Abstract
A chronic alcoholic is a person who is severely addicted to and dependent on alcohol. They will often have no job, no contact with family or friends, are not in control of their drinking, and may suffer from cognitive impairment because of their alcoholism. The health problem for which alcohol is responsible is only part of total social damage which includes family disorganization, crime and loss of productivity.4Hypertension is an established risk factor in chronic alcoholics, but little is known about the relationship between blood pressure (BP), severity of their alcohol abuse, and severity of alcohol withdrawal syndrome (AWS). Considering all such pictures this study is mainly meant to study the clinical picture, treatment and outcomes of hypertension in chronic alcoholics.8
Aim: To study Hypertension in Chronic Alcoholics in the IPD & OPD patients in our hospital. To see if there is any specific alcohol induced hypertensive cases with no influence from other risk factors except smoking and dyslipidemia. To ascertain specific line of treatment for hypertension in chronic alcoholics.
Method: Patients admitted in our hospital with diagnosed Hypertension will be enrolled.
Patients will be clinically evaluated based on: Demographic variations, Symptoms at the time of presentation, Clinical findings at the time of presentation and entire hospital stay, Lab investigations, Complications associated if any, Treatment given and, Response to the treatment. Patients will also be divided into various subgroups based on different classes of oral Antihypertensive drugs that they are going to receive.
Result: 100 alcoholic populations were examined on OPD and IPD basis and it was found that about 47% of total alcoholic have developed systemic hypertension. The age wise prevalence of systemic hypertension in alcoholic population is more in age group 51 to 60 years. All hypertensive patients were divided in 5 groups and started with 5 different groups of oral antihypertensive drugs namely CCB, ARB, ACE inhibitors, beta adrenergic blocker and Diuretics. Centrally acting antihypertensive drugs were not prescribed. Patients were followed up over 6 weeks duration, out of 5 groups of antihypertensive drugs, Beta adrenergic blockers, ACE inhibitors and ARB showed good results in controlling blood pressure since first week itself and required less modification in regimen.
Keywords: Chronic alcoholic, prevalence of hypertension, oral antihypertensive drugs, smoking and dyslipidemia.
References
- World Health Organization, Cardio-vascular diseases, http://www.who.int/mediacentre/factsheets/fs317/en/index.html.Accessed 10 Aug 2011.
- Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith Jr SC, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–52.PubMedCrossRef
- Fruchart JC, Sacks F, Hermans MP, Assmann G, Brown WV, Ceska R, Chapman MJ, Dodson PM, Fioretto P, Ginsberg HN, Kadowaki T, Lablanche JM, Marx N, Plutzky J, Reiner Z, Rosenson RS, Staels B, Stock JK, Sy R, Wanner C, Zambon A, Zimmet P. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol. 2008;102:1K–34.PubMedCrossRef
- Park k “Text book of preventive and social medicine” Nineteenth edition, Banarasidasbhanot publication.
- Gau GT, Wright RS. Pathophysiology, diagnosis, and management of dyslipi-demia. Curr Probl Cardiol. 2006;31:445–86.PubMedCrossRef
- Chase V, Neild R, Sadler CW, Batey RG. The medical complications of alcohol use: understanding mechanisms to improve management. Drug Alcohol Rev. 2005;24:253–65.PubMedCrossRef
- Aden McCormick. Hepatic Cirrhosis. In: James Dooley, Anna Lok, Andrew Burroughs, Jenny Heathcote editors. Sherlock’s Diseases of Liver and Biliary system. Chapter 7,12th edition, Wiley Blackwell Publishers; 2011.P.103-107.
- Textbook “Harrison’s principles of Internal Medicine”
- Lian C: L’alcolisme caused’ hypertension-arterielle. Bull Acadamie Natl Med 1915, 74:525–528.
- Mcfadden CB, Brensinger CM, Berlin JA, Townsend RR: Systematic review of the effect of daily alcohol intake on blood pressure. Am J Hypertens 2005, 18:276–286.
