Chronic alcoholism is the commonest cause of cardiomyopathy in the United States. Vascular hypertension and cerebrovascular accidents also occur with greater incidence in chronic alcoholics. Evidence suggests that the fundamental mechanism of injury induced by ethanol is structural and chemical disorganization of membranes, interference with ion transport, and derangement of various biochemical functions that possibly allow calcium to accumulate in the cell. Calcium accumulation in vascular smooth muscle may increase sensitivity to circulating vasopressors, and account for the increased incidence of hypertension in chronic alcoholics. Calcium accumulation may also cause problems in other tissues. The mechanisms for these complications of chronic alcoholism and their clinical relevance are reviewed.