Cigarette smoking is known to increase the risk of heart attacks and stroke.1,2 It raises blood pressure acutely, an effect that lasts 15 minutes or more.3 It damages the endothelial lining of the blood vessels over time causing vascular stiffening, inflammation, and the development of atherosclerotic plaque which leads to cardiovascular events.2,4 It is not clear if smoking increases the risk of hypertension. Some studies have shown a positive association between smoking and hypertension5,6 while others have failed to show an association.7,8 It is also unclear if quitting smoking will affect blood pressure.
Li et al examined the relationships between blood pressure and smoking and smoking cessation in a Chinese population.9 Blood pressure was found to be lower in current smokers compared to never smokers and former smokers. A random sample identified 1,248 adult men who had participated in the China National Health Survey and had not been taking antihypertensive medication at the time of the survey. History of tobacco use was determined by self-report. After adjusting for age, body mass index, alcohol use, and ethnicity, the authors found several significant differences in blood pressure measurements between current smokers and never smokers. The mean diastolic blood pressure in current smokers was significantly lower than in never smokers (78.35 +/- 10.73 mm Hg versus 79.65 +/-9.77 mm Hg; p < 0.05) and the mean arterial pressure was significantly lower among current smokers compared to never smokers (93.60 +/- 11.19 versus 95.04 +/- 10.19 mm Hg; p < 0.05). There was also a significant difference in mean systolic blood pressure between current smokers (124 +/- 14.41 mm Hg) and former smokers (126.52 +/- 13.30 mm Hg) (p<0.05).
Janzon et al studied Swedish women in a population based cohort over 3 to 15 years and ascertained weight, blood pressure, and smoking habits.10 The cohort began with 2,381 never-smokers and 1,550 smokers. At re-examination, 388 women had quit smoking. Over the follow-up period, weight gain was significantly higher in women who had quit smoking. The correlation coefficient between change in weight and change in systolic blood pressure for all subjects was r=0.16 (p<0.001). Systolic blood pressure increased significantly more among the women who had quit smoking, compared to those who had continued to smoke and those who had never smoked (20.9 ± 16.8, 19.1 ± 15.8, and 16.1 ± 16.3 mm Hg, respectively; p<0.001). The incidence of hypertension (160/95 mm Hg or higher or reported treatment) was also higher among women who had quit smoking (odds ratio [OR] 1.8, 95% confidence interval [CI] [1.4 – 2.5]) when compared with continuing smokers (OR 1.3, CI [1.07 – 1.6]).
Bartholomew and Knuiman studied the effects of smoking cessation on cardiovascular risk factors, including weight and blood pressure, in a community-based sample of 1,372 women and 888 men who participated in mass health screening in rural Australia.11 Blood pressure changes were measured at three and six year intervals after initiation in the study and results were compared among 235 people who had quit smoking, 1,499 never-smokers, and 526 people who continued to smoke. Quitting smoking was associated with more weight gain in both men and women compared to those who continued to smoke, but smoking cessation did not have a significant influence on blood pressure.
Pankova et al conducted a questionnaire survey that included information on smoking status in a representative sample of 2065 Czech adults as part of a study on healthy lifestyle.12 After adjusting for gender, age, body mass index and education, compared to non-smokers, the risk of being diagnosed with hypertension was not significantly different in smokers and former smokers (odds ratio [OR] 0.760, 95% CI 0.560 – 1.040 for smokers, p=0.082 and OR 1.020, 95% CI 0.720-1.390 for former smokers, p=0.915).
Smoking cessation has been shown to reduce the risk of cardiovascular disease. The amount of risk reduction depends on a number of factors including the duration and amount of smoking before quitting.13–15 The reduction in cardiac events ranges may be as high as 47%.14
- American Heart Association. Smoking, high blood pressure, and your health. http://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/smoking-high-blood-pressure-and-your-health. Accessed November 1, 2018.
- Virdis A, Giannarelli C, Neves MF, Taddei S, Ghiadoni L. Cigarette smoking and hypertension. Curr Pharm Des 2010; 16 (23): 2518-2525.
- Groppelli A, Giorgi DM, Omboni S, Parati G, Mancia G. Persistent blood pressure increase induced by heavy smoking. J Hypertens 1992; 10 (5): 495-499.
- Takami T, Saito Y. Effects of smoking cessation on central blood pressure and arterial stiffness. Vasc Health Risk Manag 2011; 7 (1): 633-638.
- Halperin RO, Michael Gaziano J, Sesso HD. Smoking and the risk of incident hypertension in middle-aged and older men. Am J Hypertens 2008; 21 (2): 148-152.
- Bowman TS, Gaziano JM, Buring JE, Sesso HD. A prospective study of cigarette smoking and risk of incident hypertension in women. J Am Coll Cardiol 2007; 50 (21): 2085-2092.
- Thuy AB, Blizzard L, Schmidt MD, Luc PH, Granger RH, Dwyer T. The association between smoking and hypertension in a population-based sample of Vietnamese men. J Hypertens 2010; 28 (2): 245-250.
- Li H, Tong W, Wang A, Lin Z, Zhang Y. Effects of cigarette smoking on blood pressure stratified by BMI in Mongolian population, China. Blood Press 2010; 19 (2): 92-97.
- Li G, Wang H, Wang K, et al. The association between smoking and blood pressure in men: A cross-sectional study. BMC Public Health 2017; 17 (1): 1-6.
- Janzon E, Hedblad B, Berglund G, Engström G. Changes in blood pressure and body weight following smoking cessation in women. J Intern Med 2004; 255 (2): 266-272.
- Bartholomew HC, Knuiman MW. Longitudinal analysis of the effect of smoking cessation on cardiovascular risk factors in a community sample: the Busselton Study. J Cardiovasc Risk 1998; 5 (4): 263-271.
- Pankova A, Kralikova E, Fraser K, Lajka J, Svacina S, Matoulek M. No difference in hypertension prevalence in smokers , former smokers and non-smokers after adjusting for body mass index and age : a cross-sectional study from the Czech Republic , 2010. Tob Induc Dis 2015.
- Multiple risk factor intervention trial. Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA 1982; 248 (12): 1465-1477.
- Hjermann I, Velve Byre K, Holme I, Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet 1981; 2 (8259): 1303-1310.
- Hurt RD, Weston SA, Ebbert JO, et al. Myocardial infarction and sudden cardiac death in Olmsted County, Minnesota, before and after smoke-free workplace laws. Arch Intern Med 2012; 172 (21): 1635-1641.