A study published on September 9 in the Journal of the American Heart Association found that drinking only eight alcoholic beverages per week was associated with a 60 percent higher increased risk of high blood pressure, or hypertension, in people with type 2 diabetes. The risk and the severity of the high blood pressure grew for those who drank significantly more. The findings suggest that a daily drinking habit could put an already vulnerable group for heart disease at an even higher risk. Two out of three people with diabetes report having high blood pressure or taking medication to lower blood pressure, according to the American Diabetes Association (ADA). This combination doubles the risk of developing heart disease, reports the American Heart Association (AHA). According to the AHA, adults with diabetes are two to four times more likely to die from heart disease than individuals without diabetes. Previous research has established that heavy alcohol consumption is associated with hypertension, says study coauthor Matthew J. Singleton, MD, a clinical cardiac fellow at the Wake Forest School of Medicine in Winston-Salem, North Carolina. “A key finding of our study is that even moderate alcohol consumption was associated with increased odds of hypertension in patients with diabetes,” he noted. RELATED: Men Who Drink Alcohol Should Limit Intake to One Drink a Day, Panel Urges
Even Moderate Drinking Raises Hypertension Risk for People With Type 2 Diabetes
A total of 10,200 subjects who were participants in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial participated in this latest study. Their median age was 62 years old, 61.3 percent were male and 38.7 percent were female, and 64.4 percent were white, 19.7 percent were Black, and 7.0 percent were Hispanic. The median number of years participants had been diagnosed with diabetes was 10. Participants self-reported the number of drinks they have in a typical week. One drink was defined as a 12-ounce beer, 6 ounces of wine, or 1.5 ounces of liquor. Researchers classified participants as light, moderate, or heavy drinkers:
Light: 1 to 7 drinks per weekModerate: 8 to 14 drinks per weekHeavy: 15 or more drinks per week
They categorized blood pressure according to the 2017 American College of Cardiology/American Heart Association Guidelines for blood pressure management:
Normal (below 120/80 millimeters of mercury [mmHg])Elevated (120–129/<80 mmHg)Stage 1 high blood pressure (130–139/80–89 mmHg)Stage 2 high blood pressure (140 mmHg/90 mmHg or higher)
Because most participants were already taking one or more blood pressure medications, researchers adjusted the analysis of the blood pressure readings to account for the effects of the medication and to estimate the underlying degree of high blood pressure. After adjusting for factors including preexisting heart disease, age, sex, body mass index (BMI), and smoking status, researchers found the following results:
Moderate drinking was associated with increased odds of elevated blood pressure by 79 percent, stage 1 high blood pressure by 66 percent, and stage 2 high blood pressure by 62 percent.Light drinking was not associated with elevated blood pressure or any stage of high blood pressure.Heavy drinking was associated with increased odds of elevated blood pressure by 91 percent, stage 1 high blood pressure by 149 percent (nearly a 2.5-fold increase), and stage 2 high blood pressure by 204 percent (more than a threefold increase). The more alcohol consumed, the higher the risk and severity of high blood pressure.
RELATED: What Are the Symptoms of High Blood Pressure?
New Lower Blood Pressure Guidelines May Explain the Risk of Moderate Drinking
Past research, including the well-known Framingham Study, published in the Archives of Internal Medicine, and a prospective study published in the Archives of Internal Medicine, suggests that moderate alcohol consumption was associated with a lower risk of hypertension. Yet these new findings aren’t necessarily a contradiction of what has been previously shown, in part because unlike previous epidemiological studies, this research used the new, 2017 American College of Cardiology guidelines, which lowered the threshold for defining hypertension, says Vinni Makin, MD, an endocrinologist at Cleveland Clinic in Ohio. Dr. Makin was not involved in the research. The guidelines were updated after data suggested that people with even slightly elevated blood pressure — systolic ranging from 130 to 139 and diastolic ranging from 80 to 89 — had a twofold increased risk of cardiovascular disease, says Makin. “This change puts the focus on certain factors that may have been considered insignificant before but now might make a difference in overall health by even a minor influence on blood pressure,” she says. Given what is known about type 2 diabetes, alcohol consumption, and high blood pressure, these findings make sense, adds Makin. RELATED: New Blood Pressure Guidelines for Kids Identify More Who Are at Risk for Early Heart Disease
Findings Show an Association But Not That Moderate Drinking Causes Hypertension
The findings are somewhat limited by the makeup of the study population, says Makin. “All of them had diabetes, and a majority of them had a long-standing duration of diabetes and were primarily men and of white ethnicity,” she says. This means the findings may not translate to people who do not have diabetes or who are newly diagnosed or are women or are of a different ethnicity than white, says Makin. Other limitations include the way the amount of drinking was calculated, she says. “It was reported at a point in time and might have been underestimated. This method of data collection does not take into account varying degrees of alcohol consumption over time,” says Makin. The authors also point out that the data on alcohol was self-reported, and there was no adjustment for alcohol consumption according to gender. According to the Centers for Disease Control and Prevention (CDC), moderate drinking for women is up to one drink per day, not up to two per day as it is for men. A further limitation is that the study wasn’t set up to determine causation, says Dr. Singleton. “Therefore, we cannot be sure that it is the alcohol consumption that causes the hypertension, as they might both be caused by a common factor that is not yet discovered,” he adds. Next steps to build on this research would include a longitudinal analysis of how alcohol consumption influences individuals’ risk of developing new-onset hypertension, their response to antihypertensive medication, and their risk of hard cardiovascular outcomes, says Singleton. RELATED: 8 Ways to Manage Type 2 Diabetes and Heart Health
For People With Type 2 Diabetes: To Drink or Not to Drink? That Is the Question
Regardless of diabetes status, doctors recommend abstaining from drinking alcohol or drinking in moderation, notes Singleton. “With this finding of an association between even moderate alcohol consumption and hypertension in those with diabetes, we are inclined to recommend an even lower level of consumption, particularly in those patients who have coexisting hypertension,” he says. Makin typically recommends that her patients with diabetes limit alcohol intake if they drink at all. “I also ask them to watch out for high and low blood sugars after alcohol consumption and warn them that alcohol also has calories and can contribute to weight gain,” she says, adding that she plans to counsel her patients on alcohol consumption given the new findings. “This research is interesting in light of the fact that currently, the American Diabetes Association recommends no more than two drinks per day for men,” says Makin. “This is moderate alcohol consumption and might increase blood pressure in these patients according to this new study.” For now, Makin would encourage people with diabetes to stick with the ADA’s guidelines with a word of caution that there is developing evidence that moderate alcohol consumption might also impact blood pressure. “I would reemphasize the concerns with blood glucose and weight gain at this time,” she adds. The ADA updates its guidelines very quickly as evidence changes, but it might want to see more evidence on alcohol and risk for hypertension before it changes the recommendations, says Makin.
