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

Abstract

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.

Keywords: alcohol intake; cardiovascular disease; hypertension; prevention; public health.

Figure 1.

Flow chart of systematic literature search on alcohol exposure and hypertension up to February 20, 2024.

Figure 2.

Dose-response meta-analysis of the risk ratio (RR) of hypertension according to alcohol consumption (g/day). Analysis presented in (A) all study participants (22 studies^,,,–), in (B) men (18 studies^{,–,–,–,}), and in (C) women (12 studies^,,,,,,,–). Overall spline curve (black solid line) with 95% confidence limits (gray area).

Figure 3.

Dose-response meta-analysis of the risk ratio (RR) of hypertension according to alcohol consumption (g/day) divided by region and sex. Analysis presented by Asian and Western region and sex (Asian [A] n=11 studies overall,^,,–,,,–, [B] n=11 studies in men,^,,–,,,–, and [C] n=3 in women,^,, and Western, (D) n=11 studies overall,^,–,,,–, (E) n=7 studies in men,^,,,,,, and (F) n=7 in women^,,,–,). Overall spline curve (black solid line) with 95% confidence limits (gray area).

Figure 4.

Dose-response meta-analysis of the risk ratio (RR) of hypertension according to alcohol consumption (g/day) divided by ethnicity and sex. Analysis presented stratified by Black and White populations and by sex (Black population, [A] n=4 studies overall,^–, [B] n=3 in men,^,, and [C] n=3 in women^,,; White population, [D] n=5 studies overall,^,,,, [E] n=4 studies in men,^,,, and [F] n=4 studies in women^,,,). Overall spline curve (black solid line) with 95% confidence limits (gray area).