Cigarette Smoking and Longitudinal Associations With Blood Pressure: The CARDIA Study

Abstract

Background The associations of chronic cigarette smoking with blood pressure (BP) remain mixed. It is unclear whether a lack of examination of racial differences contributed to the mixed findings in previous studies. Black smokers metabolize nicotine at a slower rate than White smokers and racial discrimination contributes to nicotine dependence and higher BP among Black smokers. Methods and Results We studied the association between cigarette smoking and longitudinal (30‐year) changes in systolic BP, diastolic BP, and pulse pressure (PP) in 4786 Black and White individuals from the CARDIA (Coronary Artery Risk Development in Young Adults) study using repeated‐measures regression models. Neither systolic BP, nor diastolic BP differed between Black consistent smokers compared with Black never smokers, although Black consistent smokers had higher PP than Black never smokers (β=1.01 mm Hg, P =0.028). White consistent smokers had similar systolic BP, but lower diastolic BP (β=−2.27 mm Hg, P <0.001) and higher PP (β=1.59 mm Hg, P <0.001) compared with White never smokers. There were no differences in systolic BP, diastolic BP, or PP between Black or White long‐term former smokers compared with never smokers (all P >0.05). Conclusions Although the associations of cigarette smoking with alterations in BP are small, the greater PP observed in consistent smokers may contribute in part to the higher cardiovascular disease risk observed in this group because PP is a strong predictor of cardiovascular disease risk after middle age.

Effects of smoking intensity trajectory, cumulative smoking exposure, and the number of years since quitting on the subsequent risk of hypertension

“…In line with the findings of the current study, a previous study found that the effect of smoking on increased aortic stiffness was reversible after smoking cessation 28 . The CARDIA longitudinal study pointed out that systolic BP and diastolic BP did not differ between long‐term former smokers and never smokers 29 . However, a 4‐year follow‐up study in Korean men reported that smoking cessation results in hypertension 30 .…”

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“…Indeed, women who smoked cigarettes had significantly lower BP than non-smoking women, by, on average, 2.8 mm and 2.2 mm for SBP and DBP respectively. While smoking is a major risk factor for cardiovascular disease the association with increased BP is still unclear [34]. Our findings for men and women are consistent with many epidemiological studies showing that BP is either lower or the same in smokers as in nonsmokers, the average difference being about 2-8 mm Hg for systolic pressure and 1-5 mm Hg for diastolic [35].…”

“…The Health Survey for England [17] found no significant difference in BP of male smokers aged 16-44 years compared to non-smokers, but in other national studies of men, notably in China and Japan, lower BP was found [20,36]. A longitudinal study in the U.S. with a 30-year follow-up did not find a significant increase in SBP or DBP over time in male or female smokers, and white women smokers had lower DBP [34]. Studies in the UK, Sweden, Israel, and China [17,22,37,38] have also found a lower BP in women current smokers compared to non-smokers, consistent with our findings, and a longitudinal study risk of incident hypertension in women conducted in the U.S. found cigarette smoking does not significantly increase the risk of incident hypertension in women smoking up to 15 cigarettes per day [15].…”

Likelihood-based Mendelian randomization analysis with automated instrument selection and horizontal pleiotropic modeling

“…However, multiple subsequent MR studies on large datasets did not support a causal relationship between the two traits ( 48 , 51 ). The association between smoking and blood pressure in observational studies is likely confounded by factors that include, but not limited to, age, BMI, social class, salt intake, drinking habits, and unmeasured confounders ( 52 ). Consistent with these previous MR studies, MRAID did not detect a significant causal effect from any of the eight smoking related traits on either systolic blood pressure (SBP) or diastolic blood pressure (DBP).…”