Effects of changes in smoking status on blood pressure among adult males and females in Indonesia: a 15-year population-based cohort study

Smarter Pregnancy Coaching and Maternal Blood Pressure

INTRODUCTION

Maternal lifestyle behaviors can affect blood pressure with consequences for maternal and offspring health. The aim of this study was to investigate the effectiveness of the Smarter Pregnancy digital lifestyle coaching program on maternal blood pressure during the first trimester.

METHODS

The study was conducted on data of the Rotterdam Periconception Cohort from 2010 to 2019, and analysis was completed in 2024. The intervention group included 132 pregnant women using Smarter Pregnancy for 6-24 weeks within 30 months before the study entry. The control group included 1,091 pregnant women who did not use Smarter Pregnancy. Outcomes included changes in systolic, diastolic, and mean arterial blood pressures between baseline and first trimester. Lifestyle behaviors were tracked in the intervention group at 12 and 24 weeks of the program, using lifestyle risk score for vegetables, fruits, smoking, and alcohol.

RESULTS

Using multivariable analysis, the intervention group showed reductions in systolic (βadj= -2.34 mmHg, 95% CI= -4.67, -0.01), diastolic (βadj= -2.00 mmHg, 95% CI= -3.57, -0.45), and mean arterial (βadj= -2.22 mmHg, 95% CI= -3.81, -0.52) blood pressures compared with the control group. When stratifying for conception mode, reductions were observed in diastolic (βadj= -2.38, 95% CI= -4.20, -0.56) and mean arterial (βadj= -2.63, 95% CI= -4.61, -0.56) blood pressures only in women who underwent assisted reproduction (n=91). Smarter Pregnancy use was associated with a reduction in lifestyle risk score, indicating improved lifestyle behaviors, after 12 (β= -0.84, 95% CI= -1.19, -0.49) and 24 (β= -1.07, 95% CI= -1.44, -0.69) weeks. The lifestyle risk score was also significantly reduced in assisted reproduction and natural pregnancy subgroups.

CONCLUSIONS

The use of Smarter Pregnancy is associated with consistent but small reductions in maternal blood pressure during the first trimester, supporting further implementation in health care.

Lifestyle Factors, Sociodemographic Characteristics and Incident Hypertension: A Prospective Analysis of the Korean National Health Insurance Service Sample Cohort

BACKGROUND

Hypertension is a significant chronic disease globally, and lifestyle modifications are crucial for the prevention of this disease. We conducted a longitudinal analysis of the associations between lifestyle factors and the incidence of hypertension, stratified by sociodemographic characteristics.

METHODS

We analyzed 113,022 adults (65,315 men), aged 20 years or older from the Korean National Health Insurance Service-National Sample Cohort 2.0 who participated in health screening between 2002 and 2003. Lifestyle factors (smoking, drinking, physical activity) were assessed at baseline using self reports, and incident hypertension was defined based on physician diagnoses. Cox proportional hazards regression models were used to assess associations.

RESULTS

During an 11.6-year follow-up, 26,812 new cases of hypertension were identified. The risk of hypertension was high among men and women who smoked over 20 cigarettes daily (men: hazard ratio [HR]: 1.15; 95% confidence interval [CI], 1.08-1.21; women: HR: 1.62; 95% CI 1.17-2.25) and those who drank over 1.5 bottles of alcohol daily (men, HR: 1.18; 95% CI, 1.12-1.24; women, HR: 1.23; 95% CI 1.02-1.47). These associations tended to be high in high-income men (HR: 1.09; 95% CI, 1.04-1.14), low-income women (HR: 1.19; 95% CI, 1.05-1.35) and non-obese women (HR: 1.13; 95% CI, 1.01-1.27) who currently smoked. Physical activity was inversely associated with incident hypertension in men (HR: 0.96; 95% CI, 0.93-0.99).

