Renin, aldosterone and cortisol during ethanol intoxication and hangover

Alcohol hangover versus dehydration revisited: The effect of drinking water to prevent or alleviate the alcohol hangover

The alcohol hangover is a combination of negative mental and physical symptoms which can be experienced after a single episode of alcohol consumption, starting when blood alcohol concentration (BAC) approaches zero. A popular theory suggests that dehydration is the primary cause of alcohol hangover and that the consumption of water could alleviate hangover symptoms. Here, the current evidence on the relationship between hangover severity, thirst, and water consumption is summarized. The positive correlations of the amount of water consumed with both hangover severity and thirst suggest that both dehydration and the hangover are co-occurring after-effects of alcohol consumption. While hangovers were typically relatively enduring, dehydration effects were usually mild and short-lasting. Survey data revealed that water consumption during or directly after alcohol consumption had only a modest effect in preventing next-day hangover. Also, the amount of water consumed during hangover was not related to changes of hangover severity and thirst. Thus, water consumption was not effective to alleviate the alcohol hangover. Taken together, these data suggests that alcohol hangover and dehydration are two co-occurring but independent consequences of alcohol consumption.

Reactive Oxygen Species Are Central Mediators of Vascular Dysfunction and Hypertension Induced by Ethanol Consumption

Consumption of high amounts of ethanol is a risk factor for development of cardiovascular diseases such as arterial hypertension. The hypertensive state induced by ethanol is a complex multi-factorial event, and oxidative stress is a pathophysiological hallmark of vascular dysfunction associated with ethanol consumption. Increasing levels of reactive oxygen species (ROS) in the vasculature trigger important processes underlying vascular injury, including accumulation of intracellular Ca2+ ions, reduced bioavailability of nitric oxide (NO), activation of mitogen-activated protein kinases (MAPKs), endothelial dysfunction, and loss of the anticontractile effect of perivascular adipose tissue (PVAT). The enzyme nicotinamide adenine dinucleotide phosphate (NADPH) oxidase plays a central role in vascular ROS generation in response to ethanol. Activation of the renin-angiotensin-aldosterone system (RAAS) is an upstream mechanism which contributes to NADPH oxidase stimulation, overproduction of ROS, and vascular dysfunction. This review discusses the mechanisms of vascular dysfunction induced by ethanol, detailing the contribution of ROS to these processes. Data examining the association between neuroendocrine changes and vascular oxidative stress induced by ethanol are also reviewed and discussed. These issues are of paramount interest to public health as ethanol contributes to blood pressure elevation in the general population, and it is linked to cardiovascular conditions and diseases.

Alterations in circadian rhythms following alcohol use: A systematic review

Increasing evidence suggest a bidirectional link between disrupted circadian rhythms and alcohol use disorders (AUD). A better understanding of these alcohol-induced changes in circadian rhythms will likely provide important therapeutic solutions. We conducted a systematic review based on the PubMed database examining biological rhythms in all stages of alcohol use: acute alcohol consumption, AUD, alcohol withdrawal, and abstinence. Different changes in circadian rhythms have been observed after a single acute alcohol intake, but also during AUD and alcohol withdrawal. Following a single acute alcohol intake, changes in biological rhythms are dose-dependent, reflected in the melatonin and cortisol secretions, and the core body temperature (CBT) rhythms. These alterations normalize the next morning and appear mostly for acute alcohol intake higher than 0.5 g/kg. These alterations are more severe during AUD and persist over time. In addition, interestingly, opposite patterns of the melatonin physiological ratio between diurnal and nocturnal secretion (N/D ratio < 1) have been observed during AUD and appear to be a marker of chronic daily use. During alcohol withdrawal, circadian rhythms desynchronization correlates with the severity of alcohol withdrawal symptoms and withdrawal complications such as delirium tremens. During abstinence a resynchronization of circadian rhythms of cortisol and CBT appears in most patients about 1 month after alcohol withdrawal. Disruption of melatonin circadian rhythms can persist after 3-12 weeks of abstinence. The circadian genetic vulnerability associated with biological rhythms alterations in alcohol use disorders increases the risk of relapses. Circadian-based interventions could play a critical role in preventing and treating AUD.

Sex Differences in the Presence and Severity of Alcohol Hangover Symptoms

Studies have demonstrated significant sex differences in alcohol intoxication effects. In contrast, the majority of studies on the alcohol hangover phase did not investigate sex differences. Therefore, the current study examined possible sex differences in the presence and severity of alcohol hangover symptoms. Data from n = 2446 Dutch students (male = 50.7%, female = 49.3%) were analyzed. They reported the presence and severity of 22 hangover symptoms experienced after their past month heaviest drinking occasion. Subjects were categorized according to their estimated peak blood alcohol concentration (eBAC) and presence and severity of the hangover symptoms were compared between men and women. In the lowest eBAC group (0% ≤ eBAC < 0.08%), no significant sex differences were found. In the subsequent eBAC group (0.08% ≤ eBAC < 0.11%), severity of nausea was significantly higher in women than in men. In the third eBAC group (0.11% ≤ eBAC < 0.2%), women reported higher severity scores on nausea, tiredness, weakness, and dizziness than men. Men reported the presence of confusion significantly more often than women, and women reported the presence of shivering significantly more often than men. In the fourth eBAC group (0.2% ≤ eBAC < 0.3%), women reported higher severity scores on nausea and tiredness than men. In the highest eBAC group (0.3% ≤ eBAC < 0.4%), no significant sex differences were found. In conclusion, across the eBAC groups, severity scores of nausea and tiredness were higher in women than in men. However, albeit statistically significant, the observed sex differences in presence and severity of hangover symptoms were of small magnitude, and therefore, have little clinical relevance.

A systematic review of the next-day effects of heavy alcohol consumption on cognitive performance

BACKGROUND AND AIMS

Studies examining the next-day cognitive effects of heavy alcohol consumption have produced mixed findings, which may reflect inconsistencies in definitions of 'hangover'. Recent consensus has defined hangover as 'mental and physical symptoms, experienced the day after a single episode of heavy drinking, starting when blood alcohol concentration (BAC) approaches zero'. In light of this, we aimed to review the literature systematically to evaluate and estimate mean effect sizes of the next-day effects of heavy alcohol consumption on cognition.

METHODS

Embase, PubMed and PsycNET databases were searched between December 2016 and May 2018 using terms based on 'alcohol' and 'hangover'. Studies of experimental designs which reported the next-day cognitive effects of heavy alcohol consumption in a 'hangover' group with BAC < 0.02% were reviewed. A total of 805 articles were identified. Thirty-nine full-text articles were screened by two independent reviewers and 19 included in the systematic review; 11 articles provided sufficient data to be included in the meta-analysis; 1163 participants across 19 studies conducted since 1970 were included in the analysis. Data for study design, hangover severity, BAC at testing and cognitive performance were extracted and effect estimates calculated.

