1. Regular alcohol consumption is a significant contributor to the prevalence of hypertension in drinking communities. 2. The effect is additive to that of obesity and is partly reversible over 2-4 weeks with moderation of ethanol intake. 3. In heavy drinkers acute alcohol withdrawal may lead to more blood pressure elevation following an initial depressor response. 4. Heavy drinking is also associated with an increased risk of haemorrhagic stroke and cardiomyopathy. 5. Lighter drinking habits appear to offer significant protection against ischaemic heart deaths and ischaemic strokes. 6. Antihypertensive drug treatment for alcohol related hypertension may mask some of the adverse cardiovascular effects of alcohol. 7. Arguments as to whether alcohol is a cause of essential hypertension are tautological, given the many reversible lifestyle factors now known to contribute to the rise in blood pressure with aging.