Alcohol consumption and the incidence of hypertension: The Atherosclerosis Risk in Communities Study

Causal validation between 179 lipids and hyperparathyroidism: A bidirectional Mendelian randomization combined meta-analysis with mediation factors

Hyperparathyroidism, an endocrine disorder linked to hypercalcemia, increases with age, particularly in those over 60. Abnormal lipid metabolism may be closely related to its occurrence and progression. The study used Mendelian randomization (MR) analysis on 179 lipid traits against hyperparathyroidism in the Finngen and UK Biobank (UKB) databases. Meta-analysis of inverse variance weighted results followed, with significance P-values corrected for multiple comparisons. Causal validation was performed between positive lipids and renal failure, and MR analysis examined the link between renal failure and hyperparathyroidism. Reverse causal validation was also conducted between lipids and hyperparathyroidism, positive lipids and renal failure, and renal failure and hyperparathyroidism. The study conducted causal validation between 179 lipid traits and hyperparathyroidism, also exploring intermediary factors. Ultimately, MR analysis was performed on triacylglycerol (52:3) levels with hyperparathyroidism in both Finngen and UKB databases, followed by meta-analysis and multiple corrections. The results showed an odds ratio (OR) of 1.147 (95% confidence interval [CI]: 1.065-1.235, P = .040). The MR results for triacylglycerol (52:3) levels and renal failure indicated an OR of 1.054 (95% CI: 1.004-1.106, P = .032). For the intermediary factor renal failure, MR analysis with hyperparathyroidism in both Finngen and UKB databases followed by meta-analysis showed an OR of 1.336 (95% CI: 1.193-1.495, P = 4.78 × 10-7). Notably, no significant associations were found in the reverse validation of each analysis process. Furthermore, the mediation effect was β12 = 0.0153, and the direct effect was β3 = 0.1207 (0.1183, 0.1230). The mediation effect accounted for 11.25%, while the direct effect accounted for 88.75% of the total effect, Z = 12.5, indicating that the direct effect predominantly influences the overall impact. The research shows that triacylglycerol (52:3) levels can directly increase the risk of hyperparathyroidism. It also raises the risk indirectly by increasing the likelihood of renal failure, an intermediary factor. About one-tenth of the lipid's effect on hyperparathyroidism is mediated through renal failure, while the direct effect constitutes roughly nine-tenths of the total effect.

Associations of high-density lipoprotein cholesterol, particles and subspecies with the risk of hypertension: findings from the PREVEND prospective study

OBJECTIVE

The prospective associations of high-density lipoprotein cholesterol (HDL-C), HDL particle (HDL-P) and subspecies concentrations with the risk of hypertension are uncertain. We aimed to evaluate the associations of HDL parameters with incident hypertension risk and their interplay with alcohol consumption in the PREVEND study.

METHODS

HDL parameters as measured by nuclear magnetic resonance spectroscopy and self-reported alcohol consumption were assessed in 3263 participants (mean age, 49 years; 45.8% males) without a history of hypertension at baseline. Multivariable-adjusted hazard ratios (HRs) with 95% CIs for hypertension per 1 standard deviation increment in HDL parameters were calculated.

RESULTS

During a median follow-up of 7.2 years, 825 participants developed hypertension. In analysis adjusted for several potential confounders, including alcohol consumption, there were inverse associations of HDL-C, HDL-P, medium HDL, HDL size, H3P and H4P with hypertension risk: HRs [95% confidence interval (CI) of 0.88 (0.81-0.97), 0.92 (0.86-0.99), 0.86 (0.80-0.93), 0.89 (0.82-0.98), 0.92 (0.85-0.98), and 0.87 (0.81-0.94), respectively]. Sex or alcohol consumption did not modify the associations of HDL parameters with hypertension risk. Compared with abstainers, the multivariable adjusted HRs (95% CI) of hypertension for occasional to light, moderate and heavy alcohol consumers were 0.84 (0.70-1.00), 0.83 (0.68-1.02), and 0.97 (0.69-1.37), respectively; the associations persisted on further adjustment for HDL parameters.

CONCLUSIONS

There are inverse associations of HDL-C, HDL-P, medium HDL, HDL size, H3P and H4P with hypertension risk, which are not confounded or modified by alcohol consumption. Light and moderate alcohol consumption is modestly and inversely associated with hypertension risk, independently of HDL parameters.

Trends in the Incidence of Hypertension Among Healthy Adults Across 6 Decades

OBJECTIVE

To determine long-term trends in the incidence of hypertension.

PATIENTS AND METHODS

Healthy adults in Olmsted County, Minnesota, from 1962 to 2012 were identified and studied with follow-up through 2024. One blood pressure (BP) reading for each calendar year (as available) through follow-up was identified. Hypertension was defined by BP ≥130/80 mm Hg or ≥140/90 mm Hg in 2 different calendar years or by use of antihypertensive medication. Analyses were adjusted for calendar period, age, sex, race, tobacco smoking, nontobacco substance use, depression/anxiety, dyslipidemia; family history of diabetes mellitus or hypertension, body mass index, systolic and diastolic BP, and fasting blood glucose level. Cumulative incidence estimates of hypertension accounted for death as a competing risk and were adjusted to characteristics of the 2000-2012 subcohort.

RESULTS

There were 8323 healthy adults studied (mean age, 39 years). Risk factors for hypertension were older age, male sex, Black race, past and current tobacco smoking, current substance use, depression/anxiety, family history of diabetes or hypertension, higher systolic and diastolic BP, higher blood glucose level, higher body mass index, and period. For the baseline periods of 1963-1969, 1970-1979, 1980-1989, 1990-1999, and 2000-2012, the adjusted 20-year cumulative incidence of hypertension defined by BP ≥130/80 mm Hg was 45%, 47%, 54%, 70%, and 67%; by BP ≥140/90 mm Hg was 22%, 24%, 26%, 35%, and 33%; and by medication use alone was 13%, 12%, 13%, 17%, and 19%, respectively.

CONCLUSION

A large increase in the incidence of hypertension among healthy adults occurred in the 1990s, with subsequent stabilization.

Additive interaction of conjoint tobacco smoking and heavy drinking on hypertension prevalence in rural Uganda: a community-based cross-sectional study

BACKGROUND

The prevalence of hypertension is high in Uganda, which places a significant burden on an already strained healthcare system. The behavioural risk factors, such as unhealthy diet, tobacco use, physical inactivity, and heavy drinking, contribute to hypertension development and complications. This study explored the associations of combined tobacco smoking and heavy alcohol consumption with existing hypertension in a community-based cross-sectional study conducted in two rural districts of Uganda.

METHODS

We analysed data collected between December 2018 and January 2019 from 4,372 adults aged 25-70 from 3,689 random households in the Mukono and Buikwe districts, Uganda. Using logistic regression, crude, and adjusted odds ratios were calculated to describe the associations between participant characteristics, smoking, drinking behaviours, and high blood pressure (HBP). To determine effect modification due to combined tobacco smoking and heavy drinking, the relative excess risk due to interaction (RERI) was computed. All analyses were performed via R programming software version 4.2.3.

RESULTS

HBP was prevalent in 23% of the participants. Smokers were 1.36 times more likely to have HBP than non-smokers (Crude OR, 1.36; 95% CI, 1.04-1.76). Compared with non-drinkers, moderate alcohol drinkers were 1.45 times more likely to have HBP (AOR, 1.45; 95% CI, 1.18-1.79), and heavy drinkers were 2.53 times more likely to have HBP (AOR, 2.53; 95% CI, 1.92-3.32). The RERI indicated an additive interaction effect between smoking and heavy drinking, with conjoint smokers and heavy drinkers having 45% higher odds of having HBP than the summation of the individual risk due to smoking and heavy drinking.

CONCLUSION

Tobacco smoke interacts with heavy alcohol consumption to increase the risk of increased blood pressure (BP) when it cooccurs. Integrated intervention strategies targeting both smoking and heavy drinking are essential for reducing the incidence of hypertension in rural Uganda.

Nonpharmacologic Management of Hypertension in Older Adults

Hypertension is ubiquitous among older adults and leads to major adverse cardiovascular events. Nonpharmacologic lifestyle interventions represent important preventive and adjunct strategies in the treatment of hypertension and have benefits beyond cardiovascular disease in this population characterized by a high prevalence of frailty and comorbid conditions. In this review, the authors examine nonpharmacologic interventions with the strongest evidence to prevent cardiovascular disease with an emphasis on the older adults.

Risk factor control and adherence to recommended Lifestyle among US hypertension patients

BACKGROUND

Although hypertension is a significant public health challenge globally, only a few studies have assessed the effectiveness of risk factor control and adherence to recommended lifestyle among United States hypertension patients.

METHODS

In this study, a detailed, stratified analysis of the 1999-2018 National Health and Nutrition Examination Survey was conducted to assess the adequacy of risk factor control and conformity to recommended lifestyle among United States patients with hypertension. Logistic regression analysis was used to identify influencing factors associated with not acheving risk factors and lifestyle targets.

RESULTS

A total of 21,770 participants (mean age, 62 ± 15 years) were enrolled in this study. About one in five (20%) participants achieved the recommended body mass index goal, 40% achieved the low-density lipoprotein cholesterol goal, and 30% achieved the recommended waist circumference. Most patients (80%) achieved the recommended smoking goal, 58% met the recommended alcohol consumption, and 19% achieved the recommended physical activity goal. Multivariate analysis demonstrated that age, gender, race, education, metabolic syndrome, and diabetes mellitus were independent predictors of not achieving risk factors and lifestyle targets.

CONCLUSIONS

Controlling risk factors and adherence to recommended lifestyles are not ideal for hypertension patients. Therefore, further research should assess how to improve the compliance rate and take targeted measures based on influencing factors for long-term prognosis.

Prevalence and Characteristics of Isolated Nighttime Masked Uncontrolled Hypertension in Treated Patients

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH.

