Blood Pressure Control among Primary Care Patients with Hypertension and Unhealthy Alcohol Use: The Role of Alcohol Brief Interventions.

Objective: Hypertension is highly prevalent in primary care. Unhealthy alcohol use can impact its management and associated cardiovascular disease risks. Alcohol screening and brief intervention (ASBI) in primary care is effective for early intervention for unhealthy use, yet its effectiveness in heterogeneous populations in real-world settings remains unclear. Using electronic health records, we emulated a pragmatic clinical trial to evaluate the effects of receiving ASBI on drinking and blood pressure (BP) outcomes among primary care patients with hypertension and unhealthy alcohol use.

Method: This observational study identified 72,979 patients with hypertension who screened positive for unhealthy drinking between 1/1/2014 - 12/31/2017. We used a target trial framework to compare the effects of receiving ASBI (intervention) to not receiving BI (comparison) on drinking (change in heavy drinking days and drinks/week) and BP outcomes (changes in diastolic and systolic BP) from baseline to 2- and 5-year follow-ups. Treatment effect estimates were obtained using inverse probability weighted models.

Results: At 2-years, the intervention condition had about 0.2 fewer heavy drinking days and about 0.1 fewer drinks/week than the comparison condition. The intervention condition had an additional -0.5 mmHg and -0.7 mmHg decline in diastolic and systolic BP, and 8% and 6% higher odds of having a ≥3mmHg reduction in diastolic and systolic BP, respectively, than the comparison condition. Between group differences in both outcomes diminished at 5-years.

Conclusions: The modest changes in drinking and blood pressure we found contribute to the emerging evidence that BI may benefit broader health outcomes on population-level.