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Recommendations Summary

HTN: Alcohol 2015

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    HTN: Alcohol Intake in Moderate Drinkers

    If an adult with hypertension (HTN) is a moderate drinker, the registered dietitian nutritionist (RDN) should advise that reducing or refraining from alcohol may or may not aid in blood pressure (BP) management. Research indicates that the effect of alcohol on BP is unclear in moderate drinkers with HTN, since studies in this population yielded contradictory results.
     

    Rating: Weak
    Conditional

    HTN: Alcohol Intake in Heavy Drinkers

    If an adult with HTN is a heavy drinker, the RDN should recommend abstinence from alcohol to aid in BP management. Research indicates that abstinence from alcohol resulted in a decrease in systolic blood pressure (SBP) of up to 28mm Hg and a decrease in diastolic blood pressure (DBP) of up to 18mm Hg in chronic heavy drinkers with HTN. 

    Rating: Strong
    Conditional

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      Recommendations apply only to individuals with HTN who consume alcohol.
       

    • Potential Costs Associated with Application

      There are no obvious costs associated with the application of this recommendation.

    • Recommendation Narrative

      A total of five studies were included in the evidence analysis supporting the recommendations:

      • One positive quality before-after study (Baros et al, 2008) 
      • One positive quality non-randomized controlled trial (Soardo et al, 2006)
      • One neutral quality randomized crossover trial (Hering et al, 2011)
      • One neutral quality time study (Kawano et al, 2004) 
      • One neutral quality randomized controlled trial (RCT) (Stewart et al, 2008).
      Alcohol Intake in Moderate Drinkers
      • Two studies (Kawano et al,  2004; Hering et al, 2011) provide evidence that in moderate drinkers with HTN, the effect of alcohol on BP is unclear. The studies measured the effect of a relatively high dose of alcohol (1g or 1ml per kg body weight) on BP and yielded contradictory results. 
        • Hering et al, 2011 found that acute intake of 1.0g per kg resulted in a significant increase in SBP and in DBP 10 minutes after consumption in hypertensives compared with no increase in normotensives
        • Kawano et al, 2004 evaluated effects in hypertensives of repeated alcohol consumption for one week, compared to a one-week period of abstinence before the alcohol consumption phase, with sodium intake of 120mmol (2, 760mg) during all phases. There were no changes in 24-hour average BP. However, after alcohol consumption at dinner, SBP decreased significantly each evening compared to the abstinence control period, returning to normal when alcohol intake was discontinued. There were non-significant (NS) increases in SBP of 5mm Hg each afternoon during the alcohol intake phase.
      • Confounders such as ethnic origin, use of sodium restriction and differences in measurement times do not allow for direct comparison of the two studies. More research is needed to discern the shorter-term and longer-term effect of alcohol intake alone, in moderate drinkers with HTN.
      Alcohol Intake in Heavy Drinkers
      • There were no studies directly examining the effect of alcohol intake on BP in heavy drinkers with HTN. However, three studies (Baros et al, 2008; Soardo et al, 2006; Stewart et al, 2008) provide evidence that in chronic heavy drinkers or alcoholics with HTN found that abstinence from alcohol resulted in a decrease in SBP of 10mm Hg to 28mm Hg and a decrease in DBP of 7mm Hg to 18mm Hg:
        • Soardo et al, 2006 found that individuals who abstained from drinking saw decreases in SBP and DBP, whereas individuals who did not stop drinking saw no changes
        • Baros et al, 2008 found that individuals who reported any drinking over a 12-week period, saw only a NS decrease in both SBP and DBP compared to decreases in those who abstained completely
        • Stewart et al, 2008 observed significant decreases in SBP and DBP of 12mm Hg and 8mm Hg after four weeks, respectively, only in those whose SBP and DBP were above the study median.

    • Recommendation Strength Rationale

      • Conclusion statement for HTN: Alcohol Intake in Moderate Drinkers is Grade III
      • Conclusion statement for HTN: Alcohol Intake in Heavy Drinkers is Grade I.

    • Minority Opinions

      None.