CONCLUSIONS

Unhealthy lifestyle factors, such as heavy smoking and drinking, was associated with an increased risk of hypertension, with variations by income, BMI, and sex. These findings underscore the importance of tailored, population-specific prevention strategies to address hypertension disparities.

Efficacy of a Benincasa hispida powdered drink in improving metabolic control in patients with type 2 diabetes: A placebo-controlled study

Objectives

There is emerging evidence of the benefits of Benincasa hispida in improving metabolic profiles in people with diabetes. This study was conducted to analyze the effect of B. hispida aqueous extract on the metabolic control of patients with type 2 diabetes in Malaysia.

Methods

A powdered drink formulated with 2.5 g of B. hispida extract was prepared as a test food. An intervention study was conducted with 50 participants randomly assigned to an intervention or a control group. Anthropometric, biochemical, and clinical variables were assessed at baseline and week 12 after intervention. Paired T-tests were applied to compare the mean differences between the baseline and post-intervention for each variable.

Results

The intervention group presented a significant reduction in diastolic blood pressure (Δ -7.0 mmHg, 95% confidence interval [CI]: -11.4, -2.5). Mean fasting plasma glucose (Δ -0.8 mmol/L, 95% CI: -1.8, 0.2) showed a greater reduction in the intervention group compared to the control group (Δ -0.4 mmol/L, 95% CI: -1.2, 0.4). Mean lean body mass showed a favorable trend of increment at week 6 (Δ 0.05 kg, 95% CI: -0.40, 0.49) and week 12 (Δ 0.16 kg, 95% CI: -0.33, 0.64) as compared to baseline in the intervention group but not in the control group which manifested decreasing lean body mass.

Conclusion

The use of B. hispida extract may potentially improve blood pressure and glycemic control in patients with type 2 diabetes and it may be an attractive candidate for the development of functional food products.

Impact of brief smoking cessation intervention on quitting rate and glycemic control in patients with diabetes: a randomized controlled trial

OBJECTIVE

We aimed to evaluate the impact of a brief smoking cessation intervention among patients with diabetes.

METHODS

This randomized interventional clinical trial involved patients with diabetes who smoked tobacco and attended the outpatient diabetes clinic at Penang Hospital, Malaysia. Participants were randomized into a control group that usual care for patients with diabetes, or an intervention group that received a 5-minute physician-delivered brief counseling session on tobacco cessation using the 5A's strategy, in addition to usual care. Primary outcome measures were assessed over three visits (every 3-4 months) including mean glycated hemoglobin level, quitting rate, blood pressure, and mean number of cigarettes smoked per day.

RESULTS

In total, 126 participants were finally enrolled in the study, with 63 patients each in the intervention and control groups. There was no significant difference between the two groups with respect to glycemic control, blood pressure, and quitting rate. However, patients in both groups reduced their cigarette consumption.

CONCLUSIONS

The present brief smoking cessation intervention did not result in better glycemic control, blood pressure, or quitting rates among patients with diabetes. This patient group may require more intensive guidance for better outcomes.Trial registration: This study is registered in ClinicalTrials.gov (NCT04864327); https://clinicaltrials.gov/ct2/results?pg=1&load=cart&id=NCT04864327.

Association between percentage of smokers and prevalence of smoking attributable morbidity in Indonesia: one decade after implementation of smoke-free area regulation

