Binge Drinking and Ambulatory Blood Pressure
Kaija Seppä, Pekka Sillanaukee
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Abstract—The effect of alcohol drinking in raising blood pressure (BP) is rapidly reversible. However, there is only limited
information on the effect of binge drinking on BP values. In this study, 20 healthy men who were all social drinkers
drank alcohol (2.2 g/kg) in controlled circumstances on a Saturday evening. Ambulatory BP measurement (ABPM)
values were compared with ABPM values of the same subjects during the previous sober Saturday, separately
throughout 6 hours of intoxication, throughout 6 hours when blood alcohol levels decreased, and throughout 6 hangover
hours. During the intoxication period, both mean systolic BP and mean diastolic BP were 5 mm Hg higher (P50.0183
and P50.0529, respectively) and the pulse was 18 beats per minute faster (P50.0001) compared with the corresponding
sober period during the previous weekend. While blood alcohol levels decreased after drinking, mean systolic BP was
4 mm Hg lower (P50.0331), diastolic BP was 5 mm Hg lower (P50.0058), and pulse was 15 bpm faster (P50.0001)
than during the sober weekend. No statistically significant difference was found between the weekends in BP values
during the hangover period. Drinking seems to increase both systolic and diastolic BP during intoxication but not during
hangover. During the period when blood alcohol levels are decreasing, usually at night, both pressure levels fall to less
than the basic level. These major and rapid changes in BP values might increase the likelihood of strokes, which are seen
in increased numbers among young adults, especially during weekends and holidays. (Hypertension. 1999;33:79-82.)
Key Words: blood pressure monitoring, ambulatory n alcohol n binge drinking n blood pressure n pulse n stroke
diastolic values.11 In their retrospective study, Maheswaran et
al12 likewise concluded that the BP effect of alcohol is due
predominantly to alcohol consumed in the days immediately
preceding BP measurement.
Ambulatory measurement of BP (ABPM) offers accurate
results because it takes into account patient-related and
physiological variations during the recording. Noninvasive
ambulatory equipment has developed considerably during the
last few years and is beginning to overcome validation
problems.13,14 Only a few studies have evaluated the BP and
alcohol relationship using ambulatory methods. Maiorano et
al15 examined alcoholics and found that 1 week of abstinence
did not influence 24-hour BP levels in normotensive subjects
but altered the diurnal pattern characterized by a fall in
systolic BP and increased BP variability. Short-term alcohol
consumption (1 g/kg) among social drinkers for a few days
has not been found to increase office or ambulatory BP.16,17
The effect of “binge” amounts on BP measured with ambulatory methods has not been examined previously.
T
he effect of alcohol drinking in raising blood pressure
(BP) has been known since the 1960s.1–5 When the daily
alcohol consumption is more than 30 g of absolute alcohol,
BP begins to rise in both men and women.3,4 The Kaiser
Permanente study demonstrated that individuals drinking 6 to
8 drinks per day have 9.1 mm Hg higher systolic and
5.6 mm Hg higher diastolic BP values than nondrinkers.6
Because alcohol abuse is a common problem, it can also be
considered an important cause of increased BP values.7,8
Half of alcoholics have BP values $160/90 mm Hg9;
however, these values have been found to normalize during
abstinence.10 A similar trend was found in population studies,6
and the present opinion is that the effect of alcohol in raising
BP is rapidly reversible.8
Binge drinking is common among heavy drinkers. An
increasing number of young adults, especially those who
work during the week, seem to concentrate their drinking on
weekends and holidays. It is probable that binge drinking has
different consequences on BP compared with daily drinking.
However, only a few studies have examined the relationship
between drinking pattern and BP. Epidemiological evidence
shows that there is no difference between BP values in
teetotalers and those who drink every now and then.6 In
Finland, where binge drinking is the prevalent pattern of
heavy drinking, we have found in a cross-sectional study that
binge drinking does not permanently affect BP, at least not
Methods
Twenty male volunteers aged 19 to 61 years (mean age, 33 years)
participated in the study, which had been approved by the Ethics
Committee of the Biomedical Research Center of Alko Ltd. In-
Received May 28, 1998; first decision July 1, 1998; revision accepted September 4, 1998.
