According to the manufacturer, taking alcohol together with spironolactone can increase the risk of orthostatic hypotension.1 However, alcohol consumption above moderate levels (one drink per day for women and two drinks for men) results in blood pressure elevations in a dose-related response.2
There were 8,334 participants in the Atherosclerosis Risk in Communities Study who were free of hypertension and coronary heart disease at the onset of this cohort study.3 Alcohol consumption was tracked by self-report and blood pressure measured after six years of follow-up. 385 participants reported drinking in excess of 210 g of alcohol (approximately 21 drinks) per week. Compared to non-drinkers, the consumption of large amounts (210 g or more) of alcohol per week increased the risk of hypertension (140/90 mm Hg or above) in most race and gender categories that were analyzed. When adjusted for age, BMI, education, physical activity, and diabetes, the odds ratio (OR) were 1.2 (95% confidence interval [CI] [0.85 – 1.67] for white men, 2.02 (95% CI [1.08 – 3.79] for white women, and 2.31 (95% CI [1.11 – 4.86] for black men.There was an insufficient number of black women who reported drinking more than 210 g ethanol per week to draw conclusions about risk. In addition, blood pressure levels were also statistically significantly higher in black men who consumed low to moderate amounts of alcohol (less than 210 g per week), compared to non-drinkers (adjusted OR 1.71, 95% CI [1.11 – 2.64]).
In a systematic review and meta-analysis of 20 cohort studies including 361,254 patients, any alcohol consumption was associated with an increased risk of hypertension in men compared to abstainers.4 In women the increased risk for hypertension was not evident until consumption exceeded one to two drinks per day.
Studies have shown that reducing alcohol consumption can reverse this trend.5 A reduction in alcohol intake to moderate levels can lower systolic blood pressure by 2 to 4 mm Hg and diastolic blood pressure by 1 to 2 mm Hg.6
- Aldactone (spironolactone) [package insert]. New York, NY: Pfizer Labs; 2018.
- Puddey IB, Beilin LJ. Alcohol is bad for blood pressure. Clin Exp Pharmacol Physiol 2006; 33 (9): 847-852.
- 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.
- Roerecke M, Tobe SW, Kaczorowski J, et al. Sex-specific associations between alcohol consumption and incidence of hypertension: a systematic review and meta-analysis of cohort studies. JAMA 2018; 7 (13).
- 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.
- Husain K, Ansari RA, Ferder L. Alcohol-induced hypertension: mechanism and prevention. World J Cardiol 2014; 6 (5): 245.