Does cigarette smoking exacerbate the effect of blood pressure on the risk of cardiovascular and all-cause mortality among hypertensive patients?

Ge, Zhen; Hao, Yongchen; Cao, Jie; Li, Jianxin; Chen, Jichun; Huang, Jianfeng; Wu, Xigui; Gu, Dongfeng

doi:10.1097/hjh.0b013e328359aa1f

Cited by 14 publications

(12 citation statements)

References 35 publications

(51 reference statements)

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“…A large cohort found that there existed a combined interaction on an additive scale between current smoking and high SBP (140 mmHg) for the risk of IHD in the female adult Chinese population [ 14 ]. The significant relationship between blood pressure and CVD mortality, and the joint effects of smoking and blood pressure observed in our study were in agreement with previous studies [ 15 , 16 ]. The effect size was also similar compared with previous studies on the Chinese population, but was lower than studies on Western populations, which could be due to different smoking exposure doses or the profiles of lipid levels [ 17 , 18 , 19 ].…”

Section: Discussionsupporting

confidence: 94%

“…To evaluate the effect of different confounding factors, we used three models to assess the association between blood pressure and mortality from all-cause, CVD, ischemic heart disease (IHD), and stroke. Variables and covariates for inclusion in the models were based on several previous studies, as well as the authors’ interest [ 14 , 15 ]. In model one, we only adjusted ages at entry.…”

Section: Methodsmentioning

confidence: 99%

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Smoking, Blood Pressure, and Cardiovascular Disease Mortality in a Large Cohort of Chinese Men with 15 Years Follow-up

Tan

Zhang

Yin

et al. 2018

IJERPH

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Background: To examine the joint effects of smoking and blood pressure on the risk of mortality from cardiovascular disease (CVD) in a cohort of Chinese men. Methods: This study followed a cohort of 213,221 men over 40 years of age who were recruited from 45 district/counties across China between 1990–1991, and whose cause-specific mortality was examined for 15 years, up to 31 December 2005. We calculated hazard ratios for all-cause mortality and CVD, ischemic heart disease (IHD), and stroke mortality for the combined sets of smoking status and blood pressure levels using the Cox proportional hazard model, adjusting for potential individual-level and contextual-level risk factors. Results: During the 15 years of follow-up, 52,795 deaths occurred, including 18,833 deaths from CVD, 3744 deaths from IHD, and 11,288 deaths from stroke. The risk of mortality from CVD, IHD, and stroke increased significantly, with increased systolic blood pressure (SBP), diastolic blood pressure (DBP), and with more pack years of smoking. Compared with never-smokers with normal blood pressure, the hazard ratios and 95% CI of CVD, IHD, and stroke mortality for those who smoked over 20 pack years with hypertension were remarkably increased to 2.30 (95% CI: 2.12–2.50), 1.78 (95% CI: 1.48–2.14), and 2.74 (95% CI: 2.45–3.07), respectively. Conclusion: There was a combined effect on the risk of CVD, IHD, and stroke mortality between smoking and hypertension. The joint efforts on smoking cessation and lowered blood pressure should be made to prevent cardiovascular disease mortality in Chinese men.

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Section: Discussionsupporting

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Smoking, Blood Pressure, and Cardiovascular Disease Mortality in a Large Cohort of Chinese Men with 15 Years Follow-up

Tan

Zhang

Yin

et al. 2018

IJERPH

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“…Smoking did however confer the greatest increase in risk for IHD-hospitalisation in our study (after antihypertensive and lipid-lowering medication use) and interestingly, results suggested the risk might be attenuated somewhat by the use of antihypertensive and/or lipid-lowering medications. Synergistic effects between smoking and hypertension in CVD incidence have been reported previously [21]. Normalisation of blood pressure through medication use in current smokers could therefore explain the drop in risk to non-significant levels in our study.…”

Section: Discussionsupporting

confidence: 78%

Lifestyle Factors, Medication Use and Risk for Ischaemic Heart Disease Hospitalisation: A Longitudinal Population-Based Study