Alcohol Intake and Risk of Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Nonexperimental Cohort Studies

BACKGROUND

Alcohol consumption has been associated with higher blood pressure and an increased risk of hypertension. However, the possible exposure thresholds and effect-modifiers are uncertain.

METHODS

We assessed the dose-response relationship between usual alcohol intake and hypertension incidence in nonexperimental cohort studies. After performing a systematic literature search through February 20, 2024, we retrieved 23 eligible studies. We computed risk ratios and 95% CI of hypertension incidence using a nonlinear meta-analytic model based on restricted cubic splines, to assess the dose-response association with alcohol consumption.

RESULTS

We observed a positive and almost linear association between alcohol intake and hypertension risk with risk ratios of 0.89 (0.84-0.94), 1.11 (1.07-1.15), 1.22 (1.14-1.30), and 1.33 (1.18-1.49) for 0, 24, 36 and 48 g/d, respectively, using 12 g alcohol/d as the reference value. In sex-specific analyses, the association was almost linear in men over the entire range of exposure but only observed above 12 g/d in women, although with a steeper association at high levels of consumption compared with men. The increased risk of hypertension above 12 to 24 g alcohol/d was similar in Western and Asian populations and considerably greater in White than in Black populations, mainly due to the positive association in women at moderate-to-high intake.

CONCLUSIONS

Overall, our results lend support to a causal association between alcohol consumption and risk of hypertension, especially above an alcohol intake of 12 g/d, and are consistent with recommendations to avoid or limit alcohol intake. Sex and ethnicity appear to be major effect-modifiers of such association.

Screening for hypertension in adults: protocol for evidence reviews to inform a Canadian Task Force on Preventive Health Care guideline update

PURPOSE

To inform updated recommendations by the Canadian Task Force on Preventive Health Care on screening in a primary care setting for hypertension in adults aged 18 years and older. This protocol outlines the scope and methods for a series of systematic reviews and one overview of reviews.

METHODS

To evaluate the benefits and harms of screening for hypertension, the Task Force will rely on the relevant key questions from the 2021 United States Preventive Services Task Force systematic review. In addition, a series of reviews will be conducted to identify, appraise, and synthesize the evidence on (1) the association of blood pressure measurement methods and future cardiovascular (CVD)-related outcomes, (2) thresholds for discussions of treatment initiation, and (3) patient acceptability of hypertension screening methods. For the review of blood pressure measurement methods and future CVD-related outcomes, we will perform a de novo review and search MEDLINE, Embase, CENTRAL, and APA PsycInfo for randomized controlled trials, prospective or retrospective cohort studies, nested case-control studies, and within-arm analyses of intervention studies. For the thresholds for discussions of treatment initiation review, we will perform an overview of reviews and update results from a relevant 2019 UK NICE review. We will search MEDLINE, Embase, APA PsycInfo, and Epistemonikos for systematic reviews. For the acceptability review, we will perform a de novo systematic review and search MEDLINE, Embase, and APA PsycInfo for randomized controlled trials, controlled clinical trials, and observational studies with comparison groups. Websites of relevant organizations, gray literature sources, and the reference lists of included studies and reviews will be hand-searched. Title and abstract screening will be completed by two independent reviewers. Full-text screening, data extraction, risk-of-bias assessment, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be completed independently by two reviewers. Results from included studies will be synthesized narratively and pooled via meta-analysis when appropriate. The GRADE approach will be used to assess the certainty of evidence for outcomes.

DISCUSSION

The results of the evidence reviews will be used to inform Canadian recommendations on screening for hypertension in adults aged 18 years and older.

SYSTEMATIC REVIEW REGISTRATION

This protocol is registered on PROSPERO and is available on the Open Science Framework (osf.io/8w4tz).

Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study

BACKGROUND

The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts.

METHODS

This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg).

RESULTS

Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P = .006, 95% CI (1.178-2.665)], [RR = 1.772, P = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P = .034, 95% CI (1.072-5.738)].

CONCLUSION

Alcohol consumption is significantly related to increase BP regardless of HIV infection.

Alcohol use patterns and hypertension among adults in the United States: findings from the 2015-2016 NHANES data

OBJECTIVES

This study assessed the association between alcohol use patterns and the prevalence of hypertension.

STUDY DESIGN

Data on alcohol use patterns and hypertension among 5918 adults from the 2015-2016 National Health and Nutrition Examination Survey was used for this study.

METHODS

The association of alcohol use patterns; "ever-used alcohol", "binge drinking", "heavy drinking", and "everyday alcohol use" with hypertension were assessed using multivariable-adjusted logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) at a two-sided P < 0.05.

RESULTS

Overall, the mean age of respondents was 48.3 ± 18.5 years, 50.9% (n = 3034) were women, and 44.6% (n = 2132) were hypertensive. Also, 85.9% (n = 4177) had used alcohol in their lifetime, 51.9% (n = 1764) were heavy drinkers, 25.1% (n = 370) engaged in binge drinking, and 17.7% (n = 721) reported everyday alcohol use. Compared to those that have never used alcohol, the aOR (95%CI) of stage II hypertension was 1.570 (1.565, 1.575) for overall alcohol use, 1.370 (1.367, 1.373) for everyday alcohol use, 1.127 (1.125, 1.129) for heavy drinking, and 1.092 (1.087, 1.098) for binge drinking. Among current active smokers, the aOR (95%CI) of stage II hypertension was aggravated for everyday alcohol use; 2.583 (2.576, 2.590).

CONCLUSION

Alcohol use patterns were associated with a higher prevalence of hypertension, particularly among smokers. A population-based longitudinal study should clarify whether these alcohol use phenotypes are predictive of hypertension at the population level in the United States.

Alcohol Intake and Blood Pressure Levels: A Dose-Response Meta-Analysis of Nonexperimental Cohort Studies

BACKGROUND

Alcohol consumption may increase blood pressure but the details of the relationship are incomplete, particularly for the association at low levels of alcohol consumption, and no meta-analyses are available for nonexperimental cohort studies.

METHODS

We performed a systematic search of longitudinal studies in healthy adults that reported on the association between alcohol intake and blood pressure. Our end points were the mean differences over time of systolic (SBP) and diastolic blood pressure (DBP), plotted according to baseline alcohol intake, by using a dose-response 1-stage meta-analytic methodology.

RESULTS

Seven studies, with 19 548 participants and a median follow-up of 5.3 years (range, 4-12 years), were included in the analysis. We observed a substantially linear positive association between baseline alcohol intake and changes over time in SBP and DBP, with no suggestion of an exposure-effect threshold. Overall, average SBP was 1.25 and 4.90 mm Hg higher for 12 or 48 grams of daily alcohol consumption, compared with no consumption. The corresponding differences for DBP were 1.14 and 3.10 mm Hg. Subgroup analyses by sex showed an almost linear association between baseline alcohol intake and SBP changes in both men and women, and for DBP in men while in women we identified an inverted U-shaped association. Alcohol consumption was positively associated with blood pressure changes in both Asians and North Americans, apart from DBP in the latter group.

CONCLUSIONS

Our results suggest the association between alcohol consumption and SBP is direct and linear with no evidence of a threshold for the association, while for DBP the association is modified by sex and geographic location.

A Systematic Review and Meta-analysis of the Clinical and Epidemiological Characteristics of Patients with Hypertensive Emergencies: Implication for Risk Stratification

INTRODUCTION

Acute severe elevation of blood pressure (BP) is a common clinical event, that can present as hypertensive emergency (HTNE) and hypertensive urgency (HTNU). HTNE results in life-threatening target organ damage, including myocardial infarction, pulmonary edema, stroke, and acute kidney injury. It is associated with high utilization of healthcare and increased cost. HTNU is high BP without acute serious complications.

AIM

The purpose of this review was to examine the clinical-epidemiological characteristics of patients with HTNE and propose a risk stratification framework to differentiate between the two conditions, since prognosis, setting of therapy and treatment is vastly different.

METHODS

Systematic review.

RESULTS

Fourteen full-text studies were included in this review. In comparison with HTNU, patients with HTNE had higher mean systolic (mean difference 2.413, 95% CI 0.477, 4.350) and diastolic BP (mean difference 2.043, 95% CI 0.624, 3.461). HTNE were more prevalent in men (OR 1.390, 95% CI 1.207, 1.601), older adults (mean difference 5.282, 95% CI 3.229, 7.335) and those with diabetes (OR 1.723, 95% CI 1.485, 2.000). Non-adherence to BP medications (OR 0.939, 95% CI 0.647, 1.363) and unawareness of hypertension diagnosis (OR 0.807, 95% CI 0.564, 1.154) did not elevate the risk of HTNE.

CONCLUSIONS

Systolic and diastolic BP are marginally higher in patients with HTNE. Given that these differences are not clinically significant, other epidemiological and medical characteristics (older age, male sex, cardiometabolic comorbidities) as well as patient's presentation should be considered to differentiate between HTNU and HTNE.

Development and validation of hypertension prediction models: The Korean Genome and Epidemiology Study_Cardiovascular Disease Association Study (KoGES_CAVAS)

This study aimed to develop and validate the hypertension risk prediction models of the CArdioVascular disease Association Study (CAVAS). Overall, 6,186 participants without hypertension at baseline were randomly divided into derivation and internal validation sets in a 6:4 ratio. We derived two prediction models: the first used the Framingham hypertension risk prediction factors (F-CAVAS-HTN); the second considered additional risk factors identified using stepwise Weibull regression analysis (CAVAS-HTN). These models were externally evaluated among Ansan and Ansung (A&A) participants, and the external validity of the Framingham and A&A prediction models (F-HTN and A&A-HTN) were assessed using the internal validation set of CAVAS. The discrimination, calibration, and net reclassification were determined. During the 4-year follow-up, 777 new cases of hypertension were diagnosed. All four models showed good discrimination (C-statistic ≥ 0.7). Internal calibrations were good for both the coefficient-based and the risk score-based F-CAVAS-HTN models, respectively (Hosmer-Lemeshow chi-square, H-L χ² < 20, P ≥ 0.05). However, the two CAVAS models (H-L χ² ≥ 20, P < 0.05, both) as well as the F-HTN and the A&A-HTN prediction models (H-L χ² = 155.39, P < 0.0001; H-L χ² = 209.72, P < 0.0001, respectively) were not externally calibrated. The F-CAVAS-HTN may be better than models with additional risk factors or derived for another population in the view of the findings of the internal validation in the present study, although future studies to improve the external validity of the F-CAVAS-HTN are needed.