BACKGROUND

For more than ten years, Indonesia has health law, one of which states that local governments are mandated to establish Smoke Free Area (SFA). The results of 2018 National Basic Health Research shows tobacco consumption is still quite high and increasing compared to the results of 2007 and 2013 National Basic Health Research. The burden of disease in Indonesia is increasing every year.  METHODS: This study aims to describe SFA regulation and analyze the relationship between the percentage of smokers and the prevalence of smoking attributable morbidity. Data from the 2018 Basic Health Research in Indonesia with the number of units of analysis were 514 districts and cities level. The design of the study was cross-sectional study. The variables analyzed were the percentage of smokers, the prevalence of diabetes, hypertension, upper respiratory tract infections (URTI), pneumonia, lung tuberculosis, asthma, and mental emotional disorders. Geographical mapping of the distribution of District/City with Smoking-Free Areas was made using QGIS 3·16.  RESULTS: Around 72% of districts/cities in Indonesia already had local regulations of SFA after more than ten years implementation of the regulation of the health law. There was a significant relationship between the high percentage of smokers and the high prevalence of diabetes (p value: 0·000, PR: 1·342, 95%CI 1·135 to 1·587), hypertension (p value: 0·000, PR 1·631, 95%CI 1·252 to 2·124), and lung tuberculosis (p value: 0·008, PR 1·219, 95%CI 1·049 to 1·417) at the District/City level. However, there was no significant association between URTI, pneumonia, asthma, and mental emotional disorders.

CONCLUSION

The percentage of smokers in an area was associated with diabetes, hypertension, and lung tuberculosis. The implementation of Smoke Free Area should be evaluated.

Association of Hypertensive Disorders of Pregnancy (HDP) and tobacco use among women of reproductive age group in India: A secondary data analysis from NFHS-4

Introduction

Tobacco use in any form is known to exert several perinatal complications. Through this study, the authors aimed to study the association between tobacco use and Hypertensive Disorders of Pregnancy (HDP) among women (aged 15-49 years) in India.

Methodology

We used data from the National Family Health Survey (NFHS-4, 2015-2016) to study the association between tobacco use and HDP among women of reproductive age (15-49 years) in India. Since the NFHS follows a complex multi-level sampling, sampling weights were used to study the univariate and multivariate associations between the independent and dependent variables. Adjusted odds ratios (AORs) are reported along with 95% Confidence Intervals.

Results

A sample of 1,07730 women was included in the analysis. HDP was more likely to be experienced by smokeless and smoking tobacco users (AOR 1.3, 95% CI (1.0-1.6) and AOR 2.7, 95% CI (2.0-3.7), respectively). Women with secondary (AOR 0.7, 95% CI (0.7-0.8)) and higher education (AOR 0.7, 95% CI (0.6-0.8)) were less likely to suffer from HDP as compared to those with no education. Women with daily (AOR 0.7, 95% CI (0.5-0.8)), weekly (AOR 0.8, 95% CI (0.6-0.9)) or occasional AOR 0.7, 95% CI (0.6-0.9)) consumption of fruits were less likely to experience HDP as compared to women with no fruit intake.

Conclusion

Healthy diet and lifestyle factors can contribute to reduce the risk of HDP across women. The antenatal check-ups in India should also comprehensively focus on screening and counseling of women against tobacco use.

Effects of smoking intensity trajectory, cumulative smoking exposure, and the number of years since quitting on the subsequent risk of hypertension

The aim of this study was to investigate the effects of smoking intensity trajectory, cumulative smoking exposure, and the number of years since quitting on the subsequent risk of hypertension in Chinese adults. The study included 2783 men and 3416 women who participated in at least three waves of the China Health and Nutrition Survey. Information regarding smoking behavior was obtained using a standardized questionnaire. The trajectory of smoking intensity was determined using a group‐based trajectory model. The number of pack‐years of smoking and the number of years since quitting were calculated. The incidence of hypertension was 18.2% and 15.5% in men and women, respectively, during a median follow‐up duration of 4 years. Male participants with trajectories denoting light and moderate smoking had increased risks of hypertension compared with those with trajectories denoting non‐smoking (P_s < .05). Compared with male participants with 0 pack‐years, those with < 5.5 pack‐years had a higher risk of hypertension (P < .05). Male participants with ≥5.5 pack‐years and weight gain had a higher risk of hypertension compared with those with 0 pack‐years and weight loss (P < .05). However, smoking was not related to an increased risk of hypertension in women. Additionally, similar to never smoking, having quit within 2–5 years or ≥5 years was not associated with the incidence of hypertension in men. The results of this study showed that light/moderate smoking or high cumulative smoking exposure accompanied by weight gain increased the risk of hypertension in Chinese men and smoking cessation decreased this effect.

