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Am Fam Physician. 2004;70(12):2367-2369

Two guidelines address alcohol consumption in patients with hypertension. The new American Heart Association advisory recommends that patients with hypertension avoid alcohol consumption. This recommendation conflicts with the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), which states that men should limit their alcohol intake to two drinks per day and women should limit their intake to one drink per day. The reason for these recommendations is that heavy alcohol consumption has been shown to elevate blood pressure.

In patients who consume more than three drinks per day, reduction in alcohol intake can lower blood pressure. Current studies have shown an inverse relation between moderate alcohol consumption and cardiovascular mortality. However, these studies are not specific for patients who have hypertension. Malinski and colleagues evaluated the relation between light and moderate alcohol consumption and cardiovascular mortality in men with hypertension.

The study population included participants in the Physicians’ Health Study who were identified as having hypertension. Baseline data included a specific question about alcoholic beverage consumption. Information also was collected about other coronary risk factors, including smoking, cholesterol levels, use of cholesterol-lowering agents, systolic and diastolic blood pressures, frequency of vigorous exercise, history of angina, and history of diabetes. Body mass index was calculated using the participants’ reported weight and height. End points assessed were total deaths, total cardiovascular disease, myocardial infarction, stroke, other cardiovascular outcomes, and cancer deaths. Data were obtained from a national database and from death certificates for those who died during the follow-up period.

The study population included 14,125 participants with a mean follow-up period of 5.4 years, resulting in 75,710 person-years. During the study, 1,018 participants died, with 56.9 percent of the deaths resulting from cardiovascular causes. Those who reported monthly, weekly, and daily alcohol consumption had an adjusted relative risk for cardiovascular mortality that was significantly less than the risk in participants who reported that they rarely or never drank. This significant trend continued even in men who reported systolic blood pressures of 140 mm Hg or higher and diastolic pressures of 90 mm Hg or higher. The relative risk for all mortality was significantly less in the group that reported monthly, weekly, or daily alcohol consumption compared with the groups who rarely or never drank. There was no association between moderate alcohol consumption and cancer deaths.

The authors conclude that light to moderate alcohol consumption is associated with a reduction in risk of total and cardiovascular mortality in hypertensive men. They note that this study needs to be confirmed by other large scale studies and that the results need to be interpreted with caution.

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