INTRODUCTION
The rising prevalence of hypertension is a public health priority, as cardiovascular disease remains the leading cause of death. However, only 43.7% of adults with hypertension have optimized blood pressure (BP).1 Meanwhile, alcohol use is increasing nationally, and use above recommended limits is a barrier to successful BP control. Binge drinking is more common than other unhealthy alcohol use2 and is associated with increases in cardiovascular risk.3 The objective of this study was to estimate the prevalence of binge drinking among adults with hypertension in the USA and to identify other health-related behaviors associated with binge drinking that may complicate the management of hypertension.
METHODS
We examined aggregated data from respondents age ≥ 18 from the 2015–2020 National Survey on Drug Use and Health,2 an annual cross-sectional nationally representative survey of non-institutionalized individuals in the USA. We limited the sample to adults who reported a hypertension diagnosis in their lifetime (N = 30,000). Characteristics of adults with hypertension who engaged in past-month binge drinking (≥ 5 alcoholic drinks on the same occasion for men and ≥ 4 for women) were compared to those who did not binge drink, with respect to demographic characteristics, BP medication use, past-month use of tobacco, cannabis, and stimulants (cocaine, methamphetamine, or prescription stimulant misuse), past-year mental health treatment utilization, and chronic diseases. Comparisons were made using Rao-Scott χ2 tests and multivariable generalized linear models using Poisson and log link to examine associations between independent variables and binge drinking. We used weights to account for the complex survey design, selection probability, non-response, and population distribution.4 This secondary analysis was exempt from review by the New York University Langone Medical Center institutional review board.
RESULTS
An estimated 18.6% (95% confidence interval [CI] = 18.0–19.3) of adults with hypertension engaged in past-month binge drinking. Table 1 presents comparisons between adults with hypertension who binge drank to those who did not. All independent variables other than asthma and HIV/AIDS were significant at the bivariable level (p < .05). In the adjusted model, past-month tobacco use (adjusted prevalence ratio [aPR] = 1.71, 95% CI = 1.56–1.87), cannabis use (aPR = 1.67, 95% CI = 1.51–1.84), and stimulant use/misuse (aPR = 1.31, 95% CI = 1.09–1.59) were associated with higher risk for binge drinking. Adults ages 50–64 (aPR =0.79, 95% CI: 0.72–0.86) and ≥ 65 (aPR = 0.46, 95% CI = 0.41–0.52) (compared to ages 18–34), females (aPR = 0.66, 95% CI = 0.61–0.72), those identifying as Black/African American (aPR = 0.87, 95% CI = 0.79–0.95) or other race (aPR = 0.72, 95% CI: 0.59–0.88) (compared to white adults), and those with heart disease (aPR = 0.81, 95% CI = 0.73–0.90), diabetes (aPR = 0.69, 95% CI = 0.62–0.76), or kidney disease (aPR = 0.62, 95% CI = 0.50–0.77) were at lower risk for binge drinking.
Table 1.
Past-Month Binge Drinking Among Adults with Hypertension, USA, 2015–2020
| Characteristic | Full sample of respondents with hypertension, n = 30,000, weighted % (95% CI) | No past-month binge drinking among adults with hypertension, n = 23,338, weighted % (95% CI) | Past-month binge drinking among adults with hypertension, n = 6,662, weighted % (95% CI) | χ2 p-value | Correlates of past-month binge drinking among adults with hypertension, adjusted prevalence ratio* (95% CI) |
|---|---|---|---|---|---|
| On blood pressure medication | 84.2 (83.6, 84.7) | 85.5 (84.9, 86.1) | 78.3 (77.1, 79.5) | < 0.001 | 1.04 (0.97, 1.11) |
| Age group | |||||
| 18–34 | 6.1 (5.8, 6.4) | 4.9 (4.7, 5.2) | 11.0 (10.1, 11.9) | < 0.001 | Ref |
| 35–49 | 16.9 (16.3, 17.5) | 14.8 (14.1, 15.5) | 25.9 (24.4, 27.5) | 0.94 (0.86, 1.03) | |
| 50–64 | 34.8 (34.0, 35.6) | 33.7 (32.9, 34.5) | 39.7 (37.9, 41.4) | 0.79 (0.72, 0.86) | |
| ≥ 65 | 42.2 (41.3, 43.2) | 46.5 (45.5, 47.6) | 23.4 (21.5, 25.5) | 0.46 (0.41, 0.52) | |
| Sex | |||||
| Male | 45.1 (44.2, 46.0) | 42.1 (41.0, 43.1) | 58.1 (56.2, 60.1) | < 0.001 | Ref |
| Female | 54.9 (54.0, 55.8) | 57.9 (56.9, 59.0) | 41.9 (39.9, 43.8) | 0.66 (0.61, 0.72) | |
| Race/ethnicity | |||||
| Non-Hispanic White | 70.1 (69.1, 71.1) | 69.7 (68.6, 70.8) | 71.9 (70.3, 73.5) | 0.01 | Ref |