From the Departments of Psychiatry (K.S.) and Clinical Chemistry (P.S.), Tampere University Hospital; the University of Tampere, Medical School,
Department of General Practice, Tampere, Finland (K.S.); and Pharmacia & Upjohn Diagnostics AB, Alcohol Related Diseases, Uppsala, and the
Karolinska Institute Medical School, Stockholm, Sweden (P.S.).
Correspondence to Professor Kaija Seppä, University of Tampere, Medical School, Teiskontie 35, FIN-33520 Tampere, Finland. E-mail [email protected]
© 1999 American Heart Association, Inc.
Hypertension is available at http://www.hypertensionaha.org
79
80
Binge Drinking and Ambulatory Blood Pressure
TABLE 1. Daytime (7
Sober Weekend
ABPM Value
AM–11 PM)
Values of BP and Pulse During the
Friday
Saturday
Sunday
Monday
Systolic BP, mm Hg
126618.1
122617.5
122617.7
120617.0
Diastolic BP, mm Hg
83618.8
77617.3
77618.2
75616.5
Pulse, bpm
75615.4
75616.8
72617.4
74617.5
Values are mean6SD.
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formed consent was obtained from all volunteers; risks of binge
drinking were outlined, and it was recommended that participants
stay at home during drinking under the supervision of a sober spouse
or friend. None of the participants were taking medication, all were
moderate drinkers (,280 g absolute alcohol per week; range, 70 to
200 g; eg, '5 to 17 drinks per week or 5 to 10 drinks per 1 or 2
occasions during the week), and 17 were nonsmokers. BP was
measured using ABPM-Meditech equipment over 2 consecutive
weekends from Friday morning until Tuesday morning. Every
subject used the same gauge during the 2 separate periods. During
the second weekend, the subjects consumed “binge” amounts of
alcohol, 2.2 g/kg of nonchilled spirits, divided into 12 drinks over 6
hours beginning at 6 PM on Saturday. During the first weekend no
alcohol was allowed, but an extra meal containing calories equivalent to the alcohol during the next weekend was added to the normal
diet. Participants were not allowed to eat salted snacks, nuts, or
crisps during the study. The 3 smokers were advised to smoke the
same amount during both weekends. Extreme physical activity (eg,
sport competition alone or in a group) was forbidden during the study
weekends to avoid its disturbing effect on BP measurements and to
make physical activity uniform during the 2 study weekends.
The BP monitoring was performed with oscillometric ABPMMeditech ambulatory BP equipment.18 The accuracy of the equipment for diastolic BP measurements has been classified as A and that
of systolic recordings as B, according to the British Hypertension
Society recommendations.14 This equipment measures BP of 0 to
280 mm Hg and pulse of 40 to 200 bpm. The BP accuracy is within
63 mm Hg or 2% of the reading, and the pulse accuracy is within
5% of the reading. The pressure is calculated based on arterial
pulsations, which are electronically registered using a capacitive
pressure sensor. The pulse rate is calculated based on the duration of
20 beats. Repeated measurements are taken if the pulse count is ,40
bpm, pulse pressure is ,50% of the previously measured value,
pulse pressure is ,20 mm Hg, or diastolic BP is .130% of the
previously measured value. The information on the BP and pulse
measurements was stored in the memory of the equipment and read
into a computer using ABPM-Meditech software.18
All subjects had arm circumference ,35 cm, and a standard cuff
was used. The monitor was applied to the nondominant arm. The
equipment was programmed to measure BP every 15 minutes during
the day (8 AM to 12 PM), every 30 minutes during the night (12 PM
to 8 AM), and every 10 minutes during the intoxication period and
during the corresponding times the week before (Saturday 8 PM to
Sunday 4 AM). Values were excluded if pulse pressure was
,15 mm Hg or diastolic BP was outside the range of 45 to
140 mm Hg.19
The BP values of the 20 subjects during the first measurement day
and night were compared with the values of the 3 following days and
nights to determine the possible effect of the equipment on the
pressure values. BPs were monitored during and compared between
2 weekends to separately analyze the possible effects of the weekend
(leisure) on the values. To find out the effect of alcohol on BP values,
the values of the first (sober) weekend were compared with the
values of the second weekend during the drinking time (Saturday 6
PM to Sunday 2 AM), during the time when the blood alcohol
concentration was falling (Sunday 2 AM to Sunday 10 AM), and
during hangover time (Sunday 10 AM to Sunday 6 PM). Statistical
analyses of the parameters 20 (systolic BP, diastolic BP, and pulse)
were performed using Student’s paired t test. P,0.05 was considered
statistically significant.
