Skip to main content
SpringerLink
Log in

Alcohol Consumption, Blood Pressure, and the Risk of Stroke

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

A synergistic effect of alcohol and hypertension has been suggested to increase the risk for stroke. However, the contribution of alcohol-induced hypertension to stroke morbidity and mortality may be greater than observed, because the effects of different drinking patterns have not been separately investigated. Alcohol-induced transient peaks in systolic blood pressure may predispose to stroke. Recent studies have measured time trends of blood pressure elevations in relation to alcohol consumption. They found a significant morning surge in blood pressure, which was related to alcohol intake in a dose-dependent manner and was independent of smoking. Men with a severe form of hypertension showed a 12-fold increased risk for cardiovascular disease mortality associated with heavy binge drinking. Binge drinking is a significant risk factor for stroke. Hypertensive patients should be warned about the risks of alcohol and urged to avoid binge drinking because of an increased risk for all subtypes of stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

  1. Lian C. L’alcoholisme, cause d’hypertension artérielle. Bull Acad Natl Méd Paris. 1915;74:525–8.

    Google Scholar 

  2. Puddey IB, Zilkens RR, Beilin LJ. Alcohol, blood pressure and hypertension. In: Preedy VR and Watson RR, Comprehensive Handbook of Alcohol Related Pathology Volume 2. Elsevier 2005, 607–625.

  3. Mazzaglia G, Britton AR, Altmann DR, Chenet L. Exploring the relationship between alcohol consumption and non-fatal or fatal stroke: a systematic review. Addiction. 2001;96:1743–56.

    Article  PubMed  CAS  Google Scholar 

  4. • Patra J, Taylor B, Irving H, et al. Alcohol consumption and the risk of morbidity and mortality for different stroke types—a systematic review and meta-analysis. BMC Public Health. 2010;10:258. This is the first meta-analysis to explicitly separate morbidity and mortality of alcohol-attributable stroke. A linear relationship between consumption of alcohol and hemorrhagic stroke morbidity and mortality was observed in men, but the relationship was J-shaped in women. Risks for both hemorrhagic and ischemic stroke mortality were greater in women than in men at doses over 60 grams per day.

    Article  PubMed  Google Scholar 

  5. Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared. Stroke severity, mortality, and risk factors. Stroke. 2009;40:2068–72.

    Article  PubMed  Google Scholar 

  6. •• O’Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–23. In this study assessing PARs for all stroke, IS, and CH, self-reported history of hypertension was the strongest risk factor for stroke and it was stronger for CH than for IS. Risk for CH increased linearly with increasing alcohol intake. PAR for alcohol intake was greater for CH than for IS.

    Article  PubMed  Google Scholar 

  7. Klag MJ, He J, Whelton PK, et al. Alcohol use and blood pressure in a unacculturated society. Hypertension. 1993;22:365–70.

    PubMed  CAS  Google Scholar 

  8. • Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118:947–54. In this study, more than half of the ischemic strokes among US health professionals might have been prevented by healthy lifestyle, including not smoking, maintaining optimal body mass index, exercising daily, and consuming a healthy diet including a small amount of alcohol. Moderate alcohol intake did not reach significance as a protective factor against IS, whereas not smoking, optimal weight, and daily exercise did.

    Article  PubMed  Google Scholar 

  9. Berger K, Ajani UA, Kase CS, et al. Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians. N Engl J Med. 1999;341:1557–64.

    Article  PubMed  CAS  Google Scholar 

  10. Elkind SMV, Sciacca R, Boden-Albala B, et al. Moderate alcohol consumption reduces risk of ischemic stroke: the Northern Manhattan Study. Stroke. 2006;37:13–9.

    Article  PubMed  Google Scholar 

  11. Collins MA, Neafsey EJ, Mukamal KJ, et al. Alcohol in moderation, cardioprotection and neuroprotection: Epidemiological considerations and mechanistic studies. Alcohol Clin Exp Res. 2009;33:206–19.

