GRADE GUIDANCE 38: Updated guidance for rating up certainty of evidence due to a dose-response gradient

Murad, M. Hassan; Verbeek, Jos; Schwingshackl, Lukas; Filippini, Tommaso; Vinceti, Marco; Akl, Elie A.; Morgan, Rebecca L.; Mustafa, Reem A.; Zeraatkar, Dena; Senerth, Emily; Street, Renee; Lin, Lifeng; Falck-Ytter, Yngve; Guyatt, Gordon; Schünemann, Holger J.

doi:10.1016/j.jclinepi.2023.09.011

Cited by 7 publications

(1 citation statement)

References 51 publications

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“…We eventually provided a graphical overlay of study-specific trends using predicted study-specific curves showing the influence of variation across studies. 15 , 20 , 21 All analyses were carried out by using Stata-MP software (v18.0, Stata Corp, College Station, TX, 2023), specifically the “meta,” “mkspline,” and “drmeta” routines.…”

Section: Methodsmentioning

confidence: 99%

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

Cecchini,

Filippini,

Whelton

et al. 2024

Hypertension

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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 Whites than in Blacks, 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.

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Section: Methodsmentioning

confidence: 99%