Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

Citation

Rehm J, Anderson P, Prieto JAA, Armstrong I, Aubin H, Bachmann M, Bastus NB, Brotons C, Burton R, Cardoso M, Colom J, Duprez D, Gmel G, Gual A & Kraus L (2017) Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union. BMC Medicine, 15, Art. No.: 173. https://doi.org/10.1186/s12916-017-0934-1

Abstract
Background Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets. Methods A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded. Results Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries. Conclusions The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

Keywords
Hypertension; Blood pressure; Alcohol use; Primary healthcare; Europe; Screening; Management; Recommendations

Notes
Additional authors: Reinhold Kreutz, Helena Liira, Jakob Manthey, Lars Møller, Ľubomír Okruhlica, Michael Roerecke, Emanuele Scafato, Bernd Schulte, Lidia Segura-Garcia, Kevin David Shield, Cristina Sierra, Konstantin Vyshinskiy, Marcin Wojnar & José Zarco

Journal
BMC Medicine: Volume 15

• Published Version