Aryn Z Phillips1, Catarina I Kiefe2, Cora E Lewis3, Pamela J Schreiner4, Gabriel S Tajeu5, Mercedes R Carnethon6. 1. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA. Aryn.phillips@northwestern.edu. 2. Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA. 3. Department of Epidemiology, University of Alabama at Birmingham School of Public Health, 1665 University Boulevard, Birmingham, AB, 35233, USA. 4. Division of Epidemiology and Community Health, University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN, 55455, USA. 5. Department of Health Services Administration and Policy, Temple University College of Public Health, 1101 W. Montgomery Avenue, Philadelphia, PA, 19122, USA. 6. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
Abstract
BACKGROUND: Alcohol use is associated with increased blood pressure among adults with hypertension, but it is unknown whether some of the observed relationship is explained by mediating behaviors related to alcohol use. OBJECTIVE: We assess the potential indirect role of smoking, physical inactivity, unhealthy diet, and poor medication adherence on the association between alcohol use and blood pressure among Black and White men and women with hypertension. DESIGN: Adjusted repeated-measures analyses using generalized estimating equations and mediation analyses using inverse odds ratio weighting. PARTICIPANTS: 1835 participants with hypertension based on ACC/AHA 2017 guidelines in three most recent follow-up exams of the longitudinal Coronary Artery Risk Development in Young Adults cohort study (2005-2016). MAIN MEASURES: Alcohol use was assessed using both self-reported average ethanol intake (drinks/day) and engagement in heavy episodic drinking (HED) in the past 30 days. Systolic and diastolic blood pressure (SBP, DBP) were measured by trained technicians (mmHg). Smoking, physical inactivity, and diet were self-reported and categorized according to American Heart Association criteria, and medication adherence was assessed using self-reported typical adherence to antihypertensive medications. KEY RESULTS: At baseline (2005-2006), 57.9% of participants were Black and 51.4% were women. Mean age (standard deviation) was 45.5 (3.6) years, mean SBP was 128.7 (15.5) mmHg, and mean DBP was 83.2 (10.1) mmHg. Each additional drink per day was significantly associated with higher SBP (β = 0.713 mmHg, 95% confidence interval (CI): 0.398, 1.028) and DBP (β = 0.398 mmHg, 95% CI: 0.160, 0.555), but there was no evidence of mediation by any of the behaviors. HED was not associated with blood pressure independent of average consumption. CONCLUSIONS: These findings support the direct nature of the association of alcohol use with blood pressure and the utility of advising patients with hypertension to limit consumption in addition to other behavioral and pharmacological interventions.
BACKGROUND: Alcohol use is associated with increased blood pressure among adults with hypertension, but it is unknown whether some of the observed relationship is explained by mediating behaviors related to alcohol use. OBJECTIVE: We assess the potential indirect role of smoking, physical inactivity, unhealthy diet, and poor medication adherence on the association between alcohol use and blood pressure among Black and White men and women with hypertension. DESIGN: Adjusted repeated-measures analyses using generalized estimating equations and mediation analyses using inverse odds ratio weighting. PARTICIPANTS: 1835 participants with hypertension based on ACC/AHA 2017 guidelines in three most recent follow-up exams of the longitudinal Coronary Artery Risk Development in Young Adults cohort study (2005-2016). MAIN MEASURES: Alcohol use was assessed using both self-reported average ethanol intake (drinks/day) and engagement in heavy episodic drinking (HED) in the past 30 days. Systolic and diastolic blood pressure (SBP, DBP) were measured by trained technicians (mmHg). Smoking, physical inactivity, and diet were self-reported and categorized according to American Heart Association criteria, and medication adherence was assessed using self-reported typical adherence to antihypertensive medications. KEY RESULTS: At baseline (2005-2006), 57.9% of participants were Black and 51.4% were women. Mean age (standard deviation) was 45.5 (3.6) years, mean SBP was 128.7 (15.5) mmHg, and mean DBP was 83.2 (10.1) mmHg. Each additional drink per day was significantly associated with higher SBP (β = 0.713 mmHg, 95% confidence interval (CI): 0.398, 1.028) and DBP (β = 0.398 mmHg, 95% CI: 0.160, 0.555), but there was no evidence of mediation by any of the behaviors. HED was not associated with blood pressure independent of average consumption. CONCLUSIONS: These findings support the direct nature of the association of alcohol use with blood pressure and the utility of advising patients with hypertension to limit consumption in addition to other behavioral and pharmacological interventions.
