Association between cotinine-verified smoking status and hypertension in 167,868 Korean adults

Kim, Byung Jin; Han, Ji Min; Kang, Jung Gyu; Kim, Bum Soo; Kang, Jin Ho

doi:10.1080/08037051.2017.1344539

Cited by 37 publications

(39 citation statements)

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“…5-7 Recently, we reported that cotinine-verified smoking was negatively associated with HTN independent of covariates, especially in men. 8 However, the cross-sectional design of the previous studies prevented clarification of a causal relationship between chronic smoking and HTN.…”

Section: Resultsmentioning

confidence: 99%

“…8 As described previously, unobserved smoking includes secondhand smoke (SHS), environmental tobacco smoke exposure, and under-reporting of exposure to cigarette smoke. 8 Previous studies have shown discordant results for the association between SHS and HTN. 8,25-27 However, those studies included different populations and were mostly cross-sectional in design.…”

Section: Discussionmentioning

confidence: 99%

“…2- 7 We reported that cotinine-verified current smoking was inversely associated with HTN and systolic and diastolic blood pressure (BP), especially in men. 8 However, because of their cross-sectional design, the previous studies could not determine a causal relationship.…”

Section: Study Populationmentioning

confidence: 99%

“…However, recent results in our cross-sectional study showed that the degree of agreement between self-reported and cotinine-verified smoking status was almost perfect (k=0.870). 8 Last, potential confounders remain, such as SHS exposure, genetic variations in nicotine metabolism, dietary factors, and other lifestyle changes including alcohol drinking and exercise during follow-up.…”

Section: Study Limitationsmentioning

confidence: 99%

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Relationship Between Cotinine-Verified Smoking Status and Incidence of Hypertension in 74,743 Korean Adults

Kim

Seo

Kim

et al. 2018

Circ J

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Background:The relationship between chronic smoking and hypertension (HTN) is inconclusive in previous studies, which were mainly based on self-reported smoking status. The aim of this study was to evaluate the association of cotinine-verified smoking status with incident HTN. Methods and Results:A total of 74,743 participants (43,104 men; age 38±5.4 years) were included in the study, with a mean follow-up period of 29 months. Individuals were divided into 4 groups on the basis of their cotinine-verified smoking status at baseline and at follow-up (never-smoking, new-smoking, former-smoking, and sustained-smoking). The incidence rate of HTN in the never-smoking, new-smoking, former-smoking, and sustained-smoking groups was 8.2%, 7.6%, 10.1%, and 8.7% for men and 1.8%, 2.5%, 1.5%, and 2.2% for women, respectively. In a multivariate Cox-hazard regression analysis adjusted for the variables with a univariate relationship, new-smoking and sustained-smoking had decreased relative risks (RRs) for incident HTN compared with never-smoking (RR [95% CI], 0.75 [0.58, 0.96] for new-smoking and 0.82 [0.74, 0.90] for sustained-smoking). Cotinine-verified current smoking at baseline was also inversely associated with incident HTN compared with cotinine-verified never-smoking at baseline (0.91 [0.84, 0.98]). These results remained significant only in men, although there was no sex interaction. Conclusions:This longitudinal study showed that cotinine-verified new-smoking and sustained-smoking decreased the risk for incident HTN, especially in men, compared with never-smoking.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

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Relationship Between Cotinine-Verified Smoking Status and Incidence of Hypertension in 74,743 Korean Adults

Kim

Seo

Kim

et al. 2018

Circ J

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“…Finally, they concluded that this urinary cotinine level was reasonable because their crosssectional study showed that the degree of agreement between self-reported and cotinine-verified smoking status was almost perfect. 19 Exposure to environmental tobacco smoke can affect the urinary cotinine level. Kim et al 13 defined unobserved smokers as cotinine-verified current smokers among the self-reported never smokers.…”

Section: Disclosuresmentioning

confidence: 99%

Smoking and Incident Hypertension　― Importance of Cotinine-Verified Smoking Status ―

