Alcohol and Blood Pressure: What You Should Know
This article was originally published on WebMD Connect to Care
Heavy drinking can damage the body in several ways, your blood pressure included. If you or a loved one struggles with drinking, it’s important to know how alcohol can affect blood pressure and what to do about it.
Does Alcohol Lower or Increase Blood Pressure?
The relationship between alcohol and the heart is still controversial. Some believe that moderate drinking is protective, but recent studies are finding that no amount of alcohol is good for you.
A 2022 study published in JAMA Network Open found that even low alcohol intake was associated with an increased risk of cardiovascular issues, like high blood pressure, and that the risk increased exponentially with increasing drinks. Senior author of the study and cardiologist at Massachusetts General Hospital Dr. Krishna Aragam explained that people who drink low to moderate amounts of alcohol are also generally more health-conscious than people who didn’t drink any alcohol. Their healthy lifestyle choices like not smoking, exercising more and eating healthier are what contributes to better heart health, not their moderate drinking.
How Does Alcohol Cause Hypertension?
“Alcohol can raise blood pressure temporarily even with short-term use.” explains Dr. Sabrina Barata, Internal Medicine Physician at Mercy Medical Center. “Typically, elevated blood pressure self resolves within a few hours in this case. However, with excessive long-term alcohol intake, alcohol can cause high blood pressure through the development of a variety of risk factors associated with long-term use.” Studies have found that binge drinking can cause a temporary increase in blood pressure that ranges from 4-7 mmHG for systolic blood pressure and 4-6 mmHg for diastolic blood pressure.
“These include risk factors for coronary artery disease through weight gain due to the high caloric intake of alcohol, the development of a buildup of plaque and narrowing in your arteries, elevated cholesterol, and elevated blood sugars. All these risk factors play a part in the development or exacerbation of high blood pressure through its effects on your body and the consequences of these conditions on your heart.” continues Dr. Barata.
Alcohol can affect blood pressure in several ways. According to a 2020 review, alcohol can affect the activity of the renin-angiotensin-aldosterone system (RAAS), which is a hormone system that helps maintain the balance of fluid and electrolytes in the body. Increasing the activity of the RAAS leads to sodium and water retention, which increases blood volume and blood pressure. Alcohol can also impact the body’s ability to detect changes in blood pressure and make adjustments to keep it controlled. In addition, drinking alcohol can increase noradrenaline and cortisol, which cause heart rate and blood pressure to increase.
Studies have found that chronic heavy drinking decreases nitric oxide in the body, which is a vasodilator and relaxes the blood vessels. Decreased nitric oxide results in the constriction of the blood vessels, making it harder for blood to move through the body.
Alcohol and Blood Pressure: Key Facts
Alcohol-related hypertension, or high blood pressure, impacts about 16% of the population. About half of U.S. adults have some form of high blood pressure or take blood pressure medications, the CDC says.
A study in The Journal of Clinical Hypertension says that just one drink may raise blood pressure for at least 2 hours. If you regularly have more than two drinks, you could be at risk for long-term high blood pressure.
“Repeated alcohol consumption can lead to long-term blood pressure abnormalities, which can present health risks that need to be medically monitored [or] managed,” explains Ashley McGee, RN, Vice President of Nursing at Mountainside Alcohol and Drug Treatment Center in Connecticut.
Early hypertension usually doesn’t bring on noticeable symptoms, but it can slowly damage your arteries, kidney, brain, and heart. Untreated hypertension can eventually lead to heart attack and stroke.
Men are more likely than women to have high blood pressure, the CDC says. In fact, even small amounts of alcohol can increase hypertension risk in men. As for binge drinking, younger men are more likely to experience high blood pressure from excess alcohol use than young women. But stroke risk can increase in men and women of all ages who binge drink regularly. The CDC defines binge drinking as four drinks in 2 hours for women and five drinks in 2 hours for men.
Can I Drink Alcohol with High Blood Pressure?
For people with a history of hypertension, a mere ounce of alcohol has been linked to increased pressure on their hearts.
“In patients who have cardiac risk factors, hypertension included, I generally advise less than one to two times per week, [or] at most two to four drinks per week, but ideally, less than that,” says David Ishizawar, MD, Assistant Professor of Medicine at Medical College of Wisconsin in Milwaukee. “There is no ‘safe’ quantity of alcohol that an individual with chronic health problems can consume.”
