title: Inflammation, abdominal obesity, and smoking as predictors of hypertension.
abstract: Development of hypertension has been linked to chronic low-grade inflammation. However, it is not known whether this connection is mediated by features of the metabolic syndrome or smoking, or their changes, which themselves have been linked to inflammation. We studied the predictive value of highly sensitive C-reactive protein (hs-CRP), smoking, and abdominal obesity to the development of hypertension in an 11-year follow-up of a population-based study cohort comprising 379 middle-aged normotensive men. During the follow-up, 124 men (33%) developed hypertension. Men with hs-CRP > or =3.0 mg/L were 2.8x (95% confidence interval, 1.2 to 6.6) more likely to develop hypertension than with hs-CRP <1.0 mg/L even after adjustment for features of the metabolic syndrome, lifestyle factors, and their changes. Cigarette smoking was also associated with development of hypertension independently of inflammation and other confounders. Waist girth increased more in men who quit smoking than in other men. An increase in waist girth during follow-up strongly predicted incident hypertension. The decrease in smoking was not associated with a lower risk of hypertension in age-adjusted analyses. Hypertension is preceded by low-grade chronic inflammation in middle-aged white men independently of smoking or features of the metabolic syndrome. Furthermore, smoking may be a risk factor for hypertension. Although stopping smoking is beneficial with respect to health outcomes, the subsequent increase in weight and waist girth associated with smoking cessation may offset the decrease in the risk of hypertension that one may otherwise expect.
authors.affiliation: Department of Medicine, Kuopio University Hospital, Finland.
authors.forename: Leo
authors.initials: L
authors.lastname: Niskanen
authors.forename: David E
authors.initials: DE
authors.lastname: Laaksonen
authors.forename: Kristiina
authors.initials: K
authors.lastname: Nyyssönen
authors.forename: Kari
authors.initials: K
authors.lastname: Punnonen
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Valkonen
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fuentes
authors.forename: Tomi-Pekka
authors.initials: TP
authors.lastname: Tuomainen
authors.forename: Riitta
authors.initials: R
authors.lastname: Salonen
authors.forename: Jukka T
authors.initials: JT
authors.lastname: Salonen
mesh_terms: D000428:Alcohol Drinking; D002097:C-Reactive Protein / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D007249:Inflammation / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000503:physiopathology; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D012307:Risk Factors; D012907:Smoking / Q000503:physiopathology*; D049629:Waist-Hip Ratio
chemical_list: D002097:C-Reactive Protein