Cigarette Smoking and Subtypes of Uncontrolled Blood Pressure Among Diagnosed Hypertensive Patients: Paradoxical Associations and Implications

Cardiometabolic Profile in Young Adults With Diverse Cigarette Smoking Histories: A Longitudinal Study From Adolescence

BACKGROUND

For the first time, the present study investigated smoking trajectory and cardiometabolic profile from adolescence to young adulthood in a middle-income developing country facing a high prevalence of smoking and cardiovascular disease-related outcomes.

METHODS AND RESULTS

Data on 1082 adolescents (12-18 years of age) who participated in the TLGS (Tehran Lipid and Glucose Study) were gathered, and participants were followed for a median of 12.5 years (baseline: 1999-2002, last follow-up: 2014-2017). Participants were categorized as non/rare smokers, experimenters, and escalators using group-based trajectory models. Statistical analysis was used to compare the trajectory groups' cardiometabolic components, clinical characteristics, and cardiometabolic changes due to the individuals' placement in experimenter and escalator groups compared with non/rare smokers. The smoking trajectory groups in young adulthood differ significantly in blood pressure, triglycerides, high-density lipoprotein cholesterol, waist circumference, and body mass index, with the escalator group having the highest risk values for each component. Significant differences were observed in blood pressure (P=0.014), triglycerides (P<0.001), and waist circumference (P<0.001) status after using clinical cut points. The adjusted linear regression revealed that the escalator group had 3.16 mm Hg-lower systolic blood pressure SBP (P=0.016), 2.69 mm Hg-lower diastolic blood pressure (P=0.011), and 4.42 mg/dL-lower high-density lipoprotein cholesterol (P=0.002), compared with the non/rare smoker group.

CONCLUSIONS

Despite elevated risks in unadjusted analyses for all cardiometabolic components among smokers, our study identified a modest protective link between early smoking and blood pressure in addition to a remarkable harmful association with high-density lipoprotein cholesterol levels exclusively in the escalator group during the developmental stage to young adulthood, using adjusted analyses.

Exposure to Volatile Organic Compounds Is Associated with Hypertension in Black Adults: The Jackson Heart Study

BACKGROUND

The prevalence of hypertension is higher among Black adults than among White and Hispanic adults. Nevertheless, reasons underlying the higher rates of hypertension in the Black population remain unclear but may relate to exposure to environmental chemicals such as volatile organic compounds (VOCs).

METHODS

We evaluated the associations of blood pressure (BP) and hypertension with VOC exposure in non-smokers and smokers in a subgroup of the Jackson Heart Study (JHS), consisting of 778 never smokers and 416 age- and sex-matched current smokers. We measured urinary metabolites of 17 VOCs by mass spectrometry.

RESULTS

After adjusting for covariates, we found that amoong non-smokers, metabolites of acrolein and crotonaldehyde were associated with a 1.6 mm Hg (95%CI: 0.4, 2.7; p = 0.007) and a 0.8 mm Hg (95%CI: 0.01, 1.6; p = 0.049) higher systolic BP, and the styrene metabolite was associated with a 0.4 mm Hg (95%CI: 0.09, 0.8, p = 0.02) higher diastolic BP. Current smokers had 2.8 mm Hg (95% CI 0.5, 5.1) higher systolic BP. They were at higher risk of hypertension (relative risk = 1.2; 95% CI, 1.1, 1.4), and had higher urinary levels of several VOC metabolites. Individuals who smoke had higher levels of the urinary metabolites of acrolein, 1,3-butadiene, and crotonaldehyde and were associated with higher systolic BP. The associations were stronger among participants who were <60 years of age and male. Using Bayesian kernel machine regression to assess the effects of multiple VOC exposures, we found that the relationship between VOCs and hypertension among non-smokers was driven primarily by acrolein and styrene in non-smokers, and crotonaldehyde in smokers.

CONCLUSIONS

Hypertension in Black individuals may be attributed, in part, to VOC exposure from the environment or tobacco smoke.

Smoking cessation and obesity-related morbidities and mortality in a 20-year follow-up study

BACKGROUND

Smoking is the biggest preventable factor causing mortality and morbidity and the health benefits of smoking cessation are commonly known. Smoking cessation-related weight gain is well documented. We evaluated the association between smoking cessation and the incidence of obesity-related morbidities such as hypertension, diabetes and metabolic syndrome as well as mortality. We also evaluated telomere length related to smoking cessation.

