Alcohol, hypertension and cardiovascular disease--implications for management

Demographic, clinical and lifestyle factors associated with high-intensity statin therapy in Australia: the AusDiab study

PURPOSE

Clinical guidelines specify who should receive high-intensity statins; however, it is unclear how high-intensity statins are used in Australia. Our objective was to determine the demographic, clinical, and lifestyle factors associated with high-intensity statin therapy in Australia.

METHODS

Data from the Australian Diabetes, Obesity and Lifestyle study collected in 2011-2012 were analyzed. High-, moderate-, and low-intensity statins were defined as use of statins at doses demonstrated to reduce low-density lipoprotein cholesterol levels by > 50, 30-50, and < 30%, respectively. Logistic regression was used to estimate adjusted odd ratios (ORs) and 95% confidence intervals (CIs) for factors associated with high- versus low-to-moderate-intensity statin therapy.

RESULTS

Overall, 1108 (24%) study participants used a statin. Data on statin intensity were available for 1072 participants. The proportions of high-, moderate-, and low-intensity statin therapy were 32 (n = 341), 65 (n = 696), and 3% (n = 35), respectively. Overall, 51% of people with prior cardiovascular disease (CVD) used a high-intensity statin. In addition to prior CVD (OR = 3.34, 95% CI = 1.95-5.73), no (OR = 1.84, 95%CI 1.02-3.31) or insufficient physical activity (OR = 1.51, 95% CI = 1.01-2.25), obesity (OR = 1.87, 95% CI = 1.13-3.10), and consuming > 2 alcoholic drinks daily (OR = 1.66, 95% CI = 1.08-2.55) were associated with high versus low-to-moderate-intensity statin therapy. Conversely, age 65-74 vs. < 65 years was inversely associated with high-intensity statin therapy (OR = 0.62, 95% CI = 0.41-0.94).

CONCLUSIONS

Prior CVD was the strongest factor associated with high-intensity statin therapy. Although the prevalence of CVD increases with age, older people were less likely to be treated with high-intensity statins.

Prevalence and treatment of diabetes mellitus and hypertension among older adults with intellectual disability in comparison with the general population

BACKGROUND

Diabetes mellitus and hypertension are risk factors for cardiovascular disease, which is the most common cause of death in the world. People with intellectual disability (ID) have been reported to have high rates of both these disorders. The aim of this study was to describe and compare prevalence ratios of diabetes mellitus and hypertension between older adults with ID and their age peers in the general population, and to describe and compare treatment patterns in these two groups.

METHODS

This is a Swedish register-based study, in which we established a cohort of people aged 55+ years and who had received support for those with ID in 2012 (n = 7936). We also established a same-sized referent cohort from the general population matched by sex and year of birth. Information on diagnoses of diabetes mellitus and hypertension, and prescription of drugs for these disorders, were collected from national registers for the period 2006-2012. The two cohorts were compared using generalized linear models (GLM).

RESULTS

People with ID were 20% more likely than the general population to have a diagnosis of diabetes mellitus, and 26% more likely to have prescription of drugs for diabetes mellitus. People in the general population were 81% more likely to have a diagnosis of hypertension, and 9% more likely to have a prescription of drugs for hypertension. Among those with diabetes, ID was associated with higher occurrence of prescription of insulin combination drugs and sulfonylureas, but lower occurrence of prescription of dipeptidyl peptidase (DPP) 4-inhibitors and exenatide/liraglutide. Among those with hypertension, ID was associated with higher occurrence of prescription of diuretics, but lower occurrence of prescription of calcium channel blockers and angiotensin II antagonists.

CONCLUSIONS

Treatment regimens among people with ID tended to include older types of medication compared with what was prescribed in the general population. To ensure that this is medically appropriate and not due to failure to update the treatment regimen, it is important to investigate if the people with ID and diabetes mellitus or hypertension are subjected to the same regular drug reviews that are recommended for older adults in general.

Brunei epidemiological stroke study: patterns of hypertension and stroke risk

OBJECTIVES

Hypertension is the most important known risk factor for cardiovascular diseases. A cross-sectional study was conducted in Brunei Darussalam to estimate the prevalence of hypertension and its association with socioeconomic and life-style factors and impact on stroke incidence.

METHODS

Five thousand and sixty-three participants aged above 18 years from 2103 randomly selected households in the Brunei-Muara district of Brunei Darussalam were surveyed. Hypertension was defined as mean SBP at least 140 mmHg, DBP at least 90 mmHg, or taking antihypertensive medication and blood pressure was measured twice. Logistic regression models are used to analyze the association between hypertension/medication for hypertension and sex, age, overweight, education, smoking, family history of hypertension, and employment.