The Association Between 24-Hour Blood Pressure Profiles and Dementia

Midlife hypertension increases risk for dementia. Around one third of adults have diagnosed hypertension; however, many adults are undiagnosed, or remain hypertensive despite diagnosis or treatment. Since blood pressure (BP) follows a circadian rhythm, ambulatory BP monitoring allows for the assessment of BP over a 24-hour period and provides an important tool for improving the diagnosis and management of hypertension. The measurement of 24-hour BP profiles, especially nocturnal BP, demonstrate better predictive ability for cardiovascular disease and mortality than office measurement. However, few studies have examined 24-hour BP profiles with respect to dementia risk. This is an important topic since improvements in BP management could facilitate the primary prevention of vascular cognitive impairment and dementia. Therefore, this review discusses the evidence linking BP to dementia, with a focus on whether the implementation of 24-hour BP measurements can improve risk prediction and prevention strategies. Pathways linking nocturnal BP to dementia are also discussed as are risk reduction strategies. Overall, limited research suggests an association between 24-hour BP elevation and poorer cognition, cerebral small vessel disease, and dementia. However, most studies were cross-sectional. Further evidence is needed to substantiate 24-hour BP profiles, over and above office BP, as predictors of vascular cognitive impairment and incident dementia.

Sclerostin, vascular risk factors, and brain atrophy in excessive drinkers

Objective

Heavy alcohol consumption causes several organic complications, including vessel wall calcification. Vascular damage may be involved in the development of brain atrophy and cognitive impairment. Recently, sclerostin (whose levels may be altered in alcoholics) has emerged as a major vascular risk factor. The objective of the present study is to analyze the prevalence of vascular calcifications in alcoholics, and the relationships of these lesions with brain atrophy, as well as the role of sclerostin on these alterations.

Patients and methods

A total of 299 heavy drinkers and 32 controls were included. Patients underwent cranial computed tomography, and several indices related to brain atrophy were calculated. In addition, patients and controls underwent plain radiography and were evaluated for the presence or absence of vascular calcium deposits, cardiovascular risk factors, liver function, alcohol intake, serum sclerostin, and routine laboratory variables.

Results

A total of 145 (48.47%) patients showed vascular calcium deposits, a proportion significantly higher than that observed in controls (χ² = 16.31; p < 0.001). Vascular calcium deposits were associated with age (t = 6.57; p < 0.001), hypertension (t = 5.49; p < 0.001), daily ethanol ingestion (Z = 2.18; p = 0.029), duration of alcohol consumption (Z = 3.03; p = 0.002), obesity (χ² = 4.65; p = 0.031), total cholesterol (Z = 2.04; p = 0.041), triglycerides (Z = 2.05; p = 0.04), and sclerostin levels (Z = 2.64; p = 0.008). Calcium deposits were significantly related to Bifrontal index (Z = 2.20; p = 0.028) and Evans index (Z = 2.25; p = 0.025). Serum sclerostin levels were related to subcortical brain atrophy, assessed by cella media index (Z = 2.43; p = 0.015) and Huckmann index (ρ = 0.204; p = 0.024). Logistic regression analyses disclosed that sclerostin was the only variable independently related to brain atrophy assessed by altered cella media index. Sclerostin was also related to the presence of vascular calcifications, although this relationship was displaced by age if this variable was also included.

Conclusion

Prevalence of vascular calcification in alcoholics is very high. Vascular calcium deposits are related to brain atrophy. Serum sclerostin is strongly related to brain shrinkage and also shows a significant relationship with vascular calcifications, only displaced by advanced age.

DNA Hypomethylation as a Potential Link between Excessive Alcohol Intake and Cardiometabolic Dysfunction in Morbidly Obese Adults

A large percentage of obese patients in the United States suffer a comorbid substance use disorder, mainly alcohol use. Alcohol consumption interferes with the absorption of dietary methyl donors such as folate required for the one-carbon metabolism pathway and subsequently for DNA methylation. In this study, we assessed the association between alcohol consumption and DNA methylation in obese subjects. We obtained visceral adipose tissue (VAT) biopsies from bariatric patients. DNA methylation of 94 genes implicated in inflammation and immunity were analyzed in VAT in relation to alcohol consumption data obtained via questionnaires. Vasoreactivity was measured in the brachial artery and the VAT-isolated arterioles. Pro-inflammatory genes were significantly hypomethylated in the heavy drinking category correlating with higher levels of circulating inflammatory cytokines. Alcohol consumption correlated positively with body mass index (BMI), fat percentage, insulin resistance, impaired lipid profile, and systemic inflammation and negatively with plasma folate and vitamin B12, inflammatory gene DNA methylation, and vasoreactivity. In conclusion, these data suggest that alcohol intake is associated with lower DNA methylation and higher inflammation and cardiometabolic risk in obese individuals.

Risk of hypertension and treatment on out-of-hospital cardiac arrest incidence: A case-control study

Hypertension (HTN) is a high risk factor for major cardiovascular adverse events. This study aimed to investigate the effect of HTN risk on out-of-hospital cardiac arrest (OHCA) incidence and determine whether the effect of HTN on OHCA incidence differs according to antihypertensive medication.This case-control study used the Korean Cardiac Arrest Resuscitation Consortium and Korean Community Health Survey (CHS). Cases were defined as emergency medical service-treated adult OHCA patients presumed to have a cardiac etiology from 2015 to 2017. Patients without information on HTN diagnosis were excluded from the study. The Korean CHS database's controls were matched at a 1:2 ratio with strata, including age, gender, and county of residence. Multivariable conditional logistic regression analysis was conducted to estimate HTN risk and antihypertensive treatment on OHCA incidence,A total of 2633 OHCA patients and 5266 community-based controls were enrolled in this study. Among them, 1176 (44.7%) patients and 2049 (38.9%) controls were diagnosed with HTN. HTN was associated with an increased risk of OHCA (adjusted odds ratio [AOR]: 1.19 [1.07-1.32]). On comparing HTN with or without the antihypertensive treatment group with the non-HTN-diagnosed group (as a reference), the HTN without treatment group had the highest AOR (95% confidence interval) (3.41 [2.74-4.24]). The AOR in the HTN treatment group was reduced to that in the non-HTN-diagnosed group (0.96 [0.86-1.08]).HTN increased OHCA risk, and the HTN without treatment group had the highest OHCA risk. Conversely, OHCA risk decreased to the non-HTN-diagnosed group level with HTN treatment.

Terapia Hormonal e Hipertensão em Mulheres na Pós-Menopausa: Resultados do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

Fundamento

A hipertensão arterial é considerada um importante fator de risco de morbidade e mortalidade cardiovascular em mulheres na pós-menopausa. Embora a terapia hormonal da menopausa (THM) seja um tratamento muito eficiente para sintomas vasomotores nesse período, a influência dessa terapia na pressão arterial ainda não está clara.

Objetivo

Avaliar a relação entre o uso de THM e a hipertensão em participantes do ELSA-Brasil.

Métodos

Um estudo transversal usando dados da linha de base da coorte ELSA-Brasil, com 2.138 mulheres que passaram por menopausa natural. Neste estudo, foi analisado a hipertensão, definida como pressão arterial ≥140/90 mmHg ou uso anterior de anti-hipertensivo, e o uso da THM, com participantes sendo classificadas em grupos daquelas que nunca usaram, que já usaram e que estavam em uso atual. As associações foram avaliadas usando-se um modelo de regressão logística multivariada com uma significância estatística definida em p<0,05.

Resultados

No total, 1.492 mulheres (69,8%) nunca tinham usado a THM, 457 (21,4%) tinham usado no passado, e 189 (8,8%) estavam em uso atual. O uso de THM foi mais comum em mulheres que tinham índice de massa corporal <25 kg/m² e níveis de triglicérides <150 mg/dl, que eram fisicamente menos inativas, não fumantes e não diabéticas. As mulheres em uso atual da THM apresentaram menores chances de ter hipertensão (OR=0,59; IC 95%: 0,41-0,85), em comparação com as que nunca a usaram. Na maioria dos casos, a THM foi iniciada com idade até 59 anos, com menos de 10 anos de menopausa e o uso durou até cinco anos.

Conclusão

O uso atual da THM não esteve relacionado à hipertensão, especialmente em mulheres saudáveis e que tinham menos de 60 anos de idade.

Prevalence of Hypertension and Related Characteristics: Perspectives from an Outpatient Podiatric Medical Clinic

BACKGROUND

Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting.

METHODS

A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure.

RESULTS

Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight (P = .022), stress level (P = .017), and presence of renal artery stenosis (P = .021). There was also a near-statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising (P = .068).

CONCLUSIONS

Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting.

Association between changes in facial flushing and hypertension across drinking behavior patterns in South Korean adults

Heavy alcohol drinking has been reported to be associated with hypertension. Moreover, when drinking alcohol, individuals may experience symptoms such as facial flushing. Therefore, this study aimed to examine the association between changes in facial flushing and hypertension across different drinking behavior patterns in South Korean adults. Data from the Korea Community Health Survey conducted in 2019 were used, and 118 129 (51 047 men and 67 082 women) participants were included. The participants were divided into five groups based on the change in facial flushing (non-drinking, non-flushing to non-flushing, flushing to flushing, non-flushing to flushing, flushing to non-flushing). The risk of hypertension in each facial flushing group was analyzed by multiple logistic regression. Men in the non-flushing to flushing group had a significantly higher association with hypertension than other groups (men: odds ratio (OR) 1.42, confidence interval (CI) 1.14-1.76). According to the level of alcohol use disorder, the non-flushing to flushing group showed a significantly increased odds of hypertension compared to all levels of drinking (men: mild drinking: OR 1.95, CI 1.40-2.71; moderate drinking: OR 2.02, CI 1.41-2.90; women: moderate drinking: OR 1.71, CI 1.16-2.52; heavy drinking: OR 1.90, CI 1.19-3.04). This study found a significant association between changes in facial flushing and hypertension among adults in South Korea. In particular, individuals who changed from non-flushing to flushing reactions had an increased association with hypertension than the other groups. Compared to people at the same drinking level, people with non-flushing to flushing reactions were highly associated with hypertension at moderate drinking level.