MATERIAL AND METHODS

This study was part of the OPERA (Oulu Project Elucidating Risk of Atherosclerosis) study. The mean follow up time among the 600 study subjects was 20 years. We divided the study subjects into four groups by smoking status ("never", "current", "ex-smokers" and "quit") and analyzed their health status. "Ex-smokers" had quit smoking before baseline and "quit" quit during the follow-up time. Information about total mortality between the years 2013-2020 was also utilized.

RESULTS

During the follow-up time systolic blood pressure decreased the most in the "current" and in the "ex-smoker" groups. Office SBP decreased the least in the "quit" group (p = 0.001). BMI increased the most in the "quit" and the least in the "ex-smokers" group (p = 0.001). No significant increases were seen in the incidence of obesity-related-diseases, such as metabolic syndrome, hypertension and diabetes was seen. There was no significant difference in the shortening of telomeres. Odds of short-term mortality was increased in the "current" group (2.43 (CI 95% 1.10; 5.39)), but not in the "quit" (1.43 (CI 95% 0.73-2.80)) or "ex-smoker" (1.02 (CI 95% 0.56-1.86)) groups when compared to "never" group.

CONCLUSIONS

Even though, the blood pressure levels were unfavorable in the "quit" group, there was no significant increase in the incidence of obesity-related-diseases, and a noticeable benefit in short-term mortality was seen during the 6-year follow-up. The benefits of smoking cessation outweigh the disadvantages in the long-term.

The role of smoking cessation programs in lowering blood pressure: A retrospective cohort study

INTRODUCTION

Cigarette smoking affects blood pressure and is a major risk factor for cardiovascular diseases. The role of smoking cessation programs with respect to blood pressure remains inconclusive. Thus, this study aimed to investigate the effects of a smoking cessation program on blood pressure.

METHODS

Participants who attended the smoking cessation program in an outpatient clinic of a tertiary medical center in Taiwan from 2017 to 2018 were enrolled in this retrospective cohort study. Their smoking cessation status was traced via phone calls during the third month, and the researchers collected participant characteristics and blood pressure before and after the program. Differences in the participants’ blood pressure, based on those with and those without hypertension, were compared using analysis of covariance. Univariable logistic regression models were used to determine factors associated with success in smoking cessation. In total, there were 721 participants. The participants had a mean age of 55.8±11.4 years and 68.1% of the participants were hypertensive.

RESULTS

During the program, the overall systolic blood pressure decreased by 4.0±17.9 mmHg and diastolic blood pressure decreased by 2.5±12.0 mmHg, from the baseline. Hypertensive participants showed a more prominent blood pressure lowering effect compared to non-hypertensive participants in terms of the subtraction difference of systolic blood pressure (-5.0±19.0 vs -1.9±15.2 mmHg, p=0.018) and diastolic blood pressure (-3.1±12.9 vs -1.1±9.6 mmHg, p=0.016). After multivariate control, the results showed that the adjusted subtraction difference of diastolic blood pressure was still more significant in the hypertensive group than in the non-hypertensive group.

CONCLUSIONS

The smoking cessation program significantly reduced both systolic blood pressure and diastolic blood pressure in the entire cohort. The results were more significant in the hypertensive group compared to the non-hypertensive group.

Resistance to antihypertensive treatment and long-term risk: The Atherosclerosis Risk in Communities study

More stringent blood pressure (BP) goals have led to greater prevalence of apparent resistant hypertension (ARH), yet the long‐term prognostic impact of ARH diagnosed according to these goals in the general population remains unknown. We assessed the prognostic impact of ARH according to contemporary BP goals in 9612 participants of the Atherosclerosis Risk in Communities (ARIC) study without previous cardiovascular disease. ARH, defined as BP above goal (traditional goal <140/90 mmHg, more stringent goal <130/80 mmHg) despite the use of ≥3 antihypertensive drug classes or any BP with ≥4 antihypertensive drug classes (one of which was required to be a diuretic) was compared with controlled hypertension (BP at goal with 1‐3 antihypertensive drug classes). Cox regression models were adjusted for age, sex, race, study center, BMI, heart rate, smoking, eGFR, LDL, HDL, triglycerides, and diabetes. Using the traditional BP goal, 133 participants (3.8% of the treated) had ARH. If the more stringent BP goal was instead applied, 785 participants (22.6% of the treated) were reclassified from controlled hypertension to uncontrolled hypertension (n = 725) or to ARH (n = 60). Over a median follow‐up time of 19 years, ARH was associated with increased risk for a composite end point (all‐cause mortality, hospitalization for myocardial infarction, stroke, or heart failure) regardless of whether traditional (adjusted HR 1.50, 95% CI: 1.23‐1.82) or more stringent (adjusted HR 1.43, 95% CI: 1.20‐1.70) blood pressure goals were applied. We conclude that in patients free from cardiovascular disease, ARH predicted long‐term risk regardless of whether traditional or more stringent BP criteria were applied.