- Taylor B, Irving HM, Baliunas D, et al. Alcohol and hypertension: gender differences in dose–response relationships determined through systematic review and meta-analysis. Addiction. 2009;104 (12):1981-1990.
- Lieber CS. Hepatic and other medical disorders of alcoholism: from pathogenesis to treatment. J Stud Alcohol. 1998;59:9–25. [PubMed]
- Lian C. L'alcoholisme, caused hypertension arterielle. Bulletin de l' Academie de Medicine. 1915;74:525–528.
- Skliros EA, Papadodima SA, Sotiropoulos A, Xipnitos C, Kollias A, Spiliopoulou CA. Relationship between alcohol consumption and control of hypertension among elderly Greeks. The Nemea primary care study. Hellenic J Cardiol. 2012;53:26–32. [PubMed]
- Kaplan NM. Alcohol and hypertension. Lancet. 1995;345:1588–1589. [PubMed]
- Gordon T, Kannel WB. Drinking and its relation to smoking, BP, blood lipids, and uric acid.The Framingham study. Arch Intern Med. 1983;143:1366–1374. [PubMed]
- Mac Mahon S. Alcohol consumption hypertension, Hypertension. 1987;9 :111–121. [PubMed]
- Burke V, Beilin LJ, German R, Grosskopf S, Ritchie J, Puddey IB, Rogers P. Association of lifestyle and personality characteristics with blood pressure and hypertension: a cross-sectional study in the elderly.JClinEpidemiol. 1992; 45 : 1061–1070 [PubMed]
- MacMahon SW, Norton RN. Alcohol and hypertension: implications for prevention and treatment. Ann Intern Med. 1986;105: 124–126. [PubMed]
- J Korean SocHypertens 2011;17(2):65-73)
- Mac Mahon S. Alcohol consumption and Hypertension. 1987;9:111-21.
- Witteman JC, Willett WC, Stampfer MJ, Colditz GA, Kok FJ, Sacks FM, et al. Relation of moderate alcohol consumption and risk of systemic hypertension in women. Am J Cardiol. 1990;65:633-7.
- Criqui MH. Alcohol and hypertension: new insights from population studies. Eur Heart J. 1987;8Suppl B:19-26.
- Wakabayashi I, Araki Y. Influences of gender and age on relationships between alcohol drinking and atherosclerotic risk factors. Alcohol ClinExp Res. 2010;34 Suppl1:S54-60.
- Fortmann SP, Haskell WL, Vranizan K, Brown BW, Farquhar JW. The association of blood pressure and dietary alcohol: differences by age, sex, and estrogen use. Am J Epidemiol. 1983;118:497-507.
- Klatsky AL. Alcohol and hypertension. ClinChimActa. 1996;246:91-105.
- Melville DI. Alcohol and hypertension [Letter]. Lancet 1981;2:1286
- Arkwright PD, Beilin LJ, Rouse IL, Vandongen R. Alcohol, personality and predisposition to essential hypertension. J Hy- pertens 1983; 1:365-371
- Ireland MA, Vandongen R, Davidson L, Beilin LJ, Rouse IL. Acute effects of moderate alcohol consumption on blood pres- sure and plasma catecholamines. ClinSci1984;66:643-J648
- Howes LG, Reid JL. Changes in plasma face 3,4-dihydroxy- phenylethyleneglycol and noradrenaline levels after acute alco-hol administration. ClinSci1985;69:423-^t28
- Arkwright PD, Beilin LJ, Vandongen R, Rouse IA, Lalor C. The pressor effect of moderate alcohol consumption: a search for mechanisms. Circulation 1982;66:515-519
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038773/
- Stokes GS. Hypertension and alcohol: is there a link? J Chronic Dis 1982;35:759-762
- Potter JF, Beevers DG. The possible mechanisms of alcohol associated hypertension. Ann Clin Res 1985;27:97-102
Altura BM, Altura BT. Microvascular and vascular smooth muscle actions of ethanol, acetaldehyde, and acetate. Fed Proc 1982;41: 2447-2451
- Altura BM, Altura BT. Microvascular and vascular smooth muscle actions of ethanol, acetaldehyde, and acetate. Fed Proc
- World Health Organization. Mental health atlas 2005 / Mental Health: Evidence and Research, Department of Mental Health and Substance Abuse, World Health Organization. Geneva : World Health Organization; 2005.