RESULTS

The systematic review suggested that sustained attention and driving abilities were impaired during hangover. Mixed results were observed for: psychomotor skills, short- (STM) and long-term memory (LTM) and divided attention. The meta-analysis revealed evidence of impairments in STM [g = 0.64, 95% confidence interval (CI) = 0.15-1.13], LTM (Hedges' g = 0.59, 95% CI = 0.01-1.17) sustained attention (g = 0.47, 95% CI = 0.07-0.87) and psychomotor speed (Hedges' g = 0.66, 95% CI = 0.31-1.00) during alcohol hangover.

CONCLUSION

The research literature suggests that alcohol hangovers may involve impaired cognitive functions and performance of everyday tasks such as driving.

Thirst sensation and oral dryness following alcohol intake

Substantial acute and chronic intakes of alcohol or ethanol (EtOH) severely influence oral sensations, such as thirst and oral dryness (dry mouth, xerostomia). Thirst sensation and oral dryness are primarily caused by the activation of neurons in brain regions, including the circumventricular organs and hypothalamus, which are referred to as the dipsogenic center, and by a decrease in salivary secretion, respectively. The sensation of thirst experienced after heavy-alcohol drinking is widely regarded as a consequence of EtOH-induced diuresis; however, EtOH in high doses induces anti-diuresis. Recently, it has been proposed that the ethanol metabolite acetaldehyde induces thirst via two distinct processes in the central nervous system from EtOH-induced diuresis, based on the results of animal experiments. The present review describes new insights regarding the induction mechanism of thirst sensation and oral dryness after drinking alcohol.

Angiotensin type 1 receptor mediates chronic ethanol consumption-induced hypertension and vascular oxidative stress

OBJECTIVES

We hypothesized that chronic ethanol intake enhances vascular oxidative stress and induces hypertension through renin-angiotensin system (RAS) activation.

METHODS AND RESULTS

Male Wistar rats were treated with ethanol (20% v/v). The increase in blood pressure induced by ethanol was prevented by losartan (10mg/kg/day; p.o. gavage), a selective AT1 receptor antagonist. Chronic ethanol intake increased plasma renin activity (PRA), angiotensin converting enzyme (ACE) activity, plasma angiotensin I (ANG I) and angiotensin II (ANG II) levels and serum aldosterone levels. No differences on plasma osmolality and sodium or potassium levels were detected after treatment with ethanol. Ethanol consumption did not alter ACE activity, as well as the levels of ANG I and ANG II in the rat aorta or mesenteric arterial bed (MAB). Ethanol induced systemic and vascular oxidative stress (aorta and MAB) and these effects were prevented by losartan. The decrease on plasma and vascular nitrate/nitrite (NOx) levels induced by ethanol was prevented by losartan. Ethanol intake did not alter protein expression of ACE, AT1 or AT2 receptors in both aorta and MAB. Aortas from ethanol-treated rats displayed decreased ERK1/2 phosphorylation and increased protein expression of SAPK/JNK. These responses were prevented by losartan. MAB from ethanol-treated rats displayed reduced phosphorylation of p38MAPK and ERK1/2 and losartan did not prevent these responses.

CONCLUSIONS

Our study provides novel evidence that chronic ethanol intake increases blood pressure, induces vascular oxidative stress and decreases nitric oxide (NO) bioavailability through AT1-dependent mechanisms.

Environmental risk factors for acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in critically ill patients. Over the past several decades, alcohol abuse and cigarette smoke exposure have been identified as risk factors for the development of ARDS. The mechanisms underlying these relationships are complex and remain under investigation but are thought to involve pulmonary immune impairment and alveolar epithelial and endothelial dysfunction. This review summarizes the epidemiologic data supporting links between these exposures and ARDS susceptibility and outcomes and highlights key mechanistic investigations that provide insight into the pathways by which each exposure is linked to ARDS.

PPARγ ligands regulate NADPH oxidase, eNOS, and barrier function in the lung following chronic alcohol ingestion

BACKGROUND

Chronic alcohol ingestion increases the incidence and severity of the acute respiratory distress syndrome (ARDS), where reactive species contribute to alveolar-capillary barrier dysfunction and noncardiogenic pulmonary edema. Previous studies demonstrated that chronic alcohol ingestion increased lung NADPH oxidase and endothelial nitric oxide synthase (eNOS) expression and that ligands for the peroxisome proliferator-activated receptor gamma (PPARγ) reduced NADPH oxidase expression. Therefore, we hypothesized that the PPARγ ligand, rosiglitazone, would attenuate alcohol-induced NADPH oxidase expression and pulmonary barrier dysfunction.

METHODS

C57Bl/6 mice were treated ± alcohol in drinking water (20% w/v) for 12 weeks. During the final week of alcohol treatment, mice were gavaged with rosiglitazone (10 mg/kg/d) or vehicle. Selected animals were treated twice with lipopolysaccharide (LPS, 2 mg/kg IP) prior to sacrifice. Pulmonary barrier dysfunction was estimated from protein content of bronchoalveolar lavage (BAL) fluid.

RESULTS

LPS treatment increased BAL protein in alcohol-fed but not control mice, and rosiglitazone attenuated LPS and alcohol-induced pulmonary barrier dysfunction. Alcohol- and LPS-induced increases in lung eNOS, Nox1, and Nox4 expression were attenuated by rosiglitazone. In vitro, alcohol (0.10% w/v) increased H(2)O(2) production, barrier dysfunction, eNOS, Nox1, and Nox4 expression in human umbilical vein endothelial cell (HUVEC) monolayers, effects also attenuated by rosiglitazone (10 μM). Alcohol-induced HUVEC barrier dysfunction was attenuated by inhibition of NOS or addition of the eNOS cofactor, tetrahydrobiopterin.

CONCLUSIONS

These results indicate that PPARγ activation reduced expression of eNOS, Nox1, Nox4, the production of reactive species, and barrier dysfunction caused by chronic alcohol ingestion and suggest that PPARγ represents a novel therapeutic target for strategies designed to reduce the risk of lung injury in patients with a history of chronic alcohol ingestion.

The roles of alcohol in the epidemiology of cardiovascular diseases

Alcohol, both alone and in concert with deficiencies or excesses of other substances, can produce cardiomyopathy. In addition, alcohol can directly affect the cardiac conduction system and produce arrhythmias. Alcohol also affects known risk factors for stroke and coronary heart disease (CHD). Alcohol increases blood pressure, which may lead to hypertension and thus increase the risk of stroke. HDL cholesterol, which is inversely related to CHD risk, increases with alcohol, and LDL cholesterol, which is positively related to CHD risk, may decrease with alcohol, a potentially dually protective effect. However, both case-control and population based studies indicate only moderate levels of consumption, defined as two drinks per day or less, may be of benefit. Preliminary data from the Lipid Research Clinics Follow-up Study suggest that the beneficial effect of moderate amounts of alcohol may be mediated in part by increased HDL cholesterol and in part by another factor, possibly reduced coagulation. Clinical and laboratory data, in addition to epidemiologic data, suggest alcohol intake above two drinks per day leads to excess cardiovascular disease (CVD), probably reflecting hypercoagulability as well as hypertension at higher levels of intake. Because alcohol can lead to excess morbidity and mortality from CVD as well as several other diseases and conditions, public health policy should continue to discourage the drinking of alcohol, especially non-moderate consumption.

