Alcohol, Blood Pressure, Heart Disease and Stroke

Alcohol and Heart Rate

Alcohol can increase the heart rate. In one study, in healthy individuals, after two drinks heart rate increased by six beats per minute in average ^[1] and in another study, after 10 drinks, it increased by 18 beats per minute ^[2]. Mechanism: alcohol widens the skin arteries and thus causes a drop of blood pressure, what reflexively increases the heart rate in order to maintain the blood pressure ^[3].

A drinker may experience increased heart rate during hangover ^[4] and alcohol withdrawal ^[5].

Alcohol and High Blood Pressure

Heavy drinking increases the risk of high blood pressure ^[9]. Reducing the amount of alcohol consumed may lower the blood pressure within two or three weeks ^[9].

In one 2007 study, two drinks did not increase the blood pressure in healthy individuals and red wine did not affect the blood pressure significantly more than ethanol itself  ^[1].

In healthy persons, after 3 or more drinks at one occasion, the blood pressure may increase for several hours, then fall under the normal level and then normalize ^[2]. These fluctuations of blood pressure may contribute to increased risk of stroke associated with binge drinking ^[2]. Binge drinking usually does not permanently increase the blood pressure, though ^[2].

• Healthy individuals drinking 3 or more drinks per day may be at increased risk to develop hypertension ^[10].
• During hangover, the blood pressure may increase or not ^[2,11].
• During alcohol withdrawal, the blood pressure often temporarily increases ^[5].
• In some individuals who combine wine or beer, which are high in tyramine, and MAO inhibitors (a type of depressants, including isocarboxazid, phenelzine, selegiline and tranylcypromine), blood pressure may dangerously increase ^[7,12,13].
• In some chronic heavy drinkers, blood pressure may be permanently increased ^[1,9]. About a half of chronic alcoholics have blood pressure above 160/90 mm Hg; the blood pressure usually normalizes within one month after alcohol withdrawal ^[2,14].
• If you have high blood pressure, do not drink excessive amounts of alcohol ^[15].

Alcohol and Decreased Blood Pressure

• After 1-2 drinks, blood pressure may not change or slightly drop and remain lower for several hours ^[1,16].
• Drinking alcohol in sauna may result in a drop of blood pressure by as much as 20 mm Hg ^[18] and increase the risk of sudden death ^[19].
• In severe alcohol poisoning, blood pressure may fall dangerously ^[21].
• In individuals with ALDH2 deficiency, even a small amount of alcohol may cause facial flushing and a drop of blood pressure (“Asian flush reaction”) within minutes of starting drinking ^[6].

Alcohol and Irregular Heart Rhythm (Arrhythmia)

Irregular heart rhythm (arrhythmia) or pounding hert (palpitations) may develop during binge drinking, acute alcohol poisoning, chronic drinking or alcohol withdrawal ^[9,20]. When it occurs within 24 hours after weekend drinking by inexperienced drinkers with otherwise healthy hearts, it is refered to as a “holiday heart syndrome ^[22]” A long-term prevention includes avoiding alcohol, caffeine and excessive physical exertion ^[22].

Excessive alcohol consumption (35 drinks per week or more for men, or 14 drinks per week or more for women) increases the risk of atrial fibrillation ^[29,30].

Alcohol may also aggravate the pre-existing arrhythmia ^[23].

Alcohol, Atherosclerosis, Chest Pain (Angina) and Heart Attack

Moderate drinking is associated with lower risk of hardening of the coronary arteries (coronary heart disease), chest pain (angina pectoris) and heart attack  than heavy drinking or not drinking at all, probably because of increases blood HDL and decreased LDL cholesterol levels and triglycerides and decreases blood clot formation ^[1,9,24,25].

Prinzmetal (variant) angina. Rarely, heavy drinking in the evening results in a spasm of the coronary arteries with severe chest pain at rest several hours later, often in the second half of the night or in the morning, when the blood alcohol concentration falls close to zero ^[26]. The pain may last for 5-30 minutes ^[27,28]. Coronary spasm may result in irregular heart rhythm (arrhythmia), heart attack or even death, but in general the prognosis is good ^[32].

Alcoholic Cardiomyopathy

Alcoholic cardiomyopathy (Greek cardio = heart; mio = muscle; -pathy = disease) refers to dilated heart with weakened heart muscle, which can be caused by drinking more than 7 drinks per day for more than 5 years; it mainly occurs in chronic drinkers in their forties ^[33]. If a person with alcoholic cardiomyopathy continues to drink, symptoms, such as difficult breathing, coughing up pink mucus, chest discomfort, pounding heart (palpitations) and fatigue may develop. Alcoholic cardiomyopathy, in general, improves after stopping or reducing drinking ^[33].

Alcohol and Sudden Cardiac Death

Sudden cardiac death is an unexpected death due to a heart condition occurring within 1 hour after onset of the symptoms in a person with a known or unknown heart disease; the common mechanism is irregular heart rhythm ^[34].

Risk factors of alcohol-related sudden cardiac death:

• Binge drinking ^[35,37]
• Alcohol withdrawal after chronic heavy drinking; death often occurs due to low blood magnesium levels ^[36]
• Alcoholic cardiomyopathy ^[33]
• Combining alcohol with cocaine ^[38]

Raynaud’s Disease

Raynaud’s disease is a disorder with painful arterial spasms and color change in the fingers and toes triggered by cold or other stressors. Moderate drinking can decrease and heavy drinking can increase the risk of Raynaud’s disease ^[40]. Some individuals report newly appearing symptoms after small doses of alcohol after having no symptoms for several years.

Can you drink alcohol if you have heart disease?

It is your doctor who can tell if you can drink alcohol after having a heart-related chest pain, heart attack or irregular heart rhythm. Doctors usually recommend stopping drinking alcohol completely if you have heart failure, uncontrolled hypertension or alcohol cardiomyopathy ^[33]. According to few studies, regular moderate drinking increases and binge drinking decreases the survival rate in survivors of heart attack ^[17,39].

If you have an implanted pacemaker, ask your doctor if and how much alcohol you can drink.

Alcohol and Stroke

Moderate drinking (up to 1 drink per day for women, up to 2 drinks per day for men) decreases the risk of ischemic, but not hemorrhagic stroke ^[9]. Any larger amount of alcohol increases the risk of both ischemic and hemorrhagic stroke ^[9].

If you have already suffered from stroke, it is your doctor who can tell, if, when and how much alcohol you can drink. According to one study, moderate drinking after stroke was not associated with any significant further brain damage ^[8].