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Benefits from moderate drinking extended?

It’s been known for years that too much alcohol ratchets up blood pressure. That’s why the American Heart Association took such a black-and-white approach to drinking and high blood pressure in its 2001 statement on alcohol and heart disease: “Patients who are hypertensive should avoid alcoholic beverages,” says the AHA.

Guidelines from the National Heart, Lung, and Blood Institute on blood pressure measurement and treatment aren’t so rigid. They caution moderation — no more than two drinks a day for men with high blood pressure and no more than one a day for women. Which one is right? An ongoing Harvard-based study gives a cautious green light to lifting the absolute booze ban for people with high blood pressure.

Harvard’s Physicians’ Health Study looked at more than 14,000 participants who had high blood pressure and who answered questions about alcohol on follow-up questionnaires. Compared with nondrinkers, the doctors who had a drink or two a day were 44% less likely to have died of cardiovascular problems like a heart attack or stroke over a five-year period.

The physicians study certainly fits in with more than 60 others that show a connection between moderate drinking and a 20%–45% lower risk of heart disease. A drink or two a day boosts protective HDL cholesterol by 10% or so. By thinning blood, alcohol suppresses the formation of blood clots that can cause heart attacks or strokes. It also seems to enhance the body’s ability to break apart small clots.

But since all of the alcohol studies merely record drinking and heart disease patterns, they can’t prove that moderate drinking causes the heart protection. It’s possible that people who drink in moderation lead all-around healthier lives than teetotalers or heavy drinkers. Maybe they’re slimmer, exercise more, smoke less, or eat healthier. If so, these habits — or other factors not measured in the studies — rather than drinking might account for the heart protection.

The weight of evidence seems to support moderate drinking as neutral or possibly beneficial. But the kind of trial needed to prove cause and effect for alcohol probably won’t ever happen. So the argument over whether moderate drinking protects the heart or harms overall health is likely to go on for a long time. If you have high blood pressure and you’ve grudgingly followed your doctor’s advice to avoid alcohol, this might be a good time to open a new discussion about drinking.

“Our study indicates that there is no compelling reason for people with high blood pressure to avoid alcohol, as long as they don’t drink immoderately,” says Dr. J. Michael Gaziano, a Harvard cardiologist who co-directs the Physicians’ Health Study. “With alcohol, the difference between daily intake of small-to-moderate amounts and large amounts may be the difference between preventing and causing disease.”

Keep in mind that the results of this and other studies on alcohol, nutrition, exercise, and even medication use show the average response. Your personal response will depend on heredity, habits, and general health. If you drink, consider taking a daily multivitamin/multimineral supplement. Alcohol blocks the absorption of folic acid and lowers certain vitamin and mineral levels in the body.

A drink a day won’t help your blood pressure. But as part of an overall healthy lifestyle that includes exercise, good nutrition, and the right medications to keep your blood pressure in check, drinking in moderation could further help protect you from the ultimate results of high blood pressure — a heart attack or stroke. But remember, exercising more and eating healthier do far more for you than quaffing a drink a day.

August 2004 Update

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