Alcohol consumption and ambulatory blood pressure-lowering effect in male patients on clinic blood pressure-guided antihypertensive treatment

Abstract

In the present analysis, we investigated the association between alcohol consumption and ambulatory blood pressure (BP) control in male patients after 8 weeks of antihypertensive therapy with two dihydropyridine calcium channel blockers. The study participants were hypertensive (clinic systolic/diastolic BP of 140-179/90-109 mmHg and 24-hour ambulatory systolic/diastolic BP ≥ 130/80 mmHg) patients enrolled in a randomized controlled trial and treated with amlodipine 5-10 mg or nifedipine gastrointestinal therapeutic system (GITS) 30-60 mg once daily. Alcohol consumption was classified as non-drinkers and drinkers. Non-dipping was defined as a BP drop from daytime to nighttime <10%. At baseline, the 131 alcohol drinkers, compared with 141 non-drinkers, had a significantly higher nighttime systolic/diastolic BP (129.3 ± 13.5/83.8 ± 9.5 vs. 125.7 ± 12.3/80.9 ± 8.2 mmHg, P ≤ 0.02), night-to-day ratio for both systolic (89.1 ± 8.5 vs. 87.0 ± 7.1%, P = 0.03) and diastolic BP (88.7 ± 8.8 vs. 86.5 ± 7.9%, P = 0.04) and prevalence of non-dippers for systolic (45.0% vs. 33.3%, P = 0.048) and diastolic BP (42.0% vs. 29.8%, P = 0.04). However, they had similar clinic and 24-hour and daytime ambulatory BP at baseline (P ≥ 0.07). Antihypertensive treatment significantly (P ≤ 0.001) reduced clinic and ambulatory systolic and diastolic BP from baseline in both alcohol drinkers and non-drinkers at 4 and 8 weeks of follow-up. However, in patients with a non-dipping pattern at baseline, the proportion of dippers for systolic/diastolic BP at 8 weeks of follow-up (36.5% vs. 58.5%) was significantly lower in 67 alcohol drinkers than in 52 non-drinkers (P = 0.035). Alcohol drinkers had higher nighttime BP and a higher prevalence of non-dippers than non-drinkers. Clinic blood pressure-guided antihypertensive treatment was insufficient in controlling nighttime BP or changing the non-dipping to dipping pattern in alcohol drinkers with sustained clinic and ambulatory hypertension. Alcohol drinkers had higher nighttime systolic and diastolic blood pressure than non-drinkers at baseline. Clinic blood pressure-guided antihypertensive treatment was insufficient in changing the non-dipping to dipping pattern in alcohol drinkers with sustained clinic and ambulatory hypertension.

Keywords: Alcohol consumption; ambulatory blood pressure; daytime; nighttime; non-dippers.