Alcohol Consumption Linked to Hypertension in Type Two Diabetes

by | Oct 8, 2020 | 2020, Alcohol, Blood Pressure, Cardiovascular Health, Diabetes, Pancreatic Health

Written by Joyce Smith, BS. This study analyzed data from 10,200 participants from the ACCORD trial aged 40 years and older with type 2 diabetes and elevated CV risk.

cardiovascular health - blood pressureHypertension is a leading cause of premature death and contributes to the number of lives lost annually due to heart, stoke, and chronic liver diseases 1. Low and middle income countries have  experienced the greatest increase in blood pressure, although since the revised 2017 guidelines for BP, the numbers of Americans with elevated BP has been increasing 2,3. More than 50 epidemiological studies have found an association between alcohol consumption and hypertension. The association is strong and independent of age, smoking, obesity, salt intake, education level, and type of alcoholic beverage 4,5,6,7. The following study 8 investigated the association of alcohol consumption with prevalent hypertension in 10,200 participants from the ACCORD trial.

Participants, aged 40 years and older with type 2 diabetes and elevated CV risk, were categorized by weekly alcohol intake as follows: no drinks (n = 7,767; mean age, 63 years; 55% men), light (one to seven drinks; n = 2,124; mean age, 63 years; 78% men), moderate (eight to 14 drinks; n = 232; mean age, 63 years; 100% men) or heavy (15 or more drinks; n = 77; mean age, 63 years; 100% men). BP was categorized as follows according to the definitions in the 2017 American Heart Association/American College of Cardiology hypertension guideline: normal (<120/<80 mm Hg), elevated (120-129/<80), stage 1 hypertension (130-139 or 80-89 mm Hg) and stage 2 hypertension (130-139 or 80-89 mm Hg). BP was measured at baseline and self-reported information on weekly alcohol intake was collected. Analyzed data revealed the following:

  • Light alcohol consumption was not associated with elevated BP (OR = 1.11; 95% CI, 0.92-1.31), stage 1 hypertension (OR = 1.11; 95% CI, 0.85-1.45) or stage 2 hypertension (OR = 1.02; 95% CI, 0.88-1.19).
  • Moderate alcohol consumption was associated with elevated BP (OR = 1.79; 95% CI, 1.04-3.11), stage 1 hypertension (OR = 1.66; 95% CI, 1.05-2.6) and stage 2 hypertension (OR = 1.62; 95% CI, 1.03-2.54). P=0.03 for all three.
  • A stronger association was seen in participants with heavy alcohol consumption with respect to all three categories: BP (OR = 1.91; 95% CI, 1.17-3.12; P=0.01), stage 1 hypertension (OR = 2.49; 95% CI, 1.03-6.17; P=0.03) and stage 2 hypertension (OR = 3.04; 95% CI, 1.28-7.22; P=0.01).

Study findings provide a cautionary note that consuming more than 7 alcoholic drinks per week can increase the risk of high BP and hypertension in type 2 diabetics particularly those with cardiovascular risk and suggests the importance of educating even moderate drinkers of alcohol’s impact on blood pressure.

This study has a number of limitations. Self-reported alcohol consumption may have been underestimated. Selection bias may also have occurred. The selection of participants based on higher CVD risk could skew extrapolation of results to the general population of type 2 diabetics. The management of type 2 diabetes has improved considerably since the inception of the 20-year-old ACCORD trial and thus may misrepresented the actual effect of diabetes on BP. In addition, the data on CVD and Type 2 diabetes medications was not recorded in the ACCORD trial and thus could not be calculated into the analysis models, potentially presenting a residual confounder. Another potential confounder is the genetic association with alcohol and type 2 diabetes which could not be ruled out. Lastly, while not a criticism, the researchers believe a data set with more participants meeting the criteria for moderate and heavy alcohol consumption would have been ideal.

Source: Mayl, Jonathan J., Charles A. German, Alain G. Bertoni, Bharathi Upadhya, Prashant D. Bhave, Joseph Yeboah, and Matthew J. Singleton. “Association of Alcohol Intake With Hypertension in Type 2 Diabetes Mellitus: The ACCORD Trial.” Journal of the American Heart Association 9 (2020): e017334.

© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License.

Click here to read the full text study.

Posted October 8, 2020.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

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