Those prone to the “Asian flush” may either suffer an unpleasant intolerance for alcohol or benefit from a genetic resistance to the disease of alcoholism, depending upon perspective.

An erythemic reddening of the face, neck, and even entire body characterizes the condition, most prevalent among people with Chinese, Japanese, and Korean heritage, with a gene variation rare among Europeans, Africans, and Hispanics. Whereas the body more typically converts acetaldehyde — a harmful metabolic byproduct of ethanol associated with esophageal cancer — into harmless acetate, as many as half of Chinese lack this ability.

Now, investigators say drinkers with the condition experience a higher than average risk of hypertension when consuming four or more alcoholic beverages per week.

Asian Flush Linked To Hypertension Risk
Some 540 people around the world, primarily of East Asian descent, experience a genetic variation affecting the ability to metabolize alcohol, leaving drinkers more susceptible to hypertension, as well as esophageal cancer. CC By 2.0

Although long associated with hypertension, the consumption of alcohol among those with the condition may present health risks at a much lower threshold than those lacking the rs671 version of the ALDH2 gene, according to investigator Kyung Hwan Cho, president of the Korean Academy of Family Medicine.

“This association persists regardless of beverage type and shows a dose-response relationship, which means excess drinking for weeks or months can increase blood pressure,” Cho said in a statement. “However, the relationship may vary by gender, race/ethnicity, or presence of other risk factors for cardiovascular disease.”

Conversely, other studies suggest that reductions in drinking may lower elevated levels of blood pressure in people with the condition; however, investigators said they were unaware of any previous work analyzing the relationship between alcohol and hypertension among individuals.

Cho, along with Jong Sung Kim, of the Chungnam National University School of Medicine, analyzed data from the medical records of nearly 1,763 men, of whom 288 didn’t drink alcohol at all. They then compared hypertension rates among 527 drinkers who experienced the Asian flush with 948 who did not.

"Our results indicate that hypertension associated with drinking has a lower threshold value and higher risk in flushers than in non-flushers," Kim said in the statement, noting adjustments in the study to control for differences in other health factors such as body mass index, smoking, and exercise.

Whereas those prone to the Asian flush experienced an elevated risk of hypertension when drinking four or more drinks per week, those without the condition hit that level at eight drinks per week — suggesting a good marker for clinicians assessing the risk of hypertension in some patients, Kim said. "Our research findings suggest that clinicians and researchers should, respectively, consider evaluating their patients' flushing response to alcohol as well as drinking amount in a daily routine care, and researching hazard by drinking.”

Although often accompanied by symptoms of nausea, headache, and heart palpitations, the Asian flush may not necessarily stop some from drinking. Thus, doctors should inquire about the condition among patients, advising those prone to flushing to lower alcohol intake. In a 2009 study finding higher risks of esophageal cancer among those with the condition, Phillip J. Brooks, of the U.S. National Institute on Alcohol Abuse and Alcoholism, noted an opportunity for clinicians.

Among 540 million suffers — or beneficiaries — of the condition, many now live in the West, exposed to more European drinking cultures, and are therefore, at risk.

Brooks, Phillip J., Enoch, Mary-Anne, Goldman, David, Li, Ting-Kai, Yokoyama, Akira. The Alcohol Flushing Response: An Unrecognized Risk Factor For Esophageal Cancer From Alcohol Consumption. PLoS Med. 2009.