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

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.

The Interdependence of Blood Pressure and Glucose in Vietnam

INTRODUCTION

Modelling of associations of systolic blood pressure (BP) and blood glucose (BG) with their explanatory factors in separate regressions treats them as having independent biological mechanisms. This can lead to statistical inferences that are unreliable because the substantial overlap in their etiologic and disease mechanisms is ignored.

AIM

This study aimed to examine the relationship of systolic blood pressure (BP) and blood glucose (BG) with measures of obesity and central fat distribution and other factors whilst taking account of the inter-dependence between them.

METHODS

Participants (n = 14706, 53.5 % females) aged 25-64 years were selected by multi-stage stratified cluster sampling from eight provinces each representing one of the eight geographical regions of Vietnam. Measurements were made using the World Health Organization STEPS protocols.

RESULTS

Structural modelling identified direct effects for BG (men P = 0.000, women P = 0.029), age (men P = 0.000, women P = 0.000) and body mass index (BMI) (men P = 0.000, women P = 0.000) in the estimation of systolic BP, and for systolic BP (men P = 0.036, women P = 0.000) and waist circumference (WC) (men P = 0.032, women P = 0.009) in the estimation of BG. There were indirect effects of age, cholesterol, physical activity and tobacco smoking via their influence on WC and BMI. The errors in estimation of systolic BP and BG were correlated (men P = 0.000, women P = 0.004), the stability indices (men 0.466, women 0.495) showed the non-recursive models were stable, and the proportion of variance explained was mid-range (men 0.553, women 0.579).

CONCLUSION

This study provided statistical evidence of a feedback loop between systolic BP and BG. BMI and WC were confirmed to be their primary explanatory factors. Saturated fat intake and physical activity were identified as possible targets of intervention for overweight and obesity, and indirectly for reducing systolic BP and BG. Harmful/hazardous alcohol intake was identified as a target of intervention for systolic BP.

Characterizing Patients with Uncontrolled Blood Pressure at an Urban Hospital in Hanoi, Vietnam

Great efforts to advance the diagnosis and treatment of hypertension for controlling hypertension have been made; however, the rates of uncontrolled blood pressure are still high. This study explored the rate of uncontrolled hypertension in patients with hypertension managed in an urban hospital of Vietnam and identified associated factors. A cross-sectional survey was performed from August to October 2019 among hypertensive patients at an urban hospital in Hanoi, Vietnam. Blood pressure was evaluated at the time of medical examination. Demographic, clinical, and behavioral characteristics were also collected. Multivariate logistic regression was used to identify the factors related to uncontrolled hypertension. Among 220 patients, the rate of uncontrolled hypertension was 40.5%. Females had a lower likelihood of having uncontrolled hypertension compared to males (adjusted OR = 0.33; 95% CI = 0.11–0.98). Higher duration of diseases (adjusted OR = 1.07; 95% CI = 1.01–1.14) and higher body mass index (adjusted OR = 1.23; 95% CI = 1.05–1.45) were positively associated with uncontrolled hypertension. Patients who carried supplies needed for self-care, cut down on stress, exercised regularly, and stopped/cut down on smoking were also less likely to develop uncontrolled hypertension. This study reveals that uncontrolled hypertension was common among hypertensive patients in Vietnam. Improving self-care capacity and encouraging healthy behaviors are critically important to control blood pressure, particularly among patients who were males and had high disease duration and body mass index.

