Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
J Gen Intern Med. 2022 Oct;37(13):3388-3395. doi: 10.1007/s11606-021-07375-3. Epub 2022 Feb 25.
Alcohol use is associated with increased blood pressure among adults with hypertension, but it is unknown whether some of the observed relationship is explained by mediating behaviors related to alcohol use.
We assess the potential indirect role of smoking, physical inactivity, unhealthy diet, and poor medication adherence on the association between alcohol use and blood pressure among Black and White men and women with hypertension.
Adjusted repeated-measures analyses using generalized estimating equations and mediation analyses using inverse odds ratio weighting.
1835 participants with hypertension based on ACC/AHA 2017 guidelines in three most recent follow-up exams of the longitudinal Coronary Artery Risk Development in Young Adults cohort study (2005-2016).
Alcohol use was assessed using both self-reported average ethanol intake (drinks/day) and engagement in heavy episodic drinking (HED) in the past 30 days. Systolic and diastolic blood pressure (SBP, DBP) were measured by trained technicians (mmHg). Smoking, physical inactivity, and diet were self-reported and categorized according to American Heart Association criteria, and medication adherence was assessed using self-reported typical adherence to antihypertensive medications.
At baseline (2005-2006), 57.9% of participants were Black and 51.4% were women. Mean age (standard deviation) was 45.5 (3.6) years, mean SBP was 128.7 (15.5) mmHg, and mean DBP was 83.2 (10.1) mmHg. Each additional drink per day was significantly associated with higher SBP (β = 0.713 mmHg, 95% confidence interval (CI): 0.398, 1.028) and DBP (β = 0.398 mmHg, 95% CI: 0.160, 0.555), but there was no evidence of mediation by any of the behaviors. HED was not associated with blood pressure independent of average consumption.
These findings support the direct nature of the association of alcohol use with blood pressure and the utility of advising patients with hypertension to limit consumption in addition to other behavioral and pharmacological interventions.
酒精摄入与高血压成年人的血压升高有关，但尚不清楚观察到的部分关系是否可以通过与酒精使用相关的中介行为来解释。
我们评估了吸烟、身体活动不足、不健康饮食和药物治疗依从性差在酒精使用与高血压黑人及白人男性和女性之间的关联中的潜在间接作用。
使用广义估计方程进行调整后重复测量分析和使用逆优势比加权进行中介分析。
基于 ACC/AHA 2017 指南，在纵向冠状动脉风险发展在年轻人队列研究的三个最近随访检查中（2005-2016 年），共有 1835 名高血压参与者。
使用自我报告的平均乙醇摄入量（每天饮料）和过去 30 天内的重度间歇性饮酒（HED）来评估酒精使用。由经过培训的技术人员测量收缩压和舒张压（SBP、DBP）（mmHg）。吸烟、身体活动不足和饮食通过自我报告并根据美国心脏协会标准进行分类，药物治疗依从性通过自我报告的典型抗高血压药物治疗依从性来评估。
在基线（2005-2006 年）时，57.9%的参与者为黑人，51.4%为女性。平均年龄（标准差）为 45.5（3.6）岁，平均 SBP 为 128.7（15.5）mmHg，平均 DBP 为 83.2（10.1）mmHg。每天多喝一杯与 SBP 升高显著相关（β=0.713mmHg，95%置信区间（CI）：0.398，1.028）和 DBP（β=0.398mmHg，95%CI：0.160，0.555），但没有证据表明任何行为存在中介作用。HED 与血压之间的关系与平均饮酒量无关。
这些发现支持了酒精使用与血压之间关联的直接性质，以及建议高血压患者除了其他行为和药物干预外，限制饮酒量的有效性。