Association between Drinking Patterns and Incident Hypertension in Southwest China

Based on a prospective cohort study of adults from southwest China with heterogeneity in their demographical characteristics and lifestyles, we aimed to explore the association between drinking patterns and incident hypertension under the interaction of these confounding factors. The Cox proportional hazard model was used to estimate the hazard ratios (HR) and 95% confidence intervals (95% CI). Subgroup analysis was performed according to sex, ethnicity, area, occupation, smoking, and exercise to compare the differences in the association between drinking patterns and the incidence of hypertension. Blood pressure was higher in participants with a high drinking frequency than those with a low drinking frequency (p < 0.001). We found that total drinking frequency, liquor drinking frequency, rice wine drinking frequency, and alcohol consumption were significantly associated with an increased risk of hypertension. Compared with the non-drinking group, a heavy drinking pattern was positively correlated with hypertension. Drinking can increase the risk of hypertension, especially heavy drinking patterns, with a high frequency of alcohol intake and high alcohol consumption. From the analysis results of the longitudinal data, drinking alcohol is still an important risk factor for hypertension among Chinese subjects, especially for men, the rural population, the employed, the Han nationality, smokers, and certain exercise populations.

Role of environmental toxicants in the development of hypertensive and cardiovascular diseases

The incidence of hypertension with diabetes mellitus (DM) as a co-morbid condition is on the rise worldwide. In 2000, an estimated 972 million adults had hypertension, which is predicted to grow to 1.56 billion by 2025. Hypertension often leads to diabetes mellitus that strongly puts the patients at an increased risk of cardiovascular, kidney, and/or atherosclerotic diseases. Hypertension has been identified as a major risk factor for the development of diabetes; patients with hypertension are at two-to-three-fold higher risk of developing diabetes than patients with normal blood pressure (BP). Causes for the increase in hypertension and diabetes are not well understood, environmental factors (e.g., exposure to environmental toxicants like heavy metals, organic solvents, pesticides, alcohol, and urban lifestyle) have been postulated as one of the reasons contributing to hypertension and cardiovascular diseases (CVD). The mechanism of action(s) of these toxicants in developing hypertension and CVDs is not well defined. Research studies have linked hypertension with the chronic consumption of alcohol and exposure to metals like lead, mercury, and arsenic have also been linked to hypertension and CVD. Workers chronically exposed to styrene have a higher incidence of CVD. Recent studies have demonstrated that exposure to particulate matter (PM) in diesel exhaust and urban air contributes to increased CVD and mortality. In this review, we have imparted the role of environmental toxicants such as heavy metals, organic pollutants, PM, alcohol, and some drugs in hypertension and CVD along with possible mechanisms and limitations in extrapolating animal data to humans.

Dose-dependent relationship between social drinking and brain aging

Low-level alcohol consumption is commonly perceived as being inconsequential or even beneficial for overall health, with some reports suggesting that it may protect against dementia or cardiovascular risks. However, these potential benefits do not preclude the concurrent possibility of negative health outcomes related to alcohol consumption. To examine whether casual, non-heavy drinking is associated with premature brain aging, we utilized the Brain-Age Regression Analysis and Computational Utility Software package to predict brain age in a community sample of adults [n = 240, mean age 35.1 (±10.7) years, 48% male, 49% African American]. Accelerated brain aging was operationalized as the difference between predicted and chronological age ("brain age gap"). Multiple regression analysis revealed a significant association between previous 90-day alcohol consumption and brain age gap (β = 0.014, p = 0.023). We replicated these results in an independent cohort [n = 231 adults, mean age 34.3 (±11.1) years, 55% male, 28% African American: β = 0.014, p = 0.002]. Our results suggest that even low-level alcohol consumption is associated with premature brain aging. The clinical significance of these findings remains to be investigated.

Alcohol Consumption and Systemic Hypertension (from the Third National Health and Nutrition Examination Survey)

Epidemiological studies have established the association between excessive alcohol consumption and systemic hypertension (SH). However, there are conflicting reports of the association of low to moderate alcohol consumption with SH. The objective of the study was to examine the associations of alcohol consumption and blood pressure categories using the 2017 American College of Cardiology/American Heart Association high blood pressure guidelines. This analysis included 17,059 participants from the Third National Health and Nutrition Examination Survey. Alcohol consumption was ascertained by way of a questionnaire. Blood pressure (mm Hg) was measured during the in-home interview and the participant's visit to the mobile examination center. We used multivariable logistic regression models to examine cross-sectional associations of alcohol consumption and blood pressure categories based on new American College of Cardiology/American Heart Association High Blood Pressure guidelines. Models were adjusted for age, gender, income, and cardiovascular risk factors. Compared with never drinkers, moderate drinkers (7 to 13 drinks/week) had increased odds of prevalent stage 1 and stage 2 SH (odds ratio [95% confidence interval] 1.51 [1.22 to 1.87] and 1.55 [1.20 to 2.00]). Similarly, there were significantly higher odds of prevalent stage 1 and stage 2 SH among heavy drinkers (≥14 drinks/week) (odds ratio [95% confidence interval] 1.65 [1.33 to 2.05] and 2.46 [1.93 to 3.14]). We did not find any association between alcohol consumption and elevated blood pressure category. Response bias must be considered because alcohol consumption was self-reported. Our study indicates the need for further research to understand the potential mechanisms by which alcohol consumption increases the risk of SH. In conclusion, this analysis from a population-based survey showed an association between moderate and heavy alcohol consumption and a higher prevalence of SH.

The Effect of Behavioral Changes on the Treatment of Hypertension

PURPOSE OF REVIEW

Hypertension is one of the leading causes of preventable premature death.

RECENT FINDINGS

Strongly advocating for lifestyle changes to improve blood pressure control is of paramount importance in the successful management of hypertension. In this review, we will discuss the effect of various behavioral and lifestyle changes and review the evidence to support these changes to improve blood pressure control. These include dietary modifications, alcohol consumption, weight loss, various types of exercise, device-guided breathing, relaxation, and biofeedback techniques.

The role of different lipid measures for incident hypertension during more than 12-year follow-up: Tehran Lipid and Glucose Study

The associations of different lipid measures and related indices with incident hypertension during a median follow-up of 12·89 years were examined. Fasting levels of total cholesterol (TC), TAG, HDL-cholesterol and LDL-cholesterol, and related indices (TC/HDL-cholesterol and TAG/HDL-cholesterol) were determined in 7335 Iranian adults (men = 3270) free of hypertension, aged 39·0 (sd 13·2) years. Multivariate Cox proportional hazard regression was applied and lipid parameters were considered either as categorical or continuous variables. During follow-up, 2413 (men = 1126) participants experienced hypertension. Using the first quartile as reference, significant trends were found between quartiles of TAG, HDL-cholesterol, TC/HDL-cholesterol and TAG/HDL-cholesterol in multivariate models; moreover considering these measures as continuous variables, a 1 sd increase in each of these parameters was significantly associated with the risk of incident hypertension; the corresponding hazard ratios and CI were 1·06 (95 % CI 1·02, 1·10), 0·94 (95 % CI 0·89, 0·98), 1·04 (95 % CI 1·01, 1·09) and 1·04 (95 % CI 1·01, 1·07), respectively. The associations between lipid measures and incident hypertension did not change after excluding lipid lowering drug users and those with type 2 diabetes mellitus and these associations were independent of the categories of baseline blood pressure (P for interaction > 0·08). These findings indicate that TAG, TAG/HDL-cholesterol and TC/HDL-cholesterol were independently associated with higher risk, while HDL-cholesterol was associated with lower risk of incident hypertension.

The longitudinal associations between trajectory of and quantity of alcohol consumption and subsequent changes in blood pressure levels among non-hypertensive adults

Given the dynamic characteristic of an individual's drinking behaviours, comprehensive consideration of alcohol consumption variation using repeated measures may improve insight into the nature of its association with blood pressure (BP) change. We examined the association between longitudinal alcohol consumption (trajectory and quantity) and changes in BP and pulse pressure (PP) among Korean aged ≥ 40 years living in rural areas. Totally, 1682 hypertension-free participants who completed all three health examinations (median, 5·3 years) were included. All three visits were used to determine the cumulative trajectory of and quantity of alcohol consumption and the latest two visits and the last visit were used for the recent trajectory and the most recent quantity of alcohol consumption, respectively. Changes in BP and PP from the baseline to the third visit were used as outcome. In men, ≥30 ml/d cumulative average alcohol consumption was associated with the greatest increase in systolic BP (SBP) in both baseline outcome-unadjusted (2·9 mmHg, P = 0·032) and -adjusted models (3·6 mmHg, P = 0·001), and the given association for the most recent alcohol consumption was observed in the baseline outcome-adjusted model (3·9 mmHg, P = 0·003). For PP, similar associations were observed only in the baseline outcome-adjusted model. No meaningful associations in diastolic BP in men and any BP or PP in women existed. The quantity of alcohol consumption rather than the trajectory may be significantly related to raised SBP, and a possible short-term influence of the most recent alcohol consumption may exist when baseline SBP is adjusted in men.