    Article  PubMed  CAS  Google Scholar 

  12. Takashima Y, Miwa Y, Mori T, et al. Sex differences in the risk profile and male predominance in silent brain infarction in community-dwelling elderly subjects: the Sefuri brain MRI study. Hypertens Res. 2010;3:748–52.

    Article  Google Scholar 

  13. Marmot MG, Elliott P, Shipley MJ, et al. Alcohol and blood pressure: the INTERSALT study. BMJ. 1994;308:1263–7.

    PubMed  CAS  Google Scholar 

  14. White SL, Polkinghorne KR, Cass A, et al. Alcohol consumption and 5-year onset of chronic kidney disease: the AusDiab study. Nephrol Dial Transplant. 2009;24:2464–72.

    Article  PubMed  Google Scholar 

  15. Ikeda A, Iso H, Yamagishi K, et al. Blood pressure and the risk of stroke, cardiovascular disease, and all-cause mortality among Japanese: the JPHC study. Am J Hypertens. 2009;22:237–8.

    Article  Google Scholar 

  16. Ariesen MJ, Claus SP, Rinkel GJ, Algra A. Risk factors for intracerebral hemorrhage in the general population. A systematic review. Stroke. 2003;34:2060–5.

    Article  PubMed  CAS  Google Scholar 

  17. Iso H, Kitamura A, Shimamoto T, et al. Alcohol intake and the risk of cardiovascular disease in middle-aged Japanese men. Stroke. 1995;26:767–73.

    PubMed  CAS  Google Scholar 

  18. Juvela S, Hillbom M, Palomäki H. Risk factors for spontaneous intracerebral hemorrhage. Stroke. 1995;26:1558–64.

    PubMed  CAS  Google Scholar 

  19. Diaz V, Cumsille MA, Bevilacqua JA. Alcohol and hemorrhagic stroke in Santiago. Chile. A case-control study. Neuroepidemiology. 2003;22:339–44.

    Article  PubMed  Google Scholar 

  20. Feldmann E, Broderick JP, Kernan WN, et al. Major risk factors for intracerebral hemorrhage in the young are modifiable. Stroke. 2005;36:1881–5.

    Article  PubMed  Google Scholar 

  21. Inagawa T. Risk factors for primary intracerebral hemorrhage in patients in Izumo City, Japan. Neurosurg Rev. 2007;30:225–34.

    Article  PubMed  Google Scholar 

  22. Tetri S, Huhtakangas J, Juvela S, et al. Better than expected survival after primary intracerebral hemorrhage in patients with untreated hypertension despite high admission blood pressures. Eur J Neurol. 2010;17:708–14.

    Article  PubMed  CAS  Google Scholar 

  23. Frey JL, Jahnke HK, Goslar PW. Study of the propensity for hemorrhage in Hispanic Americans with stroke. J Stroke Cerebrovasc Dis. 2008;17:58–63.

    Article  PubMed  Google Scholar 

  24. Hosomi N, Nava T, Ohkita H, et al. Predictors of intracerebral hemorrhage severity and its outcome in Japanese stroke patients. Cerebrovasc Dis. 2009;27:67–74.

    Article  PubMed  Google Scholar 

  25. Fujii Y, Takeuchi S, Tanaka R, et al. Liver dysfunction in spontaneous intracerebral hemorrhage. Neurosurgery. 1994;35:592–6.

    Article  PubMed  CAS  Google Scholar 

  26. Boudouresques G, Hauw J-J, Meininger V, et al. Hepatic cirrhosis and intracerebral hemorrhage: significance of the association in 53 pathological cases. Ann Neurol. 1980;8:204–5.

    Article  PubMed  CAS  Google Scholar 

  27. Ragni MV, Lewis JH, Spero JA, Hasiba U. Bleeding and coagulation abnormalities in alcoholic cirrhotic liver disease. Alcohol Clin Exp Res. 1982;6:267–74.

    Article  PubMed  CAS  Google Scholar 

  28. Peng GS, Yin SJ, Cheng CA. Increased risk of cerebral hemorrhage in Chinese male heavy drinkers with mild liver disorder. Cerebrovasc Dis. 2007;23:309–14.