Does Your Blood Pressure Go Up When You Quit Drinking?
“You can develop elevated blood pressure with long-term alcohol use after abstinence due to withdrawal effects.” explains Dr. Barata. “If someone with long-term alcohol use desires to reduce their intake, a physician will monitor the patient to avoid the side effects associated with alcohol withdrawal. If the patient has consistent long-term excessive alcohol use and dependence, they will require inpatient management for detoxification of alcohol.”
Alcohol is a central nervous system (CNS) depressant, meaning it slows down the functioning of the CNS. The brain adapts to chronic heavy drinking to try to maintain a balance. When alcohol is removed suddenly after years of heavy drinking, this adaptation causes the brain to become hyperactive and out of balance again. The severity of withdrawal symptoms will depend on things like genetics, how much you drank, and how many years you drank. In severe cases the CNS becomes hyperactive resulting in symptoms like rapid heart rate, increased body temperature, sweating, and increased blood pressure.
Alcohol Withdrawal and Blood Pressure
Alcohol withdrawal could also affect blood pressure. This is partly why it’s important to undergo detox under medical supervision.
“For some, their blood pressure will be elevated due to withdrawal and the stress it causes on the body to recover,” McGee says. “For others, blood pressure will be lowered due to sickness related to withdrawal symptoms. Managing a client’s blood pressure is something that is closely monitored by medical staff during a client’s detoxification period.”
If you are concerned with withdrawing from alcohol safely, then it’s important to get medical supervision during detox. Doctors can help keep you comfortable during the process of withdrawal and make sure that you are safe from any dangerous withdrawal symptoms that may develop.
“Blood pressure will be closely monitored by physicians in an inpatient setting while prescribing certain medications that help prevent the development of the side effects associated with withdrawal, especially when reducing your alcohol intake at a rapid rate if your body is physiologically dependent on alcohol. The side effects include elevated blood pressure as well as life-threatening symptoms such as seizures, and even heart attack or stroke depending on the patient's underlying medical conditions and dependence.” continues Dr. Barata.
Is High Blood Pressure due to Alcohol Use Reversible?
“High blood pressure from drinking alcohol is reversible.” says Dr. Barata. “The first step is determining how significant your alcohol intake is and how to safely reduce your intake in terms of an inpatient or outpatient setting. The interval between alcohol abstinence and normalization of blood pressure will vary from patient to patient and their underlying medical condition. However, you can expect that your blood pressure will decrease over time ranging from weeks to even months with close follow-up with your physician. This will be essential in managing abstinence and monitoring your blood pressure while optimizing any underlying medical conditions that may have been present or developed due to long-term alcohol use.”
How Long After Quitting Drinking Will Blood Pressure Go Down?
A study published in Alcohol and Alcoholism assessed blood pressure during alcohol withdrawal for 147 detoxing patients daily for 18 days. This study found a sharp and sustained decrease in blood pressure once the patient moved through the peak of withdrawal symptoms. On the first day of detox, blood pressure had increased in 57% of the patients and by day 18, blood pressure was elevated in only 21% of patients. Withdrawal symptoms typically peak around 48-72 hours and then begin to improve. By day 3 of withdrawal, only 36% of patients had high blood pressure. By day 5, the percentage of patients with severe hypertension, which is defined as blood pressure that is above 180/110, decreased from 6.3% on day 1 to 0.7%.
Reducing your intake or quitting drinking won’t always fix blood pressure issues and that is because heavy drinking is not the only cause of high blood pressure. Genetics, age, and weight are other factors that contribute to elevated blood pressure. If you find your blood pressure is still elevated, then it is recommended to follow up with your doctor.
Sources:
M. CECCANTI and others, HYPERTENSION IN EARLY ALCOHOL WITHDRAWAL IN CHRONIC ALCOHOLICS, Alcohol and Alcoholism, Volume 41, Issue 1, January/February 2006, Pages 5–10
Tasnim S, Tang C, Musini VM, Wright JM. Effect of alcohol on blood pressure. Cochrane Database Syst Rev. 2020;7(7):CD012787. Published 2020 Jul 1. doi:10.1002/14651858.CD012787.pub2
Piano MR. Alcohol's Effects on the Cardiovascular System. Alcohol Res. 2017;38(2):219-241.
