The only relevant disease or cause of death in GBD for this category is hypertensive heart disease (see Table 2 for exact definition). As there were no studies on alcohol consumption and hypertensive heart disease fulfilling the inclusion criteria, we substitute the studies on alcohol consumption and a wider definition of hypertensive diseases including essential hypertension. The relationship between alcohol consumption and hypertensive disease is relatively complex. On the one hand, an overall consistently detrimental dose-response effect has been shown [68] for men, while moderate consumption of alcohol has, in some studies, shown to be protective for women. However, despite the consistent effect of chronic alcohol use on increasing blood pressure [103;104], the mechanism of action is unclear, although a number of theories about potential pathways have been proposed [104]. These include activation of the sympathetic nervous system to constrict blood vessels and increase the contractile force of the heart [105], or a possible role of sensitivity of baroreceptors in vessel walls that results in a diminished ability to regulate blood pressure via arterial contraction and relaxation [106]. The protective
