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SUMMARY A direct pressor effect of alcohol is proposed as the basis for the association between regular alcohol consumption and an increase in blood pressure found in population studies. To examine this further, a randomized controlled crossover trial of the effects of varying alcohol intake on blood pressure in 46 healthy male drinkers was conducted. From an average of 336 ml of ethanol per week, alcohol consumption was reduced by 80% for 6 weeks by drinking a low alcohol content beer alone. This reduction was associated with a significant reduction in systolic and diastolic blood pressure (p < 0.001 and p < 0.05 respectively). The mean difference in supine systolic blood pressure during the last 2 weeks of normal or low alcohol intake was 3.8 mm Hg, which correlated significantly with change in alcohol consumption (r = 0.53, p < 0.001). Reduction of alcohol intake also caused a significant decrease in weight (p < 0.001). After adjustment for weight change, an independent effect of alcohol on systolic but not diastolic blood pressure was still evident, with a 3.1 mm Hg fall predicted for a decrease In consumption from 350 ml of ethanol equivalent per week to 70 ml per week (p < 0.01). Systolic blood pressure rose again when normal drinking habits were resumed. These results provide clear evidence for a direct and reversible pressor effect of regular moderate alcohol consumption in normotensive men and suggest that alcohol may play a major role in the genesis of early stages or blood pressure elevation. (Hypertension 7: 707-713, 1985)KEY WORDS • alcohol intake • blood pressure • hypertension A LTHOUGH an association between alcohol con-/ \ sumption and increased blood pressure levels X \ . has been described in a number of population studies, the nature of this relationship remains uncertain. "4 On the one hand, there is accumulating evidence that alcohol is a direct cause of blood pressure elevation, 5 " 9 while on the other, there is the suggestion that some common constitutional trait predisposes to both alcohol use and hypertension. 10In an attempt to resolve this uncertainty, we have conducted a randomized crossover trial of the effects of varying alcohol intake on blood pressure in normotensive moderate drinkers. The results show highly Subjects and Methods Seventy-one subjects responded to advertisements seeking men aged 25 to 55 years who were regular drinkers and prepared to participate in a trial designed to assess the effect of moderation of normal alcohol intake on blood pressure. They completed a questionnaire that assessed demographic details, medical history (including medications), and use of alcohol and tobacco. Alcohol consumption was estimated from a 7-day retrospective diary of both the previous week's and an average week's intake" and was expressed as the equivalent in milliliters of absolute ethanol per week. Fourteen subjects were excluded because their consumption was less than 210 ml per week. Three respondents outside the specified age range and two taking 0-blockers were also excluded....

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