    Article  PubMed  CAS  Google Scholar 

  29. Krishna V, Kim DH. Ethnic differences in risk factors for subarachnoid hemorrhage. J Neurosurg. 2007;107:522–9.

    Article  PubMed  Google Scholar 

  30. Feigin VL, Rinkel GJE, Lawes CMM, et al. Risk factors for subarachnoid hemorrhage. An updated systematic review of epidemiological studies. Stroke. 2005;36:2773–80.

    Article  PubMed  Google Scholar 

  31. Jiménez-Yepes CM. Londoño-Fernández. Risk of aneurismal subarachnoid hemorrhage. The role of confirmed hypertension. Stroke. 2008;39:1344–6.

    Article  PubMed  Google Scholar 

  32. van Munster CE, von und zu Fraunberg M, Rinkel GJE, et al. Differences in aneurysm and patient characteristics between cohorts of Finnish and Dutch patients with subarachnoid hemorrhage. Stroke. 2008;39:3166–71.

    Article  PubMed  Google Scholar 

  33. Qureshi AI, Sung GY, Suri MF, et al. Factors associated with aneurysm size in patients with subarachnoid hemorrhage: effect of smoking and aneurysm location. Neurosurgery. 2000;46:44–50.

    Article  PubMed  CAS  Google Scholar 

  34. Ellamushi HE, Grieve JP, Jäger HR, Kitchen ND. Risk factors for the formation of multiple aneurysms. J Neurosurg. 2001;94:728–32.

    Article  PubMed  CAS  Google Scholar 

  35. Wakabayashi I, Araki Y. Influences of gender and age on relationships between alcohol drinking and atherosclerotic risk factors. Alcohol Clin Exp Res. 2010;34(S1):S54–60.

    Article  PubMed  CAS  Google Scholar 

  36. Seppä K, Sillanaukee P. Binge drinking and ambulatory blood pressure. Hypertension. 1999;33:79–82.

    PubMed  Google Scholar 

  37. Yoshita K, Miura K, Morikawa Y, et al. Relationship of alcohol consumption to 7-year blood pressure change in Japanese men. J Hypertens. 2005;23:1485–90.

    Article  PubMed  CAS  Google Scholar 

  38. •• Nakashita M, Ohkubo T, Hara A, et al. Influence of alcohol intake on circadian blood pressure variation in Japanese men: The Ohasama Study. Am J Hypertens. 2009;22:1171–6. The authors measured ambulatory BPs, and 2-hour moving averages were used to compare BP variation during a 24-hour period among nondrinkers, light drinkers, and heavy drinkers. Heavy drinkers showed a rapid morning increase in BP.

    Article  PubMed  Google Scholar 

  39. •• Ohira T, Tanigawa T, Tabata M, et al. Effects of habitual alcohol intake on ambulatory blood pressure, heart rate, and its variability among Japanese men. Hypertension. 2009;53:13–9. In this cross-sectional study, even light drinkers of alcohol showed significantly higher BPs than nondrinkers. Time trends of systolic BP levels showed excess elevation of systolic BP in the morning in alcohol users in a dose-dependent manner across alcohol drinking categories.

    Article  PubMed  CAS  Google Scholar 

  40. Metoki H, Ohkubo T, Kikuya M, et al. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension. 2006;47:149–54.

    Article  PubMed  CAS  Google Scholar 

  41. Estruch R, Coca A, Rodicio JL. High blood pressure, alcohol, and cardiovascular risk. J Hypertens. 2005;23:226–9.

    Article  PubMed  CAS  Google Scholar 

  42. • Stewart SH, Oroszi G, Randall PK, Anton RF. COMT genotype influences the effect of alcohol on blood pressure: results from the COMBINE study. Am J Hypertens. 2009;22:87–91. Findings suggest that alcohol-induced BP elevation may be related to the effects of catecholamines and their genetically determined inactivation.