Ebina

2018

Circ J

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gitudinal study to perform a simultaneous assessment of cotinine-verified smoking status and self-reported smoking status and also to include the change in the smoking status at baseline and follow-up. They show that cotinine-verified current smoking at baseline significantly decreased the risk of incident HT; cotinine-verified new smoking and sustained smoking according to the change in cotinine-verified smoking status at baseline and follow-up were significantly associated with decreased risk of incident HT; and the effects of cotinine-verified smoking status on incident HT were different from those of self-reported smoking status. The most important point in this report is that this is the first and largest longitudinal study to perform an assessment of smoking status using a cotinine-verified and selfreported questionnaire and to include the change in smoking status from baseline to follow-up.Cotinine-verified smoking status is more accurate than self-reported smoking status for the evaluation of smoking status. Nicotine is metabolized by the liver to a number of metabolites 14 (Figure). The most important metabolite of nicotine is cotinine. Approximately 70-80% of nicotine is converted into cotinine in humans. Cotinine is metabolized T obacco smoke contains many toxic components and exposure to tobacco smoke, not only by active smoking but also passively, is a major risk factor for cardiovascular diseases. Nicotine is one of the toxic components in tobacco smoke and temporally raises blood pressure (BP) via activation of the sympathetic nervous system. However, the long-term effect of smoking on BP has not been clarified. The relationship between smoking and incident hypertension (HT) is controversial, although longitudinal surveys have been conducted (Table). 1-9 Several mechanisms to lower increased BP caused by long-term smoking have been speculated. In animal experimental models, chronic nicotine exposure caused tolerance to the effect of nicotine on BP and decreased BP through vasodilating mediators and the relaxation of the vascular smooth muscle. 10-12 Lower body weight of smokers is another reason for lower BP.Other issues that may affect the results of the interaction between smoking and incident HT are the misclassification of smoking status according to the estimation of smoking status by self-reported questionnaires and the exposure to environmental tobacco smoke. Measurement of nicotine metabolites is one of the methods to avoid misclassification of smoking status.In this issue of the Journal, Kim et al 13 report on a lon-

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Association of a Tobacco-specific Nitrosamine Carcinogen with Urinary Cotinine, Urinary Sodium Excretion, and Total Energy Intake in Adolescents and Children

Choi

Fujii

2021

CURR MED SCI

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Association between cotinine-verified smoking status and hypertension in 167,868 Korean adults

Abstract: This large observational study showed that cotinine-verified current smoking and unobserved smoking were inversely associated with hypertension in Korean adults, especially only in men.

Cited by 37 publications

References 32 publications

Relationship Between Cotinine-Verified Smoking Status and Incidence of Hypertension in 74,743 Korean Adults

Relationship Between Cotinine-Verified Smoking Status and Incidence of Hypertension in 74,743 Korean Adults

Smoking and Incident Hypertension　― Importance of Cotinine-Verified Smoking Status ―

Association of a Tobacco-specific Nitrosamine Carcinogen with Urinary Cotinine, Urinary Sodium Excretion, and Total Energy Intake in Adolescents and Children

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Association between cotinine-verified smoking status and hypertension in 167,868 Korean adults

Abstract: This large observational study showed that cotinine-verified current smoking and unobserved smoking were inversely associated with hypertension in Korean adults, especially only in men.

Cited by 37 publications

References 32 publications

Relationship Between Cotinine-Verified Smoking Status and Incidence of Hypertension in 74,743 Korean Adults

Relationship Between Cotinine-Verified Smoking Status and Incidence of Hypertension in 74,743 Korean Adults

Smoking and Incident Hypertension ― Importance of Cotinine-Verified Smoking Status ―

Association of a Tobacco-specific Nitrosamine Carcinogen with Urinary Cotinine, Urinary Sodium Excretion, and Total Energy Intake in Adolescents and Children

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Smoking and Incident Hypertension　― Importance of Cotinine-Verified Smoking Status ―