Influence of chronic alcohol consumption on inward rectifier potassium channels in cerebral arterioles

Inward rectifier potassium (K(IR)) channels appear to play an important role in the regulation of cerebral blood flow. Our goal was to examine the influence of chronic alcohol exposure on K(IR) channels in cerebral arterioles. Sprague-Dawley rats were fed liquid diets with or without alcohol for 8-12 weeks. Using intravital microscope, we measured diameter of pial arterioles in response to an inhibitor, BaCl(2), and an activator, KCl, of K(IR) channels in the absence and presence of a scavenger of reactive oxygen species, tempol, or an inhibitor of NAD(P)H oxidase, apocynin. Application of BaCl(2) (30 and 100 microM) produced dose-related vasoconstriction in non-alcohol-fed, but not in alcohol-fed rats. In addition, application of KCl (3, 10, and 30 mM) produced dose-related dilation in non-alcohol-fed and alcohol-fed rats, but the magnitude of vasodilatation was less in alcohol-fed rats. In contrast, nitroglycerin-induced vasodilation was similar in non-alcohol-fed and alcohol-fed rats. Superfusion of cranial window with tempol (0.1 mM) or apocynin (1 mM) did not alter baseline diameter and nitroglycerin-induced dilation of pial arterioles in non-alcohol-fed and alcohol-fed rats but significantly improved impaired KCl-induced dilation in alcohol-fed rats. Our findings suggest that chronic alcohol consumption impairs the role of K(IR) channels in basal tone and KCl-induced dilation of cerebral arterioles. In addition, impaired KCl-induced dilation of cerebral arterioles during alcohol consumption may be related to enhanced release of oxygen-derived free radicals via NAD(P)H oxidase.

Chronic ethanol ingestion increases superoxide production and NADPH oxidase expression in the lung

Alcohol abuse increases the incidence of acute respiratory distress syndrome and causes oxidative stress and cellular dysfunction in the lung. The mechanisms of ethanol (EtOH)-induced oxidative stress in the lung remain to be defined. Chronic alcohol ingestion has been associated with increased renin-angiotensin system (RAS) activity. Therefore, the current study investigated the ability of lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, to modulate oxidative stress in the lung after chronic EtOH ingestion in a well-established rat model. Male Sprague-Dawley rats were fed liquid diets containing EtOH (36% of calories) or maltose-dextrin as an isocaloric substitution for EtOH (Control) for 6 wk. Selected animals were also treated with lisinopril (3 mg/liter) for 6 wk. Chronic EtOH ingestion increased bronchoalveolar lavage fluid glutathione disulfide levels and superoxide formation in lung parenchyma. These effects of EtOH were attenuated by lisinopril treatment. Chronic EtOH ingestion failed to increase ACE expression or angiotensin II levels in lung homogenates, but increased angiotensinogen, angiotensin II type 1 and type 2 receptor levels, and ACE activity. Chronic EtOH ingestion also increased the levels of the NADPH oxidase subunit, gp91phox, an effect that was attenuated by lisinopril, but had no effect on lung p22phox or p47phox levels. These findings suggest that EtOH-mediated RAS activation plays an important role in pulmonary oxidative stress and provide new insights into mechanisms by which EtOH causes oxidative stress in the lung and potential strategies of lung protection through ACE inhibition.

Angiotensin II mediates glutathione depletion, transforming growth factor-beta1 expression, and epithelial barrier dysfunction in the alcoholic rat lung

Alcohol abuse markedly increases the risk of sepsis-mediated acute lung injury. In a rat model, ethanol ingestion alone (in the absence of any other stress) causes pulmonary glutathione depletion, increased expression of transforming growth factor-beta1 (TGF-beta1), and alveolar epithelial barrier dysfunction, even though the lung appears grossly normal. However, during endotoxemia, ethanol-fed rats release more activated TGF-beta1 into the alveolar space where it can exacerbate epithelial barrier dysfunction and lung edema. Ethanol ingestion activates the renin-angiotensin system, and angiotensin II is capable of inducing oxidative stress and TGF-beta1 expression. We determined that lisinopril, an angiotensin-converting enzyme inhibitor that decreases angiotensin II formation, limited lung glutathione depletion, and treatment with either lisinopril or losartan, a selective angiotensin II type 1 receptor blocker, normalized TGF-beta1 expression. The glutathione precursor procysteine also prevented TGF-beta1 expression, suggesting that TGF-beta1 may be induced indirectly by angiotensin II-mediated oxidative stress and glutathione depletion. Importantly, lisinopril treatment normalized barrier function in alveolar epithelial cell monolayers from ethanol-fed rats, and treatment with either lisinopril or losartan normalized alveolar epithelial barrier function in ethanol-fed rats in vivo, as reflected by lung liquid clearance of an intratracheal saline challenge, even during endotoxemia. In parallel, lisinopril treatment limited TGF-beta1 protein release into the alveolar space during endotoxemia. Together, these results suggest that angiotensin II mediates oxidative stress and the consequent TGF-beta1 expression and alveolar epithelial barrier dysfunction that characterize the alcoholic lung.

Effect of chronic alcohol consumption on the activity of the hypothalamic-pituitary-adrenal axis and pituitary beta-endorphin as a function of alcohol intake, age, and gender

BACKGROUND

Experimental evidence indicates that components of the hypothalamic-pituitary-adrenal (HPA) axis and of the endogenous opioid system, such as beta-endorphin (beta-END), influence alcohol consumption, whereas chronic alcohol abuse alters the activity of both systems. Furthermore, gender and age differences have been reported in the activity of the HPA axis under basal conditions, in response to stress and acute alcohol challenge. The objective of the present studies was to investigate the hypothesis that chronic alcohol consumption alters the activity of the HPA axis and pituitary beta-END as a function of severity of alcohol abuse, gender, and age.

METHODS

Three age groups of each gender (18-29, 30-44, and 45-60 years old) were recruited. Each age and gender group included four subgroups: (a) nondrinkers, (b) light drinkers, (c) heavy drinkers, and (d) alcoholics in treatment. Demographic characteristics, alcohol consumption, and presence of alcohol dependence were recorded by using a structured interview. Blood samples were taken on the day of the interview. The levels of plasma adrenal corticotropic hormone (ACTH), cortisol, and beta-END were estimated as an index of the activity of the HPA-axis and pituitary beta-END.

RESULTS

Plasma ACTH and beta-END levels were significantly lower in females than males of all age and drinking category groups. Plasma cortisol levels were higher in 18- to 29-year-old female subjects compared with the 18- to 29-year-old male subjects. The plasma ACTH and beta-END levels were lower whereas plasma cortisol levels were higher in heavy drinkers than nondrinkers. This decrease in plasma ACTH and beta-END levels with heavy drinking was more pronounced in female than male subjects of the 30-44 and 45-60 age groups.

