Differences in ambulatory blood pressure and heart rate between smoking and abstinence periods among current smokers: A systematic review and meta-analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Current smokers (n=104). Intervention: Smoking period vs. Abstinence period. Primary outcome: 24-h systolic blood pressure (SBP) (MD 2.41 mmHg, 95% CI -0.13 to 4.95).

Yuya Akagi; Kimika Arakawa; Atsushi Sakima; Mai Kabayama; Ken Sugimoto; Yuichi Akasaki; Ako Fukami; Satoko Sakata; Hirochika Ryuno; Hiroyuki Kadoya; Toshiya Yamamoto; Hiroko Yoshida; Yoichi Nozato; Taisuke Ueno; Makiko Abe; Hisatomi Arima; Mitsuru Ohishi; Nobuhito Hirawa; Chisa Matsumoto; Shin-Ichiro Miura; Masaki Mogi; Akira Nishiyama; Akihiro Nomura; Takayoshi Ohkubo; Yusuke Ohya; Shigeru Shibata; Yasuharu Tabara; Koichi Yamamoto; Kazuomi Kario

doi:10.1038/s41440-026-02797-0

Key result

Smoking versus abstinence linked to higher 24-hour DBP and ~6 bpm faster HR, but unchanged SBP.

MD +2.41 mmHg
95% CI -0.13 to 4.95
n=104

Why the study?

Studies on the association between smoking and out-of-office BP remain limited.

Does a smoking period compared to an abstinence period increase ambulatory blood pressure and heart rate in current smokers?

Key Points

To evaluate whether out-of-office ambulatory blood pressure and heart rate differ between periods of smoking and temporary abstinence among current smokers.
Systematic search of PubMed and IchuShi-Web through September 2025 identified four non-randomized crossover studies comprising 104 current smokers.
Included studies evaluated ambulatory blood pressure and heart rate during active smoking versus abstinence periods ranging from 1 day to 1 week.
Mean differences (MDs) between smoking and abstinence were pooled using an inverse-variance random-effects model.
Ambulatory systolic blood pressure did not differ significantly during 24-h (MD: 2.41 mmHg, 95% CI: -0.13 to 4.95), daytime (MD: 3.47 mmHg, 95% CI: -0.41 to 7.36), or nighttime periods (MD: 1.38 mmHg, 95% CI: -1.91 to 4.68).
Ambulatory diastolic blood pressure was significantly elevated during active smoking over 24-h (MD: 2.67 mmHg, 95% CI: 0.72 to 4.62) and daytime (MD: 3.17 mmHg, 95% CI: 1.15 to 5.18), but not nighttime (MD: 1.00 mmHg, 95% CI: -1.17 to 3.17).
Heart rate was significantly higher during smoking across all intervals: 24-h (MD: 6.47 bpm, 95% CI: 3.98 to 8.96), daytime (MD: 7.19 bpm, 95% CI: 4.59 to 9.79), and nighttime (MD: 3.58 bpm, 95% CI: 0.69 to 6.47).

Study Design

Type

Meta-Analysis (n=104)

Structured PICO

Does a smoking period compared to an abstinence period increase ambulatory blood pressure and heart rate in current smokers?

P

Population

104 adult current smokers from 4 crossover studies comparing ambulatory blood pressure and heart rate between smoking and short-term abstinence periods.

E

Exposure

Smoking period (usual smoking or specific cigarette consumption, ranging from 24 hours to 1 week)

C

Comparator

Abstinence period (ranging from approximately 1 day to 1 week)

O

Outcome

Mean differences (MDs) in morning home systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) between the smoking and abstinence periods among current smokerssurrogate

Main Result

Mean Difference: 2.41 (95% CI -0.13–4.95)

Habitual smoking is associated with significantly higher 24-hour diastolic blood pressure and heart rate compared to short-term abstinence, highlighting that relying solely on office blood pressure underestimates the hemodynamic burden of smoking.

Limitations

No eligible studies reported the intended primary outcomes of morning home blood pressure and heart rate.
Only four studies were eligible for inclusion, limiting the ability to perform subgroup analyses or meta-regression.
The abstinence period lasted at most 1 week, reflecting only the short-term effects of smoking rather than long-term consequences.
Limited generalizability as most included studies enrolled young-to-middle-aged normotensive adults and very few women.
Potential for publication bias could not be formally assessed due to the small number of studies.
Small number of included studies (4 studies)
Small sample size
Statistical constraints on heterogeneity assessment
Limited publication bias assessment
Differences in randomization, biochemical verification, and lifestyle control across studies
Short abstinence period (at most 1 week)
Limited generalizability (mostly young normotensive adults, few women)

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Ambulatory monitoring may better capture smoking-related diastolic BP and heart rate rises missed by office readings; reinforces consensus on underestimation of hemodynamic burden.

Abstract

Studies on the association between smoking and out-of-office blood pressure (BP) remain limited. This systematic review and meta-analysis was conducted to evaluate whether out-of-office BP differs between smoking and abstinence periods. We searched PubMed and IchuShi-Web through September 2025 and identified four non-randomized comparative studies (104 participants) that compared ambulatory BP (ABP) between smoking and abstinence periods among current smokers. The abstinence period ranged from 1 day to 1 week. Mean differences (MDs, smoking minus abstinence) and 95% confidence intervals (CIs) were estimated using a random-effects model. During the smoking period, 24-h systolic BP (SBP) (MD: 2.41 mmHg, 95% CI: -0.13 to 4.95), daytime SBP (MD: 3.47 mmHg, 95% CI: -0.41 to 7.36), and nighttime SBP (MD: 1.38 mmHg, 95% CI: -1.91 to 4.68) were not significantly different compared with those in the abstinence period. In contrast, 24-h diastolic BP (DBP) (MD: 2.67 mmHg, 95% CI: 0.72 to 4.62) and daytime DBP (MD: 3.17 mmHg, 95% CI: 1.15 to 5.18) were significantly higher, whereas nighttime DBP was not (MD: 1.00 mmHg, 95% CI: -1.17 to 3.17). Furthermore, 24-h heart rate (HR) (MD: 6.47 beats per minute [bpm], 95% CI: 3.98 to 8.96), daytime HR (MD: 7.19 bpm, 95% CI: 4.59 to 9.79), and nighttime HR (MD: 3.58 bpm, 95% CI: 0.69 to 6.47) were significantly higher. In conclusion, the ABP profile during the smoking period in current smokers is unfavorable compared with that during the abstinence period, providing further evidence to support smoking cessation.

Discussion

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Cite This Study

Akagi et al. (2026) conducted a meta-analysis in Current smokers (n=104). Smoking period vs. Abstinence period was evaluated on 24-h systolic blood pressure (SBP) (MD 2.41 mmHg, 95% CI -0.13 to 4.95). Compared with abstinence periods, smoking periods in current smokers were associated with significantly higher 24-hour diastolic blood pressure (MD 2.67 mmHg) and heart rate (MD 6.47 bpm), but no significant difference in 24-hour systolic blood pressure.

synapsesocial.com/papers/6aa27aca58559d80afc73995 https://doi.org/10.1038/s41440-026-02797-0

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Differences in ambulatory blood pressure and heart rate between smoking and abstinence periods among current smokers: A systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Differences in ambulatory blood pressure and heart rate between smoking and abstinence periods among current smokers: A systematic review and meta-analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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