Control of blood pressure levels in patients with premature coronary artery disease: Results from the Genetics of Atherosclerotic Disease study

High blood pressure (BP) is the major cardiovascular-risk factor for coronary artery disease (CAD), principally in young patients who have an important and increasing socioeconomic burden. Despite the Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), recommended BP target <140/90 mm Hg for patients with stable CAD, in 2017 the American College of Cardiology and the American Heart Association (ACC/AHA) updated BP target to <130/80 mm Hg. We aimed to analyze the prevalence of BP control in patients with premature CAD using both criteria. In addition, antihypertensive therapy, lifestyle, clinical, and sociodemographic characteristics of the patients were evaluated in order to identify factors associated with the achievement of BP targets. The present study included 1206 patients with CAD diagnosed before 55 and 65 years old in men and women, respectively. Sociodemographic, clinical, and biochemical data were collected. The results indicate that 85.6% and 77.5% of subjects with premature CAD achieved JNC-7 non-strict and ACC/AHA strict BP target, respectively. Consistently, number of antihypertensive drugs and hypertension duration >10 years were inversely associated with BP targets, whereas total physical activity and smoking were directly associated with BP targets, regardless of BP criteria. Considering that age, gender, and hypertension duration are non-modifiable cardiovascular-risk factors, our results highlight the need for more effective strategies focused on increase physical activity and smoking cessation in young patients with CAD. These healthier lifestyles changes should favor the BP target achievement and reduce the socioeconomic and clinical burden of premature CAD.

The Paradox Association between Smoking and Blood Pressure among Half Million Chinese People

Background: The association between smoking and blood pressure (BP) has been explored extensively, yet the results remain inconclusive. Using real-world evidence of a large Chinese population, we examine the effect of smoking on BP levels. Methods: We utilize half a million adults from the China Kadoorie Biobank (CKB) study with baseline sampling collected between 2004 and 2008. Multivariable linear regression analyses are used to estimate linear regression coefficients of smoking for systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: 459,815 participants (180,236 males and 279,579 females) are included in the analysis. Regular smoking is significantly associated with lower SBP (-0.57 mm Hg, p < 0.001) and DBP (-0.35 mm Hg, p < 0.001) when compared with non-smoking in men. Additionally, SBP and DBP decrease significantly among all groups of different smoking status in women (p < 0.001). Additionally, pack-years show negative associations with SBP and DBP in both men and women. Further analysis shows the interaction of smoking and alcohol consumption is associated with an increase of SBP and DBP (men: 2.38 mm Hg and 0.89 mm Hg; women: 5.21 mm Hg and 2.62 mm Hg) among co-regular smokers and regular drinkers when compared with regular smokers who are not exposed to alcohol consumption. Conclusions: A negative association between smoking and BP is observed. However, the interaction between smoking and alcohol consumption is associated with BP increase. The findings suggest the importance of considering smoking and alcohol consumption in BP control in addition to antihypertensive treatment in clinical and public health practice.

A phenome-wide association study (PheWAS) in the Population Architecture using Genomics and Epidemiology (PAGE) study reveals potential pleiotropy in African Americans

We performed a hypothesis-generating phenome-wide association study (PheWAS) to identify and characterize cross-phenotype associations, where one SNP is associated with two or more phenotypes, between thousands of genetic variants assayed on the Metabochip and hundreds of phenotypes in 5,897 African Americans as part of the Population Architecture using Genomics and Epidemiology (PAGE) I study. The PAGE I study was a National Human Genome Research Institute-funded collaboration of four study sites accessing diverse epidemiologic studies genotyped on the Metabochip, a custom genotyping chip that has dense coverage of regions in the genome previously associated with cardio-metabolic traits and outcomes in mostly European-descent populations. Here we focus on identifying novel phenome-genome relationships, where SNPs are associated with more than one phenotype. To do this, we performed a PheWAS, testing each SNP on the Metabochip for an association with up to 273 phenotypes in the participating PAGE I study sites. We identified 133 putative pleiotropic variants, defined as SNPs associated at an empirically derived p-value threshold of p<0.01 in two or more PAGE study sites for two or more phenotype classes. We further annotated these PheWAS-identified variants using publicly available functional data and local genetic ancestry. Amongst our novel findings is SPARC rs4958487, associated with increased glucose levels and hypertension. SPARC has been implicated in the pathogenesis of diabetes and is also known to have a potential role in fibrosis, a common consequence of multiple conditions including hypertension. The SPARC example and others highlight the potential that PheWAS approaches have in improving our understanding of complex disease architecture by identifying novel relationships between genetic variants and an array of common human phenotypes.

