Cigarette-smoking, Hypertension, and Cardiovascular Mortality

Posted On 2014-01-07 17:56:29

In a recent article in the ‘Journal of Hypertension, the authors from the Department of Evidence Based Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing in China examine the risk of cigarette smoking on cardiovascular disease (CVD) and all-cause mortality among hypertensive patients (1).

The article describes data from a large prospective cohort study among 36,943 hypertensive patients aged at least 40 years. Data on smoking and other variables were obtained in 1991 and follow-up evaluation was conducted in 1999-2000. During a median follow-up of 8.2 years, 7194 deaths were documented among 36 943 hypertensive patients. Compared with never-smokers, the multivariate-adjusted relative risks (MRRs) [95% confidence intervals (CIs)] for CVD mortality were 1.19 (1.07, 1.31) and 1.33 (1.23, 1.45) for those who smoked 0.1-19 pack-years and at least 20 pack-years (P for linear trends <0.001 for all). A similar pattern was observed for all-cause mortality. A dose-response association between pack-years smoked and risk of CVD and all-cause mortality (all P ≤ 0.01) was found among the SBP groups (140-159, 160-179, and ≥ 180 mmHg), DBP groups (<90, 90-94, and 100-109 mmHg), and pulse pressure groups (50-59, 60-69, and ≥ 70 mmHg). In addition, compared to never-smokers with stage 1 hypertension, MRRs of CVD and all-cause mortality for those who smoked at least 20 pack-years with stage 3 hypertension were remarkably increased to 3.06 (2.64, 3.54) and 2.51 (2.24, 2.80), respectively.

The authors conclude that smoking not only significantly increased the risk of CVD and all-cause mortality among hypertensive groups, but the synergistic effect on the risk of CVD and all-cause mortality existed between cigarette smoking and blood pressure category. Therefore, apart from hypertension management, smoking cessation should be an essential component for preventing deaths related to smoking.

Other recent article discuss the other cardiovascular risk factors (2-6).


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  2. Bernstein AS, Rice MB Lungs in a warming world: climate change and respiratory health.Chest. 2013 May;143(5):1455-9. doi: 10.1378/chest.12-2384. PMID: 23648909
  3. Xie G, Zaman MJ, Myint PK, Liang L, Zhao L, Wu Y. Factors associated with compliance to lipid-lowering treatment in China.Eur J PrevCardiol. 2013 Apr;20(2):229-37.
  4. Pan A, Malik V, Hu FB. Exporting Diabetes to Asia: The Impact of Western-Style Fast Food Circulation. 2012 Jul 2. [Epub ahead of print]
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  6. Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, Shan Z, Liu J, Tian H, Ji Q, Zhu D, Ge J, Lin L, Chen L, Guo X, Zhao Z, Li Q, Zhou Z, Shan G, He J; China National Diabetes and Metabolic Disorders Study Group. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090-101.