et al. 2013

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BackgroundLifestyle factors have been implicated in ischaemic heart disease (IHD) development however a limited number of longitudinal studies report results stratified by cardio-protective medication use.PurposeThis study investigated the influence of self-reported lifestyle factors on hospitalisation for IHD, stratified by blood pressure and/or lipid-lowering therapy.MethodsA population-based cohort of 14,890 participants aged 45+ years and IHD-free was identified from the Western Australian Health and wellbeing Surveillance System (2004 to 2010 inclusive), and linked with hospital administrative data. Adjusted hazard ratios for future IHD-hospitalisation were estimated using Cox regression.ResultsCurrent smokers remained at higher risk for IHD-hospitalisation (adjusted HR=1.57; 95% CI: 1.22-2.03) after adjustment for medication use, as did those considered overweight (BMI=25-29 kg/m2; adjusted HR=1.28; 95% CI: 1.04-1.57) or obese (BMI of ≥30kg/m2; adjusted HR=1.31; 95% CI: 1.03-1.66). Weekly leisure-time physical activity (LTPA) of 150 minutes or more and daily intake of 3 or more fruit/vegetable servings reduced risk by 21% (95% CI: 0.64-0.97) and 26% (95% CI: 0.58-0.96) respectively. Benefits of LTPA appeared greatest in those on blood pressure lowering medication (adjusted HR=0.50; 95% CI: 0.31-0.82 [for LTPA<150 mins], adjusted HR=0.64; 95% CI: 0.42-0.96 [for LTPA>=150 mins]). IHD risk in smokers was most pronounced in those taking neither medication (adjusted HR=2.00; 95% CI: 1.41-2.83).ConclusionThis study confirms the contribution of previously reported lifestyle factors towards IHD hospitalisation, even after adjustment for antihypertensive and lipid-lowering medication use. Medication stratified results suggest that IHD risks related to LTPA and smoking may differ according to medication use.

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“…Carotid intima-media thickness (CIMT) measured by ultrasound is widely used as a valid noninvasive measurement for subclinical atherosclerotic diseases, and is linked to the presence, extent, and development of atherosclerosis[21]–[24]_ENREF_18. Few studies have examined whether the association of age and metabolic syndrome with CIMT is modified by the status of cigarette smoking[13]. In the current study, we tested the hypothesis that cigarette smoking exacerbates the effects of age and metabolic syndrome on CIMT in a community-based sample of young adults from the Bogalusa Heart Study.…”

Section: Introductionmentioning

confidence: 98%

Cigarette Smoking Exacerbates the Adverse Effects of Age and Metabolic Syndrome on Subclinical Atherosclerosis: The Bogalusa Heart Study

Fernandez

et al. 2014

PLoS ONE

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Age and metabolic syndrome are major risk factors for atherosclerosis. However, limited information is available regarding whether cigarette smoking, another major, modifiable risk factor, has synergistic effects with age and metabolic syndrome on subclinical atherosclerosis, particularly in young adults. This aspect was examined in 1,051 adults (747 whites and 304 blacks; aged 24–43 years) from the Bogalusa Heart Study. General linear models were used to examine the effects of cigarette smoking and its interactive effects with age and metabolic syndrome on carotid intima-media thickness (CIMT). After adjusting for age, race, and sex, current smokers had lower BMI (mean±SE: 27.4±0.4, 29.3±0.5, and 29.9±0.3 kg/m2 in current, former, and never smokers, respectively; p<0.0001) and lower levels of fasting glucose (82.8±0.9, 89.5±2.3, and 87.1±1.1 mg/dL, respectively; p = 0.001) and insulin (10.6±0.4, 14.2±1.0, 13.6±0. 6 µU/ml, respectively; p<0.0001). Despite being lean and having favorable levels of glucose and insulin, current smokers had greater CIMT (0.850±0.012, 0.808±0.011, and 0.801±0.006 mm, respectively; p = 0.0004). Importantly, cigarette smoking showed significant interactions with age and metabolic syndrome on CIMT: Age-related change in CIMT in current smokers was significantly greater (0.013±0.002 mm/year) than in nonsmokers (former and never smokers combined) (0.008±0.001 mm/year) (p for interaction = 0.005); the difference in CIMT between those with and without metabolic syndrome was significantly greater in current smokers (0.154±0.030 mm, p<0.0001) than in nonsmokers (0.031±0.014 mm, p = 0.03) (p for interaction<0.0001). In conclusion, cigarette smoking significantly exacerbates the adverse effects of age and metabolic syndrome on subclinical atherosclerosis in young adults, which underscores the importance of prevention and cessation of cigarette smoking behavior in the young.

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Does cigarette smoking exacerbate the effect of blood pressure on the risk of cardiovascular and all-cause mortality among hypertensive patients?

Cited by 14 publications

References 35 publications

Smoking, Blood Pressure, and Cardiovascular Disease Mortality in a Large Cohort of Chinese Men with 15 Years Follow-up

Smoking, Blood Pressure, and Cardiovascular Disease Mortality in a Large Cohort of Chinese Men with 15 Years Follow-up

Lifestyle Factors, Medication Use and Risk for Ischaemic Heart Disease Hospitalisation: A Longitudinal Population-Based Study

Cigarette Smoking Exacerbates the Adverse Effects of Age and Metabolic Syndrome on Subclinical Atherosclerosis: The Bogalusa Heart Study

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