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Meta-Analysis
. 2020 Jul 1;7(7):CD012787.
doi: 10.1002/14651858.CD012787.pub2.

Effect of alcohol on blood pressure

Sara Tasnim  1 , Chantel Tang  2 , Vijaya M Musini  1 , James M Wright  1
Affiliations
Meta-Analysis

Effect of alcohol on blood pressure

Sara Tasnim et al. Cochrane Database Syst Rev. .

Abstract

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 We also contacted authors of relevant articles regarding further published and unpublished work.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.

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Conflict of interest statement

Chantel Tang: none known.

Sara Tasnim: none known.

Vijaya Musini: none known.

James M Wright: none known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.4 Heart rate.
5
5
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.1 Systolic blood pressure.
6
6
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.2 Diastolic blood pressure.
7
7
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.3 Mean arterial blood pressure.
8
8
Funnel plot of comparison: 3 High‐dose alcohol vs placebo, outcome: 3.4 Heart rate.
9
9
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.1 Systolic blood pressure.
10
10
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.2 Diastolic blood pressure.
11
11
Funnel plot of comparison: 2 Medium‐dose alcohol vs placebo, outcome: 2.3 Mean arterial blood pressure.
1.1
1.1. Analysis
Comparison 1: Low‐dose alcohol vs placebo, Outcome 1: Systolic blood pressure
1.2
1.2. Analysis
Comparison 1: Low‐dose alcohol vs placebo, Outcome 2: Diastolic blood pressure
1.3
1.3. Analysis
Comparison 1: Low‐dose alcohol vs placebo, Outcome 3: Mean arterial blood pressure
1.4
1.4. Analysis
Comparison 1: Low‐dose alcohol vs placebo, Outcome 4: Heart rate
2.1
2.1. Analysis
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 1: Systolic blood pressure
2.2
2.2. Analysis
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 2: Diastolic blood pressure
2.3
2.3. Analysis
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 3: Mean arterial blood pressure
2.4
2.4. Analysis
Comparison 2: Medium‐dose alcohol vs placebo, Outcome 4: Heart rate
3.1
3.1. Analysis
Comparison 3: High‐dose alcohol vs placebo, Outcome 1: Systolic blood pressure
3.2
3.2. Analysis
Comparison 3: High‐dose alcohol vs placebo, Outcome 2: Diastolic blood pressure
3.3
3.3. Analysis
Comparison 3: High‐dose alcohol vs placebo, Outcome 3: Mean arterial blood pressure
3.4
3.4. Analysis
Comparison 3: High‐dose alcohol vs placebo, Outcome 4: Heart rate
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Botden 2012 {published data only}
    1. Botden IP, Draijer R, Westerhof BE, Rutten JH, Langendonk JG, Sijbrands EJ, et al. Red wine polyphenols do not lower peripheral or central blood pressure in high normal blood pressure and hypertension. American Journal of Hypertension 2012;25(6):718-23. [PMID: ] - PubMed
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Braggio 1992 {published data only}
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Brasser 2004 {published data only}
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Brown 2010 {published data only}
    1. Brown J, Brignell CM, Dhiman SK, Curran HV, Kamboj SK. Acute effects of alcohol on memory: impact of emotional context and serial position. Neurobiology of Learning and Memory 2010;93:428-34. [DOI: 10.1016/j.nlm.2009.12.010] - DOI - PubMed
Brugger‐Andersen 2009 {published data only}
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Bulpitt 1999 {published data only}
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Burke 2001 {published data only}
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Campbell 1999 {published data only}
    1. Campbell NR, Burgess E, Choi BC, Taylor G, Wilson E, Cleroux J, et al. Lifestyle modifications to prevent and control hypertension. 1. Methods and an overview of the Canadian recommendations. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Center for Disease Control at Health Canada, Heart and Stroke Foundation in Canada. Canadian Medical Association Journal 1999;160(9 Suppl):S1-6. - PMC - PubMed
Carter 2011 {published data only}
    1. Carter JR, Stream SF, Durocher JJ, Larson RA. Influence of acute alcohol ingestion on sympathetic neural responses to orthostatic stress in humans. American Journal of Physiology-Endocrinology and Metabolism 2011;300:E771-8. [DOI: 10.1152/ajpendo.00674.2010] - DOI - PMC - PubMed
