Anti-Hypertensive Agents

Elevated blood pressure during alcohol withdrawal is common due to autonomic (adrenergic) hyperactivity. It generally resolves spontaneously following withdrawal, and is usually well managed by adequate doses of benzodiazepines (for example, at least 60 mg of diazepam in the preceding 24 hours). In cases where blood pressure remains markedly elevated (for example, greater than 180 mg systolic, greater than 110 diastolic) on repeated measurements, despite adequate benzodiazepine loading, a beta-blocker (such as atenolol or propranolol) is recommended, provided there are no contraindications. There are no specific trials to guide this recommendation. 

Alcohol use disorder is associated with hypertension that often remits with reduction or cessation of alcohol use. Accordingly, elevated blood pressure should be monitored after completion of withdrawal and maintaining control of hypertension may be a motivator to reduce alcohol use. Persisting hypertension should be managed according to current guidelines.