CONCLUSIONS

Chronic drinking, gender, and age influence the activity of the HPA-axis and pituitary beta-END, which in turn may influence drinking behavior.

The consequences of imbibing alcohol in the absence of adequate nutrition: the salt and water hypothesis

Alcohol can have an effect on almost every cell in the human body and it is becoming increasingly clear that when alcohol is consumed the prior nutritional status of the individual may be an important factor for long-term health. The salt and water hypothesis integrates the biochemical findings from the current alcohol literature and proposes a mechanism by which alcohol consumption prior to food intake may cause a transient alteration in the functioning of the hypothalamic-pituitary-adrenal axis due to an alcohol-induced impairment in electrolyte regulation.

The effect of a moderate level of white wine consumption on the hypothalamic-pituitary-adrenal axis before and after a meal

The nutritional status of the individual at the time of alcohol consumption may mediate the rate of alcohol absorption and metabolism, thus influencing the systemic effect of alcohol on the body. The aim in the present investigation was to assess the effect of moderate white wine consumption on the hypothalamic-pituitary-adrenal (HPA) axis under variable nutritional conditions. Seven males aged between 19 and 22 years participated in all aspects of the current investigation. The experimental procedure for the fasting trial required participants to ingest either 4 standard units of alcohol (40 g) or the equivalent amount of placebo over a 135-min period before consuming food for 45 min. Alternatively, in the feeding trial, food was consumed for 45 min prior to participants ingesting either 4 standard units of alcohol (40 g) or the equivalent amount of placebo over a 135-min period. Blood alcohol, salivary cortisol, and salivary dehydroepiandrosterone sulfate (DHEAS) levels were assessed at 45-min intervals during the 180-min experimental periods. The results demonstrated a significant alcohol-induced decrease in salivary cortisol irrespective of nutritional status and a significant decrease in salivary DHEAS when alcohol is consumed alone under fasting conditions only. It was concluded that moderate white wine consumption may promote a transient alteration in the functioning of the HPA axis.

Serum gamma-glutamyl transferase levels and blood pressure falls after alcohol moderation

Drinkers showing higher serum gamma-glutamyl transferase (GGT) levels tend to have higher blood pressure (BP), independent of the volume of alcohol consumed. To further evaluate the link between alcohol consumption and elevated serum GGT and BP, we observed BP, serum biochemical parameters, plasma pressor hormones and intraplatelet free calcium (Plt. [Ca2+]i) in 40 moderate drinkers who were composed of four categories of 10 each with or without hypertension (> or = 140/90 mmHg) or high serum GGT level (> or = 50 U/L) during four-week alcohol moderation. BP and serum hepatic enzymes including GGT decreased more conspicuously in both normotensive and hypertensive drinkers with high serum GGT. Serum triglyceride was higher and potassium was lower in the drinkers with high serum GGT, and were normalized during alcohol moderation. Serum calcium, Plt. [Ca2+]i and plasma renin activity and cortisol showed some decreases during alcohol moderation, but were not different in the drinkers with different serum GGT and BP levels. No significant changes were observed in plasma catecholamines and aldosterone. These results suggest that BP elevations in moderate drinkers are closely related to hepatic, lipid and electrolyte metabolic alterations induced by alcohol rather than specific pressor agents.

Influence of alcohol on the hydromineral hormone responses to exercise in a warm environment

Alcohol consumption at rest is associated with disturbed water and salt regulation reflected by changed responses in the hydromineral hormones. This study investigated the effect of alcohol on endocrine systems involved in body fluid and electrolyte regulation under conditions of physical exercise in the heat, a situation in which under normal circumstances, the hydromineral hormones are stimulated in an attempt to preserve physiological homeostasis. Eight healthy male volunteers participated in two trials, which differed only in the presence or absence of alcohol (1.2 g alcohol.kg-1 body mass) in a cocktail drink. After consuming the cocktail, the subjects exercised for 60 min on a cycle ergometer (45% maximal oxygen consumption) at 35 degrees C. Compared to the control situation alcohol consumption (maximal plasma concentrations reaching about 1.08 g.l-1) produced an increase in body fluid loss (P < 0.05), but did not induce significant differences in plasma volume changes. Plasma volume decreased in both sessions during exercise (P < 0.01) and a significant rebound (P < 0.001) occurred during recovery. Osmolality was significantly higher (P < 0.001) during rest, exercise and recovery periods compared to the placebo trials, but no effect of alcohol on plasma Na+ and K+ concentrations was observed. In the alcohol test conditions, the arginine vasopressin (AVP) response to exercise was significantly dampened (P < 0.05). In contrast, alcohol had no effect on aldosterone or atrial natriuretic peptide (ANP). These results demonstrated that alcohol ingestion augmented body fluid losses due to a suppressive effect on AVP during physical exercise conducted in a warm environment. The increase in osmolality due to alcohol did not influence the aldosterone and ANP responses, which would suggest that total osmolality does not play a major role in the regulation of these hormones.

Interaction of acetaldehyde with plasma proteins of the renin-angiotensin system

Chronic alcohol abuse may lead to hypertension by stimulating the activity of the renin angiotensin system (RAS). While there are reports on the alcohol associated increase of angiotensin II in rats and increases of plasma renin activity in rats and human alcoholics, the exact mechanisms of stimulation of the RAS activity is not clear. This study provides evidence for a biochemical interaction of acetaldehyde, the primary oxidative metabolite of ethanol, upon bilaterally nephrectomized (NEPEX) rat plasma that contains significant quantities of angiotensinogen and lacks active renin. Rat plasma served as the source of renin in this study. Preincubation of NEPEX plasma with 0.2 M acetaldehyde at 4 degrees C for 2 h resulted in a 21% increase in the angiotensin I (A I) formation by the rat plasma renin and 27% increase in the A I formation by the trypsinized rat plasma renin. When the rat plasma which contains modest quantities of endogenous angiotensinogen in addition to renin was preincubated with 0.2 M acetaldehyde at 4 degrees C for 2 h, the rate of A I formation was increased by 10%. Equivalent amounts of ethanol did not modify the rate of A I generation when added to NEPEX plasma or rat plasma. These results suggest the possibility of a biochemical interaction of acetaldehyde with the renin substrate which may enhance the activity of the RAS cascade, thereby contributing to hypertension in chronic alcoholics.