The Effect of Alcohol on Blood Pressure and Hypertension

PURPOSE

To examine the acute and chronic effects of alcohol on blood pressure (BP) and the incidence of hypertension. We discuss the most current understanding of the mechanisms underlining these effects and their associations with the putative cardioprotective effects of consumption of low-to-moderate amounts of alcoholic beverages.

RECENT FINDINGS

A recent meta-analysis confirmed findings of experimental studies, demonstrating an acute biphasic effect of ethanol on BP, decreasing up to 12 h of ingestion and increasing after that. This effect is mediated by vagal inhibition and sympathetic activation. A meta-analysis found that chronic consumption of alcoholic beverages was associated with a high incidence of hypertension in men and women; it also found that, in women, the risk begins at moderate alcohol consumption. The risks of alcohol consumption are higher in Blacks than in Asians or Caucasians. The mechanism underlying the chronic effects of alcohol on BP, and particularly the differential effect on Blacks, is still unknown. Short-term trials showed that alcohol withdrawal promotes BP reduction; however, the long-term effectiveness of interventions that aim to lower BP through the restriction of alcohol consumption has not been demonstrated. The harmful effects of alcohol on BP do not support the putative cardioprotective effect of low-to-moderate consumption of alcoholic beverages. The absence of a tangible mechanism of protection, and the possibility that this beneficial effect is biased by socioeconomic and other characteristics of drinkers and abstainers, calls into question the hypothesis that consuming low amounts of alcoholic beverages improves cardiovascular health. The evidence from investigations with various designs converge regarding the acute biphasic effect of ethanol on BP and the risk of chronic consumption on the incidence of hypertension, particularly for Blacks. These effects do not support the putative cardioprotective effect of consumption of low-to-moderate amounts of alcoholic beverages. Mechanisms of chronic BP increase and the demonstration of long-term benefits of reducing alcohol intake as a means to treat hypertension remain open questions.

Alcohol Exerts a Shifted U-Shaped Effect on Central Blood Pressure in Young Adults

BACKGROUND

Consumption of 1-2 alcoholic beverages daily has been associated with a lower risk of cardiovascular disease and all-cause mortality in middle-aged and older adults. Central blood pressure has emerged as a better predictor of cardiovascular risk than peripheral blood pressure. However, the effects of habitual alcohol consumption on central blood pressure particularly in young adults, who are among the largest consumers of alcohol in North America, have yet to be investigated.

OBJECTIVE

We aimed to study the effect of alcohol consumption on central and peripheral blood pressure, and arterial stiffness in young adults.

DESIGN

Cross-sectional observational study.

MAIN MEASURES

Using a standardized questionnaire, alcohol consumption (drinks/week) was queried; participants were classified as non- (< 2), light (2-6), moderate (women 7-9, men 7-14), and heavy drinkers (women > 9, men > 14). Central blood pressure and arterial stiffness were measured using applanation tonometry.

KEY RESULTS

We recruited 153 healthy, non-smoking, non-obese individuals. We found a U-shaped effect of alcohol consumption on blood pressure. Light drinkers had significantly lower central systolic and mean arterial blood pressure, but not peripheral blood pressure when compared to non- and moderate/heavy drinkers (P < 0.05). No significant associations with arterial stiffness parameters were noted.

CONCLUSIONS

A U-shaped relationship was found between alcohol consumption and central and mean arterial blood pressure in young individuals, which importantly, was shifted towards lower levels of alcohol consumption than currently suggested. This is the first study, to our knowledge, that examines the effect of alcohol consumption on central blood pressure and arterial stiffness exclusively in young individuals. Prospective studies are needed to confirm the relationships observed herein.

Noncommunicable diseases risk factors in Bhutan: A secondary analysis of data from Bhutan's nationwide STEPS survey 2014

Background

Bhutan is facing an epidemic of noncommunicable diseases; they are responsible for 53% of all deaths. Four main modifiable risk factors, including tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet, are the causes of most noncommunicable diseases (NCDs). This study aimed to assess 1) the prevalence of NCDs modifiable risk factors in Bhutan’s adult population and 2) associations between the sociodemographic factors and the NCDs modifiable risk factors with overweight or obesity, hypertension, and diabetes.

Methods

We used the 2014 Bhutan WHO Stepwise Approach to NCD Risk Factor Surveillance (STEPS) Survey dataset in this study. Data were analyzed using multiple logistic regressions, constructed with overweight or obesity, hypertension, and diabetes as outcome variables and modifiable risk factors as independent variables.

Results

The prevalence of tobacco use, harmful use of alcohol, unhealthy diet (low fruits and vegetables intake) and physically inactive was 24.8% (95% CI: 21.5, 28.5), 42.4% (95% CI: 39.4, 45.5), 66.9% (95% CI: 61.5, 71.8), and 6.2% (95% CI: 4.9, 7.8), respectively. The prevalence of overweight or obesity, hypertension and diabetes was 32.9% (95%CI: 30.0, 36.0), 35.7% (95% CI: 32.8, 38.7) and 6.4% (95% CI: 5.1, 7.9), respectively. Multiple logistic regression showed that older age groups were more likely to be overweight or obese, hypertensive, and diabetic. Our analysis also found that tobacco users were less likely to be overweight or obese (aOR 0.71, 95% CI 0.52, 0.96), and to be hypertensive (aOR 0.74, 95% CI 0.56, 0.97); but they were more likely to be diabetic (aOR 1.64, 95% CI 1.05, 2.56). Alcohol users were more likely to be hypertensive aOR 1.41 (95% CI 1.15, 1.74). Furthermore, vigorous physical activity could protect people from being overweight or obese, aOR 0.47 (95% CI 0.31, 0.70), and those consuming more than five serves of fruits and vegetables per day were more likely to be overweight or obese, aOR 1.46 (95% CI 1.17, 1.82).

Conclusion

The prevalence of NCDs modifiable risk factors and overweight or obesity and hypertension was high in Bhutan. We found strong associations between tobacco use and diabetes, alcohol use, hypertension, physically inactive, and overweight or obesity. The results suggest that the government should prioritize NCDs prevention and control programs, focusing on reducing modifiable risk factors. The health sector alone cannot address the NCDs epidemic in Bhutan, and we recommend the whole of government approach to tackle NCDs through the Bhutan Gross National Happiness framework.

Sex-specific associations between alcohol consumption, cardiac morphology, and function as assessed by magnetic resonance imaging: insights form the UK Biobank Population Study

AIMS

Data regarding the effects of regular alcohol consumption on cardiac anatomy and function are scarce. Therefore, we sought to determine the relationship between regular alcohol intake and cardiac structure and function as evaluated with cardiac magnetic resonance imaging.

METHODS AND RESULTS

Participants of the UK Biobank who underwent cardiac magnetic resonance were enrolled in our analysis. Data regarding regular alcohol consumption were obtained from questionnaires filled in by the study participants. Exclusion criteria were poor image quality, missing, or incongruent data regarding alcohol drinking habits, prior drinking, presence of heart failure or angina, and prior myocardial infarction or stroke. Overall, 4335 participants (61.5 ± 7.5 years, 47.6% male) were analysed. We used multivariate linear regression models adjusted for age, ethnicity, body mass index, smoking, hypertension, diabetes mellitus, physical activity, cholesterol level, and Townsend deprivation index to examine the relationship between regular alcohol intake and cardiac structure and function. In men, alcohol intake was independently associated with marginally increased left ventricular end-diastolic volume [β = 0.14; 95% confidence interval (CI) = 0.05-0.24; P = 0.004], left ventricular stroke volume (β = 0.08; 95% CI = 0.03-0.14; P = 0.005), and right ventricular stroke volume (β = 0.08; 95% CI = 0.02-0.13; P = 0.006). In women, alcohol consumption was associated with increased left atrium volume (β = 0.14; 95% CI = 0.04-0.23; P = 0.006).

CONCLUSION

Alcohol consumption is independently associated with a marginal increase in left and right ventricular volumes in men, but not in women, whereas alcohol intake showed an association with increased left atrium volume in women. Our results suggest that there is only minimal relationship between regular alcohol consumption and cardiac morphology and function in an asymptomatic middle-aged population.

Association between drinking patterns and cardiovascular risk: a population-based study in the Southern Cone of Latin America

BACKGROUND

Using data from general adult population, this study aims to describe epidemiology of alcohol consumption patterns and their association with cardiovascular risk.

METHODS

CESCAS I is a population-based study from four mid-sized cities in Argentina, Chile and Uruguay. Associations between diabetes, hypertension, dyslipidemia, cardiovascular disease (CVD) risk and history of CVD and drinking patterns were assessed using crude prevalence odds ratios (ORs) and adjusted OR.

RESULTS

A total of 37.2% of the studied population never drank and 18.3% reported to be former drinkers. Among current drinkers, moderate drinking was the most frequent pattern (24.2%). For women with light and moderate consumption, the odds of having >20% CVD risk was ~40% lower than that of never drinkers. The odds of having a history of CVD was 50% lower in those with moderate consumption. For men with heavy consumption, the odds of having >20% CVD risk was about twice as high as for never drinkers.

CONCLUSIONS

A harmful association was observed between heavy drinking and having >20% CVD risk for men. However, for women, an apparently protective association was observed between light and moderate drinking and having >20% CVD risk and between moderate drinking and having a history of CVD.

Alcoholic beverage consumption, changes in blood pressure, and incidence of hypertension in the Longitudinal Adult Health Study (ELSA-Brasil)

OBJECTIVES

Alcohol consumption is generally associated with increased risk of hypertension. We aimed to investigate, prospectively, the effect of alcoholic-beverage consumption on blood pressure (BP) and incidence of hypertension, after a 4-y follow-up, in participants of the Longitudinal Adult Health Study (ELSA-Brasil).

METHODS

We analyzed information from 3,990 participants (ages 35-74 y), men and women, from educational and research institutions, at baseline (2008-2010) and follow-up (2012-2014). Socioeconomic, hemodynamic, anthropometric, and health data were collected. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg and/or use of antihypertensive medication. Change in alcohol consumption (g/d) was estimated by subtracting total consumed at follow-up from total consumed at baseline, and was categorized in tertiles.

