By Crystal Phend, Senior Staff Writer, MedPage Today
Published: August 19, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical news
Binging on alcohol may be especially dangerous for hypertensive men, researchers found.
Six or more drinks at a sitting boosted the risk of cardiovascular death more than fourfold for patients with severe hypertension compared with nondrinkers with normal blood pressure, found Heechoul Ohrr, MD, PhD, of Yonsei University in Seoul, South Korea, and colleagues.
Twelve or more drinks at a time increased risk of dying from cardiovascular causes nearly 13-fold in the presence of severe hypertension, they reported in the October issue of Stroke: Journal of the American Heart Association.
The absolute risk, while small for nondrinkers without hypertension at 0.2% per year in the study, jumped to a "nontrivial" 2.7% per year for these heavy binge drinkers with grade 3 hypertension, commented Brian Silver, MD, of the Henry Ford Hospital in Detroit.
Action Points
* Explain to interested patients that binging on alcohol may be especially dangerous for hypertensive men and was associated with an increased risk of cardiovascular death in this study.
"In general, everybody should moderate their drinking, but in particular if you have elevated blood pressure there's even more reason to control the consumption of alcohol," he said in an interview.
The American Heart Association (AHA) recommends no more than two drinks per day for men and one for women for those who chose to drink, noted Silver, who serves as an AHA spokesperson.
Heavy drinking, though, is common in South Korea, where nearly half of adult men binge at least once a week and 9.2% of women do the same, Ohrr's group explained.
Their study followed more than 6,100 residents of an agricultural community in South Korea for 20.8 years.
Among these adults, who were all age 55 or older, 15.5% of normotensive men and 17.8% of hypertensive men reported moderate binge drinking (six or more drinks at a sitting) while 3.1% and 3.9%, respectively, reported heavy binge drinking (12 or more at a sitting).
Heavy binge drinking itself tended to be associated with increased mortality risk from cardiovascular disease and hypertensive disease with a hazard ratio of 1.98 (95% confidence interval 0.96 to 4.10) after full adjustment for age, hypertension status, smoking, body mass index, and total alcohol consumption, along with other factors.
Rising blood pressure as a single factor also predicted higher cardiovascular mortality (P=0.0009 for trend).
Compared with normotensive nondrinkers, heavy binge drinkers with any degree of hypertension had a hazard ratio of 4.33 for cardiovascular mortality (95% CI 1.96 to 9.56) although the interaction was not statistically significant (P=0.128).
Normotensives didn't appear to be at cardiovascular disease mortality risk regardless of their level of alcohol intake. But among those with hypertension, higher blood pressure predicted rising risk.
For grade 3 hypertension with a blood pressure above 180/110 mm/Hg, heavy binge drinkers had a risk of dying of cardiovascular disease 12.7 times that of normotensive nondrinkers (95% CI 3.47 to 46.5).
Moderate binge drinkers with grade 3 hypertension had a hazard ratio of 4.41 compared with nondrinkers with normal blood pressure (95% CI 1.38 to 14.1).
Since less than 1% of women reported binge drinking, the researchers cautioned that they could draw no conclusions about the combined impact of high blood pressure and binge drinking in women.
However, the results likely generalize outside of Korea, Silver suggested.
"This is probably a true biological effect" that would be seen regardless of the region studied, although replication elsewhere is needed, he told MedPage Today.
Ohrr's group speculated that the link between binge drinking and hypertension may be that, as seen in prior studies, binge drinking increases blood pressure, causes arterial stiffness and endothelial dysfunction, and precipitates cardiac arrhythmia.
They noted that the rural Koreans studied rarely drank wine or beer, opting instead for local alcohol varieties known as soju and makkoli.
The study may have been limited by lack of accounting for former drinkers or for antihypertensive medication use, by rough classification of smoking, and by the small sample sizes in some of the comparisons, according to the authors.
The study was supported by a Korea Science and Engineering Foundation grant funded by the Ministry of Science and Technology of Korea, and by the Seoul City R&BD program.
The researchers reported having no conflicts of interest to disclose.
Silver reported no relevant conflicts of interest to disclose, although he has done medical malpractice defense with regard to stroke and served as a consultant for Abbott Vascular.
