Race- and sex-specific association between alcohol consumption and hypertension in 22 cohort studies: A systematic review and meta-analysis

Nutr Metab Cardiovasc Dis. 2020 Jul 24;30(8):1249-1259. doi: 10.1016/j.numecd.2020.03.018. Epub 2020 Mar 27.


Background and aims: The alcohol-hypertension relation has been well documented, but whether women have protective effect or race and type of beverage consumed affect the association remain unclear. To quantify the relation between total or beverage-specific alcohol consumption and incident hypertension by considering the effect of sex and race.

Methods and results: Articles were identified in PubMed and Embase databases with no restriction on publication date. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated by random effects models. Restricted cubic splines were used to model the dose-response association. This study involved 22 articles (31 studies) and included 414,477 participants. The hypertension risk was different among liquor, wine, and beer at 5.1-10 g/d of ethanol consumption (P-across subgroups = 0.002). The hypertension risk differed between men (RR: 1.14, 95% CI: 1.07, 1.20) and women (RR: 0.98, 95% CI: 0.89, 1.06) at 10 g/d (P-across subgroups = 0.005). We found a linear alcohol-hypertension association among white (P-linearity = 0.017), black people (P-linearity = 0.035), and Asians (P-linearity<0.001). With 10 g/d increment of consumption, the RRs for hypertension were 1.06 (95% CI: 1.04, 1.08), 1.14 (95% CI: 1.01, 1.28), and 1.06 (95% CI: 1.01, 1.10) for Asians, black, and white people, respectively.

Conclusion: Sex modifies the alcohol-hypertension association at low level of alcohol consumption and we did not find evidence of a protective effect of alcohol consumption among women. Black people may have higher hypertension risk than Asians and white people at the same ethanol consumption.

Keywords: Alcohol; Dose–response; Gender; Hypertension; Meta-analysis; Race.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Alcohol Drinking / adverse effects*
  • Alcohol Drinking / ethnology*
  • Alcoholic Beverages / adverse effects*
  • Asian People*
  • Beer / adverse effects
  • Black People*
  • Blood Pressure*
  • Dose-Response Relationship, Drug
  • Ethanol / adverse effects
  • Female
  • Humans
  • Hypertension / diagnosis
  • Hypertension / ethnology*
  • Hypertension / physiopathology
  • Incidence
  • Male
  • Race Factors
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • White People*
  • Wine / adverse effects


  • Ethanol