To Drink or Not to Drink: High Blood Pressure and Alcohol

From the WebMD Archives

Some research shows that drinking alcohol in moderation makes for a healthier heart. But is drinking risky or good for your blood pressure? Weigh the pros and cons to help you make the smart choice.

Is Alcohol Good for High Blood Pressure?

It likely depends a lot on what else is going on with you.

First things first: Your best bets for lowering blood pressure are losing weight through diet and exercise, cutting sodium intake, and reducing stress.

But what if you enjoy a drink or two now and then? Light-moderate drinking (defined as up to two drinks a day for men, one for women) has shown a subtle drop in blood pressure in some cases. In small amounts, it has been shown to lower blood pressure by 2 to 4 mm Hg (millimeters of mercury) in women. Most experts agree, though, that does not show a significant enough drop to advise drinking for an entire population.

But what about those other benefits hailed for heart health -- the red wine antioxidant effect and lowering cholesterol, for example?

You need to determine your lifestyle and genetic risk factors first, says Arthur Klatsky, MD, an investigator for Kaiser Permanente's research division and formerly its chief of cardiology in Oakland, CA.

A lot of people shouldn’t drink at all for specific reasons -- family history of alcoholism or heart or liver disease, he says. But if you have no hereditary risk factors, a glass (for women) or up to two (for men) may be justified, depending on your age.

“Adults above the age of 50 are at much higher risk of heart attack and stroke than they are of any possible harmful effects to light-moderate drinking,” Klatsky says. “So even if they have high blood pressure, they could see the health benefit from something like a glass of red wine a day."

But if you're younger than 50, particularly if you're a woman, it’s not so clear. Studies have shown a rise in breast cancer risk in women under 50 from drinking alcohol. While most studies show this results from drinking more heavily (more than 1-2 drinks a day), Klatsky says some research indicates even light-moderate drinking could play a role in a younger woman’s risk of breast cancer.

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“Generally a woman 35 or younger isn’t dealing with blood pressure or vascular issues,” Klatsky says. “But I would still advise against her drinking at all because of the other risks involved. The general rule is that young people are not better off light-moderate drinkers because their heart attack risk is pretty low and won’t see any benefits from drinking.”

The bottom line, Klatsky says, is you can’t make a drinking rule that applies broadly for people with high blood pressure.

“There can be benefits related to light-moderate drinking -- like the antioxidant effect and cholesterol drop with red wine -- but likely that’s not related to blood pressure,” Klatsky says. “Either beneficial or harmful, the decision from a medical viewpoint is that it depends on the person’s entire health profile.”

A Note for Red Wine Lovers

Research has not proven that wine is linked to lowering blood pressure, says James Beckerman, MD, a cardiologist at the Providence St. Vincent Heart Clinic in Portland, OR.

A Dutch study showed that heart-healthy nutrients called polyphenols in red wine help prevent heart disease, but not because of a drop in blood pressure. Research shows that the polyphenols improve the cells lining the blood vessels, and do improve blood flow and heart health. The jury is still out, though, on whether this could potentially improve high blood pressure in severe cases.

Klatsky agrees. “One glass of red wine isn’t going to improve your blood pressure,” he says. “Ultimately, it’s lifestyle changes: low salt, optimal weight and exercise, and medication if necessary.”

Do you shudder at the thought of giving up your vino altogether? If you’ve been advised against drinking for very high blood pressure, there may be salvation in one kind of wine: nonalcoholic.

One study found that three glasses of nonalcoholic red wine a day over a month led to a significant drop in blood pressure in men with heart disease risk factors. But men who drank red wine with alcohol, or 3 ounces of gin, had no change in their blood pressure. Researchers think that the alcohol in the wine weakens any antioxidant benefit to blood pressure.

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Too Much of a Good Thing

Your age and other risk factors linked to heart and blood pressure health will ultimately aid your decision with your doctor about drinking. But don't expect any “all clears” for anything beyond light-moderate drinking.

Having more than two drinks in a day may raise your blood pressure. Drinking more than one or two drinks in a sitting has been directly linked to a rapid rise in blood pressure, which in someone with very high levels of hypertension can lead to stroke.

“It doesn’t matter what beverage if you have a high risk, it’s all about the amount,” Klatsky says. “There’s plenty of research that shows heavy beer drinkers, heavy wine drinkers, it doesn’t matter, they are all at risk of increasing high blood pressure when drinking in excess.”

Klatsky says his biggest concern is that patients keep an open dialogue with their doctors about their lifestyle to achieve an authentic diagnosis.

“One rule doesn’t fit everyone,” he says, “so talk to your doctor about how your high blood pressure -- and the rest of you -- can determine your consumption choices.”

WebMD Feature Reviewed by James Beckerman, MD, FACC on June 26, 2014

Sources

SOURCES:

Arthur Klatsky, MD, former practicing cardiologist; cardiology consultant, adjunct research investigator, Kaiser Permanente, Oakland, CA.

James Beckerman , MD , FACC, cardiologist, Providence St. Vincent Heart Clinic, Portland, OR.

Kloner, R. Circulation, 2007.

Drake, V. Linus Pauling Institute at Oregon State University Research Newsletter, spring/summer 2009.

“High Blood Pressure: Does Drinking Less Alcohol Help?” Informed Health Online, Nov. 7, 2012.

Seppa, K. Hypertension, 1999.

News release, American Heart Association.

American Heart Association: “Drink Wine to Reduce HighBlood Pressure -- JustLeave OuttheAlcohol.”

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