RESULTS

A total of 48.3% [95% confidence interval (CI): 46.9-49.7%] of all respondents were identified as hypertensive. Prevalence of hypertension was higher in men (52.8%; 95% CI: 50.7-54.9%) compared to women (45.0%; 95% CI: 43.2-46.8%) and women seek treatment more often than men. Age, overweight, lower levels of education, and a family history of high blood pressure are positively associated with the prevalence of hypertension. The prevalence of overweight (57.3%) and obesity (23.7%) is high and the attributable risk of hypertension for stroke is large.

CONCLUSION

The prevalence of hypertension in Brunei is high in both women and men. Information campaigns and prevention programs are needed to be able to cope with the increasing problem of hypertension and resulting diseases like stroke in Brunei in the near future.

Risk factor assessment of stroke and its awareness among stroke survivors: A prospective study

Background:

Stroke is the second most common cause of death and major cause of disability worldwide. The objective of this study is to identify the major risk factors and assess the awareness among the stroke survivors.

Materials and Methods:

A prospective study was conducted at super specialty hospital, from December 2010 to July 2011. All the stroke patients of the age >25 years with either sex admitted in the hospital were included in the study. In order to assess the awareness among the stroke survivors, questionnaire established on the risk factors for stroke from the previously published studies.

Results:

A total of 100 patients with stroke or cerebrovascular accident were included in the study. Of 100 patients, 73% patients had ischemic stroke and 26% patients had hemorrhagic stroke. The mean age of the patients was 50 years and the incidence of stroke was predominant in males 73%, followed by females 27. It was observed that 70% of patients were hypertensives, 28% were diabetics, 27% were alcoholics, and 24% of patients had a habit of smoking, followed by others. The knowledge of the risk factors for stroke in stroke survivors was also very low, and the knowledge was varied among the subjects according to their level of educational status.

Conclusion:

This study reveals that hypertension is the most common risk factor for stroke followed by diabetes, smoking, and dyslipidemia. The awareness of risk factor among stroke survivors was poor.

Dietary approaches to prevent hypertension

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

Interaction of current alcohol consumption and abdominal obesity on hypertension risk

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

Dietary patterns and blood pressure among middle-aged and elderly Chinese men in Shanghai

The prevalence of hypertension has increased over the past decade in many developed and developing countries, including China. This increase may be associated with changes in lifestyle, including dietary patterns. We evaluated the association of dietary patterns with blood pressure (BP) by using data from a large, population-based cohort study of middle-aged and elderly Chinese men, the Shanghai Men's Health Study. The present cross-sectional analysis includes 39 252 men who reported no prior history of hypertension, diabetes, CHD, or stroke nor use of antihypertensive drugs at study enrolment. Three dietary patterns, 'vegetable', 'fruit and milk' and 'meat', were derived using factor analysis. The fruit and milk diet was inversely associated with both systolic and diastolic BP (Ptrend < 0.001). The adjusted mean systolic BP was 2.9 mmHg lower (95 % CI - 3.4, - 2.4), and diastolic BP was 1.7 mmHg lower (95 % CI - 2.0, - 1.4) for men in the highest quintile of the 'fruit and milk' pattern compared with men in the lowest quintile. This inverse association was more evident among heavy drinkers; the highest quintile of the 'fruit and milk' pattern was associated with a 4.1 mmHg reduction in systolic BP v. a 2.0 mmHg reduction among non-drinkers (Pinteraction = 0.003) compared to the lowest quintile. The corresponding reductions in diastolic BP were 2.0 v. 1.3 mmHg (Pinteraction = 0.011). The 'fruit and milk' pattern was associated with a lower prevalence of both pre-hypertension and hypertension, and the associations appeared to be stronger among drinkers. Results of the present study suggest an important role for diet in the prevention of hypertension.

Alcohol consumption and blood pressure in the adult US population: assessment of gender-related effects

OBJECTIVE

Our objective was to assess the gender-related effects of alcohol consumption on blood pressure (BP) in a representative sample of the adult US population.

METHODS

We examined data from the National Health and Nutrition Examination Survey 1999-2000. The effects of various risk factors for hypertension on BP were examined with analysis of covariance statistics.

