Alcohol Counseling Can Reduce Blood Pressure

Unhealthy alcohol use is associated with hypertension. Two recent articles examined whether reductions in drinking can decrease blood pressure among hypertensive heavy drinkers.

Analyzing data from 1383 alcohol dependent persons enrolled in the Combining Medication and Behavioral Interventions for Alcoholism (COMBINE) study, Stewart and colleagues found that, over a 4-month treatment period,

• systolic blood pressure (SBP) decreased by 12 mm Hg in patients whose SBP was >132 mm Hg at baseline.

• diastolic blood pressure (DBP) decreased by 8 mm Hg in patients whose DBP was >84 mm Hg at baseline.

• Adjusting for age, gender, and baseline blood pressure, a 50% decrease in days of alcohol consumption decreased SBP by 2.4 mm Hg and DBP by 1.9 mm Hg in non-African Americans (p<.001).

Rose and colleagues performed a randomized trial of quality improvement measures to increase alcohol screening and brief intervention among 27,591 hypertensive patients in 21 primary care practices. The intervention included electronic medical records and reminders, site visits, annual meetings, and quarterly performance reports. Over the 2-year study period,

• hypertensive patients in intervention practices were 8 times more likely to be screened for alcohol use.

• patients with unhealthy drinking* were 5.5 times more likely to be counseled.

• no differences in blood pressure were found between the randomized groups, but SBP decreased by 4.2 mm Hg and DBP by 3.3 mm Hg (both p<.05) among hypertensive patients who received counseling.

Comments:

Counseling to reduce alcohol consumption may help reduce blood pressure in hypertensive patients with unhealthy drinking. The inclusion of alcohol screening and brief interventions in quality improvement efforts for hypertensive populations might facilitate their implementation in primary care settings.

Peter D. Friedmann, MD, MPH

References:

Stewart SH, Latham PK, Miller PM, et al. Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medication and Behavioral Interventions for Alcoholism (COMBINE) study. Addiction. 2008;103(10):1622–1628.

Rose HL, Miller PM, Nemeth LS, et al. Alcohol screening and brief counseling in a primary care hypertensive population: a quality improvement intervention. Addiction. 2008;103(8):1271–1280.