Under pressure: alcohol and hypertension
'Under pressure' [pdf], a new report on alcohol and high blood pressure, makes a series of recommendations to address what are 'two of the most common preventable health harms in the UK'. The report was developed by an expert group, initiated and supported by Lundbeck pharmaceutical.
The report says improvements in primary care for hypertension and alcohol misuse are required for better integrated screening, brief interventions, and treatment for both conditions, which would reduce the incidence of other cardiovascular diseases. Both alcohol misuse and hypertension affect around a quarter of adults, however four out of ten people with high blood pressure (BP) will be undiagnosed.
A series of recommendations are made including improving brief intervention (IBA) rates for those with both conditions in primary care, and raising awareness of the links. Currently under NICE guidelines, primary care has a responsibility to deliver IBA to those with high blood pressure as part of its QOF. However the report includes results of a survey which suggests low levels of IBA amongst patients with high BP:
"...even in this ‘at risk’ population, screening for alcohol problems is only done on an intermittent basis; the results of the GP survey ... indicate that only about 1-in-5 people with hypertension are screened for harmful drinking"
The report also identifies issues relating to pathways for referral of alcohol treatment services and challenges within the new commissioning landscape. Recommendations within the report include a move to 'joint commissioning for a holistic and integrated alcohol treatment service that reflects the patient pathway from prevention through to specialist services'. The development of networks for trainers and clinical leads to support skills and best practice are also suggested.
See here for an Alcohol Concern factsheet on alcohol and hypertension.
The Way We Drink Now
Another report, 'The Way We Drink Now' [pdf], overseen by an expert group with support from Lundbeck has been released by Alcohol Concern and DrinkWise. Based on a survey of 1,250 adults from across the UK, it uses participant's AUDIT scores to draw a number of findings about adult drinking behaviours.
The first 'key finding' draws attention to effects of the rise in drinking amongst young women during the 1990's as the 'Bridget Jones generation hits middle age'. It recommends increasing attention to the harms associated with heavy wine consumption in particular, including improved understanding of units and Alcohol by Volume (ABV). The second key finding highlights 'heavy drinkers tend to be well-educated', reflecting known national data and the alcohol harm paradox.
However one of the unexpected findings according to the report identifies that adults who said they drank heavily were more likely to live in a household with children. 26% of lower risk drinkers reported living in a household with children, but 29% of the hazardous drinkers (increasing risk) drinkers, 44% of harmful drinkers and 54% of the probably dependent drinkers lived with children. As such, a focus on safeguarding children and 'taking alcohol out of schools' is recommended; schools in England and Wales applied for permission to serve alcohol at more than 8,000 occassions in 2013.
Other key findings and discussion points in the report were:
- Alcohol misuse is contributing to the growing strain on healthcare resources in the UK
- People who drink care about keeping fit
- Alcohol can make you depressed
- People who want to quit or cut down might benefit from treatments like patches and pills
Whilst most the findings may be unlikely to come as much surprise to those familiar with the alcohol field, the authors may regard it as important to keep pushing key messages as 'heavy drinking is still commonplace and is often seen as normal social behaviour'. Certainly with a range of national statistics on alcohol, and activities from others such as Drinkaware assessing drinking behaviours and patterns, the question is how a growing understanding of alcohol consumption and harms may inform and influence practice and policy.
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