Effects of alcohol withdrawal on blood pressure in hypertensive heavy drinkers.
BACKGROUND
Epidemiological investigations have demonstrated a close association between heavy alcohol consumption and hypertension. The mechanisms of this association, however, remain elusive. We studied the effects of alcohol withdrawal on blood pressure, hormonal parameters, and circulating markers of endothelial activity.


METHODS
In 14 hypertensive heavy alcohol consumers (> 200 g/day) who agreed to participate in a hospital withdrawal programme we monitored, for 30 days, blood pressure, plasma levels of renin, aldosterone, cortisol, endothelin, and plasminogen activator inhibitor 1 (PAI-1), and urinary levels of catecholamines. Patients in the withdrawal group were compared with eight hypertensive heavy drinkers who refused to participate in the programme and maintained regular alcohol consumption and 11 normotensive teetotalers.


RESULTS
By the third day after withdrawal, blood pressure was significantly decreased and the normalization of levels was obtained in 13 of 14 patients by the end of the study. Alcohol withdrawal significantly decreased plasma aldosterone and cortisol levels, but did not affect levels of active renin and fractionated urinary catecholamines. At baseline, plasma endothelin and PAI-1 levels were significantly higher in alcoholic individuals than in teetotalers, and after the cessation of alcohol intake decreased progressively, reaching levels different from baseline within 1 week. A significant correlation was found between changes in endothelin and PAI-1, and blood pressure variations during alcohol abstinence that remained significant only for endothelin with the multivariate approach.


CONCLUSIONS
Hypertension is rapidly reversible in the majority of heavy drinkers after the withdrawal of alcohol consumption. In these patients, hypertension is associated with an increased release of endothelial factors that might contribute to the increase in blood pressure.
Soardo
Giorgio
G
Department of Internal Medicine, Liver Unit, University of Udine School of Medicine, Udine, Italy. giorgio.soardo@med.uniud.it
Donnini
Debora
D
Varutti
Rosanna
R
Milocco
Carla
C
Basan
Lorenza
L
Esposito
Walter
W
Casaccio
Daniele
D
Isola
Miriam
M
Soldano
Franca
F
Sechi
Leonardo A
LA
D000328:Adult; D000450:Aldosterone / Q000097:blood; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001794:Blood Pressure / Q000187:drug effects*; D002395:Catecholamines / Q000652:urine; D002492:Central Nervous System Depressants / Q000009:adverse effects*; D016232:Endothelins / Q000097:blood; D004730:Endothelium, Vascular / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D000431:Ethanol / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006973:Hypertension / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D012083:Renin / Q000097:blood; D012107:Research Design; D013375:Substance Withdrawal Syndrome / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D013997:Time Factors
D015415:Biomarkers; D002395:Catecholamines; D002492:Central Nervous System Depressants; D016232:Endothelins; D017395:Plasminogen Activator Inhibitor 1; D000431:Ethanol; D000450:Aldosterone; D012083:Renin; D006854:Hydrocortisone