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Assis VO, Gonzaga NA, Silva CBP, Pereira LC, Padovan CM, Tirapelli CR. Ethanol Withdrawal Alters the Oxidative State of the Heart Through AT1-Dependent Mechanisms. Alcohol Alcohol 2019; 55:3-10. [DOI: 10.1093/alcalc/agz101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/10/2019] [Accepted: 11/19/2019] [Indexed: 02/02/2023] Open
Abstract
Abstract
Aims
We investigated the cardiac effects of ethanol withdrawal and the possible role of AT1 receptors in such response.
Methods
Male Wistar rats were treated with increasing doses of ethanol (3 to 9%, vol./vol.) for 21 days. The cardiac effects of ethanol withdrawal were investigated 48 h after abrupt discontinuation of ethanol. Some animals were orally treated with losartan (10 mg/kg/day), a selective AT1 receptor antagonist.
Results
Ethanol withdrawal did not affect serum levels of creatine kinase (CK)-MB. Losartan prevented ethanol withdrawal-induced increase in superoxide anion (O2•−) production in the left ventricle (LV). However, ethanol withdrawal did no alter the levels of thiobarbituric acid reactive substances (TBARS) or the expression of Nox1, Nox2 or Nox4 were found in the LV. Ethanol withdrawal reduced the concentration of hydrogen peroxide (H2O2) in the LV and this response was prevented by losartan. Ethanol withdrawal increased catalase activity in the LV and losartan attenuated this response. No changes on superoxide dismutase (SOD) activity or expression were detected in the LV during ethanol withdrawal. The expression of AT1, AT2 or angiotensin converting enzyme (ACE) was not affected by ethanol withdrawal. Similarly, no changes on the expression of ERK1/2, SAPK/JNK, COX-1 or COX-2 were found in the LV during ethanol withdrawal.
Conclusions
Ethanol withdrawal altered the cardiac oxidative state through AT1-dependent mechanisms. Our findings showed a role for angiotensin II/AT1 receptors in the initial steps of the cardiac effects induced by ethanol withdrawal.
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Affiliation(s)
- Victor O Assis
- Laboratório de Farmacologia, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Natália A Gonzaga
- Laboratório de Farmacologia, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
- Departamento de Farmacologia, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil
| | - Carla B P Silva
- Laboratório de Farmacologia, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
- Programa de Pós-graduação em Toxicologia, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil
| | - Lucas C Pereira
- Laboratório de Farmacologia, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Cláudia M Padovan
- Departamento de Psicologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil
| | - Carlos R Tirapelli
- Laboratório de Farmacologia, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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Miquel L, López-Pelayo H, Nuño L, Arbesú JÁ, Zarco J, Manthey J, Rehm J, Gual A. Barriers to implement screening for alcohol consumption in Spanish hypertensive patients. Fam Pract 2018; 35:295-301. [PMID: 29106526 DOI: 10.1093/fampra/cmx107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol intake and hypertension (HT) are interrelated public health problems with cost-effective interventions at the primary care level that, to date, are poorly implemented. OBJECTIVE This study aims to explore the barriers to implementing alcohol interventions for people with HT in primary care. METHODS As part of the project BASIS (Baseline Alcohol Screening and Intervention Survey), an internet survey from five European countries was developed to determine the role of alcohol in the management of HT in primary care practice. The survey contained 28 core items and 7 country-specific items. We present answers from Spanish general practitioners (GPs), who were reached through the main professional and scientific societies via e-mail and asked to take the online survey. RESULTS In total, 867 GPs answered the survey (65.1% women, 70.4% > 30 years old). As indicated by the Alcohol Use Disorders Identification Test-C scores, 12.4% of GPs who responded were risky drinkers (21.3% of men versus 7.1% of women). GPs reported considering alcohol relatively unimportant in HT treatment, as well as a difficult condition to deal with. The three main barriers to implement screening for alcohol consumption in HT patients were the lack of time (50.0%), considering alcohol unimportant for HT (28.4%) and stigma (16.5%). CONCLUSIONS GPs did not consider alcohol consumption a relevant factor for HT and, additionally, found it difficult to deal with alcohol problems. Some of the barriers for alcohol screening could be overcome through structural changes in the health system, such as empowering GPs to treat alcohol use disorders (rather than a single focus on implementing preventive strategies) by enhancing training in alcohol diagnosis and treatment.
