Alcohol Intake, Circadian Blood Pressure Variation, and Stroke
2008; Lippincott Williams & Wilkins; Volume: 53; Issue: 1 Linguagem: Inglês
10.1161/hypertensionaha.108.123018
ISSN1524-4563
AutoresTakayoshi Ohkubo, Hirohito Metoki, Yutaka Imai,
Tópico(s)Heart Rate Variability and Autonomic Control
ResumoHomeHypertensionVol. 53, No. 1Alcohol Intake, Circadian Blood Pressure Variation, and Stroke Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBAlcohol Intake, Circadian Blood Pressure Variation, and Stroke Takayoshi Ohkubo, Hirohito Metoki and Yutaka Imai Takayoshi OhkuboTakayoshi Ohkubo From the Departments of Planning for Drug Development and Clinical Evaluation (T.O.), Clinical Pharmacology and Therapeutics (T.O., H.M., Y.I.), and Medical Genetics (H.M.), Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan; and the Tohoku University 21st Century Center of Excellence Program "Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation" (T.O., Y.I.), Sendai, Japan. , Hirohito MetokiHirohito Metoki From the Departments of Planning for Drug Development and Clinical Evaluation (T.O.), Clinical Pharmacology and Therapeutics (T.O., H.M., Y.I.), and Medical Genetics (H.M.), Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan; and the Tohoku University 21st Century Center of Excellence Program "Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation" (T.O., Y.I.), Sendai, Japan. and Yutaka ImaiYutaka Imai From the Departments of Planning for Drug Development and Clinical Evaluation (T.O.), Clinical Pharmacology and Therapeutics (T.O., H.M., Y.I.), and Medical Genetics (H.M.), Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan; and the Tohoku University 21st Century Center of Excellence Program "Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation" (T.O., Y.I.), Sendai, Japan. Originally published24 Nov 2008https://doi.org/10.1161/HYPERTENSIONAHA.108.123018Hypertension. 2009;53:4–5Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: November 24, 2008: Previous Version 1 In this issue of Hypertension, Ohira et al1 reported that habitual alcohol intake was positively associated with higher daytime blood pressure (BP) and a large morning BP surge based on data from 539 middle-aged Japanese men in 3 rural communities (Ikawa in the northeastern area, Noichi in the southwestern area, and Kyowa in the central area) and a southwestern urban suburb, Yao (in Osaka prefecture).As shown in the figure by Ohira et al,1 moderate drinkers (alcohol intake 23 to 46 g/d) and heavy drinkers (alcohol intake ≥46 g/d) had higher BP in the morning and during the daytime compared with nondrinkers, whereas there were no differences in BP during the 24-hour and nighttime periods among the alcohol intake groups. Because heavy alcohol intake increases the risk of stroke, especially hemorrhagic stroke, these results might indicate that a higher risk of hemorrhagic stroke in heavy drinkers is, in part, mediated by the effects of alcohol on circadian BP variation, considering previous reports that elevated morning BP and higher daytime BP levels were most closely associated with the risk of hemorrhagic stroke.2,3Although Ohira et al1 excluded subjects taking antihypertensive medication, drinking habit was a significant determinant of masked "uncontrolled" hypertension diagnosed by morning home BP among treated hypertensive patients.4 Moreover, insufficient duration of action of antihypertensive agents, which is also a risk factor for higher morning BP,5 has been raised as an explanation of higher predictive power for stroke incidence of morning home BP among treated hypertensive patients.6 Thus, it is possible that, in patients treated with antihypertensive drugs with an insufficient duration of action, higher alcohol consumption might be more strongly associated with the circadian variation characterized by an elevated morning BP and higher daytime BP, leading to more pronounced risk of stroke.Ohira et al1 have conducted annual cardiovascular risk surveys in the 4 communities studied since 1963 in the district of Yao City, Ikawa, and Noichi and since 1981 in Kyowa, and they have investigated important cardiovascular risk factors in the Japanese population. They introduced ambulatory BP monitoring into their survey in 1997. The 4 communities were geographically widely distributed from north to south and supposedly have very different environmental- and lifestyle-associated factors, including alcohol intake and dietary habits. In particular, Akita, a northeastern prefecture in which Ikawa is located, is well known to have the highest frequency of stroke, especially hemorrhagic stroke. Akita is also characterized by a higher prevalence of heavy sake drinkers, higher salt intake, and colder temperature in winter than many other prefectures.7 Alcohol intake is known to be associated with dietary and several other lifestyle factors related to BP, such as salt intake and exercise habit. Although Ohira et al1 adjusted for conventional risk factors such as body mass index, age, and smoking, these other potential confounders have not been factored into their analyses, thereby weakening the argument for a specific and independent association of alcohol intake with circadian BP variation. A previous experimental intervention study reported that red wine and beer similarly influenced the daytime BP increase,8 whereas no data are available regarding the effects of the other types of alcoholic beverage, such as sake or whisky, on circadian BP variation. Similarly, Ohira et al1 did not assess the influence of type of alcoholic beverage on circadian BP variation. Furthermore, the authors reported recently that long-term trends in the incidence of coronary heart disease and stroke and