. 2017 Sep 28;15(1):173.

doi: 10.1186/s12916-017-0934-1.

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Jürgen Rehm^{1

2

3

4

5

6}, Peter Anderson^{7

8}, Jose Angel Arbesu Prieto^{9

10}, Iain Armstrong¹¹, Henri-Jean Aubin¹², Michael Bachmann¹³, Nuria Bastida Bastus¹⁴, Carlos Brotons¹⁵, Robyn Burton¹¹, Manuel Cardoso¹⁶, Joan Colom¹⁷, Daniel Duprez¹⁸, Gerrit Gmel^{1

19

20}, Antoni Gual²¹, Ludwig Kraus^{22

23}, Reinhold Kreutz²⁴, Helena Liira^{25

26}, Jakob Manthey²⁷, Lars Møller²⁸, Ľubomír Okruhlica²⁹, Michael Roerecke^{1

2

3}, Emanuele Scafato^{30

31}, Bernd Schulte³², Lidia Segura-Garcia¹⁷, Kevin David Shield¹, Cristina Sierra³³, Konstantin Vyshinskiy³⁴, Marcin Wojnar³⁵, José Zarco³⁶

Affiliations

¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
² Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
³ Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁴ Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, Canada.
⁵ Department of Psychiatry, University of Toronto, Toronto, Canada.
⁶ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
⁷ Substance Use, Policy and Practice, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
⁸ Alcohol and Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
⁹ Primary Care Center La Eria, Oviedo, Spain.
¹⁰ Primary Care Spanish Society SEMERGEN, Madrid, Spain.
¹¹ Health and Wellbeing Directorate, Public Health England, London, UK.
¹² CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France.
¹³ Copentown Healthcare Consultants, Cape Town, South Africa.
¹⁴ Primary Health Center, Raval Nord, Barcelona, Spain.
¹⁵ Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona, Spain.
¹⁶ General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), Lisbon, Portugal.
¹⁷ Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain.
¹⁸ Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, USA.
¹⁹ Implant Systems Group, National ICT Australia, Eveleigh, Australia.
²⁰ Faculty of Engineering, University of New South Wales, Sydney, Australia.
²¹ Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain.
²² IFT Institut für Therapieforschung, Munich, Germany.
²³ Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden.
²⁴ Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
²⁵ General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia.
²⁶ University of Helsinki, Department of General Practice, and Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland.
²⁷ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany. jakob.manthey@tu-dresden.de.
²⁸ Division of Noncommunicable Diseases through the Life Course, WHO Regional Office for Europe, Copenhagen, Denmark.
²⁹ Centrum pre Liecbu Drogovych Zavislosti, Bratislava, Slovakia.
³⁰ National Observatory on Alcohol, National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy.
³¹ Società Italiana di Alcologia (SIA), Italian Society of Alcohology, Bologna, Italy.
³² Centre for Interdisciplinary Addiction Research, Hamburg University, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany.
³³ Hypertension and Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
³⁴ Research Institute on Addictions, Federal Medical Research Centre for Psychiatry and Narcology n.a. V. Serbsky, Moscow, Russia.
³⁵ Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
³⁶ Drugs Intervention Group, semFYC, Ibiza Primary Health Care Center, Madrid, Spain.

PMID: 28954635
PMCID: PMC5618725
DOI: 10.1186/s12916-017-0934-1

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Jürgen Rehm et al. BMC Med. 2017.

. 2017 Sep 28;15(1):173.

doi: 10.1186/s12916-017-0934-1.

