Does Alcohol Raise Blood Pressure?

Michael Rotman, MD, FRCPC, PhD | Medically reviewed by Robin Backlund, BHSc
Last update: October 8, 2024

High blood pressure, also known as hypertension, is a medical condition characterized by a consistent elevation in the pressure of blood against the walls of the arteries, often resulting in health hazards such as heart disease.

On the other hand, in this context, alcohol refers to ethyl alcohol or ethanol, typically found in beverages like beer, wine, spirits, and other fermented foods.

There’s a significant body of evidence suggesting that alcohol consumption can increase blood pressure.

Notably, a recent study led by Dr. Silvia Di Federico and published in the Journal of Hypertension in 2023 suggests that routine alcohol consumption may raise blood pressure, even in adults without hypertension.

The study revealed a linear increase in systolic blood pressure irrespective of gender, while diastolic pressure depended on sex and geography.

Given these findings, individuals with high blood pressure are often advised to limit or quit alcohol consumption as part of their management strategy.

Reducing alcohol intake can be a key method in controlling and lowering blood pressure, complementing other lifestyle changes and medical treatments.

Monitoring blood pressure is crucial because it helps track the effectiveness of these management strategies and provides early warnings of potential health risks.

Regular monitoring can be a proactive step in maintaining heart health and preventing complications.

It’s important to consider factors like seating position, arm level, and cuff tightness to obtain accurate readings.

When selecting a good monitor, choosing a well-recognized and highly-rated device is essential to ensure you collect clinically accurate information about your heart.

Two notable options are the CheckMe BP2 and Oxiline Pressure X Pro, both known for their precision and user-friendly features, making them excellent choices for regular blood pressure monitoring at home.

How does alcohol affect blood pressure?

Alcohol affects blood pressure both physiologically and psychologically. This fact is supported not only by clinical observations from doctors and numerous scientific studies but also by the first hand experiences of many heavy drinkers.

According to Francisco Lopez-Jimenez, M.D., from the Mayo Clinic:

“Drinking too much alcohol can raise blood pressure to unhealthy levels. Having more than three drinks in one sitting temporarily raises blood pressure. Repeated binge drinking can lead to long-term increases in blood pressure.”

This statement highlights both the immediate and cumulative effects of alcohol on blood pressure.

Even if alcohol doesn’t directly impact blood pressure, according to Dr. Jimenez:

“Keep in mind that alcohol contains calories and may cause weight gain. Weight gain is a risk factor for high blood pressure.”

He added:

“Alcohol may interact with certain blood pressure medications. It may affect the level of the medication in the body or increase side effects.”

To provide a clearer understanding of the mechanisms through which alcohol affects blood pressure, please refer to the information below.

• The renin-angiotensin-aldosterone system (RAAS): Alcohol consumption impacts this kidney-regulated system, which plays a crucial role in blood pressure regulation. Alcohol increases renin levels, leading to blood vessel constriction and reduced urine output. This results in higher fluid levels in the body, contributing to increased blood pressure.
• Vasopressin levels: Alcohol reduces the production of vasopressin, an antidiuretic hormone. This reduction can lead to dehydration due to its diuretic effect.
• Cortisol levels: Alcohol intake can elevate cortisol levels, a stress hormone that affects the body’s fluid excretion through urine. Higher cortisol levels result in reduced fluid excretion, contributing to increased blood pressure.
• Baroreceptor sensitivity: Alcohol decreases the sensitivity of baroreceptors, which are responsible for regulating blood pressure. This reduction impairs the body’s ability to adjust blood vessel stretching in response to blood pressure changes, leading to increased pressure.
• Blood calcium levels: Alcohol consumption increases the amount of calcium binding to blood vessels, making them more sensitive to compounds that constrict them, consequently raising blood pressure.

While the mechanism is well understood, one question remains: how much do you need to consume before your blood pressure increases? Is there a safe limit to which you can restrict your consumption?

More on this topic will be discussed in the following section.