RESULTS

Of the 5448 adults over 20 years of age, 2650 (48.7%) reported the intake of one or more drinks per day over the past year. In this population, the mean +/- SEM age was 46.9 +/- 0.34 years, the body mass index was 24.8 kg/m, 1257 (47.4%) were women, systolic BP was 124.3 +/- 0.44 mmHg and diastolic BP was 72.7 +/- 0.27 mmHg. Hypertension was reported in 21.1%, diabetes in 5.1% and cigarette smoking in 39.7%. A significant effect on systolic BP was shown with age (P < 0.01), body mass index (P < 0.01), race (P = 0.01), gender (P < 0.01) and diabetes (P < 0.01). The interaction with gender and alcohol drinking level was significant (P = 0.02). Post-hoc analysis localized the source of this effect. There was a significant increase in systolic BP between one and three and between one and four, but not between one and two, drinks per day in men. This effect was not observed in women.

CONCLUSION

Consistent with previous reports, our study suggests that alcohol intake up to two drinks per day has no effect on BP. There was a gender-related effect of alcohol intake in excess of two drinks per day on BP, with increased BP observed only in men but not in women.

Alcohol consumption and risk of atrial fibrillation in men and women: the Copenhagen City Heart Study

BACKGROUND

The relationship of the full range of alcohol consumption with risk of incident atrial fibrillation has been inconsistent in previous, mainly case-control studies.

METHODS AND RESULTS

In a prospective cohort study, we studied the association between self-reported alcohol use and incident atrial fibrillation among 16,415 women and men enrolled in the Copenhagen City Heart Study. We ascertained use of beer, wine, and spirits individually at up to 3 study visits with a structured questionnaire. We identified cases of atrial fibrillation by routine study ECGs and a validated nationwide registry of all hospitalizations. A total of 1071 cases occurred during follow-up. Among both women and men, alcohol consumption throughout the moderate range was not associated with risk of atrial fibrillation. However, consumption of 35 or more drinks per week among men was associated with a hazard ratio of 1.45 (95% CI 1.02 to 2.04); few women consumed this amount of alcohol. Approximately 5% of cases of atrial fibrillation among men were attributable to heavy alcohol use. Further adjustment for blood pressure and incident coronary heart disease and congestive heart failure did not attenuate the association (hazard ratio 1.63; 95% CI 1.15 to 2.31).

CONCLUSIONS

Heavy alcohol consumption is associated with a higher risk of atrial fibrillation, at least among men. This relationship does not appear to be related to the adverse effects of heavy drinking on coronary heart disease or blood pressure.

Alcohol consumption and hypertension

Hypertension is a major independent risk factor for cardiovascular disease. In alcohol-consuming populations, the amount of alcohol consumption has significant impact on blood pressure values, the prevalence of hypertension, and cardiovascular as well as all-cause mortality. In this review, we focus on the connection between alcohol consumption and hypertension, and discuss the consequences on cardiovascular risk.

Primary prevention of essential hypertension

The best approach to the primary prevention of hypertension is a combination of lifestyle changes: weight loss in overweight persons; increased physical activity; moderation of alcohol intake; and consumption of a diet that is higher in fruits, vegetables, and low-fat dairy products and lower in sodium content than the average American diet (Table 3). Recent randomized controlled trials have demonstrated that these lifestyle changes can be sustained over long periods of time (more than 3 years) and can have blood pressure-lowering effects as large as those seen in drug studies. Hypertension is an important preventable risk factor for cardiovascular disease, the leading cause of mortality in the United States. To achieve the Healthy People 2010 goal of reducing the proportion of adults with hypertension from 28% to 16%, concerted efforts must be directed toward primary prevention strategies. Lifestyle modifications including weight loss, increased physical activity, and dietary changes in individuals have been shown to reduce the incidence of hypertension and should be recommended for all persons and especially those with prehypertension. In addition, timely adoption of prevention strategies to reduce the incidence of hypertension and its subsequent complications in the general population may interrupt the costly cycle of hypertension and prevent the reductions in quality of life associated with this chronic disease.

Geographic variations in the prevalence, awareness, treatment and control of hypertension in China

OBJECTIVE

To compare the prevalence, awareness, treatment and control of hypertension in north and south, and urban and rural residents of China.

DESIGN

A cross-sectional survey conducted in 2000-2001.

SETTING AND PARTICIPANTS

A multistage cluster sampling method was used to select a nationally representative sample of 15 540 men and women aged 35-74 years from the general Chinese population.

MAIN OUTCOME MEASURES

Three blood pressure measurements were obtained by trained observers using a standardized mercury sphygmomanometer. Information on history of hypertension and use of antihypertensive medications was obtained by use of a standard questionnaire. Hypertension was defined as a mean systolic blood pressure >or= 140 mmHg and/or diastolic blood pressure >or= 90 mmHg and/or use of antihypertensive medications.

