Jareebi Mohammad A
Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
J Multidiscip Healthc. 2024 Jul 10;17:3265-3281. doi: 10.2147/JMDH.S470589. eCollection 2024.
Cigarette smoking is one of the world's largest avoidable risk factors for morbidity and mortality. Numerous studies have investigated the association between smoking and hypertension (HTN). Although observational data and cross-sectional research often exhibit a link between smoking and HTN, establishing causation remains challenging owing to potential confounding variables. Mendelian randomization (MR), a genetic epidemiological technique that employs genetic variants as instrumental variables, offers a more robust approach for evaluating causal links. This review aimed to explore both the observational and causal relationships between smoking and the risk of HTN.
A comprehensive literature search across major electronic databases was conducted to identify relevant observational and Mendelian randomization (MR) studies on smoking and HTN risk. Various characteristics were included during study selection, such as study design, exposure assessment, and age range. Standardized processes were used for data retrieval and quality evaluation.
Analysis of observational data revealed a paradoxical association between smoking and the risk of HTN, where a lower risk was observed among current smokers when compared to non-smokers. However, observational analysis also presented a dose-response effect with greater smoking intensity showed a modest linear increase in HTN risk, and older smoking initiation was associated with a slight increase in HTN risk (compared with younger). In contrast, MR-based causal estimates provide inconsistent evidence regarding the causal relationship between smoking behavior and HTN. Some MR analyses indicated a potential causal link between smoking and HTN; but this was not consistent.
Observational studies suggest a paradoxical association between smoking and HTN. However, MR studies do not provide sufficient evidence to establish a causal relationship. Regardless, lifestyle variables remain crucial for overall health. Healthcare professionals should regularly assess smoking status and provide counseling for quitting. Further research is needed to clarify the underlying processes, identify mediators, and evaluate the interventions.
吸烟是全球范围内发病率和死亡率的最大可避免风险因素之一。众多研究调查了吸烟与高血压（HTN）之间的关联。尽管观察性数据和横断面研究常常显示吸烟与高血压之间存在联系，但由于潜在的混杂变量，确定因果关系仍然具有挑战性。孟德尔随机化（MR）是一种利用基因变异作为工具变量的遗传流行病学技术，为评估因果联系提供了一种更为可靠的方法。本综述旨在探讨吸烟与高血压风险之间的观察性和因果关系。
在各大电子数据库中进行了全面的文献检索，以识别有关吸烟与高血压风险的相关观察性和孟德尔随机化（MR）研究。在研究选择过程中纳入了各种特征，如研究设计、暴露评估和年龄范围。采用标准化流程进行数据检索和质量评估。
对观察性数据的分析揭示了吸烟与高血压风险之间存在矛盾的关联，即与不吸烟者相比，当前吸烟者的风险较低。然而，观察性分析也呈现出剂量反应效应，吸烟强度越大，高血压风险呈适度线性增加，吸烟起始年龄越大，高血压风险略有增加（与年轻者相比）。相比之下，基于MR的因果估计提供了关于吸烟行为与高血压之间因果关系的不一致证据。一些MR分析表明吸烟与高血压之间可能存在因果联系，但并不一致。
观察性研究表明吸烟与高血压之间存在矛盾的关联。然而，MR研究并未提供足够的证据来确立因果关系。无论如何，生活方式变量对整体健康仍然至关重要。医疗保健专业人员应定期评估吸烟状况并提供戒烟咨询。需要进一步研究以阐明潜在机制、识别中介因素并评估干预措施。
