Sex‐Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta‐Analysis of Cohort Studies
Review article
Abstract
Background
Although 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 Results
The researchers 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 consuming 1 to 2 alcoholic drinks/day (12 g of pure ethanol per drink), incidence of hypertension differed between men and women.
- In men, the risk for hypertension in comparison with abstainers was relative risk=1.19, 1.51, and 1.74 for consumption of 1 to 2, 3 to 4, and 5 or more standard alcoholic drinks per day, respectively.
- In women, there was no increased risk for 1 to 2 alcoholic drinks/day, and an increased risk for consumption beyond this level (relative risk=1.42; 1.22–1.66).
Conclusions
Any 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 alcoholic drinks/day and an increased risk for higher consumption levels.
The researchers did not find evidence for a protective effect of alcohol consumption in women, contrary to earlier meta‐analyses.
Clinical Perspective
What Is New?
- This is the first meta‐analysis based on high‐quality cohort studies on the relationship between different levels of alcohol consumption and risk for incident hypertension.
- The researchers investigated the risk for hypertension separately for men and women in people who did not have hypertension at baseline.
- The risk for hypertension in former alcohol consumers was similar to that of lifetime abstainers.
- The researchers found that, compared with non-alcohol drinkers, the risk for hypertension was increased at all levels of alcohol consumption in men.
- Contrary to earlier meta‐analyses, the researchers did not find a protective effect of low levels of alcohol consumption in women.
What Are the Clinical Implications?
- The findings support sex‐specific alcohol consumption guidelines with regard to risk for hypertension. These guidelines may be revised to indicate the increased risk for any alcohol consumption in men.
- Alcohol consumption should be assessed at the primary care level whenever there is elevated blood pressure.
- Changing clinical practice promises to reduce substantial mortality and burden of disease associated with both alcohol consumption and hypertension.