Chagas 2016 {published data only}
    1. Chagas P, Mazocco L, Piccoli J, Ardenghi TM, Badimon L, Caramori PR, et al. Association of alcohol consumption with coronary artery disease severity. Clinical Nutrition ESPEN 2016;36(4):1036-9. [DOI: 10.1016/j.clnu.2016.06.017] - DOI - PubMed
Chang 2011 {published data only}
    1. Chang G, Fisher ND, Hornstein MD, Jones JA, Hauke SH, Niamkey N, et al. Brief intervention for women with risky drinking and medical diagnoses: a randomized controlled trial. Journal of Substance Abuse Treatment 2011;41(2):105-14. [PMID: ] - PMC - PubMed
Chaplin 2008 {published data only}
    1. Chaplin TM, Hong K, Bergquist K, Sinha R. Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving. Alcoholism: Clinical and Experimental Research 2008;32(7):1242-50. [PMID: 18482163 ] - PMC - PubMed
Chaudhuri 1994 {published data only}
    1. Chaudhuri KR, Maule S, Thomaides, Pavitt D, Mathias CJ. Alcohol ingestion lowers supine blood pressure, causes splanchnic vasodilatation and worsens postural hypotension in primary autonomic failure. Journal of Neurology 1994;241(3):145-52. [PMID: ] - PubMed
Chiadak 2017 {published data only}
    1. Chiadak JD, Perret J, Womeni HM, Kuiate JR, Cullus P, Senterre C, et al. Pilot study of risk factors associated with cardiovascular disease in northern and southern Cameroonians. Cardiovascular Journal of Africa 2017;28(4):235-41. [PMID: ] - PMC - PubMed
Childs 2011 {published data only}
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Chiva‐Blanch 2012a {published data only}
    1. Chiva-Blanch G, Urpi-Sarda M, Llorach R, Rotches-Ribalta M, Guillen M, Casas R, et al. Differential effects of polyphenols and alcohol of red wine on the expression of adhesion molecules and inflammatory cytokines related to atherosclerosis: a randomized clinical trial. American Journal of Clinical Nutrition 2012;95(2):326-34. [DOI: 10.3945/ajcn.111.022889] - DOI - PubMed
Chiva‐Blanch 2012b {published data only}
    1. Chiva-Blanch G, Urpi-Sarda M, Ros E, Arranz S, Valderas-Martinez P, Casas R, et al. Dealcoholized red wine decreases systolic and diastolic blood pressure and increases plasma nitric oxide: short communication. Circulation Research 2012;111(8):1065-8. [PMID: ] - PubMed
Chiva‐Blanch 2013a {published data only}
    1. Chiva-Blanch G, Condines X, Roth I, Magraner E, Arranz S, Valderas-Martinez, et al. Moderate beer consumption increases the number of circulating endothelial progenitor cells in high cardiovascular risk males. Annals of Nutrition and Metabolism 2013;2:40.
Chiva‐Blanch 2013b {published data only}
    1. Chiva-Blanch G, Urpi-Sarda M, Ros E, Valderas-Martinez P, Casas R, Arranz S, et al. Effects of red wine polyphenols and alcohol on glucose metabolism and the lipid profile: a randomized clinical trial. Clinical Nutrition 2013;32(2):200-6. [PMID: ] - PubMed
Chiva‐Blanch 2015 {published data only}
    1. Chiva-Blanch G, Magraner E, Condines X, Valderas-Martinez P, Roth I, Arranz S, et al. Effects of alcohol and polyphenols from beer on atherosclerotic biomarkers in high cardiovascular risk men: a randomized feeding trial. Nutrition, Metabolism and Cardiovascular Diseases 2015;25(1):36-45. [PMID: ] - PubMed
Colby 2004 {published data only}
    1. Colby SM, Rohsenow DJ, Monti PM, Gwaltney CJ, Gulliver SB, Abrams DB, et al. Effects of tobacco deprivation on alcohol cue reactivity and drinking among young adults. Addictive Behaviors 2004;29(5):879-92. [PMID: ] - PubMed
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Cordain 2000 {published data only}
    1. Cordain L, Melby CL, Hamamoto AE, O'Neill DS, Cornier MA, Barakat HA, et al. Influence of moderate chronic wine consumption on insulin sensitivity and other correlates of syndrome X in moderately obese women. Metabolism 2000;49(11):1473-8. [PMID: ] - PubMed
Covault 2014 {published data only}
    1. Covault J, Pond T, Feinn R, Arias AJ, Oncken C, Kranzier HR. Dutasteride reduces alcohol's sedative effects in men in a human laboratory setting and reduces drinking in the natural environment. Psychopharmacology 2014;231(17):3609-18. [PMID: ] - PMC - PubMed
Cox 1990 {published data only}
    1. Cox KL, Puddey IB, Morton AR, Masarei JR, Vandongen R, Beilin LJ. Controlled comparison of effects of exercise and alcohol on blood pressure and serum high density lipoprotein cholesterol in sedentary males. Clinical and Experimental Pharmacology and Physiology 1990;17(4):251-5. [PMID: ] - PubMed