Results
To eliminate the known effect of wearing the ambulatory
equipment, the daily variation, and the possible effect of
weekend on BP values, the ABPM was conducted during 2
consequent weekends. Comparison of the systolic and diastolic BP as well as pulse values of the first day with those
values during the following 3 days (Saturday to Monday)
showed that during the first measurement day, both systolic
and diastolic BPs were significantly higher (126 versus
122 mm Hg, P50.0185, and 83 versus 77 mm Hg,
P50.0007, respectively); no difference was found in pulse
values, nor was any change (P.0.05) observed in nighttime
values in systolic (110 versus 111 mm Hg) or diastolic (66
versus 67 mm Hg) values or pulse rate (43 versus 44 bpm).
The decrease of daytime values in systolic and diastolic BPs
was stabilized after the first measurement day (Table 1). This
level also remained after the weekend, on Monday. Thus, it
seems that weekend has no effect on BP values, but getting
used to the equipment takes some time. No statistically
significant differences were found in either systolic or diastolic BP values between sober and drinking periods. However, pulse frequency was significantly higher during the
drinking period in daytime (78 versus 74 bpm, P,0.001) and
nighttime (68 versus 58 bpm, P,0.001).
The BP and pulse values of the intoxication period (Saturday 6 PM to Sunday 2 AM) and the values of the corresponding time during the previous sober weekend are presented in
Table 2. The monitoring should have resulted in a total of 44
values per person. In practice, the number of measured values
TABLE 2. BP and Pulse Values of Time of Intoxication (Saturday 6 PM–Sunday
2 AM) and Values of Corresponding Time During the Sober Weekend
Sober
Intoxicated
ABPM Value
Mean6SD
Range
Mean6SD
Range
P
Systolic BP, mm Hg
119610.5
97–137
124612.4
105–153
0.0183
Diastolic BP, mm Hg
75610.5
54–91
80613.6
58–117
0.0529
Pulse, bpm
6966.6
58–79
87613.9
68–116
0.0001
Seppä and Sillanaukee
January 1999
81
TABLE 3. BP and Pulse Values During the Time When Blood Alcohol
Concentration Was Falling (Sunday 2 AM–Sunday 10 AM) and Corresponding
Values at the Same Time Period During the Sober Weekend
Sober
ABPM Value
Mean6SD
Systolic BP, mm Hg
Diastolic BP, mm Hg
Pulse, bpm
After Drinking
Mean6SD
112610.4
94–127
10868.8
91–120
0.0331
68611.9
47–97
6366.8
47–72
0.0058
6169.5
49–82
76610.8
52–97
0.0001
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ranged from 9 to 43 during the sober period (mean, 34) and
from 21 to 43 during the drinking period (mean, 36).
According to our exclusion criteria, none of the values were
excluded. The mean systolic BP was 5 mm Hg higher during
the state of intoxication, the diastolic BP was 5 mm Hg
higher, and the pulse 18 bpm faster; all differences were
statistically significant.
The comparisons of values measured when the blood
alcohol level was falling are shown in Table 3. After
drinking, BP values were lower than during the corresponding sober period the previous weekend. Systolic BP was
4 mm Hg lower, diastolic BP was 5 mm Hg lower, and pulse
was 15 bpm higher; all differences were statistically
significant.
No statistically significant difference was found between
the weekends in BP values during the hangover period. Mean
systolic BP during hangover was 124 mm Hg, and the
corresponding figure during the previous weekend was
125 mm Hg (P50.6743). The corresponding values for diastolic BP were 79 mm Hg and 81 mm Hg (P50.2704). By
contrast, the pulse rate was significantly higher during hangover (81 versus 76 bpm, P50.0016).
The BP values before, during, and after drinking and
during the corresponding sober period 1 week earlier are
shown in the Figure (top). The decrease in both systolic and
diastolic BP values is clear when blood alcohol concentrations are falling and also is significant compared with the
corresponding values during the sober weekend. During the
drinking period, the pulse values are also significantly higher,
a trend that is also seen during hangover (Figure, bottom).
