Current Smoking Raises Risk of Incident Hypertension: Hispanic Community Health Study–Study of Latinos

Abstract

Abstract Background Hypertension has been implicated as a smoking-related risk factor for cardiovascular disease but the dose–response relationship is incompletely described. Hispanics, who often have relatively light smoking exposures, have been understudied in this regard. Methods We used data from a 6-year follow-up study of US Hispanic adults aged 18–76 to address the dose–response linking cigarette use with incident hypertension, which was defined by measured blood pressure above 140/90 mm Hg or initiation of antihypertensive medications. Adjustment was performed for potential confounders and mediators, including urinary albumin-to-creatinine ratio which worsened over time among smokers. Results Current smoking was associated with incident hypertension, with a threshold effect above 5 cumulative pack-years of smoking (vs. never smokers, hazard ratio for hypertension [95% confidence interval] of 0.95 [0.67, 1.35] for 0–5 pack-years, 1.47 [1.05, 2.06] for 5–10 pack-years, 1.40 [1.00, 1.96] for 10–20 pack-years, and 1.34 [1.09, 1.66] for ≥20 pack-years, P = 0.037). In contrast to current smokers, former smokers did not appear to have increased risk of hypertension, even at the highest cumulative pack-years of past exposure. Conclusions The results confirm that smoking constitutes a hypertension risk factor in Hispanic adults. A relatively modest cumulative dose of smoking, above 5 pack-years of exposure, raises risk of hypertension by over 30%. The increased hypertension risk was confined to current smokers, and did not increase further with higher pack-year levels. The lack of a smoking–hypertension association in former smokers underscores the value of smoking cessation.