Differential Effect of Initiating Moderate Red Wine Consumption on 24-h Blood Pressure by Alcohol Dehydrogenase Genotypes: Randomized Trial in Type 2 Diabetes

Abstract

Aims: Observational studies report inconsistent associations between moderate alcohol intake and blood pressure (BP). In a sub-study of a larger randomized controlled trial, we assessed the effect of initiating moderate red wine consumption on 24-h BP recordings and the effect of a common genetic variant of alcohol dehydrogenases (ADH) among patients with type 2 diabetes.

Methods: Fifty-four type 2 diabetes, alcohol abstainers were randomized to consume 150 ml/dinner dry red wine or mineral water. Both groups were guided to adhere to a Mediterranean diet, without caloric restriction. We measured 24-h ambulatory BP monitoring (ABPM) at baseline and after 6 months.

Results: Participants (age = 57 years; 85% men; mean 24-h BP = 129/77 mm Hg) had 92% 6-month retention. After 6 months of intervention, the average 24-h BP did not differ between the wine and water groups. A transient decrease in BP was observed in the red wine group at midnight (3-4 hours after wine intake: systolic BP: red wine = -10.6mm Hg vs. mineral water = +2.3 mm Hg; P = 0.031) and the following morning at 7-9 am (red wine: -6.2mm Hg vs. mineral water: +5.6mm Hg; P = 0.014). In a second post hoc sub-analysis among the red wine consumers, individuals who were homozygous for the gene encoding ADH1B*2 variant (Arg48His; rs1229984, TT, fast ethanol metabolizers), exhibited a reduction in mean 24-h systolic BP (-8.0mm Hg vs. +3.7 mm Hg; P = 0.002) and pulse pressure (-3.8 mm Hg vs. +1.2 mm Hg; P = 0.032) compared to heterozygotes and those homozygous for the ADH1B*1 variant (CC, slow metabolizers).

Conclusions: Initiating moderate red wine consumption at dinner among type 2 diabetes patients does not have a discernable effect on mean 24-h BP. Yet, a modest temporal BP reduction could be documented, and a more pronounced BP-lowering effect is suggested among fast ethanol metabolizers.

Clinical trials registration: ClinicalTrials.gov Identifier: NCT00784433.

Keywords: ambulatory measurement; blood pressure; hypertension; moderate alcohol; pulse pressure; randomized controlled trial; type 2 diabetes..

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Figures

Figure 1.

Baseline average systolic and diastolic ambulatory blood pressure monitoring over 24 hours of the red wine and mineral water groups. Red wine (n = 27), mineral water (n = 27). Black (wine group) and white (water group) points present means of ABPM in each hour.

Figure 2.

The effect of 6-month wine intervention on changes of systolic BP (a), diastolic BP (b) and pulse pressure (c) from baseline; results from 24-h ambulatory blood pressure monitoring. Black (wine group, n = 24) and white (water group, n = 26) points present delta of ABPM in each hour after 6 months.

Figure 3.

The effect of ethanol metabolism genotypes on mean 24-h systolic blood pressure and pulse pressure; changes over 6 months of intervention among the wine group. Slow (black bar; n = 12) and fast (white bar; n = 9) ethanol metabolizers.