Range
P
Range
Earlier studies on BP and alcohol are mostly epidemiological and based on self-reports of alcohol consumption.1– 4,6
Experimental studies have measured mainly BP without
taking into account the above-mentioned biasing items and
without separating the period of rising and falling blood
alcohol levels and hangover.15–17 This may explain the differences in the results. In our study the BP and pulse values were
high while blood alcohol levels rose and were low when they
fell. If these results are combined, the net effect is near zero,
as in several earlier studies.15–17
In our study the calorie intake was stabilized during the
sober weekend, with an extra meal with calorie content
equivalent to the alcohol consumed during the following
weekend. Thus, extra alcohol calories do not explain the
changes in the BP values. Physical activity was also standardized, and extreme effort was forbidden during the study
weekends. None of the participants was a teetotaler, and most
sometimes “binge drink.” Thus, only 2 participants felt tired
Discussion
In the present study a complicated design was used. The 20
male volunteers wore ambulatory BP equipment for 2 consecutive weekends from Friday morning through Tuesday
morning. This design was based on the need for reliable
results where several biasing effects could be eliminated.
First, we wanted to acclimate the subjects to ABPM and
stabilize the known increasing effect of the equipment observed at the beginning of the follow-up period.21 Second, we
wanted to eliminate the physiological variation of BP during
different time periods of the day by comparing values for
exactly the same period of the day. Furthermore, we wanted
to eliminate the possible impact of weekend (ie, holiday) on
BP; that is why values were followed up until the next week.
At the same time, we wanted to study separately the period of
intoxication, the time when blood alcohol levels were falling,
and the hangover period.
Comparison of systolic and diastolic BP (top) and pulse (bottom) values between sober and drinking weekends. *P,0.05,
**P,0.01, ***P,0.001.
82
Binge Drinking and Ambulatory Blood Pressure
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after drinking, and none had to stop drinking because of
adverse effects.
Our study emphasizes the short-lasting effect of short-term
alcohol consumption on BP values. This finding is in accordance with earlier studies.6,8,10 It also may explain the contradictory findings in some studies where drinking pattern has
not been taken into account.22,23 Some of the different results
may be due to the fact that the studies concentrated on
alcoholics or hypertensive patients.15,22 Among these subjects,
the alcohol-BP relation may be different from that among
social drinkers. It seems that lifetime alcohol doses may
affect BP levels.24 This may explain the different findings
here compared with epidemiological studies, as does the fact
that consistent regular drinking is a more important determinant of the alcohol-BP relationship than intake in the 24 hours
before study.25 Our study does not answer the question of
whether repeated weekend binge drinking has any permanent
effect on BP values.
The important finding in the present study is that binge
drinking increases both systolic and diastolic BP. When blood
alcohol concentration falls, these values fall to less than
normal levels. Although binge drinking usually occurs during
weekends and in the evening, the huge change in BP values
takes place during the early morning hours. It has been
documented previously that binge drinking appears to be a
risk factor for stroke in young persons.26 It has also been
shown that recent moderate and heavy alcohol consumption
seem to be independent risk factors for intracerebral hemorrhage.27 Furthermore, young adults are frequently stricken by
brain infarction during weekends and holidays.28 The present
finding that binge drinking increases both systolic and diastolic BP during periods of intoxication and decreases BPs
while blood alcohol levels fall, usually at night, might
partially explain these vascular alcohol-related events.
Acknowledgments
The authors are grateful to Risto Manner, Normomedical Ltd, for
providing the ABPM-Meditech equipment. We also want to thank
the 20 men who volunteered to participate in the study and thus
sacrificed two long weekends for science.
References
1. Clark VA, Chapman JM, Coulson AH. Effects of various factors on
systolic and diastolic blood pressure in the Los Angeles Heart Study.
J Chronic Dis. 1967;20:571–581.
2. D’Alonzo CA, Pell S. Cardiovascular disease among problem drinkers. J
Occup Med. 1968;10:344 –350.
3. Klatsky AL, Friedman GD, Siegelaub AB, Gerard MJ. Alcohol consumption and blood pressure: Kaiser Permanente Multiphasic Health
Examination Data. N Engl J Med. 1977;296:1194 –1200.
4. Criqui MH, Wallace RB, Mishkel M, Barrett-Connor E, Heiss G. Alcohol
consumption and blood pressure: the Lipid Research Clinics Prevalence
Study. Hypertension. 1981;3:557–565.
5. Beevers DG, Maheswaran R. Does alcohol cause hypertension or
pseudohypertension? Proc Nutr Soc. 1988;47:111–114.
