Factors determining the acute pressor response to alcohol

Sources of inaccuracy in the measurement of adult patients' resting blood pressure in clinical settings: a systematic review

BACKGROUND

To interpret blood pressure (BP) data appropriately, healthcare providers need to be knowledgeable of the factors that can potentially impact the accuracy of BP measurement and contribute to variability between measurements.

METHODS

A systematic review of studies quantifying BP measurement inaccuracy. Medline and CINAHL databases were searched for empirical articles and systematic reviews published up to June 2015. Empirical articles were included if they reported a study that was relevant to the measurement of adult patients' resting BP at the upper arm in a clinical setting (e.g. ward or office); identified a specific source of inaccuracy; and quantified its effect. Reference lists and reviews were searched for additional articles.

RESULTS

A total of 328 empirical studies were included. They investigated 29 potential sources of inaccuracy, categorized as relating to the patient, device, procedure or observer. Significant directional effects were found for 27; however, for some, the effects were inconsistent in direction. Compared with true resting BP, significant effects of individual sources ranged from -23.6 to +33 mmHg SBP and -14 to +23 mmHg DBP.

CONCLUSION

A single BP value outside the expected range should be interpreted with caution and not taken as a definitive indicator of clinical deterioration. Where a measurement is abnormally high or low, further measurements should be taken and averaged. Wherever possible, BP values should be recorded graphically within ranges. This may reduce the impact of sources of inaccuracy and reduce the scope for misinterpretations based on small, likely erroneous or misleading, changes.

Moderate alcohol use and health: a consensus document

AIMS

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

DATA SYNTHESIS

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

CONCLUSIONS

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

The acute effects of ethanol and acetaldehyde on physiological responses after ethanol ingestion in young healthy men with different ALDH2 genotypes

BACKGROUND

This study investigated the acute effects of ethanol and acetaldehyde on physiological responses in healthy men according to ALDH2 genotype by measuring them directly in human blood.

METHODS

Twenty-four men, 12 with the ALDH2*1/*1 genotype and 12 with the ALDH2*1/*2 genotype, were selected. In a double-blind placebo-controlled crossover design, each subject was administered one of three doses of ethanol (0.25, 0.5 or 0.75 g/kg) or a placebo on four separate occasions. The blood ethanol concentration (BEC), blood acetaldehyde concentration (BAAC) and physiological responses including facial redness, pulse rate and systolic and diastolic blood pressures were assessed.

RESULTS

Significant differences were observed in the physiological responses between the ALDH2*1/*2 and ALDH2*1/*1 groups. Significant gene effects were observed for pulse rate and facial flushing (F-values =62.344; p values <0.001 and F-values =7.062; p values =0.010, respectively, by repeated-measures analysis of variance), which were significantly greater in subjects with the ALDH2*1/*2 genotype. In a linear regression analysis, BAAC significantly predicted increased facial redness at 30 minutes (adjusted R( 2 ): 0.209; p values <0.001) and pulse rate at 30, 60, 90 and 120 minutes (adjusted R( 2 ): 0.454, 0.490, 0.428 and 0.193, respectively; all p values <0.001), whereas BEC was not associated with any physiological response measure at any time.

CONCLUSIONS

Facial redness and pulse rate after ethanol ingestion were significantly higher in the ALDH2*1/*2 genotype, and were significantly associated with blood acetaldehyde concentrations. The acute effects of ethanol on the physiological responses were mediated mainly by acetaldehyde, the active metabolite of ethanol, rather than by ethanol itself.

Derivation of tolerable upper alcohol intake levels in Germany: a systematic review of risks and benefits of moderate alcohol consumption

BACKGROUND

The objective of this study is to weigh the risks of moderate alcohol consumption against its benefits and, as a result, to derive tolerable upper alcohol intake levels (TUALs) for the German adult population.

METHODS

Human studies assessing the effects of moderate alcohol consumption (< or = 40 g/day) on coronary heart disease, stroke, blood pressure, diseases of the liver, gallbladder, bile duct, and pancreas, cancer of the mouth/pharynx/larynx/oesophagus, stomach, colon/rectum, and breast, foetal alcohol syndrome/foetal alcohol effects, as well as all-cause mortality, published in the 10-15 years before 1999, have been systematically reviewed. The quality of studies has been evaluated using a self-constructed evaluation scheme. As a result of comparing the critical endpoints of alcohol intake related to morbidity and mortality, the TUALs have been derived.