Hormonal derangements in patients with severe alcohol intoxication

Controversial results of fluid and electrolyte derangements in patients with moderate alcohol intoxication have been described. However, no information is available about severe alcohol intoxication. We investigated differences of hormonal disorders between alcohol-habituated and alcohol-naive subjects with severe ethanol intoxication. The hormonal derangements and recommendations on therapy of these patients are discussed. Thirty-three patients [10 alcohol-naive (group A) and 23 alcohol-habituated (group B) subjects] with severe alcohol intoxication (blood ethanol > 200 mg/dl) were selected for the study. Electrolytes and osmolarity of serum and urine, blood ethanol, vasopressin, renin, and aldosterone were determined on admission 2, 4, and 6 hr later. Fluid balance was calculated for each hour. All patients received isotonic saline solution according to urine production. Group A: On admission, serum osmolarity was increased (308 mOsmol/kg). Concomitantly, vasopressin level was elevated on admission (9.12 pg/ml). Increased serum osmolarity was correlated with elevated vasopressin levels (r = 0.8211; p < 0.005). Serum electrolytes, renin, and aldosterone values were within normal ranges. Group B: On admission, vasopressin level was significantly decreased (0.9 pg/ml), despite an elevated serum osmolarity (309 mOsmol/kg). Serum osmolarity remained high despite a sufficient fluid substitution. In addition, vasopressin level remained suppressed over the observation period. Aldosterone level was significantly increased on admission (319 ng/ml). Accordingly, serum sodium was increased from 142 to 148 mM/liter, and serum potassium was decreased from 3.9 to 3.4 mM/liter. Response to hyperosmolarity due to severe alcohol intoxication is different in alcohol-naive and alcohol-habituated subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain angiotensin receptor subtypes in the control of physiological and behavioral responses

This review summarizes emerging evidence that supports the notion of a separate brain renin-angiotensin system (RAS) complete with the necessary precursors and enzymes for the formation and degradation of biologically active forms of angiotensins, and several binding subtypes that may mediate their diverse functions. Of these subtypes the most is known about the AT1 site which preferentially binds angiotensin II (AII) and angiotensin III (AIII). The AT1 site appears to mediate the classic angiotensin responses concerned with body water balance and the maintenance of blood pressure. Less is known about the AT2 site which also binds AII and AIII and may play a role in vascular growth. Recently, an AT3 site was discovered in cultured neoblastoma cells, and an AT4 site which preferentially binds AII(3-8), a fragment of AII now referred to as angiotensin IV (AIV). The AT4 site has been implicated in memory acquisition and retrieval, and the regulation of blood flow. In addition to the more well-studied functions of the brain RAS, we review additional less well investigated responses including regulation of cellular function, the modulation of sensory and motor systems, long term potentiation, and stress related mechanisms. Although the receptor subtypes responsible for mediating these physiologies and behaviors have not been definitively identified research efforts are ongoing. We also suggest potential contributions by the RAS to clinically relevant syndromes such as dysfunctions in the regulation of blood flow and ischemia, changes in cognitive affect and memory in clinical depressed and Alzheimer's patients, and angiotensin's contribution to alcohol consumption.

Reduction of voluntary alcohol consumption in the rat by transplantation of hypothalamic grafts

Stimulation of the peripheral renin-angiotensin system has been shown previously to decrease the voluntary intake of ethanol in the rat. The existence of a separate brain renin-angiotensin system, independent from that of the periphery, has been widely demonstrated. The brain renin-angiotensin system plays an important role in the regulation of water and electrolyte balance and neuroendocrine function. However, the role played by this system in the regulation of voluntary alcohol consumption has not yet been studied. The goal of the present work was to assess the feasibility of decreasing the voluntary alcohol intake in a strain of rats (Rapp SS/Jr rats) that have a genetic deficiency responsible for a low activity of the renin-angiotensin system and elevated alcohol intake. Adult Rapp SS/Jr rats received intraventricular transplants of fetal hypothalamic grafts (from normal donors), known to contain angiotensin-immunoreactive cell bodies. Our studies revealed that angiotensin-immunoreactivity in the cell bodies and fibres in the paraventricular, supraoptic and suprachiasmatic nuclei of the hypothalamus in Rapp SS/Jr rats was markedly reduced. Animals that had surviving grafts containing angiotensin-immunoreactive cell bodies in the dorsal third ventricle--but not in the ventral third ventricle, in the lateral ventricles, or sham operated animals--had a 40% decrease of their voluntary alcohol intake, when compared to their intake before surgery, or to the control group. However, water consumption was not reduced in both the sham and transplanted animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Regulation of alcohol consumption by the renin-angiotensin system: a review of recent findings and a possible mechanism of action

The renin-angiotensin system has traditionally been associated with the regulation of fluid and electrolyte balance. In this review we summarize the data which ascribes a completely new function to this system, i.e., the regulation of alcohol consumption. In addition, we suggest a possible mechanism for this effect based on the concept of a satiety or stop process. The approach taken was to examine the effect on alcohol intake of a wide variety of drug, genetic, dietary, surgical and neurosurgical manipulations, each of which has a range of biological effects characteristic of that manipulation, but all of which share the common property of altering activity in the renin-angiotensin system. The effect of these manipulations on alcohol intake was most parsimoniously explained by reference to their ability to raise or lower activity in the renin-angiotensin system. Any intervention which modulates activity in this system, either directly or indirectly, is likely to have consequences for alcohol consumption.

A possible role of atrial natriuretic peptide in ethanol-induced acute diuresis

The acute effects of ethanol on plasma atrial natriuretic peptide levels were investigated in 4 clinically healthy males, aged 24-26 years, consumed either 750 ml of water as a control study, or the same beverage with 1 ml/kg alcohol added, which increased the plasma alcohol concentration to 99.12 +/- 15.10 mg/dl at 60 min. Plasma atrial natriuretic peptide levels were significantly higher in the alcohol study compared to the control study at each time point (10, 20, 30, 60, 120 min after drinking onset), and with a peak at 10 min. Atrial natriuretic peptide levels showed a positive significant correlation with plasma antidiuretic hormone in the control group, while no relationship was found between the two peptides in the alcohol study. Moreover, a significant correlation exists between plasma atrial natriuretic peptide levels and systolic arterial blood pressure, and heart rate, and between the variations in atrial natriuretic peptide values and the variations in plasma sodium, serum ethanol, and plasma osmolality in the alcohol study. Acute ethanol intake causes an increase in urinary volume, and a decrease in urinary potassium excretion and urinary osmolality, and no change in urinary sodium excretion. These data suggest that acute ethanol administration causes a rapid increase in plasma levels of atrial natriuretic peptide, which could be an important factor of ethanol-induced diuresis. The main mechanisms for increased atrial natriuretic peptide release from atria after acute ethanol ingestion seem to be atrial stretch, due to the increase in arterial blood pressure, in heart rate, in sympathetic tone, and in plasma osmolality, and to a direct secretory effect by antidiuretic hormone.

Methionine lowers circulating levels of acetaldehyde after ethanol ingestion

Methionine, administered to ethanol treated mice and rats, significantly reduced circulating acetaldehyde levels without altering circulating levels of ethanol. Hepatic levels of acetaldehyde were also lowered by methionine. Methionine was effective when given prior to or after the administration of ethanol, but the time course of the action of methionine suggested the necessity for metabolic transformation of this amino acid in order for the acetaldehyde-lowering effect to be evidenced. Studies with humans, given methionine doses of approximately one-tenth of those used with mice, indicated that methionine can also lower acetaldehyde in humans ingesting ethanol. Given the toxic characteristics of acetaldehyde, methionine may prove effective in reducing the damaging effects of ethanol ingestion.

