesity and increased incidence of essential hypertension (EH) in China indicates that there may be an interaction between alcohol consumption and abdominal obesity on EH risk. Therefore, we aimed to examine the independent and combined effects of alcohol consumption and abdominal obesity on risk of EH in a Chinese cohort. We analyzed data from a population-based prospective cohort of 2778 participants aged 35-74 years from Jiangsu China who were free of hypertension, diabetes and CVD at enrollment and were followed for hypertension events. Cox proportional hazards regression model was used to calculate the hazard ratio (HR) of hypertension and corresponding 95% confidence interval (CI). Logistic regression model was used to examine the interaction between alcohol consumption and abdominal obesity on risk of hypertension. After adjusting for age, sex, smoking status, family history of hypertension, current alcohol consumption significantly increased EH risk. Compared with those without alcohol consumption, the hazard ratio of EH for participants with alcohol consumption was 1.65 (95% confidence interval 1.29-2.12). There was a statistically significant additive interaction between current alcohol consumption and abdominal obesity on EH risk. The risk of EH for current alcohol consumers with abdominal obesity was 4.49 times as high as the sum of risks in participants with a single condition alone. Both alcohol consumption and abdominal obesity are strong risk factors of EH in the Chinese population. Moreover, this study further demonstrates an additive interaction of alcohol consumption and abdominal obesity on EH risk.

The relation between habitual sleep duration and blood pressure values in Japanese male subjects

BACKGROUND

Previous studies have demonstrated that sleep duration is closely associated with metabolic risk factors. However, the relationship between habitual sleep duration and blood pressure values in Japanese population has not been fully established.

METHODS

We performed a cross-sectional study of 1,670 Japanese male subjects to clarify the relationship between habitual sleep duration and blood pressure values. The study subjects were divided into four groups (<6, 6-, 7-, and ≥8 h) according to their nightly habitual sleep duration.

RESULTS

The rate of subjects with <6, 6-, 7-, and ≥8 h sleep duration was 12.0, 37.6, 38.2, and 12.2 %, respectively. Compared with the group with 7-h sleep duration (referent), the <6 and ≥8 h groups had significantly greater systolic and diastolic blood pressure values. The rate of hypertensive subjects, defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, with sleep duration of <6, 6-, 7-, and ≥8 h was 13.4, 5.7, 7.5, and 13.8 %, respectively. Compared with the group with 7-h sleep duration (referent), the multivariate odds ratios (95 % confidence interval) of the groups with <6 and ≥8 h for hypertension was 2.43 (1.40-4.20, P < 0.01) and 2.28 (1.31-3.95, P < 0.01), respectively, adjusted for conventional cardiovascular risk factors.

CONCLUSION

The present study demonstrates that both long and short habitual sleep duration were significantly associated with high blood pressure values and hypertension occurrence in Japanese male subjects.

Increased high-density lipoprotein cholesterol is associated with a high prevalence of pre-hypertension and hypertension in community-dwelling persons

The aim of this article was that high-density lipoprotein cholesterol (HDL-C) reduces blood vessel injury through its antioxidant and anti-inflammatory functions. However, the effect of HDL-C on blood pressure may be controversial. Therefore, the aim of this study was to address whether HDL-C level is associated with blood pressure, and we examined cross-sectional data from community-dwelling persons. A total of 859 men [58 ± 15 (mean ± standard deviation); 20-89 (range) (years) and 1,169 women (61 ± 13; 19-88 years)] participants not on medication for hypertension were recruited from a single community at the time of their annual health examination. We examined the relationship between cardiovascular risk factors and blood pressure status. Multiple linear regression analysis using systolic blood pressure (SBP) and diastolic blood pressure (DBP) as an objective variable showed that HDL-C was significantly and independently associated with both SBP (β = 0.138), and DBP (β = 0.144). Compared to normotensive participants with the lowest quartile of HDL-C, multivariate-adjusted odds ratio (OR) for pre-hypertension was 1.72 (1.22-2.45) for the second quartile, 1.51 (1.07-2.15) for the third quartile, and 1.52 (1.04-2.22) for the highest quartile. Moreover, compared with normotensive participants with the lowest quartile, the multivariate-adjusted ORs for hypertension were 2.37 (1.63-3.45), 2.24 (1.54-3.28), 3.15 (2.10-4.74), respectively. There were no interactions between the two groups stratified by gender, age, BMI, drinking status, TG, FPG, and medication. Therefore, we concluded that HDL-C levels were positively associated with blood pressure in Japanese dwelling-community persons.