How much does alcohol raise blood pressure?

It is clear that alcohol consumption can lead to elevated blood pressure, but the question remains: how much alcohol will increase your blood pressure?

Several studies have suggested that consuming more than three drinks in a single session can result in a temporary increase in blood pressure. This is a cause for concern, especially for people with elevated or existing hypertension.

Again, the study conducted in 2023 by Dr. Silvia Di Federico indicated that daily alcohol intake exceeding 30 grams can lead to an increase in both systolic and diastolic blood pressure.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) categorizes alcohol consumption into three categories, and the type of consumption can indeed have an impact on blood pressure.

• Binge drinking: This is characterized by the consumption of four or more drinks within two hours for women and five or more drinks within two hours for men. Such levels of alcohol intake can be particularly detrimental.
• Moderate drinking: This entails consuming up to one drink per day for women and up to two drinks per day for men.
• Heavy alcohol use: Defined as consuming more than three drinks a day for women and more than four drinks a day for men, heavy alcohol use can have severe and lasting effects on blood pressure.

An early definitive study published by Klatsky AL and colleagues in the New England Journal of Medicine revealed that individuals consuming 6 to 8 drinks per day had systolic blood pressure higher by 9.1 mmHg and diastolic pressure higher by 5.6 mmHg compared to nondrinkers.

According to the safe limits prescribed by the American Heart Association (AHA), it is advisable to restrict alcohol intake to no more than two drinks per day for men and one drink per day for women.

A standard drink is typically equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Exceeding this safe limit can gradually raise blood pressure, as the aforementioned studies indicate.

Additionally, the pattern of consumption is a crucial factor, as alcohol must be given sufficient time to be eliminated from the body.

With that said, it’s essential to be aware of both the short-term and long-term effects of alcohol on blood pressure, which will be discussed in the upcoming sections.

What are the short-term effects of alcohol on blood pressure?

The short-term effects of alcohol on blood pressure involve a complex interplay of physiological reactions.

According to a 2020 Cochrane publication by a team of researchers from the University of British Columbia, alcohol initially decreases blood pressure and subsequently increases it.

The study also noted that alcohol consistently elevates heart rate within 24 hours of consumption.

Alcohol affects receptors in the blood, especially those near the heart, which play a crucial role in maintaining healthy blood pressure levels.

When alcohol is present in the bloodstream, these receptors do not function correctly, contributing to an initial drop in blood pressure followed by a subsequent increase.

Furthermore, alcohol disrupts the body’s hormonal balance, particularly with cortisol, a stress hormone. Cortisol is released during physical or psychological stress to prepare the body to respond to perceived threats.

Alcohol consumption can trigger an increased release of cortisol, leading to higher blood pressure and a faster heartbeat over time.

These effects of alcohol on blood pressure and heart rate can be significant and enduring.

Although there is an initial decrease, the subsequent increase in blood pressure and heart rate can persist for up to 13 hours after drinking, with the effects on heart rate potentially extending up to 24 hours.

The short-term effects of alcohol on blood pressure are summarized below.

• Temporary blood pressure elevation: Consuming alcohol can result in a short-term increase in blood pressure among individuals without underlying health issues, with levels typically returning to normal once the alcohol is metabolized.
• Dehydrating effect: Alcohol, acting as a diuretic, promotes increased urination, potentially leading to dehydration, which has the potential to impact blood pressure.
• Stimulatory impact: Alcohol has the capacity to trigger the secretion of cortisol and adrenaline, both of which contribute to heightened blood pressure.
• Sodium retention: Dehydration resulting from excessive alcohol intake can impair kidney function, potentially causing the body to retain more sodium, ultimately raising blood pressure.
• Medication interactions: Alcohol can disrupt the effectiveness of blood pressure medications and worsen their side effects, potentially resulting in elevated blood pressure.

What are the long-term effects of alcohol on blood pressure?

The long-term effects of alcohol on blood pressure are relatively straightforward, primarily leading to hypertension. However, its subsequent impact down the line can be much worse.

