Author + information
- Received March 23, 2007
- Revision received August 17, 2007
- Accepted August 20, 2007
- Published online November 20, 2007.
- Thomas S. Bowman, MD, MPH⁎,†,1,⁎ (, )
- J. Michael Gaziano, MD, MPH⁎,†,‡,
- Julie E. Buring, ScD†,‡,§,¶ and
- Howard D. Sesso, ScD, MPH†,‡,§
- ↵⁎Reprint requests and correspondence:
Dr. Thomas S. Bowman, Division of Aging, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, Massachusetts 02120.
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.
↵1 Dr. Bowman is supported by a Career Development Award from the Veterans Affairs Cooperative Studies Program.
This study was supported by research grants CA-47988 and HL-43851 from the National Institutes of Health, Bethesda, Maryland.
- Received March 23, 2007.
- Revision received August 17, 2007.
- Accepted August 20, 2007.
- American College of Cardiology Foundation