24-hour pulsatile and circadian patterns of cortisol secretion in alcoholic men

Pulsatile and circadian patterns of cortisol secretion during acute (3 to 16 days) and chronic (29 to 39 days) abstinence were examined in alcoholic men with no clinical or laboratory evidence of hepatic dysfunction or nutritional deficiencies. Mean and integrated 24-hour serum concentrations of cortisol determined by sampling the blood every 20 minutes over a 24-hour period were increased in six out of 10 alcoholic subjects during acute abstinence when compared with normal controls. Sustained abstinence in seven subjects with follow-up studies caused significant decreases in the mean maximal cortisol peak amplitude (13 +/- 1.0 SEM acutely vs. 10.3 +/- 0.52 micrograms/dl follow-up; P = 0.01), mean 24-hour serum cortisol concentrations (10.9 micrograms/dl +/- 1.2 vs. 8.5 micrograms/dl +/- 0.26; P = 0.047), interpulse valley mean (9.3 micrograms/dl +/- 0.88 vs. 6.5 micrograms/dl +/- 0.34; P = 0.007), and valley nadir (7.9 micrograms/dl +/- 0.69 vs. 5.4 micrograms/dl +/- 0.30; P = 0.0036) concentrations. Cortisol pulse frequency was normal. Although circadian cortisol rhythmicity was maintained in alcoholics, the timing of the circadian acrophase was delayed significantly (P = 0.006) during acute abstinence (1022 [clocktime] +/- 34 min) as compared with normal controls (0743 [clocktime] +/- 34 min), and the amplitude of circadian cortisol rhythms exceeded normal in five of 10 alcoholics. Analysis of data in one alcoholic subject by a new multiparameter deconvolution method demonstrated increases in secretory burst amplitude (0.64 microgram/dl +/- 0.08 SD), mass of cortisol released per burst (9.8 micrograms/dl +/- 1.2 SD), and daily endogenous cortisol production rate (22 mg +/- 2.4 SD) during acute abstinence. These values were statistically different when compared with seven normal controls and the subjects' values during sustained abstinence (P less than 0.02). In conclusion, the results of the present study suggest increased daily production of cortisol as a possible mechanism underlying the elevated serum cortisol concentrations in chronic alcoholics during acute abstinence. This abnormality is shown to be reversible with sustained abstinence from alcohol.

Ethanol as a reinforcer for rats: factors of facilitation and constraint

This review examines some particular approaches that have been used to investigate factors that facilitate or constrain the self-administration of ethanol by rats. A technique for increasing ethanol self-administration in rats, the prandial drinking method, was examined and the effect of body-weight reduction on drug intake was discussed. Emphasis was placed on how ethanol intake may be controlled by processes in addition to the direct pharmacological actions of the drug in the CNS. These processes may be physiological. Evidence was presented for a relationship between activity in the renin-angiotensin system and the self-administration of ethanol. These processes may also be environmental. Using the place-conditioning technique, demonstrations were presented of how the context or situation in which ethanol is experienced may determine whether preference or aversion for the drug develops. Such a diversity in the factors that can potentially control ethanol intake may complicate the identification of the causes of alcohol abuse, but this same diversity also holds out greater hope that manipulations may be found to reduce excessive drinking in humans.

Voluntary alcohol intake is attenuated in two-kidney, one-clip, but not in one-kidney, one-clip Goldblatt hypertensive rats

Voluntary alcohol intake was examined in two models of renovascular hypertension known to differ in their effects on the renin-angiotensin system. In experiment 1, Two-Kidney, One-Clip (renin-dependent) hypertensive rats (T-K,O-C) or their sham operated controls were offered limited access to alcohol for 1 hr each day. Over a four week period the T-K,O-C rats drank significantly less 3% and 6% (w/v) alcohol solution than the sham operated controls. In experiment 2, One-Kidney, One-Clip (renin-independent) hypertensive rats or their sham operated controls were offered alcohol on a similar limited access basis. Over a four week period, the O-K,O-C rats did not show a reduction in the intake of either a 3% or 6% alcohol solution compared to the sham operated controls. These results provide further documentation for the role of the renin-angiotensin system in modulating alcohol intake. The process by which this system might influence alcohol intake is outlined.

Angiotensin II reduces voluntary alcohol intake in the rat

The voluntary intake of alcohol has been shown to be attenuated by a variety of manipulations which increase activity in the renin-angiotensin system. In the present study we examined the effects of peripheral injections of the peptide angiotensin II on alcohol drinking. The peptide produced a dose-dependent decrease in alcohol intake with 20 micrograms/kg having little effect, 200 micrograms/kg reducing intake by approximately 50% and 1 mg/kg virtually abolishing all alcohol drinking. This decrease was not due to a peptide induced motor deficit, or state of sickness, and could also not be accounted for by the increased water intake, or by a change in pharmacokinetics and taste function. These data provide direct evidence that angiotensin II can modulate voluntary alcohol drinking. The possibility that the level of angiotensin II serves as a satiety signal in alcohol drinking is discussed.

Alcohol satiety, hypertension and the renin-angiotensin system

Evidence is presented which supports the hypothesis that the renin-angiotensin (r-a) system regulates alcohol intake. Documented findings suggest that an elevated level of r-a activity represents a satiety signal which stops alcohol intake. The fact that alcohol itself is known to stimulate r-a activity suggests that its intake may in some sense be self-regulating and that levels of r-a activity below those which signal satiety may even be rewarding. The role of the r-a system in hypertension is also considered. The ability of alcohol to elevate r-a activity may be seen as a contributing factor to alcohol-induced hypertension because angiotensin is a potent pressor agent. Furthermore, the notion that lower levels of angiotensin may be rewarding permits the hypothesis that essential hypertension may, in part, be the result of a self-induced increase in endogenous angiotensin. This would explain the otherwise puzzling utility of the angiotensin converting enzyme inhibitors in the treatment of essential hypertension.

Alcohol consumption, blood pressure, lipids, and cardiovascular mortality

Interest in the effects of alcohol on cardiovascular risk factors and disease has increased sharply with reports of complex and previously unsuspected associations. The present report focuses on the associations of alcohol with blood pressure, lipids, and cardiovascular disease mortality. The epidemiological evidence to date appears to support the idea that moderate alcohol consumption, defined as two drinks a day or less, may offer some protection for coronary heart disease, but that higher levels of alcohol promote hypertension and are directly toxic to the heart, leading to stroke, arrhythmias, cardiomyopathy, and perhaps even coronary heart disease.

