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CLINICAL RESEARCH: HYPERTENSION

A Prospective Study of Cigarette Smoking and Risk of Incident Hypertension in Women

Thomas S. Bowman, MD, MPH^_*,,_*, J. Michael Gaziano, MD, MPH^_*,,, Julie E. Buring, ScD^,,,¶ and Howard D. Sesso, ScD, MPH^,,

^_* Veterans Affairs Boston Healthcare System, Massachusetts Veterans Affairs Epidemiology, Research, and Information Center, Boston, Massachusetts
Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
^¶ Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, Massachusetts

Manuscript received March 23, 2007; revised manuscript received August 17, 2007, accepted August 20, 2007.

^_* Reprint requests and correspondence: Dr. Thomas S. Bowman, Division of Aging, Brigham and Women's Hospital, 1620 Tremont Street, Boston, Massachusetts 02120. (Email: tsbowman{at}partners.org).

Objectives: We undertook this study to prospectively evaluate whether cigarette smoking was associated with an increased risk of developing hypertension.

Background: Smoking is a well-recognized risk factor for cardiovascular disease. Few prospective cohort studies have examined the relationship between smoking and hypertension.

Methods: We conducted a prospective cohort study among 28,236 women in the Women's Health Study who were initially free of hypertension, cardiovascular disease, and cancer. Detailed risk factor information, including smoking status, was collected from self-reported questionnaires. We used Cox proportional hazards survival models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension (defined as either new diagnosis, the initiation of antihypertensive medication, systolic blood pressure 140 mm Hg or diastolic blood pressure 90 mm Hg).

Results: At baseline, 51% of women were never smokers, 36% were former smokers, 5% smoked 1 to 14 cigarettes, and 8% smoked 15 cigarettes per day. During a median of 9.8 years, there were 8,571 (30.4%) cases of incident hypertension. The age-adjusted HRs of developing hypertension among never, former, and current smokers of 1 to 14 and 15 cigarettes per day were 1.00 (reference), 1.04 (95% CI 0.99 to 1.09), 1.00 (95% CI 0.90 to 1.10), and 1.10 (95% CI 1.01 to 1.19), respectively. In multivariable models further adjusting for lifestyle, clinical, and dietary variables, the corresponding HRs were 1.00 (reference), 1.03 (95% CI 0.98 to 1.08), 1.02 (95% CI 0.92 to 1.13), and 1.11 (95% CI 1.03 to 1.21), respectively. Among women who smoked 25 cigarettes per day, the multivariable HR was 1.21 (95% CI 1.06 to 1.39).

Conclusions: In this large cohort of women, cigarette smoking was modestly associated with an increased risk of developing hypertension, with an effect that was strongest among women smoking at least 15 cigarettes per day.

Abbreviations and Acronyms   BMI = body mass index   BP = blood pressure   CI = confidence interval   CVD = cardiovascular disease   DBP = diastolic blood pressure   HR = hazard ratio   MI = myocardial infarction   SBP = systolic blood pressure   WHO = World Health Organization

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