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Affiliation(s)
- Laia Miquel
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Hugo López-Pelayo
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - Laura Nuño
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
| | - José Ángel Arbesú
- Área de Neurociencias de Semergen, Primary Health Care Center Eria, Oviedo, Spain
| | - José Zarco
- Primary Health Care Center Ibiza, Servicio Madrileño de Salud, Madrid, Spain.,Sociedad Española de Medicina Familiar y Comunitaria (semFYC), Madrid, Spain.,Departamento Medicina Interna, Universidad Complutense de Madrid, Madrid, Spain
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität, Dresden, Germany
| | - Jürgen Rehm
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität, Dresden, Germany.,Institute for Mental Health Policy Research (IMHPR), Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,Campbell Family Mental Health Research Institute, CAMH, Toronto, ON, Canada
| | - Antoni Gual
- Grup de Recerca en Addiccions Clínic, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Red de Trastornos adictivos (RETICS), Barcelona, Spain
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Gual A, Zarco J, Colom Farran J, Rehm J. [Early screening and brief intervention in alcohol misuse to improve the treatment of hypertension in primary care]. Med Clin (Barc) 2015; 146:81-5. [PMID: 26520609 DOI: 10.1016/j.medcli.2015.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Antoni Gual
- Unidad de Alcohología, Servicio de Psiquiatría, Instituto de Neurociencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España.
| | - José Zarco
- Centro de Salud Ibiza, Servicio Madrileño de Salud, Madrid, España
| | - Joan Colom Farran
- Subdirección General de Drogodependencias, Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalitat de Cataluña, Barcelona, España
| | - Jürgen Rehm
- Unidad de Investigación Epidemiológica, Psicología Clínica y Psicoterapia, Universidad Tecnológica de Dresde, Dresde, Alemania; Centre for Addiction and Mental Health, Toronto, Canadá
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Abramson JL, Lewis C, Murrah NV. Relationship of self-reported alcohol consumption to ambulatory blood pressure in a sample of healthy adults. Am J Hypertens 2010; 23:994-9. [PMID: 20489685 DOI: 10.1038/ajh.2010.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Habitual alcohol consumption has shown positive associations with office blood pressure (BP). Less well established, however, is alcohol consumption's relationship to various measures of ambulatory BP (ABP) in healthy, normotensive persons. METHODS We investigated alcohol consumption's relationship to mean ABP, ABP variability, and the ABP arterial stiffness index in a sample of nonsmoking adults who were free of hypertension and cardiovascular disease (CVD; n = 157). Total alcohol consumption, intake of specific alcoholic beverages, and binge drinking were assessed by self-report. ABP was measured every 30 min for 24 h. RESULTS In multivariable-adjusted linear regression models, higher levels of total weekly alcohol consumption were associated with higher ABP. For those consuming 0, 1-2, and 3 or more alcoholic drinks per week, mean 24-h systolic ABP values were 112.2, 115.2, and 116.6 mm Hg, respectively (P = 0.05), and mean 24-h diastolic ABP values were 70.6, 71.9, and 74.2 mm Hg, respectively (P = 0.02). Beer and liquor consumption showed stronger positive associations with ABP than did wine consumption. Among nonbinge drinkers and binge drinkers, mean 24-h systolic ABP values were 113.3 and 118.6 mm Hg, respectively (P = 0.04) and mean 24-h diastolic ABP values were 71.3 and 75.0 mm Hg, respectively (P = 0.04). Alcohol consumption was not significantly related to ABP variability or the ABP arterial stiffness index. CONCLUSION Total habitual alcohol consumption, consumption of specific alcoholic drinks, and binge drinking are associated with higher mean ABP in healthy, normotensive adults.
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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. [PMID: 18821872 PMCID: PMC2634596 DOI: 10.1111/j.1360-0443.2008.02317.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Heavy drinking is associated with hypertension. This study evaluated blood pressure changes occurring during treatment for alcohol dependence. PARTICIPANTS Subjects included 1383 people participating in the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study, a large multi-center treatment study for alcohol dependence. MEASUREMENTS Methods appropriate for repeated-measures data were used to assess the relationship of percentage of drinking days (PDD) to systolic and diastolic blood pressure over a 16-week treatment period. Modification of these associations by demographic and other variables was assessed. FINDINGS Blood pressure reduction was evident only in people who were above the median blood pressure at baseline. In this group, systolic blood pressure decreased by an average of 12 mmHg and diastolic blood pressure decreased by an average of 8 mmHg. Blood pressure reduction occurred during the first month of treatment. This effect was similar regardless of age, sex, body mass index, reported history of hypertension and use of anti-hypertensive medications. An observed association between blood pressure and PDD in Caucasians was not evident in African Americans due largely to their lower pre-treatment blood pressure. CONCLUSIONS Reduction in alcohol consumption has a potent anti-hypertensive effect in alcoholics with higher blood pressure. For hypertensive, alcohol-dependent people, treatment for alcoholism should be considered a major component of anti-hypertensive therapy.