Authors

Affiliations

¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
² Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
³ Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁴ Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, Toronto, Canada.
⁵ Department of Psychiatry, University of Toronto, Toronto, Canada.
⁶ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
⁷ Substance Use, Policy and Practice, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
⁸ Alcohol and Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.
⁹ Primary Care Center La Eria, Oviedo, Spain.
¹⁰ Primary Care Spanish Society SEMERGEN, Madrid, Spain.
¹¹ Health and Wellbeing Directorate, Public Health England, London, UK.
¹² CESP, University Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, APHP, Hôpitaux Universitaires Paris-Sud, Villejuif, France.
¹³ Copentown Healthcare Consultants, Cape Town, South Africa.
¹⁴ Primary Health Center, Raval Nord, Barcelona, Spain.
¹⁵ Sardenya Primary Health Care Center, Biomedical Research Institute Sant Pau, Barcelona, Spain.
¹⁶ General Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD), Lisbon, Portugal.
¹⁷ Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Catalonia, Barcelona, Spain.
¹⁸ Cardiovascular Division, School of Medicine, University of Minnesota, Minneapolis, USA.
¹⁹ Implant Systems Group, National ICT Australia, Eveleigh, Australia.
²⁰ Faculty of Engineering, University of New South Wales, Sydney, Australia.
²¹ Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain.
²² IFT Institut für Therapieforschung, Munich, Germany.
²³ Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden.
²⁴ Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
²⁵ General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia.
²⁶ University of Helsinki, Department of General Practice, and Helsinki University Central Hospital, Unit of Primary Health Care, Helsinki, Finland.
²⁷ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany. jakob.manthey@tu-dresden.de.
²⁸ Division of Noncommunicable Diseases through the Life Course, WHO Regional Office for Europe, Copenhagen, Denmark.
²⁹ Centrum pre Liecbu Drogovych Zavislosti, Bratislava, Slovakia.
³⁰ National Observatory on Alcohol, National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy.
³¹ Società Italiana di Alcologia (SIA), Italian Society of Alcohology, Bologna, Italy.
³² Centre for Interdisciplinary Addiction Research, Hamburg University, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany.
³³ Hypertension and Vascular Risk Unit, Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
³⁴ Research Institute on Addictions, Federal Medical Research Centre for Psychiatry and Narcology n.a. V. Serbsky, Moscow, Russia.
³⁵ Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
³⁶ Drugs Intervention Group, semFYC, Ibiza Primary Health Care Center, Madrid, Spain.

PMID: 28954635
PMCID: PMC5618725
DOI: 10.1186/s12916-017-0934-1

Abstract

Background: Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.

Methods: A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.

Results: Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.

Conclusions: The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

Keywords: Alcohol use; Blood pressure; Europe; Hypertension; Management; Primary healthcare; Recommendations; Screening.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

JR reports grants, personal fees and serving as board member (Nalmefene up to 2014) for Lundbeck. PA reports no competing interests. JAAP reports grants and personal fees from Lundbeck. IA reports no competing interests. H-JA reports serving as board member for Pfizer, D&A Pharma, Ethypharm, and Lundbeck, and receiving sponsorships, speaker honoraria and consultancy fees from Bioprojet, D&A Pharma, Ethypharm, Lundbeck, Merck-Serono, Novartis, and Pfizer. MB reports consulting fees received from Lundbeck (through consulting business Copentown) for organisational and process support in connection with the project. Copentown, which is owned by MB, also has other pharmaceutical/healthcare clients. NBB reports funding from Lundbeck for a research project on alcohol. CB reports consulting fees from Lundbeck. RB reports no competing interests. MC reports no competing interests. JC reports sponsorship from Lundbeck to attend scientific meetings. DD received consultant fee form Lundbeck. GG reports no competing interests. AG reports grants and personal fees from Lundbeck and D&A Pharma, grants from TEVA, and personal fees from Abbivie. LK reports funding from Lundbeck for a research project on alcohol. RK received honoraria for consultancy, lectures and support for research from Bayer Pharma, Berlin-Chemie Menarini, Bristol-Myers Squibb, Daiichi Sankyo, Lundbeck, and Servier. HL reports consultation fee from Lundbeck. JM reports personal fees from Lundbeck. LM reports no competing interests. LO reports no competing interests. MR reports no competing interests. ES reports sponsorship to attend scientific meetings from Lundbeck. BS reports no competing interests. LS-G reports sponsorship from Lundbeck to attend one scientific meeting. KDS reports no competing interests. CS reports sponsorship to attend scientific meetings from Lundbeck. KV reports no competing interests. MW reports personal fees from AOP Orphan, Berlin Chemie, Janssen, Lundbeck, D&A Pharma, Reckitt Benckiser. JZ reports personal fees from Lundbeck, and consultancy fees and salaries from Menarini, Lilly and Gilead.

References

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1. World Health Organization . A global brief on hypertension. Geneva: WHO; 2013.
1. Kontis V, Mathers CD, Rehm J, Stevens GA, Shield KD, Bonita R, et al. Contribution of six risk factors to achieving the “25 × 25” NCD mortality reduction target. Lancet. 2014;384:427–37. doi: 10.1016/S0140-6736(14)60616-4. - DOI - PubMed
1. Kontis V, Mathers CD, Bonita R, Stevens GA, Rehm J, Shield KD, et al. Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study. Lancet Glob Health. 2015;3:e746–57. doi: 10.1016/S2214-109X(15)00179-5. - DOI - PubMed

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Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Affiliations

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical