SUMMARY The relationship between alcohol consumption and systolic and diastolic blood pressure (BP) was examined in 2482 men and 2301 women 20 years of age or older in nine North American populations. Men at the highest level of alcohol consumption ($ 30 ml alcohol per day) had the highest BP, while women either at the highest lerel of alcohol consumption or consuming no alcohol had the highest BP. Men aged 5: 35 years of age consuming S 30 ml alcohol per day were 1.5 to 2 times more likely to be hypertensive than nondrinkers. Multivariate analysis showed systolic and diastolic BP in both men and women to be positively and significantly (p< 0.05) related to alcohol consumption, and this relationship was independent of the potential confounding effects of age, obesity, cigarette smoking, regular exercise, education, and gonadal hormone use in women. The regression coefficients indicated that an average of 30 ml of alcohol per day would produce a 2to 6 mm Hg increase in systolic BP. Analyses suggested the univariate U-shaped alcohol-BP association in women was confounded by differences in obesity and cigarette smoking in nondrinking women, and by very low alcohol consumption in hypertensive women using medication. Additional analyses indicated that alcohol consumed in the 24 hours prior to the study was much more strongly associated with elevated BP than alcohol consumed in the week prior to the study excluding the previous 24 hours. We conclude that alcohol appears to have a modest but consistent and independent effect on systolic and diastolic BP.