Smoking Amplifies Cardiovascular Risk in Patients With Hypertension and Diabetes

Smoking is considered an important “risk factor” for arterial hypertension and diabetes management, according to, respectively, the current guidelines of the European Society of Hypertension and the European Society of Cardiology on the management of arterial hypertension (1) and the guidelines on diabetes of the European Society of Cardiology and the European Association for the Study of Diabetes (2). The aim of the current article is to further evaluate the effect of smoking on mortality and cause-specific cardiovascular events in hypertension and in diabetes and to assess whether there is a significant interaction between the effects of smoking and diabetes. To assess the effect of smoking on mortality and cause-specific cardiovascular events, and the interaction between smoking and diabetes, we analyzed a database of 3,468 hypertensive patients without major cardiovascular disease at baseline and with prospective follow-up for morbidity and mortality (3). The database consists of individual data of hypertensive patients from four prospective studies performed in Europe (4–7). Age of the subjects averaged 61 ± 13 years (mean ± SD), 45% were men, and 61% were under antihypertensive treatment at baseline. Office blood pressure averaged 159.0 ± 19.9/91.0 ± 11.7 mmHg and 24-h ambulatory blood pressure 138.1 ± 16.4/82.3 ± 11.0 mmHg. Current smoking and diabetes were coded as yes or no at the baseline examination; 13.7% of the patients smoked and 8.4% had diabetes. We used Cox proportional hazards regression analysis to assess the prognostic significance of smoking, with stratification for study and adjustment for age, sex, diabetes, total cholesterol, 24-h systolic blood pressure, antihypertensive treatment, and BMI. The average 24-h blood pressure was used because its predictive power has been shown to be superior to that of office blood pressure (3). Median follow-up time was 6.57 years (range 0.08–13.1) and total follow-up time amounted to …