Hypertension among Current Cigarette Smokers Visiting Outpatient Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Hypertension is a common physical condition with high blood pressure for a prolonged period. Long risk factors like age, overweight, high dietary salt intake, smoking, sedentary lifestyle, and term hypertension might lead to various cardiovascular diseases. The normal blood pressure, systolic, is 90-119 mm Hg and diastolic 60-79 mm Hg. The objective of this study is to find out the prevalence of hypertension among current cigarette smokers patients in an outpatient department of a tertiary care centre.

Methods

A descriptive cross-sectional study was done on 385 outpatient department patients in a tertiary care centre from September, 2021 to February, 2022. The sample was collected by a convenience after approval from the Institutional Review Committee (Reference number: 0505202105). Outpatient department patients who had past history of smoking cigarette>100 cigarettes and who is still smoking were included in the study. Data were analysed by using the Statistical Package for the Social Science software version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data and mean and standard deviation for continuous data.

Results

Among 385 patients, 209 (54.28%) (47.64-60.92 at 95% Confidence Interval) were hypertensive patients. One hundred fifty-six (40.51%) males and 53 (13.76%) females were hypertensive.

Conclusions

The prevalence of hypertension was higher when compared to other studies done in similar settings.

Keywords

habits; hypertension; prevalence; smokers.

Mixed Effect of Alcohol, Smoking, and Smokeless Tobacco Use on Hypertension among Adult Population in India: A Nationally Representative Cross-Sectional Study

Sporadic evidence is available on the association of consuming multiple substances with the risk of hypertension among adults in India where there is a substantial rise in cases. This study assesses the mutually exclusive and mixed consumption patterns of alcohol, tobacco smoking and smokeless tobacco use and their association with hypertension among the adult population in India. Nationally representative samples of men and women drawn from the National Family and Health Survey (2015-2016) were analyzed. A clinical blood pressure measurement above 140 mmHg (systolic blood pressure) and 90 mmHg (diastolic blood pressure) was considered in the study as hypertension. Association between mutually exclusive categories of alcohol, tobacco smoking and smokeless tobacco and hypertension were examined using multivariate binary logistic regression models. Daily consumption of alcohol among male smokeless tobacco users had the highest likelihood to be hypertensive (OR: 2.32, 95% CI: 1.99-2.71) compared to the no-substance-users. Women who smoked, and those who used any smokeless tobacco with a daily intake of alcohol had 71% (OR: 1.71, 95% CI: 1.14-2.56) and 51% (OR: 1.51, 95% CI: 1.25-1.82) higher probability of being hypertensive compared to the no-substance-users, respectively. In order to curb the burden of hypertension among the population, there is a need for an integrated and more focused intervention addressing the consumption behavior of alcohol and tobacco.

The Effects of Home-Based Self-Care Education on Blood Pressure and Self-Care Behaviors among Middle-Aged Patients with Primary Hypertension in Iran: A Randomized Clinical Controlled Trial