According to an editorial on Johns Hopkins Medicine, one of the major long-term consequences of alcohol is an elevated risk of hypertension, which can ultimately lead to stroke, heart attack, or kidney damage.

Additionally, a study by Mariann R. Piano, Ph.D., published in Alcohol Research, observed that heightened blood pressure in chronic drinkers is one of the early warning signs of impending cardiovascular disease.

Murray Epstein, M.D., in his 1997 publication ‘Alcohol’s Impact on Kidney Function,’ clearly highlights how decreased urine and sodium excretion have a detrimental impact on the kidneys, further worsened by portal hypertension.

The implications of this sustained increase in blood pressure are extensive.

• Chronic hypertension: Regular heavy alcohol consumption can lead to persistent high blood pressure, resulting in chronic hypertension. This condition increases the risks of cardiovascular diseases and other associated health issues.
• Heart disease: Long-term heavy drinking-induced hypertension can result in various heart-related problems, such as heart attacks or cardiac myopathies. These conditions, in turn, can further exacerbate blood pressure issues.
• Stroke: Chronic hypertension resulting from prolonged alcohol abuse significantly heightens the risk of stroke, as high blood pressure is a major contributing factor to this medical emergency.
• Kidney damage: High blood pressure resulting from long-term heavy drinking can adversely affect the kidneys, impairing their ability to regulate fluids and electrolytes. This damage can lead to further blood pressure escalations.
• Alcohol dependence: Over time, consistent heavy drinking may lead to alcohol dependence. The withdrawal process from alcohol often involves spikes in blood pressure.
• Increased body weight and obesity: Alcoholic beverages, due to their high-calorie content, can promote weight gain. In the long run, this weight gain can result in obesity, a recognized risk factor for elevated blood pressure.
• Liver-related conditions: Persistent alcohol consumption may lead to liver disease, which can disrupt the hormonal system responsible for blood pressure regulation. This disruption can have a notable influence on blood pressure levels.

What factors influence the effect of alcohol on blood pressure?

Alcohol’s impact on blood pressure is influenced by several factors, including how it is metabolized in your body, your pattern of drinking, genetic factors, lifestyle, and diet.

Therefore, it is safe to say that the effect of alcohol on your blood pressure is highly individualized due to these various determining factors. Below are four major factors that influence alcohol’s effect on blood pressure.

Alcohol metabolism

Alcohol metabolism impacts blood pressure through several mechanisms. When alcohol is consumed, it’s metabolized by enzymes in the liver, producing byproducts that can affect blood vessels and heart function.

One such byproduct, acetaldehyde, can cause blood vessels to constrict, leading to higher blood pressure. The rate at which our bodies metabolize alcohol varies among individuals.

Females generally metabolize alcohol more slowly than males, potentially amplifying its effects on blood pressure. According to a 2014 publication titled “Alcohol-induced hypertension: Mechanism and prevention,” there are six metabolic pathways through which alcohol can impact blood pressure.

Your central nervous system, stress hormones, calcium metabolism, etc., are some ways this regulation happens.

Drinking patterns

The pattern of alcohol consumption significantly influences blood pressure response. Periodic binge drinking leads to sharp, temporary spikes in blood pressure.

Regular, moderate drinking causes a consistent, though lesser, elevation in blood pressure compared to binge drinking.

A 2020 study published in the Journal of Clinical Hypertension by Ryuichi Yoshimura, MD, and colleagues clearly highlights that people who consume alcohol more frequently may have an increased sensitivity to salt, which can impact their blood pressure.

The same study by Ryuichi Yoshimura, MD, also reported that individuals who drank alcohol daily exhibited a stronger association between changes in salt intake and blood pressure compared to rare or occasional drinkers.

Genetics

Genetic makeup plays a crucial role in how alcohol affects blood pressure. The interaction between genetics and alcohol’s impact on blood pressure is complex and not fully understood.

Individual genetic differences can explain varying blood pressure responses to similar alcohol consumption levels.

In a multi-author study published in PLoS One, it was found that people of African ancestry had a set of 18 genomic regions that affect blood pressure variation due to alcohol consumption.

These demographic variations in genetics could explain why certain races of people are more prone to alcohol-induced blood pressure variations and also underline the fact that it affects different groups of people differently.

Diet and lifestyle

Consuming a balanced diet rich in fruits, vegetables, whole grains, and lean proteins, and low in salt and saturated fats, can help mitigate some negative cardiovascular effects of alcohol.

Additionally, maintaining a healthy weight, engaging in regular physical activity, and avoiding smoking can also influence how the body responds to alcohol.

A 2018 Lancet study from China published by Dr. Tianshu Han et al. found that a high-quality diet and light alcohol consumption were associated with a decreased risk of hypertension in Caucasians.

However, with a low-quality diet, the risk of hypertension increased with alcohol consumption in Caucasians, Chinese, and Hispanics.

This study demonstrates that overall diet quality significantly influences the association between alcohol consumption and hypertension risk.

The above are four of the critical factors that come into play when blood pressure is influenced by alcohol consumption.

But what to do if you want to consume alcohol and you are already a hypertensive patient? Read further.

How should alcohol be consumed with high blood pressure?

According to the Mayo Clinic, if you have high blood pressure, it is advisable to avoid alcohol or drink only in moderation. Moderate typically means up to one drink a day for women and up to two drinks a day for men.

For healthy adults, this is defined as one drink a day for women and up to two drinks a day for men.

Regularly drinking alcohol can raise your blood pressure and may interfere with the effectiveness of blood pressure medications.

It’s also important to remember that alcohol contains calories, which can contribute to weight gain, a risk factor for high blood pressure.

In some cases, even moderate alcohol consumption might not be advisable. Therefore, the most crucial thing is to be in touch with your doctor and be open about this need of yours. Based on your cardiovascular health, they can suggest an optimal quantity of alcohol.

Maintaining a healthy lifestyle through diet, exercise, and stress management can help manage blood pressure effectively.

The AHA also advises that if you have been diagnosed with high blood pressure, you should limit your alcohol consumption.

They, too, recommend no more than two drinks per day for men and one drink per day for women. This guideline helps manage blood pressure effectively and reduces the risk of hypertension-related complications.

The AHA also clarifies that while there are some perceptions about red wine being heart-healthy, it should still be consumed in moderation as part of a healthy lifestyle.

What are the best and worst alcoholic beverages for high blood pressure?

When it comes to alcohol and high blood pressure, some types of alcohol are considered better choices than others, while excessive or certain types of alcohol can be worse for managing high blood pressure.

Below is a quick reference for you.

Best choices

• Red wine (in moderation): Some studies suggest that red wine, in moderation, may have certain cardiovascular benefits due to its antioxidant content, particularly resveratrol. It may have a slightly less detrimental effect on blood pressure compared to other alcoholic beverages.

Moderate choices

• Beer (in moderation): When consumed in moderation, light or moderate beer consumption may not significantly impact blood pressure in healthy individuals.
• Clear spirits (in moderation): Drinks like vodka, gin, or tequila, when consumed in moderation and without sugary mixers, can have a lesser impact on blood pressure compared to drinks with high sugar content.

Worst choices

• Excessive alcohol: Excessive alcohol consumption, regardless of the type, can raise blood pressure and increase the risk of hypertension. Heavy drinking is generally defined as more than three to four drinks in a single day or more than seven drinks per week for women and more than four drinks in a single day or more than 14 drinks per week for men.
• High-sugar alcoholic beverages: Cocktails and mixed drinks with high sugar content can contribute to weight gain and raise blood pressure. Sugary mixers, such as fruit juices and soda, can add empty calories and increase the overall negative impact on cardiovascular health.
• Salty alcoholic beverages: Some mixed drinks and cocktails may contain high levels of salt, which can contribute to elevated blood pressure. For example, margaritas often have added salt on the rim, which should be avoided if you have hypertension.

While this is a general consensus, wine has been consumed heavily throughout the world and has religious significance. Does it have anything to do with your blood pressure? The next section will speak about it.

Can wine be harmful to blood pressure?

The connection between wine intake and blood pressure is intricate and lacks a straightforward conclusion.

As per James Beckerman, MD, a cardiologist based at the Providence St. Vincent Heart Clinic in Portland, OR, there is no definitive proof indicating that wine, specifically red wine, directly reduces blood pressure.

“Our findings do not support [the idea] that potential cardiovascular benefits of red wine consumption result from blood pressure lowering by polyphenols,” says researcher Ilse Botden, MD, a Ph.D. student at Erasmus Medical Center in Rotterdam, Netherlands.

Further supporting this view, another expert, A. L. Klatsky who, in his 1977 publication in the New England Journal of Medicine, points out that a single glass of red wine won’t significantly impact blood pressure.

Instead, he emphasizes the importance of broader lifestyle changes like reducing salt intake, maintaining optimal weight, engaging in regular exercise, and, if needed, taking medication.

For those concerned about giving up wine due to high blood pressure, non-alcoholic wine might offer a compromise.

One study published in the AHA journal Circulation found that consuming three glasses of non-alcoholic red wine daily for a month significantly reduced blood pressure among men with heart disease risk factors.

Interestingly, this benefit was not observed in those who drank alcoholic red wine or gin. This suggests that alcohol might counteract the potential blood pressure-lowering effects of antioxidants in wine.

Wine may or may not help your blood pressure, depending on the type of it. But more detrimental is mixing your blood pressure medications with alcoholic drinks. The next section will help you understand how bad this could be.

What are the dangers of mixing alcohol with blood pressure medications?

Mixing alcohol with blood pressure medications can pose significant risks due to potential drug interactions and exacerbated side effects.

Cardiovascular medications, including those for high blood pressure, heart attack, and arrhythmias, often have the highest likelihood of interacting with alcohol.

An NIH study led by Dr. Breslow found that heart medications had the highest percentage of potential alcohol interactions. Specifically, alcohol and blood pressure medication interactions comprised a significant portion of these risks.

Alcohol can cause vasodilation, which may lower blood pressure in some patients.

When combined with blood pressure medication, this effect can intensify, leading to dizziness, lightheadedness, drowsiness, fainting, or even dangerous falls.

This is especially concerning for medications like vasodilators and alpha-blockers, which can cause orthostatic hypotension – a condition where blood pressure drops significantly upon standing.

This risk is more pronounced at the beginning of treatment and poses a serious threat, particularly to older patients.

Furthermore, liver enzyme interactions with heart medications can alter drug levels in the bloodstream. Liver enzymes typically break down medicines for excretion.

However, in patients with liver disease from excessive alcohol use, the breakdown of heart drugs can be affected, leading to higher medication levels and increased side effects.

Below are some common blood pressure medications and their interactions with alcohol, as reported by Leigh Ann Anderson, PharmD, on drugs.com.

• Alpha-blockers: Used for high blood pressure, alpha-blockers can interact significantly with alcohol, leading to excessive hypotension and sedation. Drugs like clonidine and doxazosin, when mixed with alcohol, can cause extremely low blood pressure and an increased risk of falls.
• Nitroglycerin and Isosorbide: These vasodilators and antianginal agents, when used with alcohol, can result in sedation and hypotension.
• Beta-blockers: Beta-blockers, such as atenolol or metoprolol, may enhance the blood pressure-lowering effect when combined with alcohol, leading to headache, dizziness, lightheadedness, fainting, and changes in pulse or heart rate.
• Diuretics: Combining diuretics like hydrochlorothiazide or furosemide with alcohol can add to the blood pressure-lowering effects, potentially causing headaches, dizziness, lightheadedness, fainting, and changes in pulse or heart rate.

If alcohol can pose such a threat to medications, will quitting alcohol have any impact on your blood pressure? Read more about it in the section below.