RESULTS

The consumption of alcoholic beverages was associated with changes in BP and hypertension only in men. Individuals who reduced total consumption of alcohol showed a smaller increase in systolic BP (1.1 versus 2.3 mm Hg; P = 0.03) and diastolic BP (1.3 versus 2.2 mm Hg; P = 0.008) compared to individuals who increased consumption. In addition, individuals in the highest tertiles of total consumption of alcohol (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.14-2.29) and consumption of beer (OR, 1.51; 95% CI, 1.07-12.13), wine (OR, 1.71; 95% CI, 1.01-2.86), and spirits (OR, 2.01; 95% CI, 1.21-3.32) showed higher odds ratios for hypertension compared to the lowest tertile.

CONCLUSIONS

Increased consumption of alcoholic beverages was positively associated with increased BP levels and higher chances of developing hypertension in men.

Risk factors for hypertensive crisis in adult patients: a systematic review

OBJECTIVE

The objective of this review was to examine the best available evidence on the risk factors for hypertensive crisis in adult patients with hypertension.

INTRODUCTION

Hypertensive crisis is an acute severe elevation in blood pressure, which can present as hypertensive urgency or emergency. In contrast to hypertensive urgency, which is a markedly elevated blood pressure without acute target organ damage, hypertensive emergency is associated with equally high blood pressure in the presence of potentially life-threatening target organ damage, such as myocardial infarction, stroke, pulmonary edema, or acute kidney injury. Hypertensive crisis results in adverse clinical outcomes and high utilization of health care.

INCLUSION CRITERIA

This review considered studies of non-modifiable factors (age, sex, ethnicity) and modifiable factors such as socioeconomic factors (lack of medical insurance, lack of access to medical care), adherence to medical therapies, presence of comorbidities (diabetes, hyperlipidemia, coronary artery disease, history of stroke, chronic kidney disease, congestive heart failure), and substance abuse in persons of either sex, older than 18 years with a diagnosis of hypertension.

METHODS

A search of four databases, seven gray literature sites, and relevant organizational websites revealed 11,387 titles. After duplicates were removed, 9183 studies were screened by the title and abstract for eligibility. Forty full-text articles were retrieved, and each was assessed for eligibility. Twenty-one articles were excluded. The remaining 19 full-text studies were critically appraised and included in this review.

RESULTS

The risk of hypertensive crisis was higher in patients with a history of comorbid cardiovascular conditions, such as chronic kidney disease (odds ratio [OR] 2.899, 95% confidence interval [CI] 1.32, 6.364), coronary artery disease (OR 1.654, 95% CI 1.232, 2.222), or stroke (OR 1.769, 95% CI 1.218, 2.571). Patients with hypertensive emergency had higher mean systolic blood pressure (mean difference [MD] 2.413, 95% CI 0.477, 4.350) and diastolic blood pressure (MD 2.043, 95% CI 0.624, 3.461). Hypertensive emergency was more common in men (OR 1.390, 95% CI 1.207,1.601), older patients (MD 5.282, 95% CI 3.229, 7.335), and those with diabetes (OR 1.723, 95% CI 1.485, 2.000) and hyperlipidemia (OR 2.028, 95% CI 1.642, 2.505). Non-adherence to antihypertensive medications (OR 0.939, 95% CI 0.647,1.363) and hypertensive diagnosis unawareness (OR 0.807, 95% CI 0.564, 1.154) did not increase the risk of hypertensive emergency.

CONCLUSIONS

Comorbid cardiac, renal, and cerebral comorbidities (coronary artery disease, congestive heart failure, cerebrovascular disease, and chronic kidney disease) increase the risk of hypertensive crisis. The risk of hypertensive crisis is higher in patients with unhealthy alcohol and recreational drug use. Systolic and diastolic blood pressure are marginally higher in patients with hypertensive emergency compared to patients with hypertensive urgency. Since these differences are small and not clinically significant, clinicians should rely on other symptoms and signs to differentiate between hypertensive urgency and hypertensive emergency. The risk of hypertensive emergency is higher in older adults. The coexistence of diabetes, hyperlipidemia, and chronic kidney disease increases the risk of hypertensive emergency.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO (CRD42019140093).

Prevalence of Hypertension and Associated Factors Among Adults in Debre Berhan Town, North Shoa Zone, Ethiopia, 2020

INTRODUCTION

Hypertension is a serious medical condition that significantly increases the risks of heart, brain, kidney, and other diseases. The prevalence is highest in Africa (27%) and lowest in America (18%). Hypertension is a major reason for premature death worldwide; this is why it will become a targeted non-communicable disease by 2025.

OBJECTIVE

To assess the prevalence of hypertension and associated factors among adults in Debre Berhan town, Amhara region, Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 680 participants who were selected by a systematic sampling technique. Data were checked, cleaned, and entered into Epi-data then exported to SPSS-23 for analysis. Hosmer-Lemeshow test was used to check the model fitness. Binary logistic regression analysis was used to see the association between dependent and independent variables. All variables with p <0.25 were taken into the multivariable model to minimize the possible confounders. The multi collinearity test was carried out to see the correlation between independent variables by using a variance inflation factor (VIF). The odds ratio along with 95% CI were estimated to measure the strength of association and to identify factors associated with hypertension using multivariable logistic regression. Descriptive statistics in the form of tables, figures, percent with measure of central tendency and dispersion with multivariable analysis were used to report the findings and to identify the factors associated with the outcome variable at a p<0.05.

RESULTS

Among 680 participants, the prevalence of hypertension was 27.5%. Sex, being male (AOR: 1.77, 95% CI: 1.12-2.81), alcohol consumption (AOR: 2.76: 95% CI: 1.87-4.05), physical exercise (AOR: 2.17, 95% CI: 1.28-3.71), being overweight (AOR: 1.99, 95% CI: 1.11-3.58), and family history of hypertension (AOR: 2.10, 95% CI: 1.43-3.08) were found to be significantly associated with hypertension.

CONCLUSION AND RECOMMENDATION

Prevalence of hypertension in Debre Berhan town was relatively high compared with other studies. So, it is necessary to emphasize intervention in the community for behavioral change, in order to minimize alcohol consumption and to encourage adoption of regular physical exercise, with the existing health system and partners working on hypertension.

Joint Effect of Alcohol Drinking and Environmental Cadmium Exposure on Hypertension in Korean Adults: Analysis of Data from the Korea National Health and Nutrition Examination Survey, 2008 to 2013

BACKGROUND

Hypertension is a common disease found in 1.13 billion adults worldwide. Several animal studies have provided evidence of the joint effect of alcohol drinking and cadmium exposure on hypertension. However, no epidemiologic study has examined the association between these 2 risk factors and hypertension. Therefore, we examined the individual effects of alcohol drinking and cadmium and the joint effect of their coexposure on hypertension in the general population.

METHODS

We analyzed data from 8,403 South Korean adults who had been randomly assigned to the Korea National Health and Nutrition Examination Survey from 2008 to 2013. Multiple linear and logistic regression analyses were conducted to estimate the association of alcohol drinking and blood cadmium concentration with blood pressure and the odds ratio (OR) for hypertension.

RESULTS

The weighted prevalence of hypertension and high-risk drinking was 25.7 and 13.6%, respectively. The weighted geometric mean of blood cadmium levels was 0.94 μg/L (95% confidence interval [CI]: 0.93 to 0.96). After adjusting for demographic characteristics, anthropometric measurements, health-related behaviors, and dietary and disease variables, the OR for hypertension in the group with the high-risk alcohol drinking was 1.67 (95% CI: 1.34 to 2.06) compared with the group without high-risk alcohol drinking. When the highest and the lowest blood cadmium quartiles were compared, the OR for hypertension was 1.46 (95% CI: 1.15 to 1.86). The positive joint effect of high-risk drinking and blood cadmium levels was statistically significant for systolic blood pressure (SBP; p = 0.037) and diastolic blood pressure (DBP; p < 0.001).

CONCLUSIONS

Our results show that heavy alcohol drinking had a joint effect with cadmium exposure to increase the risk of hypertension. Future efforts are needed to reduce alcohol drinking and environmental cadmium exposure to prevent hypertension in the general population.

The interactive association between sodium intake, alcohol consumption and hypertension among elderly in northern China: a cross-sectional study

Background

Hypertension is a worldwide public health problem. We sought to examine the interactive associations among sodium intake, alcohol consumption and hypertension among older adult residents of Inner Mongolia in northern China.

Methods

This cross-sectional study used data from the National Survey for Nutrition and Adult Chronic Disease in Inner Mongolia. The prevalence of hypertension was age standardized by the direct method. Sodium intake and alcohol consumption were estimated using a weighing method and 24-h recalls on 3 consecutive days. Hypertension was either self-reported or field-measured. Participants were categorized into six subgroups according to combinations of sodium intake status and drinking level. Logistic regression was used to determine the interactive effect of sodium intake and drinking on hypertension.

Results

Of the 820 older adults who participated in this study, 523 (63.80%, age-standardized rate = 62.33%) had been diagnosed with hypertension. The mean sodium intake was 4.88 g. Sodium intake and drinking excessively were both independently related to higher risk of hypertension. A formal test for a multiplicative interaction between sodium intake and drinking revealed a significant interaction (p = 0.042), and the multivariable-adjusted odds ratio (95% CI) for the interaction was 1.1 (1.0–1.3). After adjusting for confounders, compared with moderate sodium intake and no drinking group, the risk of hypertension was highest among those with both excessive sodium intake and excessive alcohol consumption, with an odds ratio of 3.6 (95% CI: 1.7–7.9).

Conclusions

The study highlights the interactive effect of sodium intake and alcohol consumption on hypertension. Primary health care providers should pay special attention to older adults with hypertension—especially those with an unhealthy diet including both excessive sodium and excessive alcohol intake. These findings are applicable for older adults in Inner Mongolia and worldwide.

