Bolinder G, de Faire U
Department of Emergency and Cardiovascular Medicine, Karolinska Hospital, Stockholm, Sweden.
Am J Hypertens. 1998 Oct;11(10):1153-63. doi: 10.1016/s0895-7061(98)00137-x.
Ambulatory 24-h blood pressure monitoring was conducted in 135 healthy, normotensive, middle-aged (35 to 60 years) men, with no antihypertensive medication, to study the influence of habitual smokeless tobacco use (n = 47) and smoking (n = 29) on diurnal blood pressure and heart rate. Comparisons were made with nonusers of tobacco (n = 59). Adjustments were made for differences in age, body mass index, waist-hip ratio, physical fitness, and alcohol intake. Daytime ambulatory heart rates were significantly (P < .05) elevated in both smokeless tobacco users and smokers compared with nonusers (69 +/- 14 and 74 +/- 13 beats/min, respectively, versus 63 +/- 12 beats/min). In subjects > or = 45 years old, ambulatory daytime diastolic blood pressures were significantly elevated, on average by 5 mm Hg, in both smokeless tobacco users and smokers (P < .001) compared with nonusers. Clinical measurements of heart rate and systolic blood pressure in smokers were significantly lower compared with the ambulatory mean values. Nighttime measurements showed only minor differences between the tobacco habit groups. The higher heart rates and blood pressures noted during the daytime in smokers and smokeless tobacco users were most likely due to the effects of nicotine. A strong positive relationship was found between cotinine (major nicotine metabolite) and blood pressure in smokeless tobacco users (systolic blood pressure, r = 0.48, P < .001; diastolic blood pressure, r = 0.41, P = .005), whereas an inverse relationship was found in smokers (systolic blood pressure, r = -0.12, P = .47; diastolic blood pressure, r = -0.03, P = .84), indicating additional and more complex influences on vascular tone in smokers than the influence of nicotine in smokeless tobacco users.
对135名健康、血压正常的中年（35至60岁）男性进行了24小时动态血压监测，这些男性未服用抗高血压药物，以研究习惯性使用无烟烟草（n = 47）和吸烟（n = 29）对日间血压和心率的影响。将其与不使用烟草的人群（n = 59）进行比较。对年龄、体重指数、腰臀比、身体素质和酒精摄入量的差异进行了调整。与不使用烟草的人群相比，无烟烟草使用者和吸烟者的日间动态心率均显著升高（P <.05）（分别为69±14次/分钟和74±13次/分钟，而不使用烟草的人群为63±12次/分钟）。在年龄≥45岁的受试者中，与不使用烟草的人群相比，无烟烟草使用者和吸烟者的日间动态舒张压均显著升高，平均升高5 mmHg（P <.001）。吸烟者的心率和收缩压的临床测量值显著低于动态测量平均值。夜间测量结果显示，不同烟草使用习惯组之间仅有微小差异。吸烟者和无烟烟草使用者白天较高的心率和血压很可能是尼古丁的作用所致。在无烟烟草使用者中，可替宁（主要的尼古丁代谢产物）与血压之间存在强正相关（收缩压，r = 0.48，P <.001；舒张压，r = 0.41，P =.005），而在吸烟者中则发现呈负相关（收缩压，r = -0.12，P =.47；舒张压，r = -0.03，P =.84），这表明吸烟对血管张力的影响比无烟烟草使用者中尼古丁的影响更为复杂且存在额外影响。