6. Klatsky AL, Armstrong MA, Friedman GD. Relation of alcoholic
beverage use to subsequent coronary artery hospitalization. Am J Cardiol.
1986;58:710 –714.
7. Saunders JB. Alcohol: an important cause of hypertension. BMJ. 1987;
294:1045–1046.
8. Regan TJ. Alcohol and the cardiovascular system. JAMA. 1990;264:
377–381.
9. Saunders JB, Beevers DG, Paton A. Factors influencing blood pressure in
chronic alcoholics. Clin Sci. 1979;57:295–298.
10. Saunders JB, Beevers DG, Oaton A. Alcohol-induced hypertension.
Lancet. 1981;2:653– 656.
11. Seppä K, Laippala P, Sillanaukee P. Drinking pattern and blood pressure.
Am J Hypertens. 1994;7:249 –254.
12. Maheswaran R, Singh J, Davies P, Beevers DG. High blood pressure due
to alcohol: a rapidly reversible effect. Hypertension. 1991;17:787–792.
13. O’Brien E, Atkins N, Staessen J. State of the market: a review of
ambulatory blood pressure monitoring devices. Hypertension. 1995;26:
835– 842.
14. Lupkovics G, Rudas L. Comparison of invasive and non-invasive measuring of blood pressure in patients following open heart surgery. Hungarian Med J. 1993;134:2033–2035.
15. Maiorano G, Bartolomucci F, Contursi V, Saracino E, Agostinacchio E.
Effect of alcohol consumption versus abstinence on 24-h blood pressure
profile in normotensive alcoholic patients. Am J Hypertens. 1995;8:
80 – 81.
16. Howes LG, Krum H, Phillips PA. Effects of regular alcohol consumption
on 24 hour ambulatory blood pressure recordings. Clin Exp Pharmacol
Physiol. 1990;17:247–250.
17. O’Callaghan CJ, Phillips PA, Krum H, Howes LG. The effects of
short-term alcohol intake on clinic and ambulatory blood pressure in
normotensive “social” drinkers. Am J Hypertens. 1995;8:572–577.
18. Meditech KFT. ABPM-Meditech Ambulatory Blood Pressure Monitor:
Users Manual. Budapest, Hungary: Meditech KFT; 1991.
19. Sundberg S, Gordin A. Ambulatory blood pressure measurement.
Duodecim. 1988;104:690 – 699.
20. Dixon WJ, ed. BMDP Statistical Software. Berkeley, Calif: University of
California Press; 1990.
21. Prasad N, MacFayden RJ, Ogston SA, MacDonald TM. Elevated blood
pressure during the first two hours of ambulatory blood pressure monitoring: a study comparing consecutive twenty-four-hour monitoring
periods. J Hypertens. 1995;13:291–295.
22. Abe H, Kawano Y, Kojima S, Ashida T, Kuramochi M, Matsuoka H,
Omae T. Biphasic effects of repeated alcohol intake on 24-hour blood
pressure in hypertensive patients. Circulation. 1994;89:2626 –2633.
23. Howes JB, Ryan J, Fairbrother G, O’Neill K, Howes LG. Alcohol consumption and blood pressure in recently hospitalised patients. Blood
Press. 1997;6:109 –111.
24. York JL, Hirsch JA. Residual pressor effects of chronic alcohol in
detoxified alcoholics. Hypertension. 1996;28:133–138.
25. Puddey IB, Jenner DA, Beilin LJ, Vandongen R. An appraisal of the
effects of usual vs recent alcohol intake on blood pressure. Clin Exp
Pharmacol Physiol. 1988;15:261–264.
26. You RX, McNeil JJ, O’Malley HM, Davis SM, Thrift AG, Donnan GA.
Risk factors for stroke due to cerebral infarction in young adults. Stroke.
1997;28:1913–1918.
27. Juvela S, Hillbom M, Palomäki H. Risk factors for spontaneous intracerebral hemorrhage. Stroke. 1995;26:1558 –1564.
28. Haapaniemi H, Hillbom M, Juvela S. Weekend and holiday increase in
the onset of ischemic stroke in young women. Stroke.
1996;27:1023–1027.
Binge Drinking and Ambulatory Blood Pressure
Kaija Seppä and Pekka Sillanaukee
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Hypertension. 1999;33:79-82
doi: 10.1161/01.HYP.33.1.79
Hypertension is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright © 1999 American Heart Association, Inc. All rights reserved.
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