RESULTS

The age-standardized prevalence of hypertension was significantly higher among residents living in north than in south China (33.8 versus 23.3%, P < 0.001), but similar in those living in urban and rural areas (29.0 versus 28.1%, P = 0.3). Average systolic and diastolic blood pressure levels were consistently higher in north than in south residents. Residents in north China had higher percentages of awareness but lower percentages of control compared with their counterparts in south China. Percentages of awareness, treatment and control of hypertension were significantly higher in urban than in rural residents.

CONCLUSIONS

Our study documents a marked north-south gradient in the prevalence of hypertension in China. The previously reported urban-rural difference in the prevalence of hypertension was not noted, perhaps due to a rapid increase in the prevalence of hypertension in rural China.

Cardiovascular manifestations of substance abuse: part 2: alcohol, amphetamines, heroin, cannabis, and caffeine

The abuse of alcohol is associated with chronic cardiomyopathy, hypertension, and arrhythmia. Abstinence or using alcohol in moderation can reverse these cardiovascular problems. Alcohol is also distinguished among the substances of abuse by having possible protective effects against coronary artery disease and stroke when used in moderate amounts. Amphetamines (eg, speed, ice, ecstasy) have many of the cardiovascular toxicities seen with cocaine, including acute and chronic cardiovascular diseases. Heroin and other opiates can cause arrhythmias and noncardiac pulmonary edema, and may reduce cardiac output. Cardiovascular problems are less common with cannabis (marijuana) than with opiates, but major cognitive disorders may be seen with its chronic use. It is still controversial whether caffeine can cause hypertension and coronary artery disease, and questions have been raised about its safety in patients with heart failure and arrhythmia.

Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials

Alcohol drinking has been associated with increased blood pressure in epidemiological studies. We conducted a meta-analysis of randomized controlled trials to assess the effects of alcohol reduction on blood pressure. We included 15 randomized control trials (total of 2234 participants) published before June 1999 in which alcohol reduction was the only intervention difference between active and control treatment groups. Using a standard protocol, information on sample size, participant characteristics, study design, intervention methods, duration, and treatment results was abstracted independently by 3 investigators. By means of a fixed-effects model, findings from individual trials were pooled after results for each trial were weighted by the inverse of its variance. Overall, alcohol reduction was associated with a significant reduction in mean (95% confidence interval) systolic and diastolic blood pressures of -3.31 mm Hg (-2.52 to -4.10 mm Hg) and -2.04 mm Hg (-1.49 to -2.58 mm Hg), respectively. A dose-response relationship was observed between mean percentage of alcohol reduction and mean blood pressure reduction. Effects of intervention were enhanced in those with higher baseline blood pressure. Our study suggests that alcohol reduction should be recommended as an important component of lifestyle modification for the prevention and treatment of hypertension among heavy drinkers.

Stroke risk from multiple risk factors combined with hypertension: a primary care based case-control study in a defined population of northwest England

PURPOSE

To examine how hypertension interacts with other known risk factors in affecting the risk of stroke in a primary care based setting.

METHODS

Cases were patients with first-ever stroke identified from the community-based stroke register in 1994-95 in northwest England. Two controls per case were randomly selected from the same primary care site and matched by age and sex. Information on predefined risk factors was extracted from medical records.

RESULTS

267 cases and 534 controls were included. Adjusted odds ratio (OR) for stroke from hypertension was 2.6 (95% confidence interval: 1.7-3.9). In hypertensives who were current smokers, risk of stroke was increased 6 fold as compared to non-smokers without hypertension. Hypertensives who had a preexisting history of myocardial infarction or obesity or diabetes had 3 fold higher risks of stroke. Subjects with hypertension and with a history of transient ischemic attack or atrial fibrillation had > or = 8 fold excess risk of stroke. Among them, the risk was greater in those with poorly controlled or untreated hypertension and in those with well or moderately controlled as compared to subjects without both risk factors. There appeared to be a steady increase in risk of stroke according to the number of risk factors present, particularly in hypertensive subjects.

CONCLUSIONS

Stroke risks in hypertensives associated with combinations of other risk factors appeared to follow an additive model. Subjects with multiple risk factors should be targeted in order to reduce the overall risk for stroke.

