Alterations in Alcohol Use, Even at Low Levels, Impact BP

Even at relatively low levels of alcohol consumption, either increasing or decreasing the amount one drinks has significant effects on blood pressure in both men and women, a Japanese study shows.

Among regular alcohol consumers, cutting out as little as half a drink per day, at least for women, was associated with significant reductions in BP. On the flip side, those who newly started drinking alcohol saw dose-dependent increases in both systolic and diastolic BP, with stronger relationships observed in men.

The associations were consistent across alcohol types, researchers led by Takahiro Suzuki, MD (Institute of Science Tokyo and St. Luke’s International Hospital, Japan), report in a paper published online this week in JACC.

It’s noteworthy that even among people consuming alcohol at light-to-moderate levels, a category that many individuals in the population fall into, there were beneficial changes in BP associated with stopping.

“Historically, light-to-moderate drinking (one drink per day for women and up to two for men) has often been considered ‘safe,’” Suzuki told TCTMD via email. “Yet, our results reinforce the 2025 ACC/AHA high blood pressure guidelines, which now also include recommendations for alcohol abstinence.”

Both for patients with hypertension and for the general adult population, dropping alcohol “can be viewed as a practical, nonpharmacological strategy associated with lower blood pressure,” he said. “Importantly, this recommendation should not be limited to heavy drinkers. Our findings demonstrate that even light-to-moderate drinkers can gain measurable benefit from stopping alcohol.”

On a population level, a systolic BP decrease as little as 2 mm Hg can lead to meaningful reductions in risks of stroke and cardiovascular death, Suzuki added.

Even light-to-moderate drinkers can gain measurable benefit from stopping alcohol. Takahiro Suzuki

American College of Cardiology spokesperson Beth Abramson, MD (St. Michael’s Hospital, Toronto, Canada), agreed that this study reinforces recommendations from professional societies that “one needs to limit alcohol consumption to protect us from developing high blood pressure and [to help] treat high blood pressure.”

Abramson said that, as a preventive cardiologist, she recommends moderation in most things, adding, however, that “we have to rethink what moderation is when it comes to alcohol.” Consuming alcohol, she noted, is associated not only with BP and cardiovascular risk, but also with cancer and other chronic diseases.

Abramson advises her patients to incorporate nondrinking days into their lives when trying to cut down, which will help from the perspective of managing BP but also in terms of helping with control of body weight by avoiding the calories in alcoholic drinks.

Some Sex Differences

Though it’s well known that heavy drinking raises BP, the impact of light-to-moderate alcohol consumption—and of pulling back from that small amount of drinking—has been less clear, Suzuki said. In addition, “most prior studies have focused almost exclusively on men, leaving a striking lack of data for women and making it difficult to evaluate potential sex-specific effects,” he noted.

To help fill those gaps, and to see how changes in alcohol use over time influence BP, the group retrospectively examined data from a large, longitudinal dataset that included individuals getting annual health checkups at the Center for Preventive Medicine at St. Luke’s International Hospital in Tokyo between October 2012 and March 2024. The analysis included 359,717 visits from 58,943 people who were 20 and older. All underwent at least two checkups and didn’t receive treatment for hypertension during the study period. Participants self-reported alcohol intake, which was converted to standard drinks (one drink equals 10 grams of ethanol).

The researchers formed two cohorts: 25,621 individuals (median age 50.5 years; 52.1% women) who reported drinking regularly (at least one alcoholic drink per week) at baseline and 31,532 participants (median age 50.0 years; 70.4% women) who did not.

Among the drinkers, median BP at baseline was 113/68 mm Hg for women and 123/76 mm Hg for men. Median alcohol intake was 0.7 drinks/day in women and 1.4 drinks/day in men. The median time between two checkups was 1 year.

In this group, there was a median reduction of 0.4 drinks/day between visits, with cessation associated with dose-dependent reductions in BP after accounting for demographics, clinical history, and lifestyle behaviors. Reducing alcohol consumption by a single drink per day was associated with significant reductions in both systolic (-0.92 mm Hg) and diastolic (-0.82 mm Hg) readings overall.

Among women, stopping 0.5 to 1 drinks/day didn’t have a significant impact on systolic BP, although there was a drop in diastolic BP (-0.41 mm Hg). When women cut out 1 to 2 drinks/day, there was a significant drop in both systolic and diastolic readings (-0.78 and -1.14 mm Hg, respectively).

We have to rethink what moderation is when it comes to alcohol. Beth Abramson

Stopping 0.5 to 1 drink/day was not associated with a significant change in BP in men who regularly consumed alcohol at baseline. Cutting out 1 to 2 drinks/day, however, was tied to significant reductions in both systolic and diastolic BP (-1.03 and -1.62 mm Hg, respectively).

When it came to those who reported an uptick in alcohol consumption between visits (median interval 1 year), opposite trends were seen. Those who started drinking (by a median of 0.4 drinks/day) had dose-dependent increase in BP, with generally consistent effects in both women and men. Overall, an increase of a single drink per day correlated with significant rises in both systolic and diastolic BP (0.78 and 0.53 mm Hg, respectively). There was a significant interaction indicating that this relationship was stronger in men versus women.

The findings in both cohorts were similar irrespective of whether individuals’ drink of choice was beer, wine, whiskey, sake, or shochu. They also tended to be consistent across subgroups, although changes in BP were more pronounced among individuals with preexisting hypertension.

“Our results support the management strategy of alcohol abstinence and challenge the sex-specific recommendations that consider one drink per day or less for women and two drinks per day or less for men as acceptable, indicating that even modest cessation of alcohol intake may constitute an effective public health strategy for BP reduction across both sexes,” Suzuki et al write.

Focusing on Lifestyle

Abramson framed the discussion about alcohol’s effects within the larger context of what’s needed to lead a heart-healthy lifestyle. “We tend to get very focused on our newest intervention and the new quick fix and what we can do to treat disease,” she said. “But the bigger issue is how we can prevent it in the first place, and preventing and treating high blood pressure reduces all of our future risk of heart attack and stroke.”

What it takes to manage high BP are lifestyle interventions and medications, but first, people need to know they have it. Abramson recommends that people go to either a local drugstore or a doctor to check their blood pressure as a first step. Even if the initial readings are normal, it’s important to keep checking intermittently, she advised.

Along with limiting alcohol consumption, individuals should be taking other steps to lead a heart-healthy lifestyle, including limiting salt intake, managing stress with activity and exercise, maintaining a healthy body, and eating a good diet with more fruits and vegetables, lean meats, poultry, fish, nuts, and grains, she said.

It’s critical to schedule activity into one’s weekly routine, because otherwise “it doesn’t happen,” Abramson said. “It doesn’t mean going to a gym and putting on spandex. What it does mean is even scheduling in a brisk walk, doing something that you know will be good for your heart health with activity. It’s the time to be active that it’s often hard for us to incorporate.”