Excessive alcohol use is known to adversely impact cardiovascular health by increasing blood pressure, damaging the heart muscle, causing arrhythmias, and increasing cholesterol and visceral fat, which can lead to a host of ailments including heart disease, cancer, and type 2 diabetes.

Primary care physicians are the first lines of defense when it comes to reducing risky alcohol use in patients before the problem leads to permanent heart damage. A new study published in Alcohol, Clinical and Experimental Research found that blood pressure and heart rate were higher in patients who drank excessively.

These tests could provide primary care physicians with low-cost tools, including blood pressure, heart rate, weight, and cholesterol readings, to detect problematic drinking in patients at an early stage.

Increased Blood Pressure in Patients With Excessive Drinking Habit

According to the National Center for Health Promotion and Disease Prevention, anything above moderate consumption is considered chronic drinking.

A woman should have no more than one drink per day or seven drinks per week, and a man should have no more than two drinks per day or 14 drinks per week. If you’re older than 65 years, you should have no more than one drink per day. And everyone should avoid binge drinking, defined as four or more drinks at a time for a woman and five or more drinks at a time for a man.

“A blood pressure reading is a simple and important first step as alcohol can raise your pressure over time,” said Matthew Montgomery, DO, associate director of the Cardiogenic Shock Program at Newark Beth Israel Medical Center in Newark, New Jersey. 

In the short term, when you drink, alcohol may reduce blood pressure because it calms the nervous system and opens up the arteries. But for those with chronic drinking habit, it does the opposite, increasing blood pressure, and in those who already have high blood pressure, it can worsen it. 

The arteries respond to high blood pressure by stiffening, which decreases the functioning of the vascular system, boosting a patient’s risk for heart attack and stroke. When the arteries become stiff, they no longer dilate, which makes it difficult to pump blood. A study published in Hypertension followed nearly 20,000 participants and found an association between baseline alcohol intake and changes over time to systolic and diastolic blood pressure. 

In patients who already take medication for their high blood pressure but notice that it’s seemingly getting worse, this may be an indication that alcohol is exacerbating symptoms, said William P. Shutze, MD, vascular surgeon at Texas Vascular Associates in Dallas.

“If heightened blood pressure continues to require more and more medication, it suggests that there are underlying issues that aren’t being adequately treated,” Shutze said. “Alcohol is an easy one to target if a person is drinking more than is recommended, rather than something that can’t be changed like genetics.”

Changes to Arterial Pressure and Heart Rate Shown With Acute Alcohol Intake

The study published in Alcohol: Clinical and Experimental Researchfound that individuals with risky drinking habits also had a higher mean arterial pressure (MAP), indicating that their heart was working harder to pump blood than it should be. MAP is calculated by using a mathematical formula that includes both systolic and diastolic blood pressure measurements.

Individuals with chronic drinking habit also experienced changes to heart rate, measured manually by finding a pulse at the wrist or neck or using a heart rate monitor. Simple changes to blood pressure, heart rate, and arterial pressure are all indicators that something is going on in the background and that background noise could very well be excessive alcohol intake, according to experts.

Younger people may experience something called “holiday heart syndrome,” which is binge drinking that can cause the heart to flutter and can even lead to atrial fibrillation in some patients, said Aaron J. Feingold, MD, cardiologist at Hackensack Meridian Health in Edison, New Jersey. 

“I see this in practice quite a bit these days, and it’s especially prevalent in younger patients,” said Feingold. This is a temporary irregular heartbeat that happens in response to drinking too much and is known to be especially prevalent over the holidays when patients binge drink or drink more than usual. Many patients who experience holiday heart once are also more likely to experience it again and again, which can lead to serious complications like clogged arteries. 

Obesity and Cholesterol Testing in Patients With Excessive Drinking Habit

Weight gain, especially visceral fat which accumulates over the organs, can be an indication of excessive alcohol use. It can also cause an increase in blood pressure, as noted above. A study published in Current Obesity Reports found that while light to moderate intake of alcohol was not associated with excess belly fat, excessive drinking was linked to weight gain.

“Alcohol can impact weight gain and cholesterol causing patients to develop atherosclerosis,” said Tochukwu M. Okwuosa, DO, cardiologist and professor of medicine at Rush University in Chicago.

Cholesterol testing can also be a helpful tool in patients who drink too much as it can show an increase in triglycerides; the liver processes alcohol triglycerides, showing an increased number in the bloodstream. It can also cause an increase in HDL cholesterol, or good cholesterol. Still, its positive effect is often outweighed by the negative impacts of alcohol on the body. 

When patients show weight gain, it’s worth understanding what aspects of diet and exercise are causing it. Okwuosa said that all physicians should be asking specific questions about whether patients drink, and if they do, how much and how often. Imaging has its place, Okwuosa said, “but we need to also go back to the days of getting a good social history of patients, which includes alcohol intake.”

Over time if alcohol overuse isn’t addressed, it often leads to alcoholic cardiomyopathy, where the walls of the heart enlarge and don’t pump blood as effectively. Excessive drinking can also lead to heart failure later on by causing the heart tissue to harden, as well as lead to heart rhythm issues. In the long term, none of it is good for the body’s most important organ.

“Alcohol has a directly toxic effect on the heart, leading to significant damage to the heart muscle, causing it to become weak and nonfunctional,” said Shutze.