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Affiliation(s)
- SH Stewart
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC,Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - PK Latham
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - PM Miller
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - P Randall
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - RF Anton
- Center for Drug and Alcohol Programs, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Bär KJ, Boettger MK, Neubauer R, Grotelüschen M, Jochum T, Baier V, Sauer H, Voss A. Heart rate variability and sympathetic skin response in male patients suffering from acute alcohol withdrawal syndrome. Alcohol Clin Exp Res 2006; 30:1592-8. [PMID: 16930222 DOI: 10.1111/j.1530-0277.2006.00191.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many symptoms of alcohol withdrawal (AW) such as tachycardia or elevated blood pressure might be explained by increased peripheral and central adrenergic activity. In contrast to many neurochemical studies of sympathetic activation during AW, only very few studies investigated autonomic balance using neurophysiological methods. METHODS We investigated heart rate variability (HRV) and sympathetic skin response (SSR) in male patients suffering from mild AW syndrome (n = 20, no treatment required) and in patients with moderate to severe AW syndrome (n = 20, clomethiazole treatment) in the acute stage. Sympathovagal influence was quantified using measures of time and frequency domain of HRV as well as modern nonlinear parameters (compression entropy). Furthermore, we obtained latencies and amplitudes of SSR to quantify isolated sympathetic influence. Measures were obtained during the climax of withdrawal symptomatology before treatment, 1 day after climax, and shortly before discharge from hospital. Alcohol withdrawal scores were obtained and correlated to autonomic measures. RESULTS Ambulatory blood pressure and AW scores revealed characteristic withdrawal symptoms in both patient groups. Apart from the nonlinear parameter compression entropy, Hc, measures of HRV revealed no sign of autonomic dysfunction in contrast to the significantly increased heart rates at the time of admission. Latencies and amplitudes of SSR did not indicate any increase of sympathetic activity. A negative correlation was found between Hc and mental withdrawal symptoms. CONCLUSIONS We show here that classical measures for autonomic nervous system activity such as HRV and SSR are not suitable for describing the autonomic changes seen in acute AW, although a major role for the sympathetic nervous system has been proposed. This might be due to multiple dysregulation of metabolites in AWS or to subtle alcohol-induced damage to neuronal structures, issues that should be addressed in future studies.
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Affiliation(s)
- Karl-Jürgen Bär
- Department of Psychiatry, Friedrich-Schiller-University of Jena, Jena, Germany.
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Soardo G, Donnini D, Varutti R, Milocco C, Basan L, Esposito W, Casaccio D, Isola M, Soldano F, Sechi LA. Effects of alcohol withdrawal on blood pressure in hypertensive heavy drinkers. J Hypertens 2006; 24:1493-8. [PMID: 16877950 DOI: 10.1097/01.hjh.0000239283.35562.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Epidemiological investigations have demonstrated a close association between heavy alcohol consumption and hypertension. The mechanisms of this association, however, remain elusive. We studied the effects of alcohol withdrawal on blood pressure, hormonal parameters, and circulating markers of endothelial activity. METHODS In 14 hypertensive heavy alcohol consumers (> 200 g/day) who agreed to participate in a hospital withdrawal programme we monitored, for 30 days, blood pressure, plasma levels of renin, aldosterone, cortisol, endothelin, and plasminogen activator inhibitor 1 (PAI-1), and urinary levels of catecholamines. Patients in the withdrawal group were compared with eight hypertensive heavy drinkers who refused to participate in the programme and maintained regular alcohol consumption and 11 normotensive teetotalers. RESULTS By the third day after withdrawal, blood pressure was significantly decreased and the normalization of levels was obtained in 13 of 14 patients by the end of the study. Alcohol withdrawal significantly decreased plasma aldosterone and cortisol levels, but did not affect levels of active renin and fractionated urinary catecholamines. At baseline, plasma endothelin and PAI-1 levels were significantly higher in alcoholic individuals than in teetotalers, and after the cessation of alcohol intake decreased progressively, reaching levels different from baseline within 1 week. A significant correlation was found between changes in endothelin and PAI-1, and blood pressure variations during alcohol abstinence that remained significant only for endothelin with the multivariate approach. CONCLUSION Hypertension is rapidly reversible in the majority of heavy drinkers after the withdrawal of alcohol consumption. In these patients, hypertension is associated with an increased release of endothelial factors that might contribute to the increase in blood pressure.
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Affiliation(s)
- Giorgio Soardo
- Department of Internal Medicine, Liver Unit, University of Udine School of Medicine, Udine, Italy.
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Affiliation(s)
- Ramon Estruch
- Department of Medicine, Hospital Clinic, Institut d'Investgació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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Fernández-Solà J. Consumo de alcohol y riesgo cardiovascular. HIPERTENSION Y RIESGO VASCULAR 2005. [DOI: 10.1016/s1889-1837(05)71546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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