Bowman Thomas S, Gaziano J Michael, Buring Julie E, Sesso Howard D
Veterans Affairs Boston Healthcare System, Massachusetts Veterans Affairs Epidemiology, Research, and Information Center, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2007 Nov 20;50(21):2085-92. doi: 10.1016/j.jacc.2007.08.017. Epub 2007 Nov 5.
We undertook this study to prospectively evaluate whether cigarette smoking was associated with an increased risk of developing hypertension.
Smoking is a well-recognized risk factor for cardiovascular disease. Few prospective cohort studies have examined the relationship between smoking and hypertension.
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 > or =140 mm Hg or diastolic blood pressure > or =90 mm Hg).
At baseline, 51% of women were never smokers, 36% were former smokers, 5% smoked 1 to 14 cigarettes, and 8% smoked > or =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 > or =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 > or =25 cigarettes per day, the multivariable HR was 1.21 (95% CI 1.06 to 1.39).
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.
我们开展这项研究以前瞻性评估吸烟是否与患高血压风险增加相关。
吸烟是公认的心血管疾病风险因素。很少有前瞻性队列研究探讨吸烟与高血压之间的关系。
我们在女性健康研究中的28236名女性中进行了一项前瞻性队列研究，这些女性最初无高血压、心血管疾病和癌症。通过自我报告问卷收集包括吸烟状况在内的详细风险因素信息。我们使用Cox比例风险生存模型计算新发高血压（定义为新诊断、开始使用抗高血压药物、收缩压≥140 mmHg或舒张压≥90 mmHg）的风险比（HRs）和95%置信区间（CIs）。
在基线时，51%的女性从不吸烟，36%为既往吸烟者，5%每天吸1至14支烟，8%每天吸≥15支烟。在中位9.8年期间，有8571例（30.4%）新发高血压病例。从不吸烟、既往吸烟以及每天吸1至14支和≥15支烟的当前吸烟者患高血压的年龄调整后HRs分别为1.00（参照）、1.04（95%CI 0.99至1.09）、1.00（95%CI 0.90至1.10）和1.10（95%CI 1.01至1.19）。在进一步调整生活方式、临床和饮食变量的多变量模型中，相应的HRs分别为1.00（参照）、1.03（95%CI 0.98至1.08）、1.02（95%CI 0.92至1.13）和1.11（95%CI 1.03至1.21）。在每天吸≥25支烟的女性中，多变量HR为1.21（95%CI 1.06至1.39）。
在这个大型女性队列中，吸烟与患高血压风险增加存在适度关联，这种影响在每天至少吸15支烟的女性中最为强烈。
