Manufacturers of angiotensin-converting enzyme (ACE) inhibitor have no information or recommendation regarding the specific use of ACE inhibitors while drinking alcohol.1-13 They do say ACE inhibitor can cause symptomatic hypotension with dizziness or lightheadness anytime during therapy, but particularly with an initial or increased dose. Patient who are volume- or salt-depleted are at higher risk for hypotension. Examples include those who:
- take water pills (diuretics)
- are on a low-salt diet
- take other medicines that affect your blood pressure
- get sick with vomiting or diarrhea
- do not drink enough fluids
According to the 2017 American College of Cardiology and American Heart Association (ACC/AHA) hypertension guidelines, alcohol is a substance that has the potential to impair blood pressure control.14 They recommend limiting alcohol to ≤1 drink daily for women and ≤2 drinks for men. In the United States, one “standard” drink contains roughly 14 g of pure alcohol, which is typically found in 12 oz of regular beer (usually about 5% alcohol), 5 oz of wine (usually about 12% alcohol), and 1.5 oz of distilled spirits (usually about 40% alcohol).14-16 Evidence reviewed by the panel shows that for heavy drinkers, reducing alcohol intake to this amount may result in a reduction of blood pressure by -4 mm Hg systolic and -3mm Hg diastolic or more, regardless of other interventions.14,17-20
Excessive alcohol consumption causes about 16% of hypertension cases worldwide.21,22 Drinking more than two alcoholic drinks per day raises the risk of high blood pressure.23,24
The Dietary Guidelines for Americans 2015-2020 states that if alcohol is consumed, it should be in moderation—up to one drink per day for women and up to two drinks per day for men—and only by adults of legal drinking age. For those who choose to drink, moderate alcohol consumption is recommended.25
References
- Accupril [package insert]. New York, NY: Parke Davis, Pfizer; 2017.
- Capoten [package insert]. Spring Valley, NY: Par Pharmaceutical Companies, Inc.; 2012.
- Vasotec [package insert]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; 2015.
- Lotensin [package insert]. Parsippany, NJ: Validus Pharmaceuticals LLC; 2014.
- Altace [package insert]. New York, NY: Pfizer Laboratories; 2017.
- Aceon [package insert]. North Chicago, IL: Abbot Laboratories; 2011.
- Moexipril hydrochloride [package insert]. Teva Pharmaceuticals USA Inc; 2016.
- Fosinopril sodium [package insert]. Miami, FL: Ciplo USA Inc; 2015.
- Trandolapril [package insert]. Laurelton, NY: Epic Pharma, LLC; 2017.
- Prinivil [package insert]. Whitehouse Station, NJ: Merck Sharp & Dohme Corp.; 2016.
- Sica DA. Angiotensin-converting enzyme inhibitors side effects--physiologic and non-physiologic considerations. J Clin Hypertens (Greenwich) 2004; 6 (7): 410-416.
- Warner NJ, Rush JE. Safety profiles of the angiotensin-converting enzyme inhibitors. Drugs 1988; 35 Suppl 5: 89-97.
- Izzo JL, Jr., Weir MR. Angiotensin-converting enzyme inhibitors. J Clin Hypertens (Greenwich) 2011; 13 (9): 667-675.
- Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017.
- National Institute on Alcohol Abuse and Alcoholism (NIAAA). What is a standard drink? https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/what-standard-drink. Accessed Mar 17, 2018.
- Moyer VA. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013; 159 (3): 210-218.
- Roerecke M, Kaczorowski J, Tobe SW, Gmel G, Hasan OSM, Rehm J. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health 2017; 2 (2): e108-e120.
- Stewart SH, Latham PK, Miller PM, Randall P, Anton RF. Blood pressure reduction during treatment for alcohol dependence: results from the Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) study. Addiction 2008; 103 (10): 1622-1628.
- Xin X, He J, Frontini MG, Ogden LG, Motsamai OI, Whelton PK. Effects of alcohol reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2001; 38 (5): 1112-1117.
- Lang T, Nicaud V, Darne B, Rueff B. Improving hypertension control among excessive alcohol drinkers: a randomised controlled trial in France. The WALPA Group. J Epidemiol Community Health 1995; 49 (6): 610-616.
- Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol 2006; 33 (9): 847-852.
- Husain K, Ansari RA, Ferder L. Alcohol-induced hypertension: Mechanism and prevention. World J Cardiol 2014; 6 (5): 245-252.
- Taylor B, Irving HM, Baliunas D, et al. Alcohol and hypertension: gender differences in dose-response relationships determined through systematic review and meta-analysis. Addiction 2009; 104 (12): 1981-1990.
- Fuchs FD, Chambless LE, Whelton PK, Nieto FJ, Heiss G. Alcohol consumption and the incidence of hypertension: the atherosclerosis risk in communities study. Hypertension 2001; 37 (5): 1242-1250.
- 2015 – 2020 dietary guidelines for Americans. 8 ed: U.S. Department of Health and Human Services and U.S. Department of Agriculture; 2015.