Alcohol Consumption and Blood Pressure

High blood pressure (BP) is one of the most important and preventable risk factors for cardiovascular disease. Several lifestyle and dietary habits affect BP, and interventions aimed at improving these factors are among the most important for primary prevention of high BP and hypertension. From a public health perspective, the most important measures include weight loss, increased physical activity, adherence to healthy dietary patterns, with specific attention to reducing sodium and enhancing potassium intake, and abstinence from or reduction of alcohol consumption.^1,2

In recent comprehensive meta-analyses of cohort studies, alcohol consumption has been related to BP³ and hypertension⁴ in a direct linear dose-dependent fashion from no intake to high levels of consumption, including an association at low-to-moderate intake of alcohol, ie, <2 standard drinks per day. These reports have been consistent with the World Health Organization (WHO) recommendation for abstinence from alcohol consumption and the WHO statement that “no safe amount of alcohol consumption for cancers and health can be established.”⁵ The 2025 American Heart Association/American College of Cardiology BP clinical practice guideline recommends abstinence from alcohol, or limiting alcohol consumption to no more than 2 standard drinks per day in adult men and 1 standard drink per day in adult women who wish to continue consuming alcohol.⁶

In this issue of JACC, Suzuki et al⁷ provide an important report detailing BP levels associated with changes in alcohol consumption in Japanese adults, with the use of a longitudinal study design, in which they provide statistically precise effect estimates for the relationship. After retrieval of data from annual health check-ups from 2012 to 2024, the authors investigated BP levels after cessation and initiation of alcohol consumption, with specific focus on those who reported low-to-moderate consumption of alcohol. They used nonlinear modeling in their data analysis, a methodologic approach that provides flexibility in the detection of dose-response patterns between exposures and health endpoints.

In the cessation cohort analysis, they reported an almost linear “beneficial” dose-response relationship for systolic and diastolic blood pressure, which was slightly stronger for diastolic BP in men who consumed a higher intake of alcohol. Similarly, in their initiation cohort analysis, they noted a dose-dependent increase in BP, especially in men who consumed a moderate intake (2–3 drinks/day) of alcohol, compared with women.

The report has some limitations, including reliance on BP measurements obtained in routine clinical practice, which are known to be less accurate and precise than BP measurements in research studies,⁸ self-reported intake of alcohol, and imperfect estimation of sodium and potassium intake. However, the report is valuable from a public health perspective owing to its precision and consistency with preexisting findings.^9,10 In addition, the authors were able to adjust for several important potential confounders and conduct several stratified analysis, taking into account sex, increasing age, body mass index, and smoking status. A key finding of the study is the detection of the “reversibility” of the alcohol-BP association, a finding that strongly supports advice to reduce and, if possible, eliminate alcohol intake, including intakes that were previously considered to be low (namely below the thresholds of 2 drinks/day in men and 1 drink/day in women). This finding highlights the importance of preventive medicine at any age and in both sexes, including health education and application of behavior change interventions aimed at eliminating or reducing alcohol consumption.

In the Suzuki et al⁷ study, initiation of alcohol seemed to have a similar or slightly steeper association with BP in those who had hypertension, compared with their counterparts without hypertension, and alcohol cessation was associated with greater BP reduction in those who had hypertension. This underscores the need for efforts aimed at quitting consumption of alcohol in adults with hypertension. Finally, in stratified analysis, the findings were consistent by alcohol type, confirming the belief that alcohol intake rather than beverage type is the principal basis for the higher BP associated with consumption of alcohol. The results of this study reinforce the WHO public health guidance that there is no safe level of alcohol consumption, and strengthens the need for greater public health efforts to limit alcohol intake aimed at prevention of high BP and hypertension and cardiovascular disease.