European Journal of Cardiovascular Medicine

Smoking is a well-established and independent risk factor for the development of coronary heart disease. Hypertension has been identified as the foremost contributor to the global burden of disease, accounting for approximately 9.4 million deaths worldwide in 2010 (1). Elevated blood pressure significantly increases the risk of major cardiovascular and renal complications, including stroke, ischemic heart disease, and kidney failure. It has been estimated that hypertension is responsible for nearly 51% of stroke-related deaths and 45% of deaths attributable to heart disease (2). The adverse cardiovascular effects of smoking are influenced by both the frequency and duration of tobacco consumption (3). Epidemiological evidence suggests that men below 65 years of age who smoke around 25 cigarettes per day have a substantially higher risk of developing coronary artery disease compared to non-smokers. However, the relationship between cigarette smoking and blood pressure remains controversial, as previous studies have reported conflicting findings—some demonstrating a positive association (4,5), while others have observed an inverse relationship (6). In view of these inconsistencies, the present study was undertaken to evaluate the association between cigarette smoking and blood pressure among apparently healthy individuals

This was a prospective case control study conducted at Department of Physiology, Govt. Medical College & Civil Hospital. A total of 60 participants were enrolled in the study. The case group comprised apparently healthy individuals aged between 21 and 60 years who were current smokers. The control group consisted of age- and sex-matched non-smokers. Participants were selected from among students and staff of the institute, and attendants of patients visiting outpatient departments at the hospital. The study protocol was conducted in accordance with ethical guidelines, and prior approval was obtained from the Institutional Ethics Committee (Human). Written informed consent was obtained from all eligible participants before inclusion in the study. A detailed medical history was elicited, and a thorough physical examination was performed for each subject. All findings were documented using a predesigned proforma. Individuals with a known history of cardiorespiratory disorders, any chronic systemic illness, or current alcohol consumption were excluded from the study. Information regarding smoking habits and past medical history was specifically recorded to rule out the presence of chronic diseases. Based on daily tobacco consumption, smokers were classified into three categories (7): mild smokers (1–10 cigarettes or 1–15 bidis per day), moderate smokers (11–20 cigarettes or 16–30 bidis per day), and heavy smokers (≥21 cigarettes or ≥31 bidis per day). Blood pressure (BP) measurements were taken from each patient's right arm in the seated position by using mercury sphygmanometer . Statistical Analysis : The results were tabulated and T-test statistical analyses were performed to find the association between blood pressure and cigarette smoking. The level P < 0.05 was considered as the cutoff value or significance.

Table.1:  Demographic profile age wise and sex wise distribution in both groups (n=30)

Table.2 : Blood pressure indices of the study population.

Chart 1: Comparison of data between smokers and nonsmoker groups

SBP: Systolic BP ; DBP: Diastolic BP ; PP: Pulse Pressure ; MBP : Mean BP

In the present study, a total of 1248 individuals were included in the analysis, the mean age was 40 ± 9.00 years. There is statistically significant difference in both groups. he people in non smoker group were younger as compared to smokers. Gender distribution pattern amongst male and female is also statistically significant in both groups (p<0.05), the nonsmoker group has more females as compared to smoker group.(table 1). The systolic blood pressure, diastolic blood pressure and mean arterial pressure was significantly high among smokers as compared to non smokers (Table-2).

This case control observational study done at a tertiary care hospital, total 60 people were enrolled for study; who were asymptomatic for cardiovascular illness. Their average age was 40.6 ± 9.6 years and 41 (68.3%) were male and remaining 19 (31.66%) were females, then divided according to their smoking status. mean age of smokers (both male and female included) was 40.6 ± 9.6 years as against that mean age of non-smokers was40.73 ± 9.13 years. In our study we found that systolic BP, Diastolic BP and mean BP were more in smoker group compare to non smoker group which was statistically significant. In study of Shah and prajapati found that Systolic BP , Diastolic BP were high in Tobacco Consumer than non consumers.(8) Mahmud and Feely, Kim et al. reported increased systolic blood pressure in smokers were similar to our findings(9). The rise in blood pressure is due both to an increase in cardiac output and total peripheral vascular resistance. The blood pressure rise appears immediately and occurs before any increase in circulating catecholamines (10) .Many studies show that BP gets paradoxically reduced while smoking but long-term use causes hypertension(11). It is also found in many studies that risk of development of cardiovascular disease is related to number of cigarettes smoked(12). Studies indicated that elevated nicotine mediated an increase of sympathetic nervous system activities and released of epinephrine, norepinephrine and vasopressin hormones (13-15).

The present study demonstrates a clear association between cigarette smoking and elevated blood pressure parameters in healthy individuals. Smokers showed notably higher systolic, diastolic, and mean arterial pressures compared with non-smokers. These results emphasize the importance of regular cardiovascular evaluation and offering smoking-cessation guidance, even for younger adults who smoke.

1.             Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–60.

2.             WHO. A Global Brief on Hypertension: Silent Killer, Global Public Health Crisis; World Health Day 2013. Geneva: WHO; 2013. p. 1–39.

3.             Sugiishi M, Takatsu F. Cigarette smoking is a major risk factor for coronary spasm. Circulation 1993;87:76–9

4.             Singh A, Ladusingh L. Prevalence and determinants of tobacco use in India: evidence from recent Global Adult Tobacco Survey data. PLoS One. 2014;9:e114073

5.             Halperin RO, Gaziano JM, Sesso HD. Smoking and the risk of incident hypertension in middle-aged and older men. Am J Hypertens. 2008;21(2):148–52.

6.             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):245–50.

7.             Rastogi R, Shrivastava SS, Mehrotra TN, Singh VS, Gupta MK. Lipid profile in smokers. J Assoc Physicians India 1989; 37: 764-6.

8.             Shah H, Prajapati T. Effects of Tobacco Consumption on Aerobic Fitness in Indian Adult Men. Int J Clin Exp Physiol. 2022;9(1):41-4.

9.             Mahmud A, Feely J. Effect of smoking on arterial stiffness and pulse pressure amplification. Hypertension. 2003;41(1):183-7. doi 10.1161/01. hyp.0000047464.66901.60, PMID 12511550.

10.          Primatesta P, Falaschetti E, Gupta S, Marmot MG, Poulter NR. Association between smoking and blood pressure: evidence from the Health Survey for England. Hypertension. 2001;37(2):187–93.

11.          Omvik P. How smoking affects blood pressure. Blood Press. 1996;5(2):71–7.

12.          Burns DM. Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis. 2003;46(1):11–29.

13.          Cryer PE, Haymond MW, Santiago JV, Shah SD. Norepinephrine and epinephrine release and adrenergic mediation of smoking-associated hemodynamic and metabolic events. N Engl J Med. 1976;295(11):573–7.

14.          Narkiewicz K, van de Borne PJ, Hausberg M, Cooley RL, Winniford MD, Davison DE, Somers VK. Cigarette smoking increases sympathetic outflow in humans. Circulation. 1998;98(6):528–34.

15.          Waeber B, Schaller MD, Nussberger J, Bussien JP, Hofbauer KG, Brunner HR. Skin blood flow and cigarette smoking: the role of vasopressin. Clin Exp Hypertens A. 1984;6(10–11):2003–6.