The health effects of moderate alcohol intake in humans: an epidemiologic review

A large body of scientific evidence associates the moderate intake of alcohol with reduced mortality among middle-aged and older people in industrialized societies. This association is due largely to a reduced risk of death from coronary heart disease, which appears to outweigh any possible adverse effects of moderate drinking. The regular consumption of small amounts of alcohol is more healthful than the sporadic consumption of larger amounts. No beneficial effect of moderate drinking on mortality has been demonstrated in young adults (premenopausal women and men who have not reached their forties). It is theoretically possible that moderate drinking in young adulthood might reduce the risk of later heart disease; however, this has not been clearly demonstrated. For some individuals (e.g., those who cannot keep their drinking moderate, pregnant women, and those who are taking medications that may interact adversely with alcoholic beverages), the risks of alcohol consumption, even in moderation, outweigh any potential benefits. Because even small amounts of alcohol can impair judgment and coordination, no one should drink alcoholic beverages, even in moderation, before driving a motor vehicle or performing other activities that involve attention and skill.

Hypertension in adult American Indians. The Strong Heart Study

Hypertension is a primary risk factor for cardiovascular disease in the United States. Although cardiovascular disease is the leading cause of death among American Indians, the prevalence of hypertension, its awareness and control, and its association with other cardiovascular disease risk factors and physiological variables have not been well studied in this population. The Strong Heart Study is a longitudinal study of cardiovascular disease and its risk factors in American Indians. Participants (2703 women and 1846 men) were members of 13 tribes in central Arizona, southwestern Oklahoma, and regions of South and North Dakota. At least 1500 individuals between 45 and 74 years of age participated from each center in a baseline clinical examination conducted between July 1989 and January 1992. The examination consisted of a personal interview and physical examination that included an oral glucose tolerance test and three consecutive blood pressure measurements. This study reports data from the baseline examination on the prevalence of hypertension and correlates of blood pressure. Results indicated that despite the high frequency of diabetes and obesity, prevalence rates of hypertension in Arizona and Oklahoma were similar to those in the US population in the Third National Health and Nutrition Examination Survey (NHANES III), and rates among South/North Dakota participants were significantly lower (P < .0001). Blood pressure was higher in individuals with diabetes (P < .0001) and was significantly correlated with age (P < .0001) and albuminuria (P < .0001) but only weakly related to obesity. There was no independent relation between blood pressure and insulin. Blood pressure seems to be less affected by obesity and hyperinsulinemia in American Indians compared with other populations. Nevertheless, hypertension should be aggressively treated and controlled in American Indians because it is a known precursor to morbidity and mortality associated with diabetes and cardiovascular disease.

Alcohol consumption and physical fitness among young adults

The relationship between alcohol consumption and physical fitness was analyzed using data from the baseline examination of the Coronary Artery Disease Risk Development In Young Adults study (CARDIA), a longitudinal study of the evolution of risk factors for cardiovascular disease in Black and White men and women aged 18-30 years. Two parameters of submaximal exercise treadmill testing were evaluated: time to heart rate 130 and duration of the treadmill test. In men and women qualified for treadmill testing, time to reach heart rate 130 was positively associated with ethanol intake. The relationship between fitness and ethanol intake persisted in sex-specific analysis after adjustment for age, ethnicity, systolic blood pressure, sum of subscapular and triceps skinfolds, and physical activity level. The magnitude and strength of the relationship were greater in women than in men. A negative interaction between ethanol intake and smoking status was evident. Linear regression coefficients in men were 0.29 sec to heart rate 130/ml ethanol/day in nonsmokers and -0.06 sec to heart rate 130/ml ethanol/day in smokers. Linear regression coefficients in women were 1.07 sec to heart rate 130/ml ethanol/day in nonsmokers and 0.23 sec to heart rate 130/ml ethanol/day in smokers. Men and women who smoked showed 31 sec longer time to heart rate 130, regardless of ethanol intake. Mean daily ethanol intake was positively associated with duration of treadmill testing in women, but weakly associated with duration in men. These results show increased physical fitness as ethanol intake increased in women and nonsmoking men and mildly decreased physical fitness as ethanol consumption increases among men who smoke.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol and hypertension

1. Regular alcohol consumption is a significant contributor to the prevalence of hypertension in drinking communities. 2. The effect is additive to that of obesity and is partly reversible over 2-4 weeks with moderation of ethanol intake. 3. In heavy drinkers acute alcohol withdrawal may lead to more blood pressure elevation following an initial depressor response. 4. Heavy drinking is also associated with an increased risk of haemorrhagic stroke and cardiomyopathy. 5. Lighter drinking habits appear to offer significant protection against ischaemic heart deaths and ischaemic strokes. 6. Antihypertensive drug treatment for alcohol related hypertension may mask some of the adverse cardiovascular effects of alcohol. 7. Arguments as to whether alcohol is a cause of essential hypertension are tautological, given the many reversible lifestyle factors now known to contribute to the rise in blood pressure with aging.