What does alcohol do to blood pressure?

Alcohol raises blood pressure through multiple mechanisms that are dose-dependent and begin at low consumption levels. Acutely, alcohol causes vasodilation, which is why drinking feels relaxing, but within hours the vasodilatory effect reverses as acetaldehyde activates the sympathetic nervous system and renin-angiotensin-aldosterone system, raising vascular tone and blood pressure. Chronically, regular drinking at above 14 units per week produces measurable hypertension effects, and the population-attributable fraction of hypertension in men that is explained by alcohol has been estimated in the range of 14% in the GBD analysis.

For men who already have blood pressure in the 130–140/80–90 mmHg range, the "elevated" category where the decision about antihypertensive treatment is often being weighed, alcohol intake above 14 units per week is not a lifestyle footnote. It is a blood pressure contributor that needs to be quantified and reduced before assuming pharmacological treatment is the appropriate next step. A man who reduces from 21 units per week to 7 units per week often achieves blood pressure reductions of 3–4 mmHg systolic without any other intervention. (GBD 2016 Alcohol Collaborators, Lancet, 201831310-2/fulltext))

Cardiologist's calibrated position, Solid (1). The alcohol-blood pressure dose-response is one of the most clinically established relationships in cardiovascular medicine.

What to do: Measure your blood pressure on drinking mornings versus non-drinking mornings consistently for two weeks. The data from your own cuff is more persuasive than any study abstract.

For the full picture, read The Bourbon Collector's Honest Reckoning.