Self-care education (SCE) through home visit is one of the methods with potential effects on self-care. This study aimed to evaluate the effects of home-based SCE on blood pressure and self-care behaviors among middle-aged patients with primary hypertension in Iran. This randomized controlled trial was conducted on 110 middle-aged patients with hypertension recruited from public healthcare centers in the south of Tehran, Iran in September 2019. After convenience sampling, Participants were simple randomly allocated to control and intervention groups. Intervention group received a 2-month home-based SCE while control group received routine care services. Before and 2 months after the intervention, self-care behaviors were assessed using the Hypertension Self-Care Activity Level Effects (H-SCALE). Data were analyzed using the SPSS software (v. 16.0) at a significance level of less than .05. After 2 months, the posttest mean scores of self-care behaviors in medication adherence (17.42 ± 1.03 vs 14.49 ± 1.01, p = .04), physical activity (8.16 ± 0.39 vs 6.47 ± 0.52, p = .01), low-salt diet (52.51 ± 3.8 vs 35.36 ± 3.47, p = .001), and blood pressure control (3.47 ± 0.22 vs 2.42 ± 1.89, p = .001), in the intervention group were significantly greater than the control group. However, there were no significant between-group differences respecting the posttest mean scores of the weight management ( p = .06) and smoking cessation ( p = .2). Also, the mean blood pressure between the 2 groups changed after the intervention, but this difference was not statistically significant. This study suggests the effectiveness of home-based SCE in significantly improving self-care behaviors among patients with hypertension. But more studies are needed to measure the effectiveness of intervention on blood pressure.

IRCT code: IRCT20190623043985N1. Registered 06/30/2019, https://fa.irct.ir/trial/40351 .

Association of Left Atrial Size Measured by Non-Contrast Computed Tomography with Cardiovascular Risk Factors—The Danish Cardiovascular Screening Trial (DANCAVAS)

Left atrium (LA) size is associated with adverse cardiovascular events. The purpose of this study was to investigate the association of LA enlargement measured by non-contrast CT (NCCT) with traditional cardiovascular risk factors. Individuals aged 60–75 years from the population-based multicentre Danish Cardiovascular Screening (DANCAVAS) trial were included in this cross-sectional study. The LA was manually traced on the NCCT scans, and the largest cross-section area was indexed to body surface area. All traditional risk factors were recorded, and a subgroup received an echocardiographic examination. We enrolled 14,987 individuals. Participants with known cardiovascular disease or lacking measurements of LA size or body surface area were excluded, resulting in 10,902 men for the main analysis and 616 women for a sensitivity analysis. Adjusted multivariable analysis showed a significantly increased indexed LA size by increasing age and pulse pressure, while smoking, HbA1c, and total cholesterol were associated with decreased indexed LA size. The findings were confirmed in a supplementary analysis including left ventricle ejection fraction and mass. In this population-based cohort of elderly men, an association was found between age and pulse pressure and increasing LA size. Surprisingly, smoking, HbA1c, and total cholesterol were associated with a decrease in LA size. This indicates that the pathophysiology behind atrial cardiomyopathy is not only reflected by enlargement, but also shrinking.

Influence of dietary total antioxidant capacity on the association between smoking and hypertension in Brazilian graduates (CUME project)

BACKGROUND AND AIMS

Hypertension (HTN) is a chronic non-communicable disease influenced by non-modifiable risk factors, such as sex and age, as well as modifiable risk factors such as lifestyle, including diet and smoking. Moreover, diet quality among smokers is worse than that of non-smokers, mainly in terms of antioxidant content. Thus, the current study aimed to investigate whether dietary total antioxidant capacity (dTAC) influences the association between smoking and HTN.

METHODS AND RESULTS

This cross-sectional study included 4303 graduates (69.35% women) from the Cohort of Minas Gerais Universities (CUME) project. An online food frequency questionnaire was administered to participants, and dTAC was estimated using the ferric reducing antioxidant power method. In the questionnaires, individuals reported smoking status, systolic and diastolic blood pressure values, previous HTN diagnosis, and use of antihypertensive drugs. Logistic regression models were used to estimate the odds ratio and 95% confidence interval between smoking and HTN, stratified by the median dTAC. Current and former smokers had higher dTAC values despite their lower fruit intake. Moreover, coffee was the main contributor to dTAC among them. Smoking was associated with a higher likelihood of HTN, mainly among individuals with a higher dTAC. However, after exclusion of coffee antioxidant capacity, there was an association between only smoking and HTN in individuals with lower dTAC.

