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Original Investigation
June 8, 1998

Prevention and Treatment of Hypertension Study (PATHS): Effects of an Alcohol Treatment Program on Blood Pressure

Author Affiliations

From the Veterans Affairs Medical Center, Memphis, Tenn (Dr Cushman and Ms Walsh); National Heart, Lung, and Blood Institute, Bethesda, Md (Drs Cutler, Follmann, and Allender); National Institute on Alcohol Abuse and Alcoholism, Rockville, Md (Drs Hanna, Harford, and Dufour); Perry Point Veterans Affairs Cooperative Studies Program Coordinating Center, Perry Point, Md (Drs Bingham and Collins and Ms Kirk); Veterans Affairs Medical Center, Jackson, Miss (Dr Dubbert); Veterans Affairs Medical Center, West Haven, Conn (Dr Burg); Veterans Affairs Medical Center, Phoenix, Ariz (Dr Felicetta); Veterans Affairs Medical Center, Baltimore, Md (Dr Hamilton); Veterans Affairs Medical Center, New York, NY (Dr Katz); Veterans Affairs Medical Center, St Louis, Mo (Dr Perry); Veterans Affairs Medical Center, Minneapolis, Minn (Dr Willenbring); Central Lipids Laboratory, Veterans Affairs Medical Center, Washington, DC (Dr Lakshman); and Central Renal Laboratory, Veterans Affairs Medical Center, Boston, Mass (Dr Hamburger).

Arch Intern Med. 1998;158(11):1197-1207. doi:10.1001/archinte.158.11.1197

Objectives  To determine whether blood pressure is reduced for at least 6 months with an intervention to lower alcohol intake in moderate to heavy drinkers with above optimal to slightly elevated diastolic blood pressure, and whether reduction of alcohol intake can be maintained for 2 years.

Design  A randomized controlled trial.

Methods  Six hundred forty-one outpatient veterans with an average intake of 3 or more alcoholic drinks per day in the 6 months before entry into the study and with diastolic blood pressure 80 to 99 mm Hg were randomly assigned to a cognitive-behavioral alcohol reduction intervention program or a control observation group for 15 to 24 months. The goal of the intervention was the lower of 2 or fewer drinks daily or a 50% reduction in intake. A subgroup with hypertension was defined as having a diastolic blood pressure of 90 to 99 mm Hg, or 80 to 99 mm Hg if recently taking medication for hypertension.

Results  Reduction in average weekly self-reported alcohol intake was significantly greater (P<.001) at every assessment from 3 to 24 months in the intervention group vs the control group: levels declined from 432 g/wk at baseline by 202 g/wk in the intervention group and from 445 g/wk by 78 g/wk in the control group in the first 6 months, with similar reductions after 24 months. The intervention group had a 1.2/0.7–mm Hg greater reduction in blood pressure than the control group (for each, P=.17 and P=.18) for the 6-month primary end point; for the hypertensive stratum the difference was 0.9/0.7 mm Hg (for each, P=.58 and P=.44).

Conclusions  The 1.3 drinks per day average difference between changes in self-reported alcohol intake observed in this trial produced only small nonsignificant effects on blood pressure. The results from the Prevention and Treatment of Hypertension Study (PATHS) do not provide strong support for reducing alcohol consumption in nondependent moderate drinkers as a sole method for the prevention or treatment of hypertension.