RESULTS

The TUALs have been set at 10-12 g/day for healthy women and 20-24 g/day for healthy men of the adult population (18 years and older). Additional guidelines on alcohol use have been defined, taking into account further important aspects like alcohol consumption patterns and high-risk groups.

CONCLUSIONS

The TUALs are not intended to be recommended intake levels. However, if the TUALs and the additional guidelines are followed, a relation of alcohol consumption to an increased risk of alcohol-associated diseases is unlikely for the majority of the population.

Nutrition and prevention of ischemic stroke: present knowledge, limitations and future perspectives

Stroke, particularly ischemic stroke, has a major impact on public health due to its high incidence, prevalence and rate of subsequent disability in Italy as in most industrialised countries. Apart from age, many modifiable factors, such as hypertension, smoking, diabetes, dyslipidemia, obesity, physical inactivity, alcohol abuse and hyperhomocysteinemia, have been recognised as playing a role in the pathogenesis of this disease. While appropriate pharmacological therapy has proven effective in the prevention of stroke in particular categories of patients, most of the above mentioned predisposing conditions are amenable to be affected by nutrition. Unequivocal demonstration of a protective or adverse role of single foods and nutrients against the risk of stroke has been however difficult to achieve due to confounding by biological variability, methodological inadequacies in the assessment of individual nutritional habits and difficulty to carry out long-term randomised controlled trials in the nutritional area. Notwithstanding, in several cases, causal relationships could be inferred from case-control and cohort studies in the presence of plausible and reproducible associations, evidence of dose-dependent effects and consistency in the results of different studies. The aim of this paper was to review present knowledge and highlight limitations and future perspectives about the role of nutrition in the prevention of ischemic stroke.

Influence of pattern of alcohol intake on blood pressure in regular drinkers: a controlled trial

OBJECTIVE

To evaluate the effects of patterns of drinking (weekend versus daily drinking) on the pressor responses to alcohol in 55 male drinkers using clinic and 24 h ambulatory blood pressure monitoring.

DESIGN

A randomized, controlled cross-over trial.

METHODS

Recruitment required a regular alcohol intake of 210-500 ml absolute alcohol/week, with > 60% consumed as beer. Fourteen subjects were categorized as predominantly weekend drinkers, whereas the remaining 41 subjects regularly drank on a daily basis. After 4 weeks of familiarization, all subjects were randomly allocated to drinking low-alcohol beer (0.9% vol:vol) only or to maintain their usual drinking habits with provision of full-strength beer (5% vol:vol) for 4 weeks. They then switched back to their usual drinking habits or low-alcohol beer, respectively, for a further 4 weeks while maintaining their usual drinking pattern.

RESULTS

Baseline ambulatory systolic blood pressure in weekend but not in daily drinkers was 2.4 mmHg higher on Monday than it was on Thursday (P = 0.02). This Monday-Thursday difference was lost during intervention. When subjects switched from the high-alcohol to the low-alcohol period the falls in ambulatory systolic blood pressure in weekend (3.1 mmHg, P < 0.001) and daily drinkers (2.2 mmHg, P < 0.001) were similar. Most of the fall was evident during week 1 of the low-alcohol period for weekend drinkers but not until week 4 for daily drinkers.

CONCLUSION

The pressor response to alcohol consumption is similar in magnitude in weekend and daily drinkers, present throughout a 24 h period and has a rapid onset/offset in weekend drinkers but is more sustained in daily drinkers.

Alcohol, coronary disease, and hypertension

Disparities in the relationships between alcohol consumption and various cardiovascular conditions are now evident, with complex interrelationships between conditions. An inverse relationship of alcohol use to coronary heart disease is supported by many population studies. Interpretation of these data as a protective effect of alcohol against coronary disease is strengthened by plausible mechanisms. Although some experimental data suggest the hypothesis that wine, in particular, has additional protective benefit, prospective studies show no consensus on this point. Strong, consistent epidemiologic data support a relationship of heavier drinking to hypertension. Intervention studies show a pressor effect of alcohol, which appears and regresses within several days, but a mechanism has not yet been established. As with most aspects of alcohol and health effects, the data do not suggest monotonic relationships of alcohol with these conditions. Thus, amount of alcohol taken is a crucial consideration. Advice to concerned persons needs to take into account individual factors in drinkers or potential drinkers.