Alcohol brief intervention in primary care: Blood pressure outcomes in hypertensive patients

Abstract Background In clinical trials alcohol brief intervention (BI) in adult primary care has been efficacious in reducing alcohol consumption, but we know little about its impact on health outcomes. Hypertension is a prevalent and costly chronic condition in the U.S. and worldwide, and alcohol u...

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Bibliographic Details
Published in:Journal of substance abuse treatment 2017-06, Vol.77, p.45-51
Main Authors: Chi, Felicia W, Weisner, Constance M, Mertens, Jennifer R, Ross, Thekla B, Sterling, Stacy A
Format: Article
Language:English
Subjects:
Adults
Aged
Alcohol Drinking - adverse effects
Alcohol Drinking - prevention & control
Alcohol screening and brief intervention
Alcohol use
Alcoholism - complications
Alcoholism - rehabilitation
Blood Pressure
Blood pressure control
Brief interventions
Chronic illnesses
Clinical outcomes
Clinical research
Clinical trials
Cohort analysis
Cohort Studies
Drinking behavior
Female
Follow-Up Studies
Health care delivery
Health status
Humans
Hypertension
Hypertension - epidemiology
Hypertension - etiology
Integrated care
Male
Medical referrals
Medical screening
Middle Aged
Moderation
Patients
Physicians
Primary care
Primary Health Care - methods
Prospective Studies
Psychiatry
Randomized Controlled Trials as Topic
Referral and Consultation
Risk Factors
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Summary:Abstract Background In clinical trials alcohol brief intervention (BI) in adult primary care has been efficacious in reducing alcohol consumption, but we know little about its impact on health outcomes. Hypertension is a prevalent and costly chronic condition in the U.S. and worldwide, and alcohol use is a modifiable hypertension risk factor. Objective To evaluate the effect of receiving BI for unhealthy drinking on blood pressure (BP) control among adult hypertensive patients by analyzing secondary data from a clustered, randomized controlled trial on alcohol screening, brief intervention and referral to treatment (SBIRT) implementation by primary care physicians (PCP intervention arm) and non-physician providers and medical assistants (NPP&MA intervention arm) in a large, integrated health care delivery system. Design Observational, prospective cohort study. Subjects 3811 adult hypertensive primary care patients screening positive for past-year heavy drinking at baseline, of which 1422 (37%) had an electronic health record BP measure at baseline and 18-month follow-up. Main outcome measures Change in BP and controlled BP (systolic/diastolic BP < 140/90 mm Hg). Results Overall no significant associations were found between alcohol BI and BP change at 18-month follow-up when analyzing the combined sample of subjects in both intervention arms. However, moderation analyses found that receiving BI for positive past-year unhealthy drinking was positively associated with better BP control at 18 months in the PCP intervention arm, and for those with lower heavy drinking frequency and poor BP control at the index screening. Conclusions Our findings suggest that hypertensive patients may benefit from receiving physician brief intervention for unhealthy alcohol use in primary care. Findings also highlight potential population-level benefits of alcohol BI if widely applied, suggesting a need for the development of innovative strategies to facilitate SBIRT delivery in primary care settings.
ISSN:0740-5472
1873-6483
DOI:10.1016/j.jsat.2017.03.009