Alcohol and blood pressure: a social comparison in Zimbabwe

The blood pressures of 252 men and 250 women, living in both urban and rural Zimbabwe, were measured on three separate occasions. Food and alcohol intakes were determined using a 3-day weighed diet survey checked by means of a detailed interview. Anthropometric data were also collected. No relationship was found between mean blood pressures and the alcohol intake for any socioeconomic group. Using only the first of the three blood pressure measurements, a correlation between systolic pressure and alcohol intake was found for white males (r = 0.234, P less than 0.05), and just missed statistical significance (r = 0.156, P = 0.065) for black middle class males. No relationship was found between blood pressure and alcohol consumption for black working class males, or for females. Epidemiological evidence suggests that alcohol consumption is associated with increased blood pressure. However, a convincing physiological mechanism is lacking. It is suggested that psychological factors may be partly responsible for this relationship.

Interactive roles of monovalent and divalent cations in pathogenesis of hypertension caused by alcohol

Subjects whose daily alcohol intake varied from less than 22 g to over 88 g were studied. They differed in their mean systolic and diastolic blood pressures compared with those of controls who were teetotallers. The association between alcohol consumption and blood pressure was independent of age. Ex-alcohol users who were much older than current alcohol users had lower systolic and diastolic blood pressures. The association of body mass index with sustained raised blood pressure was apparent. When body mass index was eliminated as a variable there was an appreciable residual effect on mean arterial pressure. Alcohol users and controls did not differ in mean plasma sodium concentration. Red blood cell intracellular sodium concentration, however, was higher in beer drinkers than in controls. On the other hand, red blood cell intracellular concentration of magnesium in beer drinkers was decreased. It is suggested that definite interactions between sodium, magnesium, and calcium ions may have some vital roles in the sustained rise in blood pressure in alcohol users.

The pressor and metabolic effects of alcohol in normotensive subjects

Changes in blood pressure, pulse rate, and plasma catecholamines, renin activity, cortisol, and calcium were studied in 16 normotensive subjects (eight with a family history of hypertension) for 5 hours following ingestion of alcohol-free and alcohol-loaded beer. Both systolic and diastolic blood pressure rose after alcohol consumption; maximum responses occurred at peak blood alcohol concentrations and were significantly higher than those seen after placebo. Pulse rate was also significantly higher after alcohol ingestion and continued to rise throughout the study. There was no difference in the pressor response to alcohol between the groups with and without a family history of hypertension. No difference was found in plasma norepinephrine or epinephrine levels between alcohol and placebo phases. However, subjects with no family history of hypertension had significantly higher plasma norepinephrine levels (p less than 0.01) than did those with a family history during both the alcohol and placebo phases, although baseline blood pressures were not significantly different. Plasma epinephrine level was similar in both groups. Plasma renin activity was unchanged throughout, but plasma cortisol fell during both phases. Plasma calcium showed a small but significant fall with alcohol consumption in both groups (p less than 0.001). These results indicate that in normotensive subjects alcohol ingestion causes a rise in systolic and diastolic blood pressure that is not influenced by a family history of hypertension. This effect does not appear to be sympathetically mediated but may be due to a direct vasoconstrictor effect of alcohol, possibly with an alcohol-induced shift in intracellular calcium.

Elevations in plasma angiotensin II with prolonged ethanol treatment in rats

Chronic alcohol consumption frequently leads to hypertension in humans. While previous reports have implicated the renin-angiotensin system as a potential mediator of this effect, plasma angiotensin II (AII) levels were either not measured or yielded negative results. The present investigation noted significant elevations in circulating AII in rats intubated daily with ethanol (4 g/kg) for 50 days. Animals administered ethanol only once evidenced AII concentrations equivalent with water intubated controls. Radioligand binding assay data indicated no differences in the number or affinity of Sar1,Ile8-AII binding sites in the thalamus, septum-anterior ventral third ventrical region or adrenal gland comparing those groups chronically treated with ethanol to water intubated controls. These results may support a role for the vasoconstrictive hormone AII in the etiology of alcohol-induced hypertension.

Disorders of the serum electrolytes, acid-base balance, and renal function in alcoholism

This chapter reviews the disturbances of the serum sodium and potassium concentrations, acid-base imbalances, and acute renal dysfunction that are seen frequently in alcoholic patients. The hyponatremia common in decompensated cirrhotics is caused by an impairment of renal free water clearance and concomitant water ingestion. Excessive proximal renal tubular sodium reabsorption and nonosmotic vasopressin release underlie the defect in renal water excretion in cirrhosis. Restriction of water intake is the principal therapeutic measure for hyponatremia. Hypokalemia is common in alcoholics but when observed does not always represent true potassium depletion. Although most cirrhotics have a diminished total body potassium content, intracellular potassium concentration is usually normal. In some patients gastrointestinal and renal potassium losses and nutritional potassium deficiency may cause true potassium depletion. Respiratory and metabolic alkalosis are the acid-base disturbances seen most frequently in alcoholics. Acidosis is relatively uncommon and is usually due to renal insufficiency, lactic acid or keto-acid accumulation. Toxin ingestion (methanol, ethylene glycol, or isopropanol) may also cause severe acidosis. Rhabdomyolysis, common in severe alcoholism, may produce various electrolyte disturbances and acute renal failure. The prognosis for recovery is good although temporary dialysis may be necessary.

Alcohol and hypertension: implications from research for clinical practice

Despite the fact that recent epidemiological and laboratory studies appear to confirm that alcohol has an effect upon blood pressure, its impact has largely been ignored in clinical practice. This study was undertaken in an effort to answer four basic questions Is there an association between blood pressure and ethanol ingestion and if so is it causal or related to common genetic and/or environmental factors?; If an association exists, what is its likely physiological mechanism?; What additional studies are needed in order to further elucidate the relationship between alcohol and blood pressure?; What clinical recommendations, if any, are justified with our present state of knowledge?

Regional differences in stroke mortality and alcohol consumption in Japan

The relationship between alcohol consumption and stroke mortality in 1975 in 46 prefectures of Japan was investigated. This was done by adjusting salt intake and several socio-economic factors, i.e., the annual per capita income, the number of persons who received public aid, the number of tatamis (a Japanese traditional floor unit) per household, the unemployment rate, and the unmarried or divorce rate, using a stepwise multiple regression analysis. As dependent variables, the sex-specific and age-adjusted mortality for the middle-aged (35-59 years) and for all ages due to stroke were used. For men, alcohol consumption was significantly related to age-adjusted stroke mortalities for the middle-aged and for all ages independent of salt intake and several socio-economic factors. Alcohol consumption was more strongly related to age-adjusted stroke mortality for the middle-aged than for all ages. For women alcohol was weakly correlated with the stroke mortality of the middle-aged. Salt intake was significantly correlated with stroke mortality for women but not for men. Furthermore, the male: female ratios of the age-adjusted stroke mortality for the middle aged and for all ages were analyzed as well, because alcohol is mostly consumed by men in Japan, and it was expected that the sex ratios would be well correlated to alcohol consumption. The results were as expected. Therefore, it was suggested that the regional difference in stroke mortality in Japan may be explained in part by that of alcohol consumption.