Dietary patterns and chronic kidney disease risk: a systematic review and updated meta-analysis of observational studies

BACKGROUND

A number of studies have reported the association between dietary patterns and the risk of chronic kidney disease (CKD), however a consistent perspective hasn't been established to date. Herein, we conducted this systematic review and meta-analysis of observational studies to assess the association between dietary patterns and CKD.

METHODS

MEDLINE, EBSCO and references from eligible studies were searched for relevant articles published up to 9 May 2020 that examined the association of common dietary patterns and CKD. The heterogeneity among studies was assessed by Cochran's Q test and I² methods.

RESULTS

Seventeen eligible studies, involving 149,958 participants, were included in our systematic review and meta-analysis. The highest compared with the lowest category of healthy dietary pattern was significantly associated with a lower risk of CKD (OR=0.69; CI: 0.57, 0.84; P=0.0001). A higher risk of CKD was shown for the highest compared with the lowest categories of Western-type dietary pattern (OR=1.86; CI: 1.21, 2.86; P=0.005). There were evidence of a lower risk of CKD in the highest compared with the lowest categories of light-moderate drinking pattern (OR=0.76; CI: 0.71, 0.81; P< 0.0001) and heavy drinking pattern (OR=0.67; CI: 0.56, 0.80; P< 0.0001).

CONCLUSIONS

The results of this systematic review and meta-analysis show that a healthy dietary pattern and alcohol drinking were associated with lower risk of CKD, whereas a Western-type dietary pattern was associated with higher risk of CKD.

The role of dietary salt and alcohol use reduction in the management of hypertension

Introduction: Despite the improved treatment protocol of hypertension, the magnitude of the disease and its related burden remains raised. Hypertension makes up the leading cause of stroke, kidney disease, arterial disease, eye disease, and cardiovascular disease (CVD) growth. Areas covered: This review provides the overview of the role of dietary salt and alcohol use reduction in the management of hypertension, a brief history of alcohol, the vascular endothelium functions, the effects of alcohol use on blood pressure (BP), the mechanisms of alcohol, brief history of salt, the effects of dietary salt intake on BP, and the mechanisms of salt. Expert opinion: Studies found that high dietary salt intake and heavy alcohol consumption have a major and huge impact on BP while both of them have been identified to increase BP. Also, they raise the risk of hypertension-related morbidity and mortality in advance. On the other way, the dietary salt and alcohol use reduction in the management of hypertension are significant in the control of BP and its related morbidity and mortality. Further, studies suggested that the dietary salt and alcohol use reductions are the cornerstone in the management of hypertension due to their significance as part of comprehensive lifestyle modifications.

Tobacco Smoking and Association between Betel Nut Chewing and Metabolic Abnormalities Among Military Males: The CHIEF Study

AIM

To investigate the effect of smoking and alcohol intake on the association between betel nut chewing and each metabolic abnormality.

BACKGROUND

Betel nut chewing has been associated with metabolic syndrome.

OBJECTIVE

Whether the association is affected by tobacco or alcohol use is not clarified so far.

METHODS

The authors conducted a cross-sectional study using 6,657 military males, aged 18-50 years in eastern Taiwan in 2013-2014. Metabolic syndrome was defined according to the International Diabetes Federation's ethnic criteria for Asians. The population was classified as non-betel nut chewers (N =5,749), current chewers with both tobacco and alcohol use (N =615), and current chewers without tobacco and/or alcohol use (N =293). Multiple logistic regression analyses were stepwise adjusted for the confounders including alcohol and tobacco use to determine the association of betel chewing with the metabolic abnormalities.

RESULTS

As compared to the non-current chewers, the current chewers with both tobacco/alcohol use and those without had a higher risk of metabolic syndrome (odds ratios (OR) and 95% confidence intervals: 2.46 (2.00-3.02), and 2.04 (1.53-2.73), respectively) after controlling for age, service specialty, total cholesterol levels ≥200 mg/dL and exercise frequency (model 1). The association did not change much in the two chewing groups after additionally adjusting for alcohol consumption (model 2) (OR: 2.49 (1.99-3.12), and 2.04 (1.52-2.73), respectively), whereas the relationship reduced significantly in the chewers with both tobacco/alcohol use rather than those without after further adjusting for smoking (model 3) (OR: 2.18 (1.71-2.78) and 2.02 (1.51-2.71), respectively). This was in parallel with the pattern for the association of betel nut chewing with serum triglycerides >150 mg/dL in the chewers with both tobacco/alcohol use and those without in model 1 (OR: 2.90 (2.40-3.51) and 1.90 (1.45-2.49), respectively, p =0.011), in model 2 (OR: 2.82 (2.30-3.46) and 1.89 (1.44-2.49), respectively, p =0.040), and in model 3 (2.26 (1.81-2.81) and 1.87 (1.42-2.45), respectively, p =0.76).

CONCLUSION

Our findings suggest that tobacco smoking but not alcohol intake could increase the relationship of betel nut chewing with metabolic syndrome, which is likely mediated by a synergic effect on increasing serum triglycerides levels.

Association of Alcohol Intake With Hypertension in Type 2 Diabetes Mellitus: The ACCORD Trial

Background Heavy alcohol consumption has a well-established association with hypertension. However, doubt persists whether moderate alcohol consumption has a similar link. This relationship is not well-studied in patients with diabetes mellitus. We aimed to describe the association of alcohol consumption with prevalent hypertension in participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial. Methods and Results Alcohol consumption was categorized as none, light (1-7 drinks/week), moderate (8-14 drinks/week), and heavy (≥15 drinks/week). Blood pressure was categorized using American College of Cardiology/American Heart Association guidelines as normal, elevated blood pressure, stage 1 hypertension, and stage 2 hypertension. Multivariable logistic regression was used to explore the association between alcohol consumption and prevalent hypertension. A total of 10 200 eligible participants were analyzed. Light alcohol consumption was not associated with elevated blood pressure or any stage hypertension. Moderate alcohol consumption was associated with elevated blood pressure, stage 1, and stage 2 hypertension (odds ratio [OR], 1.79; 95% CI, 1.04-3.11, P=0.03; OR, 1.66; 95% CI, 1.05-2.60, P=0.03; and OR, 1.62; 95% CI, 1.03-2.54, P=0.03, respectively). Heavy alcohol consumption was associated with elevated blood pressure, stage 1, and stage 2 hypertension (OR, 1.91; 95% CI, 1.17-3.12, P=0.01; OR, 2.49; 95% CI, 1.03-6.17, P=0.03; and OR, 3.04; 95% CI, 1.28-7.22, P=0.01, respectively). Conclusions Despite prior research, our findings show moderate alcohol consumption is associated with hypertension in patients with type 2 diabetes mellitus and elevated cardiovascular risk. We also note a dose-risk relationship with the amount of alcohol consumed and the degree of hypertension.

Association of Alcohol Consumption and Ideal Cardiovascular Health Among South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study

BACKGROUND

Observational studies have shown that alcohol consumption above the recommended limit is associated with increased cardiovascular disease (CVD), although its association in South Asians is unclear. Less is known regarding the association between alcohol consumption and cardiovascular health (CVH), assessed by the American Heart Association's Life's Simple 7 (LS7) health metrics among those with South Asian ancestry.

METHODS

This analysis included 701 participants without CVD from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort (2015 to 2018). Based on a personal history questionnaire, participants were divided into never, former, and current drinkers. The current drinking category was further classified into 1 to 3 drinks/wk, 4 to 7 drinks/wk, and >7 drinks/wk. The consumption of 5 or more drinks on 1 occasion in the past month was defined as binge drinking. Each LS7 component was given a point score of 0, 1, or 2. The total score was categorized into 0 to 6, 7 to 10, and 11 to 14 to represent poor, intermediate, and ideal CVH, respectively. We use multinomial logistic regression to examine the association between alcohol consumption and CVH.

RESULTS

In the MASALA cohort (mean age = 59 years, 43% female), participants consuming >7 drinks/wk had the lowest mean CVH score. Compared with never drinkers, male participants consuming >7 drinks/wk were less likely to have intermediate CVH (0.44 [0.08, 0.91]) and ideal CVH (0.23 [0.03, 0.96]). Binge drinking was associated with significantly lower odds of ideal CVH compared with never drinkers.

CONCLUSION

We found evidence of an inverse association of moderate to heavy alcohol consumption and ideal CVH in South Asian men. These findings further underscore the important relationship between alcohol consumption and CVH in this unique population of South Asians.

Race- and sex-specific association between alcohol consumption and hypertension in 22 cohort studies: A systematic review and meta-analysis

BACKGROUND AND AIMS

The alcohol-hypertension relation has been well documented, but whether women have protective effect or race and type of beverage consumed affect the association remain unclear. To quantify the relation between total or beverage-specific alcohol consumption and incident hypertension by considering the effect of sex and race.

METHODS AND RESULTS

Articles were identified in PubMed and Embase databases with no restriction on publication date. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random effects models. Restricted cubic splines were used to model the dose-response association. This study involved 22 articles (31 studies) and included 414,477 participants. The hypertension risk was different among liquor, wine, and beer at 5.1-10 g/d of ethanol consumption (P_{-across subgroups} = 0.002). The hypertension risk differed between men (RR: 1.14, 95% CI: 1.07, 1.20) and women (RR: 0.98, 95% CI: 0.89, 1.06) at 10 g/d (P_{-across subgroups} = 0.005). We found a linear alcohol-hypertension association among white (P-_linearity = 0.017), black people (P-_linearity = 0.035), and Asians (P-_linearity<0.001). With 10 g/d increment of consumption, the RRs for hypertension were 1.06 (95% CI: 1.04, 1.08), 1.14 (95% CI: 1.01, 1.28), and 1.06 (95% CI: 1.01, 1.10) for Asians, black, and white people, respectively.

CONCLUSION

Sex modifies the alcohol-hypertension association at low level of alcohol consumption and we did not find evidence of a protective effect of alcohol consumption among women. Black people may have higher hypertension risk than Asians and white people at the same ethanol consumption.

