What You Need to Know About Alcohol and Blood Pressure Treatment

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Hypertension, or high blood pressure, affects millions of Americans. Many are prescribed medication as part of a treatment plan as an intervention to reduce the risk of cardiovascular conditions.¹ You may be advised to change alcohol use behavior or avoid using alcohol and blood pressure medication together.

What Is Blood Pressure Medicine?

With every beat of your heart, blood enters the arteries. The force at which it enters the arteries is referred to as your blood pressure. If you have high blood pressure, your heart is working harder to pump blood. The longer your heart is required to work harder, the more strain on your heart muscle. This strain can increase your risk of developing heart disease, as well as serious or life-threatening diseases like kidney failure, heart failure, and stroke.²

Blood pressure medicines lower the rate at which blood pumps into the arteries. Each type of medicine works differently to reduce pressure. Below are first-line treatments most often chosen by physicians.³

There are potential side effects even when using blood pressure medicine as prescribed. One of the risks of mixing blood pressure medication and alcohol is increasing the intensity of these effects, especially if alcohol is misused chronically over time.

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Thiazide-Type Diuretics

Diuretics, such as chlorothiazide, are water pills that eliminate excess water and sodium in the body. This process reduces pressure by reducing the amount of fluid flowing through your veins to the heart.

Potential side effects of diuretics include:

Dry mouth
Weak muscles
Confusion

Beta-Blockers

Beta-blocker medicines, such as metoprolol (Lopressor), reduce blood pressure by slowing heart rate. They block adrenaline—or epinephrine—allowing the heart to use less force to supply blood to the arteries.

Potential side effects of beta-blockers include:

Skin rashes
Swollen mucus membranes
Shortness of breath due to constriction in the bronchi

ACE Inhibitors

If you have existing heart or kidney issues, your doctor is most likely to prescribe an ACE inhibitor. ACE stands for angiotensin-converting enzyme. These inhibitors work by preventing the chemical angiotensin, which narrows blood vessels. It takes more force to pump blood through narrow vessels.

By limiting the amount of angiotensin released into the body, blood vessels can relax and open more, pumping blood at a slower rate. Lisinopril (Qbrelis, Zestril, Prinivil) is a common ACE inhibitor.

Potential side effects of ACE inhibitors include:

Dry cough
Impaired sense of taste

Calcium Channel Blockers

If calcium enters the blood vessels, the heart muscle contracts harder to maintain blood flow. Calcium channel blockers, like amlodipine (Norvasc), prevent this calcium buildup.

Potential side effects of calcium channel blockers include:

Facial flushing
Skin rashes
Rapid heart rate
Swelling in the ankles
Tightness in the lower leg

There are many other types of blood pressure medicines. Sometimes, doctors use a combination of medications to control blood pressure.

What Are the Effects of Mixing Alcohol and Blood Pressure Medicine?

Blood pressure medicines can interact with other substances and affect underlying medical conditions.⁴ The National Institute of Health reports that 42% of Americans who drink alcohol also take medications that can interact with alcohol, like blood pressure medication.⁵

The effects of alcohol intensify when mixed with blood pressure medications which can lead to:⁶

Nausea
Vomiting
Dizziness
Sleepiness or drowsiness
Concentration problems
Motor skills dysfunction
Accidents or injuries
Arrhythmia, or abnormal heart rate

How Do Alcohol and Blood Pressure Medicine Interact?

Alcohol and blood pressure medicines alter how the body functions. While blood pressure medicine instructs your body to decrease the pressure with which blood pumps to the arteries, alcohol triggers other chemical processes.⁷

The following are examples of how alcohol influences blood pressure.

Constriction of Blood Vessels

Alcohol increases the production of renin, which can trigger a constriction—or reduction in size—of blood vessels.⁸When the related hormone system causes blood vessels to get smaller, a person retains fluid, which can increase blood pressure, especially in someone who already has hypertension.

Dehydration

Consuming alcohol affects how the body uses water by impacting the hormone vasopressin. When using alcohol, you become dehydrated more easily. It can also potentially lead to higher blood pressure.⁹

This hormone is also associated with nausea and vomiting, which can contribute to dehydration.

Cortisol Increase

Cortisol regulates the body’s immune system, stress, metabolism, and inflammation. Alcohol causes an increase in cortisol. Cortisol increases the rate of certain physical functions, like how blood pumps to the arteries.¹⁰

Calcium in Blood Vessels

Alcohol use is associated with calcium buildup in blood vessels over time. This limits the amount of blood that can pass through the vessels, forcing the heart to work harder as it tries to pump blood.¹⁰

What Are the Risks of Mixing Alcohol and Blood Pressure Medicine?

Any alcohol use can cause a temporary increase in blood pressure. Alcohol misuse can also lead to conditions that cause secondary hypertension, such as the ones below:¹¹

Insulin resistance
Sleep apnea
Oxidative stress
Renal disease
Hyperthyroidism
Weight gain

Misuse of blood pressure medication, alcohol, or other drugs poses a risk of physical and psychological consequences. Combining blood pressure medication and alcohol can be related to the following.

