This study aims to examine the relationship between alcohol consumption patterns and hypertension in high-altitude populations. Additionally, it seeks to assess the mediating effects of metabolic factors on this association.

Cross-sectional study.

A subproject of a national survey conducted in high-altitude regions of Tibet, China.

A total of 53 460 residents aged 35–75 years were selected using multistage cluster sampling.

Hypertension was defined as a systolic blood pressure ≥140 mm Hg and/or a diastolic blood pressure ≥90 mm Hg, self-reported physician-diagnosed hypertension or current use of antihypertensive medications.

Multivariate logistic regression analyses were used to assess the association between different frequencies of alcohol consumption and hypertension. Simple and parallel multiple multicategorical mediation analyses were performed to estimate the individual and combined mediation effects of dyslipidaemia and obesity.

Finally, 50 044 participants were included in the analysis, with a hypertension prevalence of 42.97%. Among them, 41.3% were males, and the mean age was 51.12 years. Compared with non-drinkers, occasional alcohol consumption was not significantly associated with hypertension in the overall population. However, in subgroup analysis, it was linked to a 12% increase in odds among males (OR 1.12, 95% CI 1.02 to 1.24) and an 11% decrease among females (OR 0.89, 95% CI 0.81 to 0.97). The odds of hypertension rose significantly by 1.25 (95% CI 1.15 to 1.36), 1.23 (95% CI 1.12 to 1.36) and 1.51 (95% CI 1.37 to 1.65) times in the groups consuming alcohol two to four times a month, two to three times a week and ≥4 times a week, respectively. The indirect effects of these mediators were evident in the light-to-moderate alcohol consumption group but not in the heavy drinking group, a pattern that was also confirmed in sensitivity analyses.

This large-scale study underscores that the impact of occasional drinking on hypertension varies by gender, while consistent associations between frequent alcohol consumption and a higher prevalence of hypertension were observed. Given the differing mediating effects of metabolic abnormalities across individuals with varying alcohol consumption patterns, tailored interventions should be implemented. These findings provide valuable evidence to inform public health strategies to prevent hypertension.