Pressor effects of alcohol in normotensive and hypertensive subjects

The effects of acute alcohol consumption and abstinence on blood pressure were studied in normal healthy subjects and in non-drinking and regularly drinking hypertensive patients. All subjects drank alcohol (1 g/kg body weight daily) for 5 days then abstained for 5 days. There was no significant difference in blood pressure in normal subjects during and after alcohol ingestion. However, in hypertensive non-drinkers both systolic and diastolic pressures when standing were significantly higher during the period of alcohol intake; supine blood pressure was not significantly higher. In hypertensive patients who drank regularly, standing and supine systolic and diastolic blood pressures were significantly higher during the period of drinking.

Hypertension associated with alcohol withdrawal: assessment of mechanisms and complications

Two hundred and fifty-six consecutive alcoholics admitted for detoxification, but not having delirium tremens, were evaluated for hypertension. Thirty-three per cent (84) of the alcoholics had a blood pressure greater than or equal to 160/95 mm Hg on or within 72 hr of admission. In 71% (60 of 84) of alcoholics with hypertension, pressure elevation was transitory, whereas 29% (24 of 84) required therapy. After 4 to 5 days of abstinence, alcoholics with transitory hypertension, whose blood pressure was no longer elevated, had a larger increment of pressure (p less than 0.001) with a cold pressor test than did normotensive alcoholics. Hypertensive alcoholics were older and tended to use greater amounts of alcohol, but their liver enzymes, alcohol levels on admission, and serum magnesium concentrations did not distinguish them from normotensive alcoholics. Basal plasma renin activity and epinephrine were elevated in both hypertensive and normotensive alcoholics, whereas plasma norepinephrine was normal. Although plasma renin activity (4.08 +/- 0.9 vs. 2.88 +/- 0.4 ng/ml/hr) and epinephrine (138 +/- 17 vs. 108 +/- 28 pg/ml) were higher in alcoholics with hypertension than in normotensive alcoholics, differences were not significant. However, elevated plasma epinephrine was found in 86% of alcoholics with hypertension, whereas only 44% of normotensive subjects had elevations (chi 2 = 5.49; p = 0.01). Although alcoholics with hypertension demonstrated an exaggerated catecholamine response with the cold pressor test, these changes per se did not explain the elevations in blood pressure. Thus, a transitory, reactive form of hypertension associated with increased catecholamines and vascular hyperresponsiveness is present in alcoholics.

Modification of ethanol-induced motor impairment by diet, diuretic, mineralocorticoid, or prostaglandin synthetase inhibitor

Ethanol-induced motor impairment in rats was measured following a number of different dietary or drug treatments. A low sodium diet combined with injections of the diuretic furosemide, but not a low sodium diet alone, increased motor impairment while a high sodium diet decreased impairment. Blood ethanol measurements indicated that both effects were probably mediated by changes in blood ethanol levels. However, the synthetic mineralocorticoid, DOCA, and the nonsteroidal anti-inflammatory, indomethacin, both altered ethanol-induced motor impairment without concomitant changes in blood ethanol levels. The aldosterone antagonist, spironolactone, failed to produce any effect. Since all treatments can modulate activity in the renin-angiotension system, this system appears to play a role in altering some of the behavioral properties of ethanol.

Alcohol use and hypertension. Clinical considerations and implications

Alcohol abuse is a more frequent contributor to hypertension than is generally appreciated. Although hypertension is transitory in most alcoholics and may not be evident after a short period of abstinence, it is potentially dangerous. Paroxysms of hypertension might result in target-organ damage. Hypertension may be the causal link to the increased incidence of stroke and coronary heart disease observed in problem drinkers as well as a contributor to the pathogenesis of alcoholic cardiomyopathy. Because of its transitory nature, however, alcohol-associated hypertension may, regrettably , be dismissed as inconsequential. Thus, a major potential cause of cardiovascular morbidity may go untreated.

The effect of a non-selective lipophilic beta-blocker on the blood pressure and noradrenaline, vasopressin, cortisol and renin release during alcohol withdrawal

Alcoholics during detoxification have elevated blood pressures which are related to the severity of their withdrawal symptoms. We studied the effect of a non-selective beta-blocker, timolol on symptoms, blood pressure and plasma levels of cortisol (PC), noradrenaline (NA), vasopressin (AVP) and renin activity (PRA) during alcohol withdrawal. Eighteen alcoholics, admitted for detoxification, were randomly allocated to timolol or placebo in a double blind trial. Alcohol withdrawal symptoms did not differ either before or after timolol or placebo but patients receiving timolol required less sedation with chlormethiazole. Systolic blood pressures (SBP) and pulse both fell significantly during detoxification in both groups, the change being greater with timolol. Plasma levels of cortisol, NA, AVP and PRA fell significantly, though only NA and PC correlated with initial SBP. Timolol had no effect on any of the biochemical parameters observed. The pressor response to alcohol withdrawal is reduced by beta-blockade and the height of the blood pressure is related to plasma NA and PC levels. Alcohol withdrawal hypertension is probably due to increased sympathetic activity.

Alcohol intake and hypertension among urban and rural Japanese populations

A significant positive relationship was found between alcohol intake and blood pressure for men 40-69 years old living in urban Osaka (492 men) and in rural Akita (395 men), Japan, surveyed from 1975 to 1977. Both mean blood pressure and the prevalence of hypertension were related to alcohol intake in a graded fashion. Stepwise multiple regression also showed that both systolic and diastolic pressure were associated with alcohol intake independent of ponderosity index, serum cholesterol, triglycerides, hemoglobin, uric acid, smoking, and age. This cross-sectional study indicates a continuous--and not a threshold--relationship between alcohol and blood pressure, with the effect of even moderate consumption, e.g. 28-55 g per day (equivalent to about 2-4 U.S. drinks per day).

The effects of alcohol on blood pressure and electrolytes

The interaction between alcohol abuse, changes in blood pressure, and electrolyte abnormalities is complex. Some effects of alcohol are seen only with acute ingestion, some during withdrawal, and some only in chronic drinkers. Careful attention to the interactions between the metabolism of various electrolytes can prevent unnecessary morbidity and mortality in alcoholic patients.

Relation of alcohol and cigarette consumption to blood pressure and serum creatinine levels

From the records of an automated multi-phasic health testing centre, daily drinkers in four alcohol consumption groups were each separately matched for sex, age and obesity to a single non-drinker control. All subjects satisfied strict eligibility criteria selected to exclude the effects of other factors known to influence blood pressure or renal function or both. The 5500 pairs of subjects were compared for systolic and diastolic blood pressure and serum creatinine. After allowing for smoking, drinkers had significantly elevated blood pressure compared with their controls, and the elevation was greater the heavier the alcohol intake, except for the heaviest drinking females. This result was more pronounced in males than females, and for systolic than diastolic blood pressure. By contrast, smoking cigarettes was shown to be associated with lower blood pressure, independent of sex and drinking history. Smoking was also associated with a decreased serum creatinine concentration as was drinking three or more drinks per day. However, drinkers of two or fewer drinks daily had higher serum creatinine concentrations than their non-drinker controls.