Diseases

Polysubstance misuse—or misuse of more than one substance—is associated with an increased risk of developing certain diseases. Mixing alcohol and blood pressure medications can be related to a higher risk of:¹²

Alcohol-related or progressive heart disease related to high blood pressure, such as hypertensive heart disease, cardiomyopathy, congestive heart failure, or stroke
Liver disease, including cirrhosis and hepatitis
Kidney disease
Certain types of cancer, including potential risk of cancer of the throat, lungs, esophagus, stomach, liver, rectum, or breasts

Disorders

Alcohol misuse and blood pressure medication misuse are a risk factor for certain physical and mental disorders, including:¹²

Respiratory illness, such as asthma and community-acquired pneumonia
Mental health conditions, including anxiety, depression and other mood disorders, and eating disorders
Sexual health disorders, such as infertility and decreased libido

Overdose

Alcohol overdose can happen to anyone. Combining alcohol with any other substance, including prescription medication, can affect an individual’s risk of overdose.

Overdose occurs when a large amount of alcohol is in the blood, and it affects the areas of the brain that control vital functioning. As blood alcohol concentration increases, the brain areas that regulate breathing, heart rate, and body temperature control start to shut down.¹³

Signs of an alcohol overdose include:¹³

Vomiting
Going in and out of consciousness
Confusion or appearing zoned out
Becoming unable to answer simple questions
Exhibiting pale, damp skin that is cool to the touch
Exhibiting slowed heart rate
Taking shallow breaths
Demonstrating a lack of coordination or balance

Overdose is a medical emergency. Tell emergency responders all medication a person who has overdosed takes, as well as any other substances they have used.

Dependence

A sign of alcohol dependence is the presence of withdrawal symptoms when you try to change how you use alcohol. Withdrawal symptoms can be mild, moderate, or severe. Examples of withdrawal symptoms include nausea, vomiting, flu-like symptoms, and body aches, pains, and spasms.¹³

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Alcohol Use Disorder

A person can have a dependence on alcohol without having an alcohol use disorder—the clinical diagnosis that describes the behaviors generally described as “alcohol addiction.” However, the longer a person misuses alcohol or combines it with other substances, the higher the likelihood of developing an alcohol use disorder or polysubstance disorder.¹³

Symptoms of an alcohol use disorder include being unable to stop using alcohol despite direct negative consequences such as alcohol-related health problems, interpersonal issues, or job loss due to absenteeism.¹³

Who Is at Risk for Severe Side Effects?

While anyone can experience the side effects of mixing alcohol and blood pressure medicine, some are more at risk for negative outcomes.

Individuals 65 and older are considered at higher risk of experiencing side effects due to changes in the body’s ability to process alcohol and other substances related to aging. Individuals in this age category are also more likely to take other prescription medications, which can interact with alcohol, blood pressure medication, or both, increasing the likelihood of profound side effects.¹⁴

Others who should avoid mixing alcohol and blood pressure medicine include:¹⁵

If you take prescription medication—such as antibiotics, corticosteroids, or antidepressants—or over-the-counter medication—such as Tylenol or cold and flu medication—that could interact with alcohol or blood pressure medication
If you are pregnant or trying to get pregnant
If you have an underlying medical condition that is known to worsen with alcohol use, such as liver or kidney disease
If you have a family history of polysubstance overdose or addiction, such as a parent with alcohol addiction

If you take blood pressure medication, talk to your prescribing doctor about safe levels of alcohol use and signs of alcohol interactions with the medication.

If you experience the signs of alcohol use disorder or polysubstance use disorder, treatment can start by discussing your symptoms and experiences with a licensed mental health professional.

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Resources

Center for Disease Control and Prevention. (2021). Facts About Hypertension.
S. National Library of Medicine. (2021). High Blood Pressure. MedlinePlus.
Khalil, H. & Zeltser, R. (2021). Antihypertensive Medications. Treasure Island (FL): StatPearls Publishing.
(2019, May 23). What medications are used to treat high blood pressure?
National Institute of Health. (2015). NIH Study Reveals Many Americans At Risk for Alcohol-Medication Interactions.
National Institute of Health. (2014). Harmful Interactions: Mixing Alcohol With Medicines.
Fountain, J.H. & Lappin, S.L. (2021). Physiology, Renin-Angiotensin System. Treasure Island (FL): StatPearls Publishing.
Breese, G.R., Criswell, H.E., Harper, K.M. & Knapp, D.J. (2018). Vasopressin and alcohol: a multifaceted relationship. Psychopharmacology, 235(12), 3363-3379.
Thau, L., Gandhi, J. & Sharma, S. (2021). Physiology, Cortisol. Treasure Island (FL): StatPearls Publishing.
Ansari, R.A., Ferder, L. & Husain, K. (2014). Alcohol-induced hypertension: Mechanism and prevention. World Journal of Cardiology, 6(5), 245–252.
Chiwome, L., Hamid, P., Javed, F. & Okojie, O.M. (2020, August 27). Hypertension and Alcohol: A Mechanistic Approach. Cureus, 12(8), e10086.
Iranpour, A., & Nakhaee, N. (2019). A Review of Alcohol-Related Harms: A Recent Update. Addiction & Health, 11(2), 129–137.
National Institute on Alcohol Abuse and Alcoholism. (2021). Understanding the Dangers of Alcohol Overdose.
National Institute on Alcohol Abuse and Alcoholism. (2021). Older Adults.
National Institutes of Health (2007). Information About Alcohol. Biological Sciences Curriculum Study. NIH Curriculum Supplement Series. Bethesda (MD): National Institutes of Health (US).
National Institute on Alcohol Abuse and Alcoholism. (2021). Treatment for Alcohol Problems: Finding and Getting Help.