Research Paper Example: The Effect of Smoking on Blood Pressure: A Synthesis of Recent Evidence

The Effect of Smoking on Blood Pressure: A Synthesis of Recent Evidence

Abstract

Despite the acute pressor effects of cigarette smoking, several epidemiologic and longitudinal studies have paradoxically observed lower blood pressure (BP) readings among chronic smokers compared to nonsmokers. In this paper, we review findings from multiple recent investigations that explore the association between smoking and BP, with attention to racial differences, the impact of smoking intensity and duration, and the benefits of smoking cessation in hypertensive patients. Overall, while acute nicotine exposure raises BP, long-term smoking appears associated with lower systolic and diastolic BP, although alterations in pulse pressure (PP) have been noted. Furthermore, smoking cessation interventions have demonstrated significant improvements in BP control among hypertensive smokers.

Introduction

Cigarette smoking remains a major risk factor for cardiovascular disease, yet its chronic effects on resting blood pressure are complex. Although smoking acutely stimulates the sympathetic nervous system and causes transient increases in BP, cross-sectional surveys and large-scale studies have frequently reported lower BP values among habitual smokers compared with nonsmokers [5]. Clarifying this paradox is vital, as BP is a major determinant of cardiovascular risk. Moreover, smoking behaviors, including intensity and duration, as well as potential interactions with alcohol consumption, may further modify this relationship.

Chronic Smoking and Blood Pressure

The Health Survey for England provided early evidence that, despite the immediate pressor effect of smoking, habitual smokers tend to exhibit lower resting BP than nonsmokers [5]. Similarly, a large study among half a million Chinese individuals found that regular smoking is significantly associated with modest reductions in both systolic and diastolic BP in men, with cumulative tobacco exposure (pack-years) showing a negative relationship with BP levels. However, the study also noted that concurrent alcohol consumption among smokers may counteract this effect, resulting in BP increases [6].

Racial and Gender Differences

Longitudinal data from the CARDIA study further underscore the complexity of the smoking–BP relationship. In this 30‐year study of Black and White participants, no significant differences in systolic BP were observed between consistent smokers and never smokers. Nevertheless, among White smokers, diastolic BP was lower, while both Black and White smokers exhibited increased pulse pressure relative to nonsmokers. Notably, the pronounced elevation in pulse pressure was especially evident in female smokers, suggesting that racial and sex-specific physiological or psychosocial factors may be influential [7].

Impact of Smoking Cessation on Blood Pressure

In hypertensive subpopulations, smoking cessation has been shown to yield beneficial effects on BP control. A subgroup analysis from the randomized controlled trial GENTSMOKING demonstrated that hypertensive smokers who successfully ceased smoking experienced significant decreases in systolic BP, diastolic BP, mean arterial pressure, and heart rate. These improvements were more marked in those with higher baseline BP values, underscoring the clinical significance of cessation strategies in optimizing hypertension management [8]. Although weight gain is frequently reported following smoking cessation, the net cardiovascular benefits—particularly improved BP control—support aggressive cessation efforts in hypertensive patients.

Discussion and Conclusions

Collectively, evidence from these studies reveals a paradoxical association: chronic smoking is related to lower resting BP readings, yet this phenomenon does not imply cardiovascular benefit. It likely reflects complex physiologic adaptations, such as altered vascular responsiveness and lower total vascular resistance, potentially mediated by nicotine metabolites. At the same time, increases in pulse pressure observed particularly among female smokers may indicate underlying vascular stiffness and heightened cardiovascular risk. Importantly, smoking cessation in hypertensive subjects leads to significant BP reductions, which may help patients achieve target BP levels despite associated weight gain.من

In summary, while acute smoking exerts hypertensive effects, habitual smoking is generally associated with lower resting BP. Nonetheless, the altered hemodynamic profile of smokers—including increased pulse pressure—and the established adverse effects of smoking on overall cardiovascular risk reinforce the importance of smoking cessation as a critical component of hypertension management.

References

[5] Primatesta P, Falaschetti E, Gupta S, Marmot MG, Poulter NR. Association between smoking and blood pressure: evidence from the health survey for England. Hypertension. 2001;37(2):187-93. doi: 10.1161/01.hyp.37.2.187.

[6] Wang M, Li W, Zhou R, et al. The Paradox Association between Smoking and Blood Pressure among Half Million Chinese People. Int J Environ Res Public Health. 2020;17(8):2824. doi: 10.3390/ijerph27082824.

[7] Luehrs RE, Zhang D, Pierce GL, Jacobs DR Jr, Kalhan R, Whitaker KM. Cigarette Smoking and Longitudinal Associations With Blood Pressure: The CARDIA Study. J Am Heart Assoc. 2021;10(9):e019566. doi: 10.1161/JAHA.120.019566.

[8] Gaya PV, Fonseca GWP, Tanji LT, et al. Smoking cessation decreases arterial blood pressure in hypertensive smokers: A subgroup analysis of the randomized controlled trial GENTSMOKING. Tob Induc Dis. 2024;22. doi: 10.18332/tid/186853.