Relationship between lifestyle pattern and blood pressure - Iranian national survey

We aimed to evaluate the relationship between different lifestyle patterns and blood pressure. This study is based on the national survey of the risk factors for non-communicable diseases in Iran in 2012. A total of 8244 people aged 25–70 years old have been enrolled in the survey. Clustering on the individual data of lifestyle factors (nutrition, physical activity, and smoking) were carried out using self-organizing neural network method. Multivariable regression models were used to determine the relationship between blood pressure and the clusters. This study revealed seven lifestyle clusters in the national survey. The first cluster had a healthier lifestyle (15%), and the rest of the clusters had at least one or more lifestyle-related risk factors. Among all the clusters, people in two clusters, i.e. one characterized by consumption of sugar-sweetened beverages, salt, and fast foods, and the other one characterized by physical inactivity, were more exposed to the risk of hypertension (odds ratios of 1.44 and 1.12, respectively). People in another cluster who were 100% smokers and had a very high level of work-related physical activity were about 30% less likely to experience elevated blood pressure. Although a lifestyle with cigarette smoking was associated with a reduction in blood pressure, this might be due to other related factors, such as work-related physical activity, which lower blood pressure. Of course, this hypothesis still needs to be further studied in the future.

Associations of medium and long chain omega-3 polyunsaturated fatty acids with blood pressure in Hispanic and non-Hispanic smokers and nonsmokers

Epidemiology studies and clinical trials have shown that omega-3 polyunsaturated fatty acids (n-3 PUFAs) are inversely associated with blood pressure. We sought to determine the influence of cigarette smoking and Hispanic ethnicity on this association. Age- and sex-matched smokers and nonsmokers (n = 98) 19-50 years old lacking cardiovascular disease were recruited. Systolic and diastolic blood pressure (SBP, DBP), heart rate, HbA1c, lipids, BMI, and RBC fatty acids were measured. The omega-3 index (percent eicosapentaenoic and docosahexaenoic acid, EPA+DHA, in RBCs) was significantly lower in smokers (Smokers: 3.19 ± 0.86%; Nonsmokers, 3.88 ± 1.05%, p = 0.001) and Hispanics (Hispanic 3.32 ± 0.93%; Non-Hispanic, 3.82 ± 1.03%, p = 0.006). DHA exhibited a significant inverse association with BP in both smokers and nonsmokers, while alpha-linolenic acid (ALA) exhibited a significant positive association with BP only in smokers. Multiple regression analyses showed that BMI, DHA, smoking status, and smoking status*ALA interaction significantly predicted SBP (p < 0.0001, R2 = 0.44) and DBP (p < 0.0001, R2 = 0.33), while ethnicity had no effect. The observed lower BP when DHA levels are high suggests a possible protective role of DHA on BP in normotensive smokers and nonsmokers. Additionally, the observed higher BP when ALA levels are high only in smokers suggests that ALA may influence the BP-lowering effects of chronic smoking.

Active smoking among people with diabetes mellitus or hypertension in Africa: a systematic review and meta-analysis

The objective was to summarize existing data on the prevalence of active tobacco smoking among patients with hypertension or diabetes mellitus in Africa. We searched PubMed, EMBASE, and AJOL to include studies published from January 01, 2000 to August 23, 2017 reporting on the prevalence of active smoking in individuals aged ≥15 years with hypertension or diabetes mellitus residing inside Africa. We used a random-effects meta-analysis model to pool studies. The pooled prevalence of active smoking among patients with hypertension or diabetes was 12.9% (95%CI: 10.6–15.3; 50 studies; 16,980 patients) and 12.9% (95%CI: 9.6–16.6; 42 studies; 18,564 patients), respectively. For both conditions, the prevalence of active smoking was higher in males than in females (p < 0.001), and in Northern compared to sub-Saharan Africa (p < 0.001). There was no difference between urban and rural settings, and between community-based and hospital-based studies, except for patients with diabetes for whom the prevalence was higher in hospital-based studies (p = 0.032). The prevalence of active smoking is high among patients with hypertension or diabetes mellitus in Africa, with the heaviest burden in Northern Africa. Interventions for smoking prevention or cessation should be implemented in these high risk populations, targeting particularly the males.

Prevalence of arterial hypertension and risk factors among people with acquired immunodeficiency syndrome

OBJECTIVES

to verify the prevalence of arterial hypertension and its risk factors among people with acquired immunodeficiency syndrome under antiretroviral therapy.

METHOD

cross-sectional study with 208 patients. Data collection was conducted through interviews using a form containing data on sociodemographic, clinical and epidemiological aspects, hypertension risk factors, blood pressure, weight, height, body mass index and abdominal circumference. Mean, standard deviation, odds ratio and confidence interval were calculated, t-test and Chi-square test were used, considering P < 0.05 as statistically significant. Hypertension associated variables were selected for logistic regression.

