Adverse blood pressure (BP) is a major risk factor for cardiovascular disease. The World Health Organisation Global Burden of Disease Comparative Risk Analysis study (2000) reported that regular consumption of alcohol elevated BP and attributed 16% of all hypertensive disease worldwide to alcohol. Epidemiological studies have demonstrated a positive relationship between heavy alcohol use and high BP, but few studies have directly addressed the role of drinking patterns, type of alcoholic beverages, nutrient intakes, foods and urinary metabolites. The International Collaborative Study of Macro-/Micro-nutrients and Blood Pressure (INTERMAP) is a cross-sectional epidemiological study designed to investigate the role of macro and micronutrients in the aetiology of adverse BP patterns in populations. This report investigates the relationship of alcohol consumption and BP in 4,680 men and women aged 40 to 59 years from 17 population samples in Japan, People's Republic of China, United Kingdom and the United States, using data including macro-/micro-nutrients from four 24-hour dietary recalls, two 7-day alcohol records, urinary electrolytes and urinary metabolites from two timed 24-hour urine collections, together with socioeconomic data. Specific aims include investigation of the relationship between BP and alcohol drinking patterns and type of alcoholic beverage; the relationship between alcohol intake and other nutrients, the role of nutrient pattern and foods of non-drinker (teetotallers and ex-drinkers) and drinkers (moderate and heavy drinkers) and their BP; the difference in urinary amino acid excretion among non-drinkers and current drinkers; identify urinary metabolites detected by nuclear magnetic resonance in relation to different alcohol intake levels and alcohol drinking pattern; use of INTERMAP data to explore country/population differences in alcohol metabolism. Findings from the INTERMAP Study show that the harmful effect of alcohol intake on blood pressure is related particularly to the quantity of alcohol consumed (average intake per day), not drinking pattern or type of beverage.