| Non-Hispanic Black/African American | 14.4 (13.7, 15.1) | 14.6 (13.9, 15.4) | 13.5 (12.4, 14.7) | 0.87 (0.79, 0.95) | |
| Hispanic | 9.3 (8.7, 10.0) | 9.2 (8.5, 9.9) | 9.9 (8.5, 11.5) | 0.99 (0.86, 1.14) | |
| Other | 6.2 (5.7, 6.7) | 6.5 (5.9, 7.1) | 4.7 (3.9, 5.7) | 0.72 (0.59, 0.88) | |
| Chronic disease | |||||
| Diabetes | 24.9 (24.2, 25.6) | 26.9 (26.1, 27.7) | 16.1 (14.7, 17.5) | < 0.001 | 0.69 (0.62, 0.76) |
| Heart disease | 23.7 (23.0, 24.4) | 25.3 (24.6, 26.1) | 16.5 (15.1, 18.1) | < 0.001 | 0.81 (0.73, 0.90) |
| Asthma | 12.1 (11.6, 12.5) | 12.3 (11.7, 12.8) | 11.2 (10.1, 12.4) | 0.12 | 0.95 (0.84, 1.07) |
| Cancer | 12.1 (11.5, 12.6) | 12.9 (12.2, 13.6) | 8.5 (7.6, 9.5) | < 0.001 | 0.98 (0.88, 1.09) |
| Chronic obstructive pulmonary disease | 9.7 (9.2, 10.3) | 10.1 (9.5, 10.8) | 7.9 (6.9, 9.0) | 0.002 | 0.92 (0.80, 1.05) |
| Kidney disease | 5.7 (5.3, 6.1) | 6.4 (5.9, 6.8) | 2.6 (2.1, 3.2) | < 0.001 | 0.62 (0.50, 0.77) |
| HIV/AIDS | 0.3 (0.2, 0.3) | 0.3 (0.2, 0.4) | 0.2 (0.1, 0.4) | 0.70 | 0.61 (0.31, 1.22) |
| ≥ 2 of above chronic diseases | 23.4 (22.6, 24.2) | 25.3 (24.4, 26.3) | 15.0 (13.6, 16.5) | < 0.001 | 0.99 (0.85, 1.15) |
| Substance use (past month) | |||||
| Tobacco use | 18.0 (17.4, 18.7) | 14.4 (13.7, 15.2) | 33.8 (31.6, 36.0) | < 0.001 | 1.71 (1.56, 1.87) |
| Cannabis use | 6.1 (5.6, 6.6) | 4.1 (3.7, 4.6) | 14.5 (13.1, 16.0) | < 0.001 | 1.67 (1.51, 1.84) |
| Stimulant use/misuse† | 0.8 (0.7, 1.0) | 0.5 (0.3, 0.6) | 2.3 (1.8, 3.0) | < 0.001 | 1.31 (1.09, 1.59) |
| Mental health treatment (past year) | |||||
| Received any mental health treatment | 19.8 (19.2, 20.4) | 19.2 (18.5, 19.9) | 22.4 (20.8, 24.0) | < 0.001 | 1.05 (0.96, 1.15) |
*Adjusted for all presented characteristics including survey year; †includes cocaine use, methamphetamine use, and prescription stimulant misuse, the latter was defined as using in any way not directed by a doctor, including use without a prescription, use in greater amounts, more often, or longer than instructed to take them, or use in any other way a doctor did not direct2
DISCUSSION
In this nationally representative study, nearly one in five adults with hypertension was estimated to have binge drank in the past month. Binge drinking is associated with elevated cardiovascular risk and complicates BP control management.3 Additionally, we found that current use of tobacco and stimulants, which are independent risk factors for hypertension,4 is associated with binge drinking among adults with hypertension. These results suggest a high-risk population of adults with hypertension that may use multiple substances that increase BP. Furthermore, other psychoactive substances, including cannabis, which was also associated with binge drinking, can present challenges to managing BP control. Suboptimal adherence to antihypertensives and lifestyle changes is an important contributor to the high prevalence of uncontrolled hypertension.1 Psychoactive substance use adds complexity to managing chronic diseases and is associated with reduced adherence to anti-hypertensive medications,5 which has important implications for long-term cardiovascular health. Meanwhile, our study found similar patterns from previous studies among people with hypertension showing lower prevalence of binge drinking among women, older adults, Black individuals, and those with chronic diseases.6 In contrast, our study identifies men, younger adults, and white adults as a high-risk population. Limitations of this study include self-report, lack of information on the number of medications or if BP is controlled, and possible limited recall and social desirability bias.
Clinicians managing patients with hypertension should regularly screen their patients for potential unhealthy psychoactive substance use, including excess alcohol use, especially for patients with difficult-to-control BP. Discussions about alcohol, tobacco, and stimulant use should be conducted with all people living with hypertension and discussed in the context of overall long-term cardiovascular health. Patients exceeding recommended alcohol use limits should receive brief intervention and referral to treatment if indicated.
Funding
Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Numbers K23DA043651 (PI: Han) and R01DA044207 (PI: Palamar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Footnotes
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