Association between smoking and blood pressure - Evidence from the Health Survey for England

Cigarette smoking causes acute blood pressure (BP) elevation, although some studies have found similar or lower BPs in smokers compared with nonsmoker s. Cross-sectional data from 3 years (1994 to 1996) of the annual Health Su rvey for England were used to investigate any difference in BP between smok ers and nonsmokers in a nationally representative sample of adults (greater than or equal to 16 years old). Randomly selected adults (33 860; 47% men) with valid body mass index (BMI) and BP measurements provided data on smok ing status (never, past, or current) and were stratified into younger (16 t o 44 years old) and older (greater than or equal to 45 years old) age group s. Analyses provided between 89% and 94% power to detect a difference of 2 mm Hg systolic BP between smokers and nonsmokers in the 4 age/gender strata (alpha =0.05). Older male smokers had higher systolic BP adjusted for age, BMI, social class, and alcohol intake than did nonsmoking men. No such dif ferences were seen among younger men or for diastolic blood pressure in eit her age group. Among women, light smokers (1 to 9 cigarettes/d) tended to h ave lower BPs than heavier smokers and never smokers, significantly so for diastolic BP, Among men, a significant interaction between BMI and the BP-s moking association was observed. In women, BP differences between nonsmoker s and light smokers were most marked in those who did not drink alcohol. Th ese data show that any independent chronic effect of smoking on BP is small . Differences between men and women in this association are likely to be du e to complex interrelations among smoking, alcohol intake, and BMI.