Will quitting alcohol lower blood pressure?

Yes, quitting alcohol can lower blood pressure. Alcohol consumption is linked to an increase in blood pressure, and reducing alcohol intake can have a beneficial effect on blood pressure levels.

This is particularly significant for heavy drinkers. If you have been consuming alcohol heavily and decide to cut down on your intake, you may observe a noticeable reduction in both systolic and diastolic blood pressure.

This decrease could potentially contribute to a reduced risk of developing heart disease and stroke, especially if you have hypertension or are at risk of cardiovascular diseases.

This was demonstrated in a 2006 study published by Dr. Giorgio Soardo in the Journal of Hypertension, focusing on individuals with high blood pressure who were also heavy drinkers.

The study involved 14 hypertensive individuals who were heavy alcohol consumers. These participants underwent a hospital withdrawal program, and their blood pressure was monitored for 30 days.

The results showed a significant decrease in blood pressure just three days after stopping alcohol consumption.

By the end of the study, most participants had seen their blood pressure return to normal levels.

The study also noted improvements in certain hormonal parameters and markers related to blood vessel health following alcohol cessation.

As for how long it takes to see a drop in blood pressure after quitting alcohol, this study suggests that significant changes can start as early as three days, with more substantial improvements within 30 days.

If quitting seems like a logical approach, then below are some more tips you can follow to lower your blood pressure.

How can blood pressure be lowered besides limiting alcohol?

Lowering blood pressure is a critical health goal for many because a significant amount of damage might have already been inflicted by the time medications start.

Medical logic always stresses prevention, followed by a natural approach to fixing issues and then moving to treatment using medical techniques to cure them.

There are several ways to lower blood pressure; lifestyle changes and diet are often the first line of defense in managing and reducing high blood pressure.

This approach is especially beneficial as it addresses the root causes of high blood pressure and promotes overall health without the potential side effects of medication.

Below are practices adopted from a 2013 publication in the AHA journal Circulation titled “2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk” by Prof. Robert H. Eckel and colleagues from the American College of Cardiology/American Heart Association Task Force.  

How do you use a blood pressure monitor?

A blood pressure monitor could be an all-you-need tool to manage your blood pressure. With a boom in silicon technology, modern-day monitors are very accurate and provide you with clinically valid data.

Hang said that there are two factors you need to make sure to achieve an accurate result. One is a proper device, and the second is the way you use that device.

The upcoming section will help you choose a better device, while the below tips will help you use a blood pressure monitor correctly.

• Choose the correct monitor: Opt for an automatic, cuff-style monitor designed for the upper arm. Avoid wrist and finger monitors as they tend to be less reliable.
• Prepare for the measurement: Refrain from consuming caffeine, engaging in physical activity, or smoking for at least 30 minutes prior to taking the reading. Sit quietly for five minutes before commencing.
• Ensure proper positioning: Sit in a posture with your back supported and your feet flat on the floor. Rest your arm on a table so that it is at heart level. Ensure that the cuff fits snugly but is not overly tight.
• Take multiple readings: Take two or three readings, with at least one minute in between each, and record all the results for consistency.
• Monitor regularly: Check your blood pressure at consistent times throughout the day, as it can vary.
• Document your readings: Maintain a record of your readings, including the date and time, to share with your healthcare provider.

Which blood pressure monitor is considered the best?

The best blood pressure monitors for home-based applications are Oxiline Pressure X Pro and Check Me BP2. Both of these are top-of-the-line products with a vast user base and thousands of reviews.

While a mercury-based sphygmomanometer is often considered the most accurate, the learning curve and clinical knowledge required might be the biggest obstacles.

On the other hand, Oxiline and CheckMe devices have electronic sensors that will handle the analysis for you.

Your only task is to position them correctly on your arm and take the reading following the guidelines explained above.

Below is a side-by-side comparison of Oxiline’s top model, Pressure X Pro, and CheckMe’s best option, BP2.

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