their risk factors differed between Ikawa and Yao.9 Although significant heterogeneity among regions was not found in the results of the present study,1 this might merely be attributable to the small number of subjects in each region. Therefore, further studies are needed to clarify the external validity of these findings in other areas and other countries. Moreover, follow-up of cardiovascular events in these subjects, as a single cohort as well as a candidate study for inclusion in the international database on ambulatory BP monitoring, would surely help to explore the possible reasons for inconsistency in the prognostic significance of morning BP surge on cardiovascular events.10The opinions expressed in this editorial are not necessarily those of the editors or of the American Heart Association.Sources of FundingThis work was supported by grants from the Ministry of Health, Labor, and Welfare, Japan; grants for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology, Japan; Grant-in-Aid for Japan Society for the Promotion of Science Fellows; and Japan Atherosclerosis Prevention Fund.DisclosuresNone.FootnotesCorrespondence to Takayoshi Ohkubo, Department of Clinical Pharmacology and Therapeutics, Tohoku University Hospital, Sendai, 980-8574, Japan. E-mail [email protected] References 1 Ohira T, Tanigawa T, Tabata M, Imano H, Kitamura A, Kiyama M, Sato S, Okamura T, Cui R, Kazuko KA, Shimamoto T, Iso H. Effects of habitual alcohol intake on ambulatory blood pressure, heart rate, and its variability among Japanese men. Hypertension. 2009; 53: 13–19.LinkGoogle Scholar2 Metoki H, Ohkubo T, Kikuya M, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension. 2006; 47: 149–154.LinkGoogle Scholar3 Metoki H, Ohkubo T, Kikuya M, Asayama K, Obara T, Hara A, Hirose T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Prognostic significance of night-time, early morning, and daytime blood pressures on the risk of cerebrovascular and cardiovascular mortality: the Ohasama Study. J Hypertens. 2006; 24: 1841–1848.CrossrefMedlineGoogle Scholar4 Obara T, Ohkubo T, Funahashi J, Kikuya M, Asayama K, Metoki H, Oikawa T, Hashimoto J, Totsune K, Imai Y. Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study. J Hypertens. 2005; 23: 1653–1660.CrossrefMedlineGoogle Scholar5 Chonan K, Hashimoto J, Ohkubo T, Tsuji I, Nagai K, Kikuya M, Hozawa A, Matsubara M, Suzuki M, Fujiwara T, Araki T, Satoh H, Hisamichi S, Imai Y. Insufficient duration of action of antihypertensive drugs mediates high blood pressure in the morning in hypertensive population: the Ohasama Study. Clin Exp Hypertens. 2002; 24: 261–275.CrossrefMedlineGoogle Scholar6 Asayama K, Ohkubo T, Kikuya M, Obara T, Metoki H, Inoue R, Hara A, Hirose T, Hoshi H, Hashimoto J, Totsune K, Satoh H, Imai Y. Prediction of stroke by home "morning" versus "evening" blood pressure values: the Ohasama Study. Hypertension. 2006; 48: 737–743.LinkGoogle Scholar7 Takahashi E. Epidemiological studies on hypertension and cerebral haemorrhage in north-east Japan. Tohoku J Exp Med. 1961; 74: 188–210.CrossrefMedlineGoogle Scholar8 Zilkens RR, Burke V, Hodgson JM, Barden A, Beilin LJ, Puddey IB. Red wine and beer elevate blood pressure in normotensive men. Hypertension. 2005; 45: 874–879.LinkGoogle Scholar9 Kitamura A, Sato S, Kiyama M, Imano H, Iso H, Okada T, Ohira T, Tanigawa T, Yamagishi K, Nakamura M, Konishi M, Shimamoto T, Iida M, Komachi Y. Trends in the incidence of coronary heart disease and stroke and their risk factors in Japan, 1964 to 2003: the Akita-Osaka Study. J Am Coll Cardiol. 2008; 52: 71–79.CrossrefMedlineGoogle Scholar10 Ohkubo T, Metoki H, Imai Y. Prognostic significance of morning surge in blood pressure: which definition, which outcome? Blood Press Monit. 2008; 13: 161–162.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Wang Y, Yan N, Wang E and Pu Y (2021) Circadian variations in the occurrence of first‐ever intracerebral hemorrhage from different sources of income: a hospital‐based cross‐sectional study, BMC Neurology, 10.1186/s12883-021-02163-2, 21:1, Online publication date: 1-Dec-2021. Wang S and Liao Y (2020)(2020) How social norms affect alcohol dependence: the mediating role of perceived benefits and alcohol identity, British Food Journal, 10.1108/BFJ-12-2019-0942, 122:12, (3935-3946), Online publication date: 13-May-2020., Online publication date: 13-Oct-2020. Tahir M, Rehman M, Lateef A, Khan R, Khan A, Qamar W, Ali F, O'Hamiza O and Sultana S (2013) Diosmin protects against ethanol-induced hepatic injury via alleviation of inflammation and regulation of TNF-α and NF-κB activation, Alcohol, 10.1016/j.alcohol.2012.12.010, 47:2, (131-139), Online publication date: 1-Mar-2013. Agapito M, Mian N, Boyadjieva N and Sarkar D (2010) Period 2 Gene Deletion Abolishes β-Endorphin Neuronal Response to Ethanol, Alcoholism: Clinical and Experimental Research, 10.1111/j.1530-0277.2010.01246.x, 34:9, (1613-1618), Online publication date: 1-Sep-2010. Manzo-Avalos S and Saavedra-Molina A (2010) Cellular and Mitochondrial Effects of Alcohol Consumption, International Journal of Environmental Research and Public Health, 10.3390/ijerph7124281, 7:12, (4281-4304) Guo R and Ren J (2010) Alcohol and Acetaldehyde in Public Health: From Marvel to Menace, International Journal of Environmental Research and Public Health, 10.3390/ijerph7041285, 7:4, (1285-1301) January 2009Vol 53, Issue 1 Advertisement Article InformationMetrics https://doi.org/10.1161/HYPERTENSIONAHA.108.123018PMID: 19029484 Originally publishedNovember 24, 2008 PDF download Advertisement SubjectsBehavioral/Psychosocial TreatmentCerebrovascular Disease/StrokeEpidemiologyIntracranial HemorrhageIschemic Stroke
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