RESULTS

patients were male (70.7%), self-reported as mixed-race (68.2%), had schooling between 9 and 12 years of study (46.6%), had no children (47.6%), were single (44.2%), in the sexual exposure category (72.1%) and heterosexual (60.6%). The prevalence of people with acquired immunodeficiency syndrome and arterial hypertension was 17.3%. Logistic regression confirmed the influence of age greater than 45 years, family history of hypertension, being overweight and antiretroviral therapy for more than 36 months for hypertension to occur.

CONCLUSION

the prevalence of hypertension was 17.3%. Patients with acquired immunodeficiency syndrome and hypertension were older than 45 years, had family history of hypertension, were overweight and under antiretroviral therapy for more than 36 months.

Sedentary Lifestyle and Hypertension in a Periurban Area of Mbarara, South Western Uganda: A Population Based Cross Sectional Survey

Introduction

Globally, cardiovascular diseases (CVDs) and diabetes constitute over 50% of the noncommunicable disease (NCD) burden and projections indicate Sub-Saharan Africa will experience a larger burden. Urbanization on the continent is contributing to the change in lifestyle such as diet and physical activity, which may increase the risk for CVDs. There is lack of sufficient data from the African continent on hypertension and its association with sedentary lifestyle.

Methods

We conducted a cross sectional study in periurban Uganda among adults aged at least 35 years. We administered questions on diet, physical activity, and smoking. We took anthropometric measurements, blood pressure, and fasting blood glucose. Hypertension was defined as systolic BP > = 140 and/or diastolic BP > = 90 and/or history of hypertension medications. Logistic regression was used to determine the crude and adjusted odds ratios for the factors associated with hypertension.

Results

We enrolled 310 participants and 50% were female. The prevalence of systolic hypertension was 24.5%, diastolic hypertension was 31%, obesity was 46%, and diabetes was 9%. Of those with hypertension (n = 76), 53 participants (69.7%) were not aware they had high BP. Sedentary lifestyle was significantly associated with hypertension even after adjusting for age and obesity.

Conclusion

There is a high prevalence of obesity, hypertension, and diabetes and majority of participants with hypertension are not aware. Participants with a sedentary work style should be targeted for prevention and screening.

Racial/ethnic disparity in the associations of smoking status with uncontrolled hypertension subtypes among hypertensive subjects

Background

Racial/ethnic differences in the associations of smoking with uncontrolled blood pressure (BP) and its subtypes (isolated uncontrolled systolic BP (SBP), uncontrolled systolic-diastolic BP, and isolated uncontrolled diastolic BP (DBP)) have not been investigated among diagnosed hypertensive subjects.

Methods

A sample of 7,586 hypertensive patients aged ≥18 years were selected from the National Health and Nutrition Examination Survey 1999–2010. Race/ethnicity was classified into Hispanic, non-Hispanic white, and non-Hispanic black. Smoking was categorized as never smoking, ex-smoking, and current smoking. Uncontrolled BP was determined as SBP≥140 or DBP≥90 mm Hg. Isolated uncontrolled SBP was defined as SBP≥140 and DBP<90 mm Hg, uncontrolled SDBP as SBP≥140 and DBP≥90 mm Hg, and isolated uncontrolled DBP as SBP<140 and DBP≥90 mm Hg. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) of uncontrolled BP and its subtypes were calculated using weighted logistic regression models.

Results

The interaction effect of race and smoking was significant after adjustment for the full potential confounding covariates (Adjusted p = 0.0412). Compared to never smokers, current smokers were 29% less likely to have uncontrolled BP in non-Hispanic whites (OR = 0.71, 95% CI = 0.56–0.90), although the likelihood for uncontrolled BP is the same for smokers and never smokers in Hispanics and non-Hispanic blacks. Current smokers were 26% less likely than never smokers to have isolated uncontrolled SBP in non-Hispanic whites (OR = 0.74, 95% CI = 0.58–0.95). However, current smoking is associated with an increased likelihood of uncontrolled systolic-diastolic BP in non-Hispanic blacks, and current smokers in this group were 70% more likely to have uncontrolled systolic-diastolic BP than never smokers (OR = 1.70, 95% CI = 1.10–2.65).

Conclusion

The associations between current smoking and uncontrolled BP differed over race/ethnicity. Health practitioners may need to be especially vigilant with non-Hispanic black smokers with diagnosed hypertension.