Alcohol consumption in patients with hypertension in primary care comparing Phosphatidylethanol and AUDIT – Cross-sectional study

Abstract

Background Hazardous alcohol use often goes unidentified in management of hypertension. The aim was to describe alcohol consumption using the alcohol biomarker Phosphatidylethanol (PEth) and the Alcohol Use Disorders Identification Test (AUDIT) in relation to hypertension (controlled, uncontrolled, and treatment resistant). Additionally, analyse the correlation between PEth and AUDIT and compare their performance in identifying hazardous alcohol use. Methods Cross-sectional study of patients with hypertension (ICD-code I10.9) from primary care in Sweden (2022–2024). A random sample of 270 participants from three groups of hypertension, mmHg, (controlled < 140/<90, uncontrolled ≥ 140/≥90, and treatment resistant ≥ 140/≥90 with at least three antihypertensive drugs regardless of class) was included. Data on alcohol consumption were collected during clinical hypertension check-up. In relation to three groups of hypertension, prevalence of alcohol consumption with PEth µmol/L (< 0.05, 0.05–0.3, and > 0.3) and AUDIT points (0–7, 8–15, and 16–40) and hazardous alcohol use with PEth (≥ 0.120 µmol/L) and AUDIT (8p), was calculated. The Spearman rank correlation coefficient was calculated between PEth values and AUDIT scores. Results Mean age 67 ± 11 years, 42% were women. Using PEth, approximately 40% in all groups of hypertension had “no/low/sporadic” consumption according to PEth. Using AUDIT, about 85% in all groups of hypertension did not have hazardous alcohol use. With PEth, the prevalence of “high and regular consumption” was 6.4% in controlled hypertension, 5.3% in uncontrolled hypertension, and 19.2% in treatment-resistant hypertension (p = 0.027 controlled hypertension vs treatment resistant hypertension, p = 0.013 uncontrolled hypertension vs treatment resistant hypertension). In the entire study population, the prevalence of hazardous alcohol with PEth was 23.7% (men 27%, women 19.1%, p = 0.138) and with AUDIT 12.4% (men 17.1%, women 6.1%, p = 0.008). The Spearman rank correlation coefficient between PEth values and AUDIT scores was 0.590, p < 0.001. PEth identified 14.7% with hazardous alcohol use that AUDIT missed, while AUDIT identified 3.5% that PEth did not identify. Conclusions PEth identified higher alcohol consumption and higher prevalence of hazardous alcohol use, compared to AUDIT. The results suggest that PEth provides valuable information about alcohol consumption, and highlights the importance of identifying alcohol use, especially in patients with treatment resistant hypertension and in men. Trial registration Retrospectively registered in Clinical Trials, SLSO2022-0143, 2022-12-10.