CONCLUSIONS

The controversial association between higher dTAC and HTN can result from high coffee intake. Higher dTAC without coffee intake may mitigate the association between smoking and HTN in this population.

Self-Care Practice and Associated Factors among Hypertensive Patients in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Hypertension is one of the leading causes of morbidity and mortality in developing countries including Ethiopia. Self-care practice has been provided as one of the most important preventive mechanisms of hypertension and is considered as a basic treatment for hypertension. There is no national-level study that assesses hypertensive self-care practice in Ethiopia. Therefore, this study aimed to assess the pooled level of hypertensive self-care practices and associated factors in Ethiopia.

METHODS

This study was carried out using published and unpublished articles accessed from databases: PubMed/MEDLINE, HENARI, Google Scholar, Web of Science, Scopus, African Journals, and university repositories. Data were extracted using a standard data extraction format. Data analysis was carried out using STATA version 11. Heterogeneity across the included studies was assessed using Cochrane's Q statistics and I 2 test with its corresponding p values. Publication bias was determined using Egger's test and presented with a funnel plot. The pooled level of hypertensive self-care practice was estimated using a random-effects meta-analysis model.

RESULTS

This systematic review included 17 cross-sectional studies with 5,248 study participants. The overall pooled level of self-care practice among hypertensive patients in Ethiopia was 41.55% (95% CI 33.06, 50.05). Participant formal education (AOR = 2.82; 95% CI 2.18, 3.64) and good knowledge of hypertension (AOR = 4.04; 95% CI 2.19, 7.44) were significantly associated with self-care practice among hypertensive patients in Ethiopia.

CONCLUSION

In this study, more than half of hypertensive patients had poor hypertensive self-care practice in Ethiopia. Participant's formal education and good knowledge of hypertension were significantly associated with self-care practice among people living with hypertension in Ethiopia. Therefore, based on the evidence of this study, we recommended that programmers and policymakers should enhance the awareness of hypertensive patients on self-care practice domains and strengthen local programs working on noncommunicable diseases.

Predicting hypertension using machine learning: Findings from Qatar Biobank Study

Background and objective

Hypertension, a global burden, is associated with several risk factors and can be treated by lifestyle modifications and medications. Prediction and early diagnosis is important to prevent related health complications. The objective is to construct and compare predictive models to identify individuals at high risk of developing hypertension without the need of invasive clinical procedures.

Methods

This is a cross-sectional study using 987 records of Qataris and long-term residents aged 18₊ years from Qatar Biobank. Percentages were used to summarize data and chi-square tests to assess associations. Predictive models of hypertension were constructed and compared using three supervised machine learning algorithms: decision tree, random forest, and logistics regression using 5-fold cross-validation. The performance of algorithms was assessed using accuracy, positive predictive value (PPV), sensitivity, F-measure, and area under the receiver operating characteristic curve (AUC). Stata and Weka were used for analysis.

Results

Age, gender, education level, employment, tobacco use, physical activity, adequate consumption of fruits and vegetables, abdominal obesity, history of diabetes, history of high cholesterol, and mother’s history high blood pressure were important predictors of hypertension. All algorithms showed more or less similar performances: Random forest (accuracy = 82.1%, PPV = 81.4%, sensitivity = 82.1%), logistic regression (accuracy = 81.1%, PPV = 80.1%, sensitivity = 81.1%) and decision tree (accuracy = 82.1%, PPV = 81.2%, sensitivity = 82.1%. In terms of AUC, compared to logistic regression, while random forest performed similarly, decision tree had a significantly lower discrimination ability (p-value<0.05) with AUC’s equal to 85.0, 86.9, and 79.9, respectively.

Conclusions

Machine learning provides the chance of having a rapid predictive model using non-invasive predictors to screen for hypertension. Future research should consider improving the predictive accuracy of models in larger general populations, including more important predictors and using a variety of algorithms.