Authors: Quynh C Nguyen; Theresa L Osypuk; Nicole M Schmidt; M Maria Glymour; Eric J Tchetgen Tchetgen Journal: Am J Epidemiol Date: 2015-02-17 Impact factor: 4.897
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Authors: John F Steiner; P Michael Ho; Brenda L Beaty; L Miriam Dickinson; Rebecca Hanratty; Chan Zeng; Heather M Tavel; Edward P Havranek; Arthur J Davidson; David J Magid; Raymond O Estacio Journal: Circ Cardiovasc Qual Outcomes Date: 2009-08-11
Authors: Michael V Holmes; Caroline E Dale; Luisa Zuccolo; Richard J Silverwood; Yiran Guo; Zheng Ye; David Prieto-Merino; Abbas Dehghan; Stella Trompet; Andrew Wong; Alana Cavadino; Dagmar Drogan; Sandosh Padmanabhan; Shanshan Li; Ajay Yesupriya; Maarten Leusink; Johan Sundstrom; Jaroslav A Hubacek; Hynek Pikhart; Daniel I Swerdlow; Andrie G Panayiotou; Svetlana A Borinskaya; Chris Finan; Sonia Shah; Karoline B Kuchenbaecker; Tina Shah; Jorgen Engmann; Lasse Folkersen; Per Eriksson; Fulvio Ricceri; Olle Melander; Carlotta Sacerdote; Dale M Gamble; Sruti Rayaprolu; Owen A Ross; Stela McLachlan; Olga Vikhireva; Ivonne Sluijs; Robert A Scott; Vera Adamkova; Leon Flicker; Frank M van Bockxmeer; Christine Power; Pedro Marques-Vidal; Tom Meade; Michael G Marmot; Jose M Ferro; Sofia Paulos-Pinheiro; Steve E Humphries; Philippa J Talmud; Irene Mateo Leach; Niek Verweij; Allan Linneberg; Tea Skaaby; Pieter A Doevendans; Maarten J Cramer; Pim van der Harst; Olaf H Klungel; Nicole F Dowling; Anna F Dominiczak; Meena Kumari; Andrew N Nicolaides; Cornelia Weikert; Heiner Boeing; Shah Ebrahim; Tom R Gaunt; Jackie F Price; Lars Lannfelt; Anne Peasey; Ruzena Kubinova; Andrzej Pajak; Sofia Malyutina; Mikhail I Voevoda; Abdonas Tamosiunas; Anke H Maitland-van der Zee; Paul E Norman; Graeme J Hankey; Manuela M Bergmann; Albert Hofman; Oscar H Franco; Jackie Cooper; Jutta Palmen; Wilko Spiering; Pim A de Jong; Diana Kuh; Rebecca Hardy; Andre G Uitterlinden; M Arfan Ikram; Ian Ford; Elina Hyppönen; Osvaldo P Almeida; Nicholas J Wareham; Kay-Tee Khaw; Anders Hamsten; Lise Lotte N Husemoen; Anne Tjønneland; Janne S Tolstrup; Eric Rimm; Joline W J Beulens; W M Monique Verschuren; N Charlotte Onland-Moret; Marten H Hofker; S Goya Wannamethee; Peter H Whincup; Richard Morris; Astrid M Vicente; Hugh Watkins; Martin Farrall; J Wouter Jukema; James Meschia; L Adrienne Cupples; Stephen J Sharp; Myriam Fornage; Charles Kooperberg; Andrea Z LaCroix; James Y Dai; Matthew B Lanktree; David S Siscovick; Eric Jorgenson; Bonnie Spring; Josef Coresh; Yun R Li; Sarah G Buxbaum; Pamela J Schreiner; R Curtis Ellison; Michael Y Tsai; Sanjay R Patel; Susan Redline; Andrew D Johnson; Ron C Hoogeveen; Hakon Hakonarson; Jerome I Rotter; Eric Boerwinkle; Paul I W de Bakker; Mika Kivimaki; Folkert W Asselbergs; Naveed Sattar; Debbie A Lawlor; John Whittaker; George Davey Smith; Kenneth Mukamal; Bruce M Psaty; James G Wilson; Leslie A Lange; Ajna Hamidovic; Aroon D Hingorani; Børge G Nordestgaard; Martin Bobak; David A Leon; Claudia Langenberg; Tom M Palmer; Alex P Reiner; Brendan J Keating; Frank Dudbridge; Juan P Casas Journal: BMJ Date: 2014-07-10
Authors: Kara M Whitaker; David R Jacobs; Kiarri N Kershaw; Ryan T Demmer; John N Booth; April P Carson; Cora E Lewis; David C Goff; Donald M Lloyd-Jones; Penny Gordon-Larsen; Catarina I Kiefe Journal: Am J Prev Med Date: 2018-06-18 Impact factor: 6.604