What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Blood pressure. Intervention: Smoking vs. Nonsmokers. Primary outcome: 24-h ambulatory systolic blood pressure (MD 2.89, 95% CI 1.44-4.35).

What question did this study set out to answer?

To systematically evaluate the association between tobacco smoking and out-of-office ambulatory blood pressure and heart rate compared with nonsmoking.

September 12, 2026Hypertension Research

Ambulatory blood pressure is higher in smokers than in nonsmokers: a systematic review and meta-analysis of observational studies

Q: What are the key findings of this study?

Smoking was associated with significantly higher 24-h ambulatory systolic blood pressure compared to nonsmokers (MD 2.89 mmHg; 95% CI 1.44-4.35).

Q: What does this research mean for the field?

Smoking is associated with significantly higher 24-h ambulatory systolic blood pressure compared to nonsmokers (MD 2.89 mmHg; 95% CI 1.44-4.35). Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Smoking linked to ~3 mmHg higher 24-h ambulatory SBP versus nonsmokers.

MD 2.89
95% CI 1.44-4.35

Why the study?

Findings regarding the association between smoking and office BP have been inconsistent, and its relationship with out-of-office BP remains unclear.

Does smoking increase ambulatory blood pressure and heart rate compared to nonsmokers?

Comparison

Smokers vs nonsmokers

Design

Systematic review and meta-analysis of observational studies

Authors

KAKimika ArakawaNational Kyushu Medical Center ASAtsushi SakimaUniversity of the Ryukyus MKMai KabayamaOsaka Gakuin University

Discussion

Member takes

Implication

Smoking is associated with significantly higher 24-hour and daytime ambulatory systolic blood pressure and heart rate, highlighting its negative impact on blood pressure control and the importance of smoking cessation.

Key Points

To systematically evaluate the association between tobacco smoking and out-of-office ambulatory blood pressure and heart rate compared with nonsmoking.
Searched PubMed and Ichushi-Web through September 2025 for non-randomized comparative studies assessing ambulatory blood pressure.
Identified and included 19 cross-sectional studies meeting eligibility criteria.
Synthesized mean differences (MDs) between smokers and nonsmokers using random-effects meta-analysis models.
Smokers had significantly higher 24-hour SBP (MD, 2.89 mmHg; 95% CI, 1.44–4.35) and daytime SBP (MD, 2.85 mmHg; 95% CI, 1.47–4.23), as well as higher 24-hour DBP (MD, 1.87 mmHg; 95% CI, 0.73–3.00) and daytime DBP (MD, 1.25 mmHg; 95% CI, 0.00–2.50).
Nighttime ambulatory blood pressure did not differ significantly, but smokers exhibited higher heart rates across 24-hour (MD, 5.17 bpm; 95% CI, 3.14–7.21), daytime (MD, 6.75 bpm; 95% CI, 4.83–8.67), and nighttime (MD, 4.09 bpm; 95% CI, 2.81–5.38) periods.
Differences in 24-hour and daytime SBP were significantly amplified in cohorts with hypertension compared to those without hypertension (P for interaction = 0.006 and P < 0.001, respectively).

Study Design

Type

Meta-Analysis

Structured PICO

Does smoking increase ambulatory blood pressure and heart rate compared to nonsmokers?

Population

Meta-analysis of 19 cross-sectional studies evaluating ambulatory blood pressure profiles in smokers versus nonsmokers.

Exposure

Smoking

Comparator

Nonsmokers

Outcome

Ambulatory blood pressure (24-h, daytime, and nighttime systolic and diastolic BP) and heart ratesurrogate

Main Result

Mean Difference: 2.89 (95% CI 1.44–4.35)

Cite This Study

Arakawa et al. (2026) conducted a meta-analysis in Blood pressure. Smoking vs. Nonsmokers was evaluated on 24-h ambulatory systolic blood pressure (MD 2.89, 95% CI 1.44-4.35). Smoking was associated with significantly higher 24-h ambulatory systolic blood pressure compared to nonsmokers (MD 2.89 mmHg; 95% CI 1.44-4.35).

synapsesocial.com/papers/6aa55644327956e4761fa0a0 https://doi.org/10.1038/s41440-026-02796-1

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Ambulatory blood pressure is higher in smokers than in nonsmokers: a systematic review and meta-analysis of observational studies

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Ambulatory blood pressure is higher in smokers than in nonsmokers: a systematic review and meta-analysis of observational studies

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider