Liu Xuefeng, Zhu Tinghui, Manojlovich Milisa, Cohen Hillel W, Tsilimingras Dennis
Department of Systems, Population, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States of America.
Frankel Cardiovascular Center, University of Michigan School of Medicine, Ann Arbor, MI, United States of America.
PLoS One. 2017 Aug 9;12(8):e0182807. doi: 10.1371/journal.pone.0182807. eCollection 2017.
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.
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.
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).
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.
在已确诊的高血压患者中，尚未对吸烟与血压控制不佳及其亚型（单纯收缩压控制不佳、收缩压-舒张压均控制不佳和单纯舒张压控制不佳）之间的种族/民族差异进行研究。
从1999 - 2010年国家健康与营养检查调查中选取了7586名年龄≥18岁的高血压患者样本。种族/民族分为西班牙裔、非西班牙裔白人及非西班牙裔黑人。吸烟情况分为从不吸烟、既往吸烟和当前吸烟。血压控制不佳定义为收缩压≥140或舒张压≥90 mmHg。单纯收缩压控制不佳定义为收缩压≥140且舒张压<90 mmHg，收缩压-舒张压均控制不佳定义为收缩压≥140且舒张压≥90 mmHg，单纯舒张压控制不佳定义为收缩压<140且舒张压≥90 mmHg。使用加权逻辑回归模型计算血压控制不佳及其亚型的校正比值比（OR）及95%置信区间（CI）。
在对所有潜在混杂协变量进行校正后，种族与吸烟的交互作用显著（校正p = 0.0412）。与从不吸烟者相比，在非西班牙裔白人中，当前吸烟者血压控制不佳的可能性降低29%（OR = 0.71，95% CI = 0.56 - 0.90），尽管在西班牙裔和非西班牙裔黑人中，吸烟者和从不吸烟者血压控制不佳的可能性相同。在非西班牙裔白人中，当前吸烟者单纯收缩压控制不佳的可能性比从不吸烟者低26%（OR = 0.74，95% CI = 0.58 - 0.95）。然而，在非西班牙裔黑人中，当前吸烟与收缩压-舒张压均控制不佳的可能性增加相关，该组当前吸烟者收缩压-舒张压均控制不佳的可能性比从不吸烟者高70%（OR = 1.70，95% CI = 1.10 - 2.65）。
当前吸烟与血压控制不佳之间的关联因种族/民族而异。医疗从业者可能需要对已确诊高血压的非西班牙裔黑人吸烟者格外警惕。
