Abstract
BackgroundHazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.MethodsA consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.ResultsScreening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.ConclusionsThe implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.
Highlights
Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide
Methods the various stages in preparation for and the activities performed at the consensus conference on “Screening and intervention for harmful alcohol use as a tool to improve the management of hypertension in primary care” will be outlined
As indicated by the potential threshold, the dose-response relationship is not linear over the full range of alcohol consumption, but for both sexes there is a monotonic dose-response relationship for higher levels of consumption [20, 22, 24], and hazardous/ harmful drinking and Alcohol use disorders (AUDs) are closely associated with elevated blood pressure (BP) and/or hypertension [23, 27, 28]
Summary
Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. The main target [1] comprises a 25% reduction in the risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases To achieve this overall target, a number of individual targets for risk factors have been established, including, but not limited to, at least a 10% reduction in the harmful use of alcohol and a 25% reduction in the prevalence, or limitation of the increase in the prevalence, of raised blood pressure (BP), according to national circumstances. We will show, using data from five European countries, that screening and interventions for both hazardous and harmful use of alcohol (including alcohol use disorders (AUDs)) and for hypertension in primary healthcare can lead to public health-relevant reductions of NCDs in Europe, albeit at higher costs than best buys (see point on economic considerations below), as these are individual-level interventions. This paper will list recommendations from a consensus conference on what should be performed to achieve these reductions
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