The effect of alcohol dose on the development of hypertension in Asian and Western men: systematic review and meta-analysis

BACKGROUND/AIMS

There are inconsistencies in the effects of low to moderate dose alcohol consumption on the development of hypertension in adult men. We hypothesized that a region-specific effect might participate in this heterogeneity.

METHODS

We conducted a systematic review and meta-analysis to evaluate the effect of alcohol dose on hypertension incidence using contemporary data through December 2017. Subjects were categorized according to their level of alcohol consumption as non-drinkers (reference) and low- (0.01 to 20.0 g/day), moderate- (20.1 to 40.0 g/day), moderate- to high- (40.1 to 60.0 g/day), and high-dose (> 60.0 g/day) drinkers. We defined hypertension as a blood pressure ≥ 140/90 mmHg and/or the use of anti-hypertensive drugs.

RESULTS

In total, 11 articles (seven Asian and four Western) were selected for our analysis. Among Asian men, a significantly elevated risk was observed even in the low alcohol dose group in comparison with the group with no alcohol consumption, and the risk increased in a dose-dependent manner (pooled relative risks [95% confidence intervals (CI)]: 1.25 [1.13 to 1.38], 1.48 [1.27 to 1.72], 1.75 [1.43 to 2.15], and 1.78 [1.51 to 2.09]). Among Western men, a similar dose-response relationship was noted in general (p for subgroup difference > 0.1), but a significantly elevated risk was evident only in the high-dose group (pooled relative risks [95% CI]: 1.22 [0.85 to 1.74], 1.57 [0.90 to 2.75], 1.47 [0.44 to 4.91], and 1.49 [1.02 to 2.18]).

CONCLUSION

Even low doses of alcohol can lead to the development of hypertension, particularly in Asian men. Our findings could serve as additional evidence for developing an appropriate preventive strategy in each region.

Effect of alcohol on blood pressure

BACKGROUND

Alcohol is consumed by over 2 billion people worldwide. It is a common substance of abuse and its use can lead to more than 200 disorders including hypertension. Alcohol has both acute and chronic effects on blood pressure. This review aimed to quantify the acute effects of different doses of alcohol over time on blood pressure and heart rate in an adult population.

OBJECTIVES

Primary objective To determine short-term dose-related effects of alcohol versus placebo on systolic blood pressure and diastolic blood pressure in healthy and hypertensive adults over 18 years of age. Secondary objective To determine short-term dose-related effects of alcohol versus placebo on heart rate in healthy and hypertensive adults over 18 years of age.

SEARCH METHODS

The Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to March 2019: the Cochrane Hypertension Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 2), in the Cochrane Library; MEDLINE (from 1946); Embase (from 1974); the World Health Organization International Clinical Trials Registry Platform; and ClinicalTrials.gov. We also contacted authors of relevant articles regarding further published and unpublished work. These searches had no language restrictions.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing effects of a single dose of alcohol versus placebo on blood pressure (BP) or heart rate (HR) in adults (≥ 18 years of age).

DATA COLLECTION AND ANALYSIS

Two review authors (ST and CT) independently extracted data and assessed the quality of included studies. We also contacted trial authors for missing or unclear information. Mean difference (MD) from placebo with 95% confidence interval (CI) was the outcome measure, and a fixed-effect model was used to combine effect sizes across studies.  MAIN RESULTS: We included 32 RCTs involving 767 participants. Most of the study participants were male (N = 642) and were healthy. The mean age of participants was 33 years, and mean body weight was 78 kilograms. Low-dose alcohol (< 14 g) within six hours (2 RCTs, N = 28) did not affect BP but did increase HR by 5.1 bpm (95% CI 1.9 to 8.2) (moderate-certainty evidence). Medium-dose alcohol (14 to 28 g) within six hours (10 RCTs, N = 149) decreased systolic blood pressure (SBP) by 5.6 mmHg (95% CI -8.3 to -3.0) and diastolic blood pressure (DBP) by 4.0 mmHg (95% CI -6.0 to -2.0) and increased HR by 4.6 bpm (95% CI 3.1 to 6.1) (moderate-certainty evidence for all).  Medium-dose alcohol within 7 to 12 hours (4 RCTs, N = 54) did not affect BP or HR. Medium-dose alcohol > 13 hours after consumption (4 RCTs, N = 66) did not affect BP or HR. High-dose alcohol (> 30 g) within six hours (16 RCTs, N = 418) decreased SBP by 3.5 mmHg (95% CI -6.0 to -1.0), decreased DBP by 1.9 mmHg (95% CI-3.9 to 0.04), and increased HR by 5.8 bpm (95% CI 4.0 to 7.5). The certainty of evidence was moderate for SBP and HR, and was low for DBP. High-dose alcohol within 7 to 12 hours of consumption (3 RCTs, N = 54) decreased SBP by 3.7 mmHg (95% CI -7.0 to -0.5) and DBP by 1.7 mmHg (95% CI -4.6 to 1.8) and increased HR by 6.2 bpm (95% CI 3.0 to 9.3). The certainty of evidence was moderate for SBP and HR, and low for DBP. High-dose alcohol ≥ 13 hours after consumption (4 RCTs, N = 154) increased SBP by 3.7 mmHg (95% CI 2.3 to 5.1), DBP by 2.4 mmHg (95% CI 0.2 to 4.5), and HR by 2.7 bpm (95% CI 0.8 to 4.6) (moderate-certainty evidence for all).  AUTHORS' CONCLUSIONS: High-dose alcohol has a biphasic effect on BP; it decreases BP up to 12 hours after consumption and increases BP > 13 hours after consumption. High-dose alcohol increases HR at all times up to 24 hours. Findings of this review are relevant mainly to healthy males, as only small numbers of women were included in the included trials.

Associations Between Medical Conditions and Alcohol Consumption Levels in an Adult Primary Care Population

IMPORTANCE

Excessive alcohol consumption is associated with increased incidence of several medical conditions, but few nonveteran, population-based studies have assessed levels of alcohol use across medical conditions.

OBJECTIVE

To examine associations between medical conditions and alcohol consumption levels in a population-based sample of primary care patients using electronic health record data.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study used separate multinomial logistic regression models to estimate adjusted associations between 26 medical conditions and alcohol consumption levels in a sample of 2 720 231 adult primary care patients screened for unhealthy drinking between January 1, 2014, and December 31, 2017, then only among those reporting alcohol use. The study was conducted at Kaiser Permanente Northern California, a large, integrated health care delivery system that incorporated alcohol screening into its adult primary care workflow. Data were analyzed from June 29, 2018, to February 7, 2020.

MAIN OUTCOMES AND MEASURES

The main outcome was level of alcohol use, classified as no reported use, low-risk use, exceeding daily limits only, exceeding weekly limits only, or exceeding daily and weekly limits, per National Institute on Alcohol Abuse and Alcoholism guidelines. Other measures included sociodemographic, body mass index, smoking, inpatient and emergency department use, and a dichotomous indicator for the presence of 26 medical conditions in the year prior to the alcohol screening identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes.

RESULTS

Among the 2 720 231 included patients, 1 439 361 (52.9%) were female, 1 308 659 (48.1%) were white, and 883 276 (32.5%) were aged 18 to 34 years. Patients with any of the conditions (except injury or poisoning) had lower odds of drinking at low-risk and unhealthy levels relative to no reported use compared with those without the condition. Among 861 427 patients reporting alcohol use, patients with diabetes (odds ratio [OR], 1.11; 95% CI, 1.08-1.15), hypertension (OR, 1.11; 95% CI, 1.09-1.13), chronic obstructive pulmonary disease (COPD; OR, 1.16; 95% CI, 1.10-1.22), or injury or poisoning (OR, 1.06; 95% CI, 1.04-1.07) had higher odds of exceeding daily limits only; those with atrial fibrillation (OR, 1.12; 95% CI, 1.06-1.18), cancer (OR, 1.06; 95% CI, 1.03-1.10), COPD (OR, 1.15; 95% CI, 1.09-1.20), or hypertension (OR, 1.37; 95% CI, 1.34-1.40) had higher odds of exceeding weekly limits only; and those with COPD (OR, 1.15; 95% CI, 1.07-1.23), chronic liver disease (OR, 1.42; 95% CI, 1.32-1.53), or hypertension (OR, 1.48; 95% CI, 1.44-1.52) had higher odds of exceeding both daily and weekly limits.

CONCLUSIONS AND RELEVANCE

Findings suggest that patients with certain medical conditions are more likely to have elevated levels of alcohol use. Health systems and clinicians may want to consider approaches to help targeted patient subgroups limit unhealthy alcohol use and reduce health risks.

Does Compassion Predict Blood Pressure and Hypertension? The Modifying Role of Familial Risk for Hypertension

Background

This study investigated (i) whether compassion is associated with blood pressure or hypertension in adulthood and (ii) whether familial risk for hypertension modifies these associations.

Method

The participants (N = 1112–1293) came from the prospective Young Finns Study. Parental hypertension was assessed in 1983–2007; participants’ blood pressure in 2001, 2007, and 2011; hypertension in 2007 and 2011 (participants were aged 30–49 years in 2007–2011); and compassion in 2001.

Results

High compassion predicted lower levels of diastolic and systolic blood pressure in adulthood. Additionally, high compassion was related to lower risk for hypertension in adulthood among individuals with no familial risk for hypertension (independently of age, sex, participants’ and their parents’ socioeconomic factors, and participants’ health behaviors). Compassion was not related to hypertension in adulthood among individuals with familial risk for hypertension.

Conclusion

High compassion predicts lower diastolic and systolic blood pressure in adulthood. Moreover, high compassion may protect against hypertension among individuals without familial risk for hypertension. As our sample consisted of comparatively young participants, our findings provide novel implications for especially early-onset hypertension.

Electronic supplementary material

The online version of this article (10.1007/s12529-020-09886-5) contains supplementary material, which is available to authorized users.