By Tanner Lambson 

The No. 1 preventable risk factor for cardiovascular disease — as well as kidney disease, and cognitive decline — is high blood pressure. Unfortunately, nearly half of Americans are living with high blood pressure. 

High blood pressure can be caused by a wide variety of lifestyle factors, including obesity, diet, smoking, stress and alcohol consumption. New blood pressure management guidelines recently published by the American Heart Association recommend Americans abstain from drinking alcohol completely to control their blood pressure. 

Delia Endicott, ACNP, a nurse practitioner with the VCU Health Pauley Center, regularly speaks with patients about heart health and safe alcohol-use.  

Delia Endicott, ACNP, of VCU Health Pauley Heart Center. (Tom Kojcsich, Enterprise Marketing and Communications)“We’ll talk about serving size and amount. I really try to help them understand that whether they drink beer, wine or other stilled spirits – it's not the type of alcohol but the overall amount that they drink. It’s best to moderate or even abstain from drinking completely since any alcohol can affect your blood pressure,” she said. 

To ground this recommendation in everyday practice, Endicott breaks down alcohol’s impacts on blood pressure and shares her strategies for approaching blood pressure management with patients. 

How does alcohol affect blood pressure and the heart? 

Drinking alcohol can impact the heart in a variety of ways, in both the short and long term. In the short term, blood pressure increases just after drinking a moderate to large amount of alcohol and will continue to go up for several hours. This occurs because alcohol stimulates the sympathetic nervous system, which is responsible for regulating heart rate and blood pressure. It also alters the balance of certain hormones that regulate blood vessel tone and kidney function, causing the narrowing of blood cells and increased heart rate, adding strain to the cardiovascular system. 

In the long term, regular heavy drinking (more than one drink a day for women and more than two drinks a day for men) or binge drinking (greater than four drinks a day for women and greater than five drinks a day for men) can lead to sustained high blood pressure due to increased stress hormones like cortisol and renin, inflammation and structural changes in blood vessels, electrolyte imbalance and dehydration from alcohol’s diuretic effect and weight gain from excess calories, which further elevates blood pressure.  

As drinking continues, we start to see alcoholic cardiomyopathy, where heavy drinking can weaken and enlarge the heart muscle, reducing its pumping efficiency, and increased risk of heart failure, stroke and sudden cardiac death. 

Binge drinking can also trigger irregular heart rhythms such as atrial fibrillation (AFib), even in healthy individuals. 

What do the new recommendations from the American Heart Association say about high blood pressure and drinking alcohol? 

We’ve known for a long time that alcohol can raise blood pressure, but the new guidance from the American Heart Association is even clearer:  

• The healthiest choice for your blood pressure is no alcohol at all.  
• If you do drink, keep it to no more than one drink a day for women and no more than two for men – and less is always better. 

Research cited in the recommendations strongly indicates that even moderate drinking can nudge your blood pressure up over time. The good news is that your body responds pretty quickly when you cut back. I have seen patients lower their blood pressure within weeks by reducing alcohol to just half of what they were drinking previously. 

The recommendations present this all as part of a “package deal.” When you reduce your alcohol intake alongside maintaining a healthy weight, making heart-healthy food choices, incorporating moderate exercise and managing your stress, your risks of hypertension and cardiovascular disease greatly decrease. 

The American Heart Association guidelines also mention the link between hypertension and cognitive decline. How does alcohol play a role in this connection? 

Chronic high blood pressure damages small cerebral vessels, starving the brain of oxygen and nutrients, which over time erodes memory and executive function. Alcohol compounds this by promoting systemic inflammation and disrupting sleep.  

Heavy or binge drinking can trigger repeated short-lived blood pressure surges that stress those tiny vessels further. So, limiting alcohol is a key modifiable risk factor for brain health alongside hypertension. 

How have you seen the relationship between alcohol consumption and heart health evolve in recent years? 

These days, I’ve noticed people are much more aware of the relationship between their consumption of alcohol and their health. More and more patients are willing to have a conversation with me. Some especially savvy patients will ask, “How will this interact with my medications?”  

A recent Gallup poll tells us that 53% of US adults realize that moderate drinking is bad for their health. Even medical consensus has shifted— moderate drinking used to be seen as having some health benefits. Now, the recent AHA guidelines emphasize that we shouldn’t drink if we don’t already, and if you do, limiting daily intake to two drinks for men and one drink for women is really the best for your health. 

Are there specific populations who are more vulnerable to alcohol’s effects on blood pressure? 

Absolutely. Older adults metabolize alcohol more slowly, so even modest drinking can produce higher blood alcohol concentrations and greater blood pressure spikes. They’re also more likely to be taking medications — like beta-blockers or diuretics — that interact with alcohol and magnify its effects.  

Patients with existing hypertension or diabetes bear a double hit: alcohol worsens metabolic control and amplifies vascular stiffness, driving blood pressure up further.  

Pregnant women are also uniquely vulnerable: alcohol can exacerbate preeclampsia risk and compromise both maternal blood pressure control and fetal health. 

Beyond alcohol, what other lifestyle changes can help manage high blood pressure? 

I always stress to my patients a multi-pronged approach to manage hypertension, which includes: 

• Maintaining a healthy weight through portion control and regular movement. 
• Eating a heart-healthy diet rich in fruits, vegetables and lean proteins. 
• Cutting back on sodium while boosting potassium naturally. 
• Committing to at least 150 minutes of moderate activity each week. 
• Finding daily stress-management techniques — whether meditation, walking meetings, or hobby time.  
• Prioritizing sleep.  

Each of these are tools in a toolbox: no single change does it all, but together they can ease hypertension. 

If I want to start taking better care of my heart – what’s the first step? 

Talk to your health care provider at your next appointment.  We have a great team here at the VCU Health Pauley Heart Center that emphasizes preventative cardiovascular health and are happy to talk with patients about diet, exercise, weight loss, alcohol intake and management of blood pressure and cholesterol. 

When thinking about changing your alcohol consumption, if you think your intake may be excessive, it is important to look at patterns of drinking to develop a plan to safely reduce alcohol intake. Most providers are comfortable having this discussion and I always appreciate that my patients are invested in their health. 

With the full spectrum of cardiovascular expertise within reach, our specialists offer hope to people with heart disease. Discover more about VCU Health Pauley Heart Center’s services and programs.

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