    Article  PubMed  CAS  Google Scholar 

  43. Li S-J, Hu W-L, Liu D-T. MTAP gene is associated with ischemic stroke in Chinese Hans. J Neurol Sci. 2009;284:103–7.

    Article  PubMed  CAS  Google Scholar 

  44. • Mostofsky E, Burger MR, Schlaug G, et al. Alcohol and acute ischemic stroke onset. The Stroke Onset Study. Stroke. 2010;41:1845–9. The relative risk of IS in the hour after consuming even a small amount of alcohol was 2.3 (95% CI, 1.4–4.0) compared with the risk during periods of no alcohol consumption. The risk remained after adjusting for age, sex, smoking status, etiology of stroke, and other potential stroke triggers. Alcohol consumption within 1 h of stroke onset was reported by 14 of 390 subjects.

    Article  PubMed  Google Scholar 

  45. Rantakömi SH, Laukkanen JA, Kurl S, Kauhanen J. Binge drinking and the progression of atherosclerosis in middle-aged men: an 11-year follow-up. Atherosclerosis. 2009;205:266–71.

    Article  PubMed  Google Scholar 

  46. Nakaguchi H, Teraoka A. Relationship between the occurrence of spontaneous intracerebral hemorrhage and holidays and traditionally unlucky days in Fukuyama city, Hiroshima prefecture, Japan. J Stroke Cerebrovasc Dis. 2007;16:194–8.

    Article  PubMed  Google Scholar 

  47. • Sundell L, Salomaa V, Vartiainen E, et al. Increased stroke risk is related to a binge drinking habit. Stroke. 2008;39:3179–84. The authors found that binge drinking was an independent risk factor for IS after adjusting for average alcohol consumption and other potential confounders. They found no association between average alcohol consumption and any type of stroke. This is not surprising, as binge drinking is the prevailing pattern of drinking in Finland. Similar findings may not be found in countries where the pattern is regular moderate drinking with meals.

    Article  PubMed  Google Scholar 

  48. • Sull JW, Yi SW, Nam CM, Ohrr H. Binge drinking and mortality from all causes and cerebrovascular diseases in Korean men and women. A Kangwha Cohort Study. Stroke. 2009;40:2953–8. In a cohort of 6,291 subjects followed for 20.8 years, frequent binge drinking showed a harmful effect on total stroke and hemorrhagic stroke in men.

    Article  PubMed  Google Scholar 

  49. •• Sull JW, Yi SW, Nam CM, et al. Binge drinking and hypertension on cardiovascular disease mortality in Korean men and women. A Kangwha Cohort Study. Stroke. 2010;41:2157–62. In the same cohort as in ref. [48•], binge drinkers and heavy binge drinkers with Grade 3 hypertension revealed 4.4-fold and 12.7-fold increased risk of cardiovascular mortality even after adjusting for total alcohol consumption.

    Article  PubMed  Google Scholar 

  50. Leon DA, Chenet L, Shkolnikov VM, et al. Huge variation in Russian mortality rates 1984–94: artifact, alcohol, or what? Lancet. 1997;350:383–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Neurology, Oulu University Hospital, Box 20, Oulu, 90 029 OYS, Finland

    Matti Hillbom

  2. Department of Neuropsychiatry and Psychogeriatrics, Kellokoski Hospital, Tuusula, Vanha valtatie 198, Kellokoski, 04500, Finland

    Pertti Saloheimo

  3. Department of Clinical Neurosciences, University of Helsinki, Mäkkylänmutka 5 A 2, Espoo, FI-02650, Finland

    Seppo Juvela

Authors
  1. Matti Hillbom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pertti Saloheimo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seppo Juvela
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matti Hillbom.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hillbom, M., Saloheimo, P. & Juvela, S. Alcohol Consumption, Blood Pressure, and the Risk of Stroke. Curr Hypertens Rep 13, 208–213 (2011). https://doi.org/10.1007/s11906-011-0194-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-011-0194-y

Keywords

Search

Navigation