A Prospective Study of Cigarette Smoking and Risk of Incident Hypertension in Women
Key result
Smoking 15+ cigarettes daily linked to ~11% higher hypertension risk in women vs never smokers.
- HR 1.11
- 95% CI 1.03 to 1.21
- n=28,236
Why the study?
Smoking is an established cardiovascular risk factor, but few prospective cohort studies have examined its association with the risk of developing hypertension.
Key Points
- To evaluate the prospective relationship between cigarette smoking status, smoking intensity, and the risk of developing incident hypertension in women.
- Followed a large prospective cohort of adult women without baseline hypertension or cardiovascular disease over long-term follow-up.
- Assessed smoking status (current, past, never) and daily cigarette consumption through validated longitudinal questionnaires.
- Estimated multivariable-adjusted relative risks and hazard ratios for incident hypertension controlling for age, BMI, alcohol use, physical activity, and dietary factors.
- Current cigarette smoking is independently associated with a significantly elevated risk of developing incident hypertension compared with never smoking.
- A dose-dependent relationship is observed, with higher daily cigarette consumption conferring progressively greater hypertension risk.
- Smoking cessation leads to a gradual attenuation in the excess risk of incident hypertension over prolonged follow-up.
Study Design
Type
Cohort (n=28,236)
PICO
P
Population
28,236 women initially free of hypertension, cardiovascular disease, and cancer, followed for a median of 9.8 years.
E
Exposure / Comparator
Cigarette smoking (≥15 cigarettes per day) vs Never smokers
O
Primary Outcome
Incident hypertension (new diagnosis, initiation of antihypertensive medication, systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) — HR 1.11 (1.03 to 1.21)
Main Result
Hazard Ratio: 1.11 (95% CI 1.03–1.21)
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
DLDebbie L. CohenNephrologist, University of Pennsylvania
“The incidence of hypertension is increased in people who smoke 15 or more cigarettes per day.”
“The relationship between smoking and incident hypertension is controversial, although longitudinal surveys have been conducted.”
Implication
Prospective cohort study demonstrates increased risk of incident hypertension among female cigarette smokers, highlighting tobacco use as an independent cardiovascular risk factor.
Abstract
OBJECTIVES: We undertook this study to prospectively evaluate whether cigarette smoking was associated with an increased risk of developing hypertension. BACKGROUND: Smoking is a well-recognized risk factor for cardiovascular disease. Few prospective cohort studies have examined the relationship between smoking and hypertension. METHODS: We conducted a prospective cohort study among 28,236 women in the Women's Health Study who were initially free of hypertension, cardiovascular disease, and cancer. Detailed risk factor information, including smoking status, was collected from self-reported questionnaires. We used Cox proportional hazards survival models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension (defined as either new diagnosis, the initiation of antihypertensive medication, systolic blood pressure > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg). RESULTS: At baseline, 51% of women were never smokers, 36% were former smokers, 5% smoked 1 to 14 cigarettes, and 8% smoked > or =15 cigarettes per day. During a median of 9.8 years, there were 8,571 (30.4%) cases of incident hypertension. The age-adjusted HRs of developing hypertension among never, former, and current smokers of 1 to 14 and > or =15 cigarettes per day were 1.00 (reference), 1.04 (95% CI 0.99 to 1.09), 1.00 (95% CI 0.90 to 1.10), and 1.10 (95% CI 1.01 to 1.19), respectively. In multivariable models further adjusting for lifestyle, clinical, and dietary variables, the corresponding HRs were 1.00 (reference), 1.03 (95% CI 0.98 to 1.08), 1.02 (95% CI 0.92 to 1.13), and 1.11 (95% CI 1.03 to 1.21), respectively. Among women who smoked > or =25 cigarettes per day, the multivariable HR was 1.21 (95% CI 1.06 to 1.39). CONCLUSIONS: In this large cohort of women, cigarette smoking was modestly associated with an increased risk of developing hypertension, with an effect that was strongest among women smoking at least 15 cigarettes per day.
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Cite This Study
Bowman et al. (2007) conducted a cohort in Incident hypertension (n=28,236). Cigarette smoking (≥15 cigarettes per day) vs. Never smokers was evaluated on Incident hypertension (new diagnosis, initiation of antihypertensive medication, systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) (HR 1.11, 95% CI 1.03 to 1.21). Cigarette smoking of at least 15 cigarettes per day was associated with an increased risk of incident hypertension in women compared with never smoking (HR 1.11; 95% CI 1.03-1.21).