Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies

Abstract

BackgroundAlthough it is well established that heavy alcohol consumption increases the risk of hypertension, the risk associated with low levels of alcohol intake in men and women is unclear.Methods and ResultsWe searched Medline and Embase for original cohort studies on the association between average alcohol consumption and incidence of hypertension in people without hypertension. Random‐effects meta‐analyses and metaregressions were conducted. Data from 20 articles with 361 254 participants (125 907 men and 235 347 women) and 90 160 incident cases of hypertension (32 426 men and 57 734 women) were included. In people drinking 1 to 2 drinks/day (12 g of pure ethanol per drink), incidence of hypertension differed between men and women (relative riskwomen vs men=0.79; 95% confidence interval, 0.67–0.93). In men, the risk for hypertension in comparison with abstainers was relative risk=1.19 (1.07–1.31; I2=59%), 1.51 (1.30–1.76), and 1.74 (1.35–2.24) for consumption of 1 to 2, 3 to 4, and 5 or more standard drinks per day, respectively. In women, there was no increased risk for 1 to 2 drinks/day (relative risk=0.94; 0.88–1.01; I2=73%), and an increased risk for consumption beyond this level (relative risk=1.42; 1.22–1.66).ConclusionsAny alcohol consumption was associated with an increase in the risk for hypertension in men. In women, there was no risk increase for consumption of 1 to 2 drinks/day and an increased risk for higher consumption levels. We did not find evidence for a protective effect of alcohol consumption in women, contrary to earlier meta‐analyses.

Alcohol Consumption, Hypertension, and Cardiovascular Health Across the Life Course: There Is No Such Thing as a One‐Size‐Fits‐All Approach

“…They found that frequency of binge drinking was associated with elevated levels of systolic blood pressure in men but not women. This result is in some ways supported by the work of Roerecke et al,2 who similarly found a less pronounced effect of average alcohol intake on risk of developing hypertension in women. However, this study regrettably falls short of “completing the puzzle” of whether this difference in association with blood pressure by sex is driven by variation in drinking pattern (ie, episodes of heavy drinking being more common in men) through having not included either adjustment for, or the formal testing of an interaction with, overall volume of alcohol consumed.…”

“…Roerecke and colleagues2 carried out a systematic review and dose–response meta‐analysis of the association between alcohol consumption, defined using average number of drinks consumed per day, and incident hypertension separately in men and women. They found that no level of alcohol intake was associated with a lower risk of developing hypertension in either sex, which is in contrast to previous systematic reviews of this topic as well as observational studies of alcohol consumption and some cardiovascular outcomes 3, 4…”

“…However, as Roerecke et al2 note, the association of alcohol consumption with cardiovascular end points is not always linear, or necessarily negative (this is echoed in the work of Piano et al5 also) 3. This leaves public health officials and clinicians in some ways stuck between a rock and a hard place when it comes to providing advice on alcohol consumption.…”

The effect of alcohol dose on the development of hypertension in Asian and Western men: systematic review and meta-analysis

“…There was no threshold level below which alcohol consumption exerted a beneficial effect on the development of hypertension both in Asian and Western men. Our data, along with a recent meta-analysis [21], could serve as additional evidence in establishing the recommendations in each region.…”

ICD‐11 for Alcohol Use Disorders: Not a Convincing Answer to the Challenges

“…As an example, one can consider the relationship between alcohol and the risk of hypertension where 1 drink per day on average has been shown to increase blood pressure and the risk of hypertension (Roerecke et al., ). Consider a patient with hypertension and alcohol consumption: There is a good chance that her or his hypertension has been caused or worsened by alcohol consumption, fulfilling the definition of “harmful drinking.” But is such a diagnosis clinically meaningful when we cannot draw a definitive link?…”