Cox 1993 {published data only}
    1. Cox KL, Puddey IB, Morton AR, Beilin LJ, Vandongen R, Masarei JR. The combined effects of aerobic exercise and alcohol restriction on blood pressure and serum lipids: a two-way factorial study in sedentary men. Journal of Hypertension 1993;11(2):191-201. [PMID: ] - PubMed
Croissant 2011 {published data only}
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Cushing 2009 {published data only}
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Cushman 1994 {published data only}
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Cushman 1998 {published data only}
    1. Cushman WC, Cutler JA, Hanna E, Bingham SF, Follmann D, Harford T, et al. Prevention and treatment of hypertension study (PATHS): effects of an alcohol treatment program in blood pressure. Archives of Internal Medicine 1998;158(11):1197-207. [PMID: ] - PubMed
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deLorenzo 1985 {published data only}
    1. Lorenzo A, Ceccanti M, Assogna G, Romeo M, Cavalieri G, Attilia ML. Ketanserin hypertension and chronic alcoholism DB study in 40 patients. Bollettino Chimico Farmaceutico 1985;124(10):125S-8S. [PMID: ] - PubMed
deLorenzo 1988 {published data only}
    1. Lorenzo A, Ceccanti M, Assogna G, Romeo M, Cavaleri G, Attilia ML. Ketanserin, hypertension, and chronic alcoholism: double-blind study in forty patients. International Journal of Clinical and Pharmacological Research 1988;8(5):321-5. [PMID: ] - PubMed
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deRijke 1996 {published data only}
    1. Rijke YB, Demacker PN, Assen NA, Sloots LM, Katan MB, Stalenhoef AF. Red wine consumption does not affect oxidizability of low-density lipoproteins in volunteers. American Journal of Clinical Nutrition 1996;63(3):329-34. [PMID: ] - PubMed
DiGarbo 2004 {published data only}
    1. Di Garbo V, Campisi D, Alonzo G, Gambino L, Avellone G, De Simone R, et al. Effects of two Sicilian red wines on some cardiovascular risk factors [Effetto di due vini rossi siciliani su alcuni fattori di rischio cardiovascolare]. Italian Heart Journal 2004;5(5):382-8. - PubMed
Dimmitt 1998 {published data only}
    1. Dimmitt SB, Rakic V, Puddey IB, Baker R, Oostryck R, Adams MJ, et al. The effects of alcohol on coagulation and fibrinolytic factors: a controlled trial. Blood Coagulation & Fibrinolysis 1998;9(1):39-45. [PMID: ] - PubMed
Draijer 2015 {published data only}
    1. Draijer R, Graaf Y, Slettenaar M, Groot E, Wright CI. Consumption of a polyphenol-rich grape-wine extract lowers ambulatory blood pressure in mildly hypertensive subjects. Nutrients 2015;7(5):3138-53. [PMID: ] - PMC - PubMed
Droste 2013a {published data only}
    1. Droste DW, lliescu C, Vaillant M, Gantenbein M, De Vremaeker N, Lieunard C, et al. A daily glass of red wine and lifestyle changes do not affect arterial blood pressure and heart rate in patients with carotid arteriosclerosis after 4 and 20 weeks. Cerebrovascular Research 2013;3(1):121-9. [PMID: ] - PMC - PubMed
Droste 2013b {published data only}
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Durocher 2011 {published data only}
    1. Durocher JJ, Larson RA, Carter JR. Acute alcohol ingestion lengthens sympathetic burst latency in humans. FASEB Journal. Conference: Experimental Biology 2011;25:No pagination.
Eisenhofer 1987 {published data only}
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Estevez 1995 {published data only}
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Farre 1993 {published data only}
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Farre 2017 {published data only}
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Fazio 2001 {published data only}
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Flanagan 2002 {published data only}
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Flechtner‐Mors 2004 {published data only}
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Foltin 1988 {published data only}
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Foppa 1999 {published data only}
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Frisk‐Holmberg 1990 {published data only}
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Garcia‐Andrade 1997 {published data only}
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Gepner 2013 {published data only}
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Gepner 2015 {published data only}
    1. Gepner Y, Golan R, Harman-Boehm I, Henkin Y, Schwarzfuchs D, Shelef I, et al. Effects of initiating moderate alcohol intake on cardiometabolic risk in adults with type 2 diabetes: a 2-year randomized, controlled trial. Annals of Internal Medicine 2015;163(8):569-79. [PMID: 26458258 ] - PubMed
Gepner 2016 {published data only}
    1. Gepner Y, Henkin Y, Schwarzfuchs D, Golan R, Durst R, Shelef I, et al. Differential effect of initiating moderate red wine consumption on 24-h blood pressure by alcohol dehydrogenase genotypes: randomized trial in type 2 diabetes. American Journal of Hypertension 2016;29(4):476-83. [PMID: ] - PMC - PubMed
Giovannelli 2011 {published data only}
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    1. Golan R, Schwarzfuchs D, Gepner Y, Harman-Boehm I, Stampfer MJ, Rudich A, et al. The effect of moderate wine intake on carotid atherosclerosis in type 2 diabetes, a 2-year intervention study. European Heart Journal 2016;37(Suppl 1):733.
Golan 2017 {published data only}
    1. Golan R, Shelef I, Shemesh E, Henkin Y, Schwarzfuchs D, Gepner Y, et al. Effects of initiating moderate wine intake on abdominal adipose tissue in adults with type 2 diabetes: a 2-year randomized controlled trial. Public Health Nutrition 2017;20(3):549-55. - PMC - PubMed
Golan 2018 {published data only}
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Gopane 2010 {published data only}
    1. Gopane RE, Pisa PT, Vorster HH, Kruger A, Margettes BM. Relationships of alcohol intake with biological health outcomes in an African population in transition: the transition and health during urbanisation in South Africa (THUSA) study. South African Journal of Clincial Nutrition 2010;23(3 Suppl 1):S16-21. [DOI: 10.1080/16070658.2010.11734297] - DOI
Gourlay 2013 {published data only}
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Greyling 2016 {published data only}
    1. Greyling A, Bruno RM, Draijer R, Mulder T, Thijssen DH, Taddei S, et al. Effects of wine and grape polyphenols on blood pressure, endothelial function and sympathetic nervous system activity in treated hypertensive subjects. Journal of Functional Foods 2016;27:448-60. [DOI: 10.1016/j.jff.2016.10.003] - DOI
Hansen 2005 {published data only}
    1. Hansen AS, Marckmann P, Dragsted LO, Finne Nielsen IL, Nielsen SE, Gronbaek M. Effect of red wine and red grape extract on blood lipids, haemostatic factors, and other risk factors for cardiovascular disease. European Journal of Clinical Nutrition 2005;59(3):449-55. [PMID: 15674304 ] - PubMed
Hartmann 2017 {published data only}
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Hijmering 2007 {published data only}
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Jain 2016 {published data only}
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Jones 1979 {published data only}
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Kawano 2002 {published data only}
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Kelbaek 1987 {published data only}
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Kelbaek 1988 {published data only}
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Nicholas 2013b {published data only}
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Pitsavos 2004 {published data only}
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Rada 2018 {published data only}
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Rajdl 2007 {published data only}
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Roth 2017 {published data only}
    1. Roth I, Casas R, Medina A, Ribo Coll M, Lamuela-Raventos RM, Estruch R. Acute effects of age wine, Spanish white wine, consumption increased circulating endothelial progenitor cells and reduced cardiovascular risk factors in men: a randomized intervention trial. Annals of Nutrition and Metabolism 2017;71(Suppl 2):940-1.
Roth 2018 {published data only}
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Sagawa 2011 {published data only}
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Sierksma 2002 {published data only}
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Takashima 1998 {published data only}
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Yin 2007 {published data only}
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References to ongoing studies

Polzein ongoing {published data only}
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