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The aim of the study was to assess the impact of current smoking on 24-hour blood pressure (BP) and inflammatory and hemostatic activity and thereby the incidence of cardiovascular disease (CVD) in Japanese hypertensive patients. A total of 810 hypertensive patients (mean age 72 years; 38% men) were prospectively followed-up (2799 person-years). During the follow-up, 66 cases of CVD occurred (stroke, 55; myocardial infarction, 7; both, 4). At baseline, the current smokers (n=166) had higher levels of high-sensitivity C-reactive protein (hs-CRP) (0.21 mg/dL vs 0.14 mg/dL) and plasminogen activator inhibitor-1 (PAI-1) (46.1 ng/mL vs 37.8 ng/mL; both P=.001), but not of 24-hour BP, compared with nonsmokers. Using a Cox regression analysis, current smoking was independently associated with an increased risk of CVD (hazard ratio [HR], 2.6; P<.01), and the risk was substantially higher in women (HR, 6.1; P<.001) than in men (HR, 1.4; P=.41). The CVD risk of current smokers was magnified when it was accompanied with high hs-CRP (highest quartile range, ≥0.40 mg/L) or PAI-1 levels (≥58.9 ng/mL) compared with that in smokers with low hs-CRP or PAI-1 levels (both P<.05). Among hypertensive patients, current smokers had increased risk of CVD events, and the increase was more prominent when accompanied by circulatory inflammatory and hemostatic abnormalities. J Clin Hypertens (Greenwich). 2012;00:00–00. ©2012 Wiley Periodicals, Inc.
There is compelling evidence of the impact of cigarette smoking on the development of coronary artery disease (CAD), stroke, and sudden cardiac death.1–5 In Japan, smoking could explain a large portion of cardiovascular disease (CVD) mortality and all-cause mortality.5 In particular, the combined effect of smoking and hypertension on CVD and all-cause mortality is large,3 which highlights the importance of elucidating the pathophysiological mechanisms of smoking in hypertensive patients and identification of CVD-prone high-risk patients.
Some studies have shown that current normotensive or hypertensive smokers tend to have higher ambulatory blood pressure (BP), rather than higher office BP, compared with nonsmokers.6,7 Moreover, it is increasingly recognized that low-grade inflammation as well as alterations of coagulation and/or fibrinolysis homeostasis in the circulation or at the vascular interface can occur in current smokers.8–12 These abnormalities may in part explain the increased cardiovascular risk of current smoking. However, we are not aware of any existing data directly assessing the impact of current smoking on the incidence of CVD events in relation to its adverse effects on 24-hour BP and inflammatory and hemostatic activity in hypertensive patients.
Accordingly, in the present study we examined whether current smoking is associated with abnormalities of 24-hour BP and inflammatory and hemostatic factors, and, as a consequence, CVD events in Japanese hypertensive patients.
Acknowledgments: This study was supported by a research grant for cardiovascular medicine (14-6) from the Ministry of Health, Labor, and Welfare (K.K.) and a research grant (C-2) from the Ministry of Education, Culture, Sports, Science, and Technology (K.K.) of Japan.