- Sushil K Bansal,Vartika Saxenaet al: The prevalence of hypertension and hypertension risk factors in a rural Indian community: A prospective door-to-door study2012, Journal of cardiovascular disease research (3).2 :117-123.
- Grant BF, Stinson FS, Trends in the prevalence, awareness, treatment and control of hypertension in the adult U.S population data from the health examination survey, 1960 to 1991, Hypertension 26(1) : 60-69.
- STEPHEN MACMAHON on “Alcohol Consumption and Hypertension” Hypertension 9: 111-121, 1987)
- SK.et.al.Time trends in the prevalence of hypertension and associated risk factors in Chandigarh. Journal of Indian medical association.2002 September; 100(9):546
- OkuboY, MiyamotoT, SuwazonoY, KobayashiE,Nogawa K, An association between smoking habits and blood pressure in normotensive Japanese man ,J Hum Hypertens;2002;16(2):9
- Fogari R, Zoppi A, Lusardi P, Marasi G, Villa G, Vanasia A. Cigarette smoking and blood pressure in a worker population: a cross-sectional study.JCardiovasc Risk. 1996 Feb;3(1):55-9
- Tourdjman M, Jacobi D., Petit P, et al: Ten-year incidence of high blood pressure in the general population: influence of clinical parameters, and implication for screening strategies, Archives des Maladies du Coeur et des Vaisseaux, Aug 2007, vol./is. 100/8(615-619), 0003-9683 (Aug 2007).
- Witteman JC, Willett WC, Stampfer MJ, Colditz GA, Kok FJ, Sacks FM, et al. Relation of moderate alcohol consumption and risk of systemic hypertension in women. Am J Cardiol. 1990;65:633-7.
- Criqui MH. Alcohol and hypertension: new insights from population studies. Eur Heart J. 1987;8Suppl B:19-26
- Folkow B. Pathophysiology of hypertension: differences between young and elderly. J Hypertens Suppl. 1993;11: S21-4.
- Furmaga EM, Murphy CM, Carter BL. Isolated systolic hypertension in older patients. Clin Pharm. 1993;12:347- 58.
- Fortmann SP, Haskell WL, Vranizan K, Brown BW,Farquhar JW. The association of blood pressure and dietary alcohol: differences by age, sex, and estrogen use. Am J Epidemiol. 1983;118:497-507.
- Wakabayashi I, Araki Y. Influences of gender and age on relationships between alcohol drinking and atherosclerotic risk factors. Alcohol ClinExp Res. 2010;34 Suppl1:S54-60.
- Wakabayashi I,Kobaba-Wakabayashi R. Effects of age on the relationship between drinking and atherosclerotic risk factors. Gerontology. 2002;48:151-6.
- Gillman MW, Cook NR, Evans DA, Rosner B, Hennekens CH. Relationship of alcohol intake with blood pressure in young adults. Hypertension. 1995;25: 1106-10.
- Mukamal KJ. The Effects of Smoking and Drinking On Cardiovascular Disease and Risk Factors. Health Risks 2006; 29(3): 199-202.
- Ahmed ST and Memon MA. Smoking And Its Relationship With Blood Pressure, Blood Glucose And Blood Parameters In Patients With Coronary Heart Disease. Pak J Physiol 2008; 4(1): 5-7.
Corresponding Author
Dr Ghodke B.
Associate Professor,Department of General Medicine, M
GM Medical College, MGM Institute of Health Sciences
[Deemed University, U/S.3 of UGC Act 1956] Navi Mumbai